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BACKGROUND: According to the Physical Activity Guidelines Advisory Committee Scientific Report, limited evidence is available on sedentary behaviors (screen time) and their joint associations with physical activity (steps) for cardiovascular health in adolescence. The objective of this study was to identify joint associations of screen time and physical activity categories with cardiovascular disease (CVD) risk factors (blood pressure, hemoglobin A1c, cholesterol) in adolescence. METHODS: This study analyzed data from the Adolescent Brain Cognitive Development (ABCD) Study, comprising a diverse sample of 4,718 U.S. adolescents aged 10-15 years between 2018 and 2021. Steps were measured by a Fitbit wearable device and levels were categorized as low (1,000-6,000), medium (> 6,000-12,000), and high (> 12,000) averaged daily step counts. Self-reported recreational screen time hours per day were classified as low (0-4), medium (> 4-8), and high (> 8) hours per day. CVD risk factors including blood pressure, hemoglobin A1c, and cholesterol (total and HDL) were measured. RESULTS: The analytical sample averaged 6.6 h of screen time per day and 9,722 steps per day. In models including both screen time and steps, the high screen time category was associated with a 4.27 higher diastolic blood pressure percentile (95% CI 1.83-6.73) and lower HDL cholesterol (B= -2.85, 95% CI -4.77 to -0.94 mg/dL) compared to the low screen time category. Medium (B = 3.68, 95% CI 1.24-6.11) and low (B = 7.64, 95% CI 4.07-11.20) step categories were associated with higher diastolic blood pressure percentile compared to the high step category. The medium step category was associated with lower HDL cholesterol (B= -1.99, 95% CI -3.80 to -0.19 mg/dL) compared to the high step category. Findings were similar when screen time and step counts were analyzed as continuous variables; higher continuous step count was additionally associated with lower total cholesterol (mg/dL). CONCLUSIONS: Combinations of low screen time and high steps were generally associated with favorable cardiovascular health markers including lower diastolic blood pressure and higher HDL cholesterol, which can inform future adolescent health guidelines.

This study aims to investigate the effect of pre-operative hemoglobin A1c (HbA1c) and pre-operative blood glucose control on the rate of surgical site infection (SSI) after posterior lumbar instrumentation surgery in diabetes mellitus (DM) patients. A total of 1046 patients who had undergone posterior lumbar instrumentation surgery were reviewed. Based on pre-operative HbA1c, patients were divided into three groups: non-DM group, low HbA1c group (HbA1c < 7.0 % in DM) and high HbA1c group (≥7.0). As well, based on the status of blood glucose control in DM patients immediately before surgery, patients were divided into two groups: good control group (post-prandial blood glucose [PBG] < 200 mg/dl) and poor control group (≥200). The rate of SSI was compared among these groups. SSI occurred in 1.9 % in non-DM group, 2.4 % in low HbA1c group, and 9.3 % in high HbA1c group. Compared with non-DM group, high HbA1c group had significantly higher rate of SSI (p = 0.001). There was not statistically different between non-DM and low HbA1c groups (p = 0.550). SSI occurred in 2.2 % in good control group, and 10.2 % in poor control group. The rate of SSI was significantly lower in good control group (p = 0.013). This study showed that the rate of SSI after posterior lumbar instrumentation surgery tend to be higher in DM patients with high HbA1c. However, the rate might be reduced to the same level as that of non-DM group by lowering PBG to <200 mg/dl immediately before surgery. [ABSTRACT FROM AUTHOR]

Elevated Hb A1C is a modifiable risk factor for postoperative complications. However, in bariatric surgery, as published by our group and others, elevated preoperative Hb A1C may not be associated with increased postoperative complications. Previous literature has focused on primary bariatric surgery and has excluded the higher-risk revisional surgery cohort. To assess the impact of Hb A1C on early postoperative outcomes in patients requiring revisional bariatric surgery. Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. We undertook a retrospective review of patients undergoing revisional bariatric surgery between 2017 and 2018 from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. Two groups were studied, defined by Hb A1C cutoff, ≤8% versus >8% and ≤10% versus >10%. Early postoperative complications were compared at each threshold, with the primary outcome defined as a composite of all complications. Propensity score matching (PSM) was used with one-to-one matching for covariates, and the complication rates before and after PSM were calculated and assessed by Fisher's exact test and conditional logistic regression, respectively. A total of 16,234 patients had undergone revisional bariatric surgery. After PSM, elevated Hb A1C was not associated with worse outcomes. No significant difference was seen in the composite outcomes for Hb A1C ≤8% versus Hb A1C >8% (P =.22) or for patients with Hb A1C ≤10% versus Hb A1C >10% (P <.46). There were no differences in individual outcomes such as surgical-site infections, cardiopulmonary complications, or readmissions/reinterventions. In this study of revisional bariatric patients, elevated Hb A1C >8% or >10% was not associated with increased postoperative complications. Prospective studies are needed to investigate this further. • High A1c of >8% and >10% does not increase the risk for early post operative complications. • HgbA1c alone should not be used to withhold surgery, individual assessment of co-morbidities should guide the decision. • Further controlled studies are needed to assess HgbA1c and its effects on early and late postoperative complications and to address the limitations of the current study. [ABSTRACT FROM AUTHOR]

Glucagon-like-peptide-1 (GLP-1) agonists are an emerging class of medications used to manage type 2 diabetes mellitus (T2DM) and weight loss, with demonstrated efficacy in reducing hemoglobin A1c levels, body mass index, and adverse cardiovascular events. While previous studies have reviewed notable cutaneous adverse effects with other antidiabetic medications, little is known about GLP-1 agonist-induced cutaneous reactions. Nevertheless, rare but significant cutaneous adverse reactions have been reported, including but not limited to dermal hypersensitivity reactions, eosinophilic panniculitis, bullous pemphigoid, and morbilliform drug eruptions. As GLP-1 induced cutaneous reactions are diverse, diagnosis requires clinical suspicion, thorough history-taking, and supportive histopathological findings when available. Management involves cessation of the offending agent with a tailored regimen to address inflammatory and/or immunogenic etiologies as well as irritative symptoms. This review aims to consolidate available information from case reports and case series regarding rare skin-related adverse outcomes due to GLP-1 use, aiming to provide a comprehensive overview of the presentation, pathogenesis, and management for dermatologists and other clinicians. [ABSTRACT FROM AUTHOR]

Purpose: The role of lower hemoglobin A1c (HbA1c) variability in the effect of sodium glucose cotransporter‐2 inhibitors (SGLT2i) on acute kidney injury (AKI) remains unclear. We compared AKI risk between SGLT2i and dipeptidyl peptidase 4 inhibitors (DPP4i) initiators. Additionally, we aimed to explore the extent to which SGLT2i's influence on AKI risk is mediated by reducing long‐term HbA1c variability. Methods: Using 2018–2022 year data in Yinzhou Regional Health Care Database, we included adult, type 2 diabetes patients who were new users of SGLT2i or DPP4i. The effect of SGLT2i versus DPP4i on AKI, HbA1c variability, and AKI through HbA1c variability was compared using inverse probability of treatment weighted Cox proportional hazards models, median regression models, and causal mediation analysis. Results: With a median follow‐up of 1.76 years, 19 717 adults (for SGLT2i, n = 6008; for DPP4i, n = 13 709) with type 2 diabetes were included. The adjusted hazard ratio for SGLT2i versus DPP4i was 0.79 (95% confidence interval [CI] 0.64–0.98) for AKI. The adjusted differences in median HbA1c variability score (HVS) and HbA1c reduction were −16.67% (95% CI: −27.71% to −5.62%) and −1.98% (95% CI: −14.34% to 10.38%), respectively. Furthermore, lower AKI risk associated with SGLT2i was moderately mediated (22.77%) through HVS. The results remained consistent across various subgroups and sensitivity analyses. Conclusions: Compared to DPP4i, lower AKI risk associated with SGLT2i is moderately mediated through HbA1c variability. These findings enhance our understanding of the effect of SGLT2i on AKI and underscore the importance of considering HbA1c variability in diabetes treatment and management. [ABSTRACT FROM AUTHOR]

Aims/Introduction: A debate exists on the relation of adverse pregnancy outcomes with glycemic levels in early pregnancy. We aimed to investigate the association of maternal characteristics including post‐load glucose and first‐trimester HbA1c test results with adverse pregnancy outcomes in women without gestational diabetes mellitus. Materials and Methods: A dataset (January 2011 and September 2017) from a hospital prenatal clinic was explored to find the important predictors of adverse pregnancy outcomes using maternal characteristics and glucose assessments in mothers without gestational diabetes. We used two machine learning algorithms to capture nonlinearity in selecting important maternal characteristics and developed predictive models for each outcome. In total, 1,618 pregnant women were included in the analytic dataset with a mean (SD) age of 26.8 (3.5) years and gravida of 1.7 (0.9). Results: Important associations were detected between maternal features and primary cesarean section, fetal distress, premature rupture of membranes, macrosomia, small or large for gestational age, APGAR <7 at 1 or 5 min, hyperbilirubinemia, and poly‐ or oligo‐hydramnios. Overall, the predictive models showed good performance and large areas under the curves (0.732, 0.765, 0.646, 0.651, 0.730, 0.646, 0.684, 0.716, and 0.678, respectively). Specifically, they had high positive likelihood ratios. Conclusions: High glucose levels were associated with adverse pregnancy outcomes. Post‐load glucose was the most reliable test for predicting the outcomes. Overall, fasting blood sugar was of more predictive value than HbA1c. Our study showed that further research should account for the nonlinearity and interactions inherent in the data. [ABSTRACT FROM AUTHOR]

We present 3 cases of discordant results from screening hemoglobin A1c (HbA1c) measured by ion-exchange high-performance liquid chromatography (HPLC) all due to various forms of interference and flagged by the instrument as "suspected hemoglobin E (HbE)." The first case was due to a rare hemoglobin variant, later confirmed to be hemoglobin Hoshida, the second due to "true" heterozygous HbE, and the third a result of analytical artifact causing splitting of the HbA1c peak without an underlying variant hemoglobin. We examine the similarities in these cases along with the laboratory work-up to classify each cause of interference to demonstrate the wide array of potential causes for the suspected HbE flag and why it warrants proper work-up. Because there is no standardized method of reporting out hemoglobin variant interference in HbA1c measurement, we discuss our laboratory's process of investigating discordant HbA1c measurements and reporting results in cases with variant interference as 1 possible model to follow, along with discussing the associated laboratory, ethical, and clinical considerations. We also examine the structure of hemoglobin Hoshida, HbE, and conduct a brief literature review of previous reports. [ABSTRACT FROM AUTHOR]

Introduction: This study aims to evaluate the effects of sodium‐glucose cotransporter 1 inhibitors (SGLT1i) and sodium‐glucose cotransporter 2 inhibitors (SGLT2i) on neurodegenerative disorders and to investigate the role of hemoglobin A1c (HbA1c) levels. Methods: Utilizing drug target Mendelian randomization, we employed single nucleotide polymorphisms (SNPs) proximal to the SLC5A1 and SLC5A2 genes to analyze the influence of SGLT1i and SGLT2i on Alzheimer's disease (AD), Parkinson's disease (PD), multiple sclerosis (MS), frontotemporal dementia (FTD), Lewy body dementia (LBD), and amyotrophic lateral sclerosis (ALS), with type 2 diabetes (T2D) as a positive control. An additional analysis examined the impact of HbA1c levels on the same disorders. Results: SGLT1i exhibited a significant association with decreased risk for ALS and MS. Conversely, SGLT2i were linked to an increased risk of AD, PD, and MS. Elevated HbA1c levels, independent of SGLT1 and SGLT2 effects, were associated with an increased risk of PD. Sensitivity analyses supported the robustness of these findings. Conclusion: Our study suggests that SGLT1i may confer protection against ALS and MS, whereas SGLT2i could elevate the risk of AD, PD, and MS. Additionally, elevated HbA1c levels emerged as a risk factor for PD. These findings underscore the importance of personalized approaches in the utilization of SGLT inhibitors, considering their varying impacts on the risks of neurodegenerative diseases. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims/Introduction A debate exists on the relation of adverse pregnancy outcomes with glycemic levels in early pregnancy. We aimed to investigate the association of maternal characteristics including post‐load glucose and first‐trimester HbA1c test results with adverse pregnancy outcomes in women without gestational diabetes mellitus. Materials and Methods A dataset (January 2011 and September 2017) from a hospital prenatal clinic was explored to find the important predictors of adverse pregnancy outcomes using maternal characteristics and glucose assessments in mothers without gestational diabetes. We used two machine learning algorithms to capture nonlinearity in selecting important maternal characteristics and developed predictive models for each outcome. In total, 1,618 pregnant women were included in the analytic dataset with a mean (SD) age of 26.8 (3.5) years and gravida of 1.7 (0.9). Results Important associations were detected between maternal features and primary cesarean section, fetal distress, premature rupture of membranes, macrosomia, small or large for gestational age, APGAR

Objective: To explore the feasibility of screening for type 2 diabetes (T2DM) and the prevalence of adult patients seen in a dental clinic at risk for T2DM based on American Diabetes Association (ADA) diabetes risk test (DRT) scores and point of care hemoglobin A1C (A1C) values. Method and materials: This was a cross-sectional analysis of data from adults 18 to 89 years old seen in an academic dental clinic between November 2019 and April 2022 without prior history of diabetes. Clinical and demographic data were obtained from electronic health records and odontograms. Frequency distributions, chi-square, and Mann-Whitney U tests were used for data analysis. Results: Of the 13,519 patients whose data were included, 54.7% (n = 7,389) were women. Of those with race and ethnicity data, 53.6% (n = 2,871) were white, 40.2% (n = 2,153) were African American, and 29.5% (n = 1,559) were Hispanic/Latino. Mean ± SD age was 47.0 + 17.0 years; mean ± SD body mass index was 28.0 ± 6.1 kg/m2. Thirty-five percent (n = 4,774) had diabetes risk test scores reflecting T2DM risk. Those at risk were more likely to be older, male, and overweight/obese than those not at risk (P < .001). Of those at risk who consented to a point of care A1C (9.8%, n = 470), 40.2% (n = 189) had values consistent with dysglycemia (A1C = 5.7%); 34.9% (n = 164) reflecting prediabetes (A1C = 5.7% to 6.4%) and 5.3% (n = 25) diabetes (A1C = 6.5%). Conclusions: Diabetes screening in a dental clinic identified that over one-third of adults without T2DM were at risk based on diabetes risk test scores. Of those who had point of care A1Cs conducted; 40% had dysglycemia. Diabetes screening in an academic dental clinic can help identify patients at risk for T2DM. [ABSTRACT FROM AUTHOR]

Abstract Aims To investigate the efficacy and safety of tadalafil (TAD) versus pentoxifylline (PTX) in the management of diabetic kidney disease (DKD). Some animal studies and clinical trials reported that tadalafil and pentoxifylline have a reducing effect on different blood glucose parameters and lipid profiles which contribute to progress the patients with diabetes mellitus (DM) to DKD. Methods From February 2022 to March 2023, 90 patients with type 2 DM and DKD (micro-albuminuria) were enrolled in this randomized-controlled study. The patients were randomized into three equal groups: control group, TAD group, and PTX group. The three groups received traditional blood glucose lowering therapy + ramipril 10 mg PO. The TAD group also received tadalafil 20 mg PO every other day. The PTX group also received pentoxifylline 400 mg PO twice daily. Results Both TAD and PTX groups produced statistically significant improvement in the primary outcomes by a significant reduction in Urinary albumin/creatinine ratio (UACR) which was pronounced by a reduction percentage of—47.47%, −53.73% respectively. In addition to a significant decrease in Hemoglobin A1C (HbA1c) (mmol/mol), Fasting blood glucose (FBG), 2-h postprandial blood glucose (2-h PPG) (p

Background and Objective: Lack of sleep and insomnia are associated with an increase in the risk of diabetes. Sleep disorders in diabetic people are significantly higher than in healthy people. Moreover, sleep duration is related to blood sugar control in diabetes. This study was conducted with the purpose of investigating the level of sleepiness and obstructive sleep apnea in type 2 diabetic patients and its relationship with glycemic levels. Materials and Methods: This cross-sectional study was conducted on 200 patients with type 2 diabetes referred to Shahid Beheshti Hospital in Hamadan in­ 2023­. Diabetes control status was evaluated by hemoglobin A1c, and the frequency of sleepiness and obstructive sleep apnea was assessed by the Epworth Sleepiness Scale and STOP-BANG questionnaires. Data analysis was done using SPSS 26 statistical software. Results: The mean age of the participants was 56.16 ± 9.77 years. A significant difference was observed between the frequency of daily sleepiness score with gender (P

Jian Yu,1,&ast; Hong Wang,1,&ast; Min Zhu,1,&ast; Meijing Zhou,1 Jingjing Xu1– 3 1Department of Endocrinology, The First Affiliated Hospital with Nanjing Medical University (Jiangsu Province Hospital), Nanjing, LA, 210029, People’s Republic of China; 2Department of Nursing, The First Affiliated Hospital with Nanjing Medical University (Jiangsu Province Hospital), Nanjing, LA, 210036, People’s Republic of China; 3School of Public Health, Nanjing Medical University, Nanjing, LA, 210036, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jingjing Xu, The First Affiliated Hospital with Nanjing Medical University (Jiangsu Province Hospital), Nanjing, LA, 210029, People’s Republic of China, Email dsnxjj@njmu.edu.cnObjective: This study aimed to explore the stable longitudinal patient-centered self-protective factors of glycosylated hemoglobin (HbA1c) in adolescents with type 1 diabetes mellitus (T1DM).Methods: We used both cross-sectional and longitudinal datasets at the Diabetes Education Center and National Endocrine and Metabolism Centre of a university hospital in China from April 2020 to July 2022. Participants were assessed using the Adolescent Diabetic Behavior Rating Scale (DBRS), Diabetes Strengths and Resilience Measure for Adolescents (DSTAR-Teen). HbA1c and other clinical variables were obtained from the medical record at the same time. 266 adolescents (131 male, age 14.1± 3.9 years) completed the cross-sectional assessments and 131 (62 male, age 14.6± 3.3 years) participated in a follow-up at a 1-year visit interval.Results: Logistic regression analysis of cross-sectional data of 266 cases showed that there were significant positive effects between pump treatment (β=0.090, OR 2.460, P=0.005), DBRS scores (β=2.593, OR 13.366, P=0.002) and the meeting of standard HbA1c (< 7.5%, 58 mmol/mol). Disease duration (β=− 0.071, OR 0.932, P=0.033) was negatively correlated with it. The longitudinal multivariate generalized estimation equation model showed that DBRS scores (β=3.165, OR 23.681, P=0.009) and DSTAR-Teen scores (β=0.050, OR 1.051, P=0.012) had a positive influence on the meeting of standard HbA1c over one year time of 131 cases.Conclusion: Self-care and resilience had higher cross-temporal stability in influencing glycemic control over time. To reach a better glycemic control and improve long-term health outcomes, attention should be paid to the detection and enhancement of these patient-centered promoters.Keywords: type 1 diabetes mellitus, T1DM, hemoglobin a1c, hba1c, adolescent, self-care, resilience

Aims: To investigate the efficacy and safety of tadalafil (TAD) versus pentoxifylline (PTX) in the management of diabetic kidney disease (DKD). Some animal studies and clinical trials reported that tadalafil and pentoxifylline have a reducing effect on different blood glucose parameters and lipid profiles which contribute to progress the patients with diabetes mellitus (DM) to DKD. Methods: From February 2022 to March 2023, 90 patients with type 2 DM and DKD (micro-albuminuria) were enrolled in this randomized-controlled study. The patients were randomized into three equal groups: control group, TAD group, and PTX group. The three groups received traditional blood glucose lowering therapy + ramipril 10 mg PO. The TAD group also received tadalafil 20 mg PO every other day. The PTX group also received pentoxifylline 400 mg PO twice daily. Results: Both TAD and PTX groups produced statistically significant improvement in the primary outcomes by a significant reduction in Urinary albumin/creatinine ratio (UACR) which was pronounced by a reduction percentage of—47.47%, −53.73% respectively. In addition to a significant decrease in Hemoglobin A1C (HbA1c) (mmol/mol), Fasting blood glucose (FBG), 2-h postprandial blood glucose (2-h PPG) (p < 0.001). Only the PTX group showed a significant increase in Cr Cl and a significant decrease in S. Cr (p < 0.001). Only the TAD group showed a significant increase in high-density lipoprotein—cholesterol (HDL-C) (p < 0.001), while the PTX group showed a significant decrease in low-density lipoprotein—cholesterol (LDL-C) (p-value 0.011), and triglyceride (p-value 0.002). Both TAD and PTX groups showed a decrease in tumor necrosis factor-α (TNF-α) which was significant only in the PTX group (p < 0.001). There was a significant increase in malondialdehyde (MDA) (p < 0.001), and an increase in urinary neutrophil gelatinase-associated Lipocalin (uNGAL) (p-value 0.850, 0.014 respectively) which was significant only in the PTX group. Conclusions: The use of tadalafil or pentoxifylline may serve as an effective adjuvant therapy for patients with diabetic kidney disease. Trial Registration: ClinicalTrials.gov identifier NCT05487755, July 25, 2022. [ABSTRACT FROM AUTHOR]

Introduction: Individuals with Turner syndrome (TS) are at increased risk of developing diabetes mellitus (DM). Currently, annual DM screening with hemoglobin A1c (HbA1c) with or without fasting blood glucose (FBG) is recommended starting at age 10. However, the optimal DM screening for individuals with TS is not known. The purpose of this study was to evaluate the correlation between HbA1c, FBG, and the 2-h oral glucose tolerance test (OGTT). A second goal was to query whether optimal HbA1c and FBG cut points for TS-associated DM and impaired glucose tolerance (IGT), as defined by the OGTT 2-h blood glucose (BG), might differ from those for the general population. Methods: Individuals with TS ≥ age 10 from the TS: Genotype Phenotype study in the National Institute of Child Health and Human Development's Data and Specimen Hub (DASH) who had 2-h OGTT BG, HbA1c, and FBG were included. Correlations between HbA1c, FBG, and 2-h OGTT BG were evaluated. Areas under the receiver operative characteristic (ROC-AUC) curves were generated. Optimal cut points for predicting TS-associated IGT (2-h BG ≥7.77 mmol/L) and DM (2-h BG ≥11.10 mmol/L) were determined. Results: 348 individuals had complete data (2-h OGTT BG <7.77 mmol/L, n = 239; TS-associated IGT, n = 79; DM, n = 30). ROC-AUC was poor for HbA1c to predict IGT (0.57, 0.49–0.65) but better for DM (0.81, 0.71–0.90). ROC-AUC was also poor for FBG to predict IGT (0.63, 0.56–0.70) but better for DM (0.85, 0.77–0.93). At a cut point of 38 mmol/mol (5.6%), HbA1c had 67% sensitivity (95% CI: 47–83%) and 86% specificity (95% CI: 82–90%) for identifying TS-associated DM defined by 2-h OGTT BG. Conclusions: The correlation of HbA1c and 2-h OGTT BG is lower in TS than in other published studies regarding type 2 DM. HbA1c is fairly specific for DM in TS but lacks sensitivity, especially at currently utilized levels. Future research should focus on characterizing individuals with TS whose glycemic status is discordant, as this may provide additional insights into the pathophysiology of glucose metabolism in TS. Longitudinal assessment of glycemia as it relates to micro- and macrovascular complications in individuals with TS will further inform DM screening in this population. [ABSTRACT FROM AUTHOR]

To examine whether racial and ethnic disparities in uncontrolled type 2 diabetes mellitus (T2DM) persist among those taking medication and after accounting for other demographic, socioeconomic, and health indicators. Adults aged ≥20 years with T2DM using prescription diabetes medication were among participants assessed in a retrospective cohort study of the National Health and Nutrition Examination Survey 2007–2018. We estimated weighted sequential multivariable logistic regression models to predict odds of uncontrolled T2DM (HbA1c ≥ 8%) from racial and ethnic identity, adjusting for demographic, socioeconomic, and health indicators. Of 3649 individuals with T2DM who reported taking medication, 27.4% had uncontrolled T2DM (mean HgA1c 9.6%). Those with uncontrolled diabetes had a mean BMI of 33.8, age of 57.3, and most were non–Hispanic white (54%), followed by 17% non–Hispanic Black, and 20% Hispanic identity. In multivariable analyses, odds of uncontrolled T2DM among those with Black or Hispanic identities lessened, but persisted, after accounting for other indicators (Black OR 1.38, 97.5% CI: 1.04, 1.83; Hispanic OR 1.79, 97.5% CI 1.25, 2.57). Racial and ethnic disparities in T2DM control persisted among individuals taking medication. Future research might focus on developmental and epigenetic pathways of disparate T2DM control across racially and ethnically minoritized populations. • Racial disparities in type 2 diabetes (DM) control persist among individuals taking DM medication. • Clinical and social factors do not fully explain racial and ethnic disparities in DM control. • Future research on developmental and epigenetic pathways of poor DM control is warranted. [ABSTRACT FROM AUTHOR]

Objectives: Diabetes in the 21st century presents one of the greatest burdens of disease on the global population. Digitally mediated interventions have become imperative in alleviating this disease epidemic. We aimed to systematically review randomized controlled trials (RCTs) on different health technologies for preventing Type 2 diabetes mellitus, and their efficacy in decreasing diabetes risk-related outcomes in at-risk patients in comparison to standard care. Methods: Five electronic databases were searched between October 2021 and December 2022. Studies including digital health technology interventions used for preventing diabetes development by reducing diabetes risk-related outcomes in at-risk adults (⩾18 years) were identified. Data on glycemic levels, incidence of T2DM, weight, and intervention descriptions were extracted, and the risk of bias (ROB) was assessed. Results: Nine studies met the inclusion criteria and 5 studies (56%) achieved clinically significant outcomes in at least one of the following: decreased weight (22%), glycemic levels (22%), or incidence of T2DM (11%). Two of the 3 (67%) computer-based interventions effectively reduced the HbA1c levels and mean weight of their study population, and 3 of 6 (50%) mobile based interventions (text messages, mobile app, and telehealth) decreased the incidence of T2DM and HbA1c levels. Four studies each had an overall low ROB and one had a high ROB due to attrition. Conclusion: Preliminary evidence identified in our review demonstrated that health technologies for diabetes prevention are effective for improving diabetes risk-related outcomes. Future research into digital technology protocol and studies of longer duration and more diverse populations are needed for clinical feasibility. Plain Language Summary: Role of Digital technology in Diabetes prevention In the 21st century, diabetes has become a major health challenge globally. To address this, we conducted a systematic review, looking at studies that used digital interventions to prevent Type 2 diabetes mellitus (T2DM) and how effective they are compared to standard care. In this study, we searched electronic databases from October 2021 to December 2022 and identified 9 studies that met our criteria. These studies focused on adults aged 18 and above who were at risk of developing diabetes. We looked at outcomes like glucose concentrations, T2DM incidence, and weight, and assessed the risk of bias in each study. The results showed that more than half of the studies showed significant outcomes. For instance, some interventions led to decreased weight, lower glucose concentrations, or reduced incidence of T2DM. Computer-based interventions and mobile-based interventions (including text messages, mobile apps, and telehealth) were particularly effective in improving these outcomes. In conclusion, our review suggests that digital health technologies can be effective in preventing diabetes and improving related outcomes. However, we note that more research is needed, especially looking at diverse populations and longer study durations, to confirm the clinical feasibility of these digital interventions for diabetes prevention. This is a promising step forward in using technology to tackle the growing diabetes epidemic, offering new ways to support individuals at risk and improve their health outcomes. [ABSTRACT FROM AUTHOR]

Background: According to the Physical Activity Guidelines Advisory Committee Scientific Report, limited evidence is available on sedentary behaviors (screen time) and their joint associations with physical activity (steps) for cardiovascular health in adolescence. The objective of this study was to identify joint associations of screen time and physical activity categories with cardiovascular disease (CVD) risk factors (blood pressure, hemoglobin A1c, cholesterol) in adolescence. Methods: This study analyzed data from the Adolescent Brain Cognitive Development (ABCD) Study, comprising a diverse sample of 4,718 U.S. adolescents aged 10–15 years between 2018 and 2021. Steps were measured by a Fitbit wearable device and levels were categorized as low (1,000–6,000), medium (> 6,000–12,000), and high (> 12,000) averaged daily step counts. Self-reported recreational screen time hours per day were classified as low (0–4), medium (> 4–8), and high (> 8) hours per day. CVD risk factors including blood pressure, hemoglobin A1c, and cholesterol (total and HDL) were measured. Results: The analytical sample averaged 6.6 h of screen time per day and 9,722 steps per day. In models including both screen time and steps, the high screen time category was associated with a 4.27 higher diastolic blood pressure percentile (95% CI 1.83–6.73) and lower HDL cholesterol (B= -2.85, 95% CI -4.77 to -0.94 mg/dL) compared to the low screen time category. Medium (B = 3.68, 95% CI 1.24–6.11) and low (B = 7.64, 95% CI 4.07–11.20) step categories were associated with higher diastolic blood pressure percentile compared to the high step category. The medium step category was associated with lower HDL cholesterol (B= -1.99, 95% CI -3.80 to -0.19 mg/dL) compared to the high step category. Findings were similar when screen time and step counts were analyzed as continuous variables; higher continuous step count was additionally associated with lower total cholesterol (mg/dL). Conclusions: Combinations of low screen time and high steps were generally associated with favorable cardiovascular health markers including lower diastolic blood pressure and higher HDL cholesterol, which can inform future adolescent health guidelines. [ABSTRACT FROM AUTHOR]

Aim: To determine the prevalence of dry eye (DE) and some related factors in patients with type 2 diabetic nephropathy (T2DN). Methods: We performed a cross-sectional study on 338 people, who were divided into 2 groups: 169 T2DN patients and 169 patients diagnosed with type 2 diabetic mellitus (T2DM) without renal complications as a control group. The Ocular Surface Disease Index (OSDI) and test fluorescein tear-film break-up time (TBUT) were done in all 338 subjects. Patients with OSDI scores < 13 and TBUT values equal to or under 10 seconds were diagnosed with dry eye. Results: The prevalence of DE in T2DN patients was significantly higher than T2DM group (55.6% versus 37.3%). The T2DN groups with dry eye had a median duration of DM, the proportion of hypertension, peripheral nerve complications, anemia, proportion of using insulin, and concentration of plasma glucose, HbA1C, urea, creatinine, CRP-hs significantly higher than those of T2DN without dry eye. Advanced age, high HbA1C level, and decreased eGFR were independent factors associated with dry eye in T2DN patients. Conclusion: Dry eye was a common condition associated with advanced age, high HbA1C levels, and decreased GFR in T2DN patients. [ABSTRACT FROM AUTHOR]

Background: Polychlorinated biphenyls (PCBs) are persistent organic pollutants classified as endocrine disruptors related to prediabetes and diabetes. Polybrominated biphenyls are similar in structure to PCBs and are used as flame retardants. Due to the increased worldwide prevalence of diabetes, there is increased interest in understanding the role of environmental and occupational pollutants in its development. The study aims to assess the relation between PCBs and PBBs in the serum of electronic workers and glycated hemoglobin level as an early indicator of prediabetes and type 2 diabetes mellitus among occupationally exposed workers. Methods: Blood samples were collected from 152 workers to assess PCBs (by GCMS), random blood sugar (RBS), and glycated hemoglobin (HbA1c). Participants were classified into two groups according to the presence or absence of PCBs in their serum and were compared for RBS and HbA1c levels. Results: Only two participants had detectable PCB derivate in their serum by GCMS, PCB 1 with methyl and benzole side chains. Regarding PBBs, 18 participants (12%) had detectable PBBs in their serum by GCMS. All participants had RBS and HbA1c levels within the normal range. No statistically significant difference was found between mean levels of RBS and HbA1c between participants with detected biphenyls and those without. Conclusion: The banning of PCB use in industry and modern automated techniques have prevented exposure to PCBs among electronics workers. However, exposure to PBBs continues in electronic industries, but it has no association with diabetes or prediabetes. [ABSTRACT FROM AUTHOR]

Introduction: Glucagon-like peptide 1 receptor agonists (GLP-1) elicit substantial reductions in glycemia and body weight in people with type 2 diabetes (T2D) and obesity, but existing data suggest the therapy must be continued indefinitely to maintain clinical improvements. Given the high cost and poor real-world persistence of GLP-1, an effective therapy that enables deprescription with sustained clinical improvements would be beneficial. Thus, the purpose of this real-world study was to assess the effect of GLP-1 deprescription on glycemia and body weight following co-therapy with carbohydrate restricted nutrition therapy (CRNT) supported via telemedicine in a continuous remote care model. Methods: A retrospective, propensity score matched cohort study among patients with T2D at a telemedicine clinic was conducted. Patients in whom GLP-1 were deprescribed (DeRx; n = 154) were matched 1:1 with patients in whom GLP-1 were continued (Rx). HbA1c and body weight at enrollment in clinic (pre-CRNT), at date of deprescription or index date (derx/ID), and at 6 and 12 months (m) post-derx/ID were utilized in this study. Results: No regression in weight was observed following deprescription with > 70% maintaining ≥ 5% weight loss 12 m post-derx/ID. HbA1c rose 6 m and 12 m post-derx/ID in both DeRx and Rx cohorts, but most patients maintained HbA1c < 6.5%. HbA1c and body weight measured 6 m and 12 m following derx/ID did not significantly differ between cohorts and were improved at derx/ID and at follow-up intervals compared to pre-CRNT. Conclusion: These results demonstrate the potential for an alternate therapy, such as CRNT supported via telemedicine, to enable maintenance of weight loss and glycemia below therapeutic targets following discontinuation of GLP-1 therapy. [ABSTRACT FROM AUTHOR]

Although glycemic status is associated with impaired cardiac structure and function, less is known on left atrial (LA) function across the glycemic spectrum. We evaluated the association of diabetes and glycemic control with LA function in a community-based cohort of older adults. This cross-sectional analysis included 5075 participants from the Atherosclerosis Risk in Communities Study (mean age 75.5 years, 58 % women, and 20 % Black adults) with echocardiographic strain data for LA reservoir, conduit, and contractile function. Multivariable linear regression was used to assess associations of diabetes status and glycemic control with LA function. In participants without diabetes, we used ordinal linear regression to evaluate associations of fasting glucose and HbA1c with LA function. Compared to individuals with a normal fasting glucose, prevalent diabetes was associated with 0.68 % lower LA conduit function (95 % confidence interval (CI): 1.11 to −0.25) and prediabetes a 0.47 % reduction (95 % CI: 0.85 to −0.09) in fully adjusted analyses. Persons with diabetes and high HbA1c (HgbA1c ≥ 7 % vs <7 %) had 1.05 % lower LA conduit function (95 % CI: 1.63, −0.48). Among individuals without diagnosed diabetes, higher fasting glucose, but not HbA1c, was significantly associated with worse LA conduit function. No significant associations were observed for LA reservoir and contractile function. A history of diabetes, prediabetes, and higher fasting glucose levels in persons without diabetes were associated with worse LA conduit function. Corroborative research is needed in prospective cohorts as well as studies that explore underlying mechanisms. • We evaluated differences in LA function according to diabetes status and glycemic control. • Diabetes and prediabetes were associated with worse LA function compared to those with normal fasting glucose levels. • Poorer diabetes control was associated with worse LA function. • Higher fasting glucose amongst those without diabetes was associated with worse LA function. • Findings suggest impaired glucose may adversely affect LA function. [ABSTRACT FROM AUTHOR]

Hemoglobin variants are often discovered when hemoglobin A1c (HbA1c) levels measured with a high-performance liquid chromatography (HPLC) system in fast mode are found to be low. The HA-8180V HPLC analyzer by Arkray offers two measurement modes: fast mode (FM) and variant mode (VM). Two Japanese patients with α-chain variant Hb Q-Iran detected incidentally after analyses with the HA-8180V in VM showed an abnormal peak, are presented. The first patient was a man in his 70 s, and the second patient was a man in his 50 s. Both were non-diabetic, but their results from HbA1c measurement in VM showed an abnormal peak. The VM–HbA1c, FM–HbA1c, and HbA1c measured by enzymatic assay and glycated albumin levels of the two patients were all within the reference ranges. They were diagnosed as having Hb Q-Iran (α2-75Asp → His) by globin gene analysis. It is difficult to detect α-chain hemoglobin variants based on abnormal FM–HbA1c levels, but measuring HbA1c in VM is useful for efficiently detecting hemoglobin variants. [ABSTRACT FROM AUTHOR]

Background: Global diabetes prevalence has doubled since 1980; India has the second-largest diabetic population. Nearly half of type 2 diabetes mellitus (T2DM) cases go undiagnosed. This study assesses glycated hemoglobin A1c (HbA1c) for diagnosing T2DM and prediabetes in at-risk individuals. Materials and Methods: We conducted a community-based cross-sectional study in a rural area. We assessed glucose intolerance risk factors among 1353 individuals (age >20 years), categorizing participants into low and moderate– high risk using the Indian Diabetes Risk Score (IDRS). For 363 participants with moderate- or high-T2DM risk, we evaluated fasting plasma glucose, hemoglobin, and HbA1c. Receiver Operating Characteristics (ROC) were constructed for HbA1c against gold standard fasting plasma glucose and 2-h-postload glucose to determine diagnostic accuracy and cut-point values for prediabetes and T2DM. We used decision curve analysis (DCA) to assess the utility of the new HbA1c cut point for T2DM diagnosis. Results: The prevalence of newly diagnosed T2DM and prediabetes was 44.63% (95% CI: 39.44–49.91) and 48.48% (95% CI: 43.24–53.76), respectively in people with moderate to high risk of T2DM on IDRS. On ROC, the area under the curve was 90.36% and 79.18%, respectively, reflecting high diagnostic accuracy. The optimum cut point of HbA1c for diagnosis of T2DM was 6.34%, with sensitivity and specificity of 74% and 94%, respectively. The HbA1c cut point for prediabetes was 5.65%, with a sensitivity and specificity of 80% and 75%, respectively. The new cut point of 6.34% on DCA gives substantial net benefit at a 40% probability risk, identifying 31 additional cases per 100 individuals at risk of T2DM and reducing the false positive by 47%. Conclusion: Our findings offer potential for developing a diagnostic protocol for T2DM and prediabetes (impaired fasting glucose) using HbA1c cut-point in people with moderate- to high-T2DM risk in rural settings. [ABSTRACT FROM AUTHOR]

PurposeTo develop models for progression of nonproliferative diabetic retinopathy (NPDR) to proliferative diabetic retinopathy (PDR) and determine if incorporating updated information improves model performance.DesignRetrospective cohort study.ParticipantsElectronic health record (EHR) data from a tertiary academic center, University of California San Francisco (UCSF), and a safety-net hospital, Zuckerberg San Francisco General (ZSFG) Hospital were used to identify patients with a diagnosis of NPDR, age ≥ 18 years, a diagnosis of type 1 or 2 diabetes mellitus, ≥ 6 months of ophthalmology follow-up, and no prior diagnosis of PDR before the index date (date of first NPDR diagnosis in the EHR).MethodsFour survival models were developed: Cox proportional hazards, Cox with backward selection, Cox with LASSO regression and Random Survival Forest. For each model, three variable sets were compared to determine the impact of including updated clinical information: Static0 (data up to the index date), Static6m (data updated 6 months after the index date), and Dynamic (data in Static0 plus data change during the 6-month period). The UCSF data were split into 80% training and 20% testing (internal validation). The ZSFG data were used for external validation. Model performance was evaluated by the Harrell's concordance index (C-Index).Main outcome measuresTime to PDR.ResultsThe UCSF cohort included 1130 patients and 92 (8.1%) patients progressed to PDR. The ZSFG cohort included 687 patients and 30 (4.4%) patients progressed to PDR. All models performed similarly (C-indices ∼ 0.70) in internal validation. The random survival forest with Static6m set performed best in external validation (C-index 0.76). Insurance and age were selected or ranked as highly important by all models. Other key predictors were NPDR severity, diabetic neuropathy, number of strokes, mean Hemoglobin A1c, and number of hospital admissions.ConclusionsOur models for progression of NPDR to PDR achieved acceptable predictive performance and validated well in an external setting. Updating the baseline variables with new clinical information did not consistently improve the predictive performance.Financial disclosuresProprietary or commercial disclosure may be found after the references.

Abstract Introduction This study aims to evaluate the effects of sodium‐glucose cotransporter 1 inhibitors (SGLT1i) and sodium‐glucose cotransporter 2 inhibitors (SGLT2i) on neurodegenerative disorders and to investigate the role of hemoglobin A1c (HbA1c) levels. Methods Utilizing drug target Mendelian randomization, we employed single nucleotide polymorphisms (SNPs) proximal to the SLC5A1 and SLC5A2 genes to analyze the influence of SGLT1i and SGLT2i on Alzheimer's disease (AD), Parkinson's disease (PD), multiple sclerosis (MS), frontotemporal dementia (FTD), Lewy body dementia (LBD), and amyotrophic lateral sclerosis (ALS), with type 2 diabetes (T2D) as a positive control. An additional analysis examined the impact of HbA1c levels on the same disorders. Results SGLT1i exhibited a significant association with decreased risk for ALS and MS. Conversely, SGLT2i were linked to an increased risk of AD, PD, and MS. Elevated HbA1c levels, independent of SGLT1 and SGLT2 effects, were associated with an increased risk of PD. Sensitivity analyses supported the robustness of these findings. Conclusion Our study suggests that SGLT1i may confer protection against ALS and MS, whereas SGLT2i could elevate the risk of AD, PD, and MS. Additionally, elevated HbA1c levels emerged as a risk factor for PD. These findings underscore the importance of personalized approaches in the utilization of SGLT inhibitors, considering their varying impacts on the risks of neurodegenerative diseases.

This document discusses the association between the severity of female pattern hair loss (FPHL) and abnormal blood sugar levels, specifically hemoglobin A1c (hbA1c). The study conducted a retrospective chart review of patients with FPHL and found that those with abnormal hbA1c levels had higher Sinclair scale scores, indicating more severe hair loss. However, there were no significant differences in age, onset of FPHL, history of polycystic ovarian syndrome, or use of diabetes medications between the groups. The study suggests that optimizing hbA1c levels may be important in managing FPHL, particularly in patients with more severe hair loss. [Extracted from the article]

Abstract The objective of this research is to analyze the influence of various factors on glycemic control in pediatrics with type 1 diabetes mellitus (T1DM). The study, a cross-sectional analysis, involved 221 T1DM patients below 18 years old who visited our clinic between 2011 and 2020, predating the COVID-19 outbreak. Out of the initial pool, 204 participants were chosen based on specific criteria. By computing odds ratios and 95% confidence intervals, we determined the correlation between these factors and achieving optimal glycemic control (HbA1c

Abstract Background At present, the relationship between serum uric acid and blood glucose is controversial, and even opposite conclusions have been reached. We aimed to investigate the relationship between time in range and serum uric acid and estimate the influence of serum uric acid on blood glucose fluctuations in Chinese patients with type-2 diabetes mellitus (T2DM). Methods A total of 458 hospitalized patients with T2DM were selected. According to the SUA level, patients were divided into four groups by quartile: Q1 (≤ 254.5 µmol/L), Q2 (254.5–306.0 µmol/L), Q3 (306.0–385.5 µmol/L) and Q4 (> 385.5 µmol/L). The differences in general data, TIR and other clinical indicators between the four groups were assessed. Multifactor regression was used to analyze the relationship between subgroups of SUA and TIR, TBR, TAR, MAGE, SD, ADRR, MODD and M value. Curve fitting was used to analyze the association between TIR and SUA and to identify the inflection point. Results TIR showed an overall increasing trend with increasing SUA, while HbA1c, TAR, MAGE, SD, ADRR, MODD and M value showed an overall decreasing trend with increasing SUA. Multivariate regression analysis showed that, compared with Q1, there was no correlation between SUA and TIR, TAR, ADRR, SD, or MODD in all models of Q2. In the Q3 and Q4 groups, SUA was correlated with SD, MODD, and MAGE in all models. In the Q4 group, SUA was correlated with TIR, TAR, ADRR, and the M value in all models. When SUA > 306 µmol/L (Q3 and Q4), TIR and SUA have a curve-like relationship, and the inflection point of the fitted curve was SUA = 460 mmol/L. Before the inflection point, β was 0.1, indicating that when SUA increases by 10 mmol/L, the corresponding TIR increases by 1%. After the inflection point, there was no significant difference in the correlation between TIR and SUA (P > 0.05). Conclusions There is a close relationship between TIR and SUA in T2DM patients, it is speculated that SUA in a certain range had a positive protective effect on blood glucose control.

Abstract Background It is hypothesized that whole salivary prostaglandin E2 (PgE2) levels are higher in patients with type-2 diabetes mellitus (type-2 DM) than non-diabetic individuals with periodontal inflammation; and that whole salivary expression of PgE2 is correlated with hemoglobin A1C (HbA1c) levels. The aim of the present study was to compare whole salivary PgE2 levels among patients with type-2 DM and non-diabetic individuals with periodontal inflammation. Methods Sociodemographic data, duration since the diagnosis and management of type-2 DM, most recent hemoglobin A1C (HbA1c level), and any familial history of DM was retrieved from patient’s healthcare records. Participants were divided into four groups: Group-1: type-2 diabetics with periodontal inflammation; Group-2: type-2 diabetics without periodontal inflammation; Group-3: non-diabetics with periodontal inflammation; and Group-4: non-diabetics without periodontal inflammation. Plaque and gingival indices (PI and GI), probing depth (PD), clinical attachment loss (CAL) and marginal bone loss (MBL) were measured. Unstimulated whole saliva samples were collected and PgE2 levels were measured. Group-comparisons were done and P

Meiraf Daniel Meshesha,1 Ayantu Melke,2 Abraham Teka Ajema,2 Kaleb Mayisso3 1Department of Internal Medicine, Dilla University, Dilla, Ethiopia; 2Department of Epidemiology, Hawassa University, Hawassa, Ethiopia; 3Department of Public Health, Hawassa University, Hawassa, EthiopiaCorrespondence: Meiraf Daniel Meshesha, Tel +251 096 089 0307, Email meirafdanielm@gmail.comBackground: Achieving target glycemic control in people living with diabetes lessens most of the diabetes-related complications and hemoglobin A1C is the gold standard test for assessing the long-term glycemic control. However, the expensive cost, and its limited access are problematic for routine use in developing countries, demanding an urgent alternative solution. Hence, this study aimed to assess the potential of red blood cell indices in predicting glycemic control among people living with type 2 diabetes at Dilla University Hospital.Methods: A cross-sectional study was conducted among 207 participants with type 2 diabetes. Red blood cell indices were compared between the poor and good glycemic control groups using the t-test. Performance of red cell indices in discriminating poor glycemic control was assessed using receiver operating characteristic analysis.Results: The prevalence of poor glycemic control among the participants was 91.8%. Higher mean hemoglobin (p=0.002) and mean corpuscular hemoglobin (p=0.015) was found in the good glycemic control group. An inverse correlation was also observed between hemoglobin A1C and mean corpuscular hemoglobin (r=− 0.158; P=0.023). The area under the curve to discriminate poor glycemic control from good was statistically significant for hemoglobin, hematocrit, and mean corpuscular hemoglobin. However, hemoglobin had the highest discrimination ability at a cutoff ≤ 14.8 g/dL; area under the curve was 0.738 (P=0.001), sensitivity, specificity, and positive predictive value were 68.95%, 82.35%, and 97.77%, respectively.Conclusion: This study revealed that hemoglobin can potentially be used to assess glycemic control among people with type 2 diabetes but the interpretation needs to be cautious.Keywords: red blood cell indices, hemoglobin A1C, Ethiopia

Cheryl Modica,1 Joy H Lewis,2 R Curtis Bay3 1National Association of Community Health Centers, Bethesda, MD, USA; 2Department of Medicine and Public Health, A.T. Still University, School of Osteopathic Medicine, Mesa, AZ, USA; 3Department of Interdisciplinary Health Sciences, Arizona School of Health Sciences, A.T. Still University, Mesa, AZ, USACorrespondence: Cheryl Modica, National Association of Community Health Centers, Inc, 7501 Wisconsin Avenue, Suite 1100W, Bethesda, MD, 20814, USA, Tel +1 301 310 2250, Email cmodica@nachc.orgIntroduction: Health centers are community-based, patient directed primary care providers that offer accessible, high-quality primary care within medically underserved communities. Screening for cancer and managing complex chronic conditions such as diabetes, hypertension, obesity, and depression are vital services for the vulnerable populations seen by community health centers. Delivering care for complex chronic conditions and preventive services using virtual models that integrate self-care tools and technology is an important approach to increasing access for hard-to-reach patients served by health centers.Objective: This study aimed to explore the use of a virtual care model, applied using a systems approach and patient-driven tools and technology, on the performance of clinical and patient experience measures.Methods: A virtual care model, applied using a systems approach offered by the Value Transformation Framework (VTF), was combined with self-care tools and technology in twenty health centers across 17 states to drive improvement efforts. Changes in clinical measures and patient experience were compared.Results: A total of 385 patients were enrolled and 270 (70.1%) completed a baseline visit and at least four virtual visits during the six-month intervention period. Statistically significant improvements were seen in measures for HbA1c, systolic and diastolic blood pressure, and bodyweight. Among the 270 who completed the baseline and at least 4 virtual visits, the percentage up-to-date for colorectal cancer screening increased from 113/270 (41.9%) to 169/270 (62.6%) after six months, p< 0.001, a 20.7% increase. Patients completing the baseline visit and at least 4 virtual visits reported a 10.7% decrease in depression and increased satisfaction with virtual care visits compared to in-person visits (p< 0.001).Conclusion: Health centers applying the Value Transformation Framework’s organizing framework to the use of virtual care models together with patient self-care tools, technology, and education, had improvements in measures for chronic and preventive conditions and patient experience.Plain Language Summary: The Value Transformation Framework (VTF) was designed by the lead author to serve as an organizing framework for health center systems change and advancement toward the Quintuple Aim: improved health outcomes, improved patient experiences, improved staff experiences, reduced costs, and equity. When applied in the health care setting, the VTF translates research, evidence-based solutions, and promising practices into clear and practical steps that health centers can use to achieve value-driven care. In this paper, the authors report on results from a study where the VTF’s organizing approach was combined with evidence-based virtual care models supported by patient self-care tools, technology, and education with improvements seen in measures for colorectal cancer screening, hypertension control, diabetes control, weight, patient reported depression, and patient experience. The action steps taken by health centers participating in this quality improvement project can be replicated by other health centers.The impact of colon cancer, hypertension, diabetes, obesity, and depression, particularly among health center patients, is substantial. Identifying strategies to change health center systems in ways that improve performance is critically important. The authors demonstrated that implementing the VTF can provide health centers with a practical and actionable approach to health center systems change to achieve significant improvements in clinical measurements, patient-reported depression, and patient experience with care.Keywords: vulnerable populations, colorectal cancer screening, hemoglobin A1c, obesity, depression, patient experience

Abstract Background It is unknown whether high hemoglobin A1c (HbA1c) is associated with increases in the risk of cardiovascular disease among individuals with elevated genetic susceptibility. We aimed to investigate the association between HbA1c and atrial fibrillation (AF), coronary artery disease (CAD), and ischemic stroke according to the polygenic risk score (PRS). Methods The UK Biobank cohort included 502,442 participants aged 40–70 years who were recruited from 22 assessment centers across the United Kingdom from 2006 to 2010. This study included 305,605 unrelated individuals with available PRS and assessed new-onset AF, CAD, and ischemic stroke. The participants were divided into tertiles based on the validated PRS for each outcome. Within each PRS tertiles, the risks of incident events associated with HbA1c levels were investigated and compared with HbA1c

Abstract Background Hemoglobin A1c (HbA1c), a “gold standard” for the assessment of glycemic control, was associated with an increased risk of cardiovascular disease and coronary artery calcification. However, its effects on abdominal aortic calcification (AAC) are uncertain. The present study comprehensively investigated the association between HbA1c and AAC in the 2013–2014 National Health and Nutrition Examinations Surveys. Methods Among 1,799 participants ≥ 40 years, dual-energy X-ray absorptiometry-derived AAC was quantified using the Kauppila score (AAC-24). Severe AAC was defined as a total AAC-24 > 6. Weighted linear regression models and logistic regression models were used to determine the effects of HbA1c on AAC. The restricted cubic spline model was used for the dose-response analysis. Results The mean AAC-24 of participants was 1.3, and 6.7% of them suffered from severe AAC. Both AAC-24 and the prevalence of severe AAC increased with the higher tertile of HbA1c (P

Introduction: The prevalence of Type 2 Diabetes Mellitus (T2DM) is expected to rise, increasing the risk of cardiovascular disease. This study explores the relationship between high-density lipoprotein cholesterol (HDL) and glycemic control in T2DM patients, measured by hemoglobin A1c (HbA1c). While HDL is known to confer cardiovascular benefits, its impact on glycemic control remains unclear. Methods: This cross-sectional study analyzed 30,195 Thai adults with T2DM data from the 2018 Thailand DM/HT database. Well-controlled HbA1c was defined as less than 53 mmol/mol (7 %). The study utilized multivariable linear, piecewise linear, and logistic regression analyses to investigate the relationship between HDL levels and glycemic control. Results: The impact of HDL on HbA1c levels was nonlinear, showing a U-shaped relationship among the study participants with an HDL inflection point of 59 mg/dl. In females, a U-shaped relationship was also observed at the same inflection point, where increased HDL above this level was associated with a rise in HbA1c (Adjusted β = 0.205, P < 0.001). In contrast, a linear model better explained the consistent negative relationship between HDL and HbA1c in males (Adjusted β = –0.076, P < 0.001). Furthermore, in the poorly controlled HbA1c group, a significant U-shaped pattern was observed with an inflection point at 59 mg/dl. Conclusion: This study found a nonlinear, gender-specific relationship between HDL and HbA1c in T2DM patients. Males with higher HDL are more likely to achieve glycemic control, while a U-shaped relationship is observed in females. Further research is needed to understand the differing correlation between well-controlled and poorly controlled groups.

Background: At present, the relationship between serum uric acid and blood glucose is controversial, and even opposite conclusions have been reached. We aimed to investigate the relationship between time in range and serum uric acid and estimate the influence of serum uric acid on blood glucose fluctuations in Chinese patients with type-2 diabetes mellitus (T2DM). Methods: A total of 458 hospitalized patients with T2DM were selected. According to the SUA level, patients were divided into four groups by quartile: Q1 (≤ 254.5 µmol/L), Q2 (254.5–306.0 µmol/L), Q3 (306.0–385.5 µmol/L) and Q4 (> 385.5 µmol/L). The differences in general data, TIR and other clinical indicators between the four groups were assessed. Multifactor regression was used to analyze the relationship between subgroups of SUA and TIR, TBR, TAR, MAGE, SD, ADRR, MODD and M value. Curve fitting was used to analyze the association between TIR and SUA and to identify the inflection point. Results: TIR showed an overall increasing trend with increasing SUA, while HbA1c, TAR, MAGE, SD, ADRR, MODD and M value showed an overall decreasing trend with increasing SUA. Multivariate regression analysis showed that, compared with Q1, there was no correlation between SUA and TIR, TAR, ADRR, SD, or MODD in all models of Q2. In the Q3 and Q4 groups, SUA was correlated with SD, MODD, and MAGE in all models. In the Q4 group, SUA was correlated with TIR, TAR, ADRR, and the M value in all models. When SUA > 306 µmol/L (Q3 and Q4), TIR and SUA have a curve-like relationship, and the inflection point of the fitted curve was SUA = 460 mmol/L. Before the inflection point, β was 0.1, indicating that when SUA increases by 10 mmol/L, the corresponding TIR increases by 1%. After the inflection point, there was no significant difference in the correlation between TIR and SUA (P > 0.05). Conclusions: There is a close relationship between TIR and SUA in T2DM patients, it is speculated that SUA in a certain range had a positive protective effect on blood glucose control. [ABSTRACT FROM AUTHOR]

Introduction: Diabetic ketoacidosis (DKA) at diagnosis is associated with short- and long-term complications. We assessed the relationship between DKA status and hemoglobin A1c (A1c) levels in the first year following type 1 diabetes (T1D) diagnosis. Research Design and Methods: The Pilot Teamwork, Targets, Technology, and Tight Control (4T) study offered continuous glucose monitoring to youth with T1D within 1 month of diagnosis. A1c levels were compared between historical (n = 271) and Pilot 4T (n = 135) cohorts stratified by DKA status at diagnosis (DKA: historical = 94, 4T = 67 versus without DKA: historical = 177, 4T = 68). A1c was evaluated using locally estimated scatter plot smoothing. Change in A1c from 4 to 12 months postdiagnosis was evaluated using a linear mixed model. Results: Median age was 9.7 (interquartile range [IQR]: 6.6, 12.7) versus 9.7 (IQR: 6.8, 12.7) years, 49% versus 47% female, 44% versus 39% non-Hispanic White in historical versus Pilot 4T. In historical and 4T cohorts, DKA at diagnosis demonstrated higher A1c at 6 (0.5% [95% confidence interval (CI): 0.21–0.79; P < 0.01] and 0.38% [95% CI: 0.02–0.74; P = 0.04], respectively), and 12 months (0.62% [95% CI: −0.06 to 1.29; P = 0.07] and 0.39% [95% CI: −0.32 to 1.10; P = 0.29], respectively). The highest % time in range (TIR; 70–180 mg/dL) was seen between weeks 15–20 (69%) versus 25–30 (75%) postdiagnosis for youth with versus without DKA in Pilot 4T, respectively. Conclusions: Pilot 4T improved A1c outcomes versus the historical cohort, but those with DKA at diagnosis had persistently elevated A1c throughout the study and intensive diabetes management did not mitigate this difference. DKA prevention at diagnosis may translate into better glycemic outcomes in the first-year postdiagnosis. Clinical Trial Registration: clinicaltrials.gov: NCT04336969. [ABSTRACT FROM AUTHOR]

Introduction: Normal pregnancy is a diabetogenic state since during pregnancy there is an increase in insulin resistance. Gestational diabetes mellitus (GDM) is now emerging as the most common medical complication during pregnancy which leads to serious consequences. It is observed that women with GDM had a 7 times higher chance of manifestation of developing impaired glucose tolerance (IGT) or type 2 diabetes mellitus (T2DM) during the later part of life. The present study was planned to find out the association between HbA1c level before 14 weeks of gestation and cut-off values for better pregnancy outcomes. Materials and methods: This hospital-based prospective observational study was conducted with 112 patients at the Department of Obstetrics and Gynaecology, Aarupadai Veedu Medical College & Hospital, Vinayaka Mission’s Research Foundation (Deemed to be University), Puducherry, India, during the period of January 2021 to June 2022. Healthy 112 patients fulfilling the inclusion criteria were included in this study. The patient was asked to undergo screening for GDM at 24–26 weeks of gestation [International Association of Diabetes and Pregnancy Study Groups (IADPSG)]. Patients were followed up closely throughout pregnancy till delivery and 5 days postnatal period. Chi-square test and multivariate analysis were adapted to analyze the data by using the statistical package for the social sciences (SPSS), version 25.0, software. Results: A total of 112 participants fulfilling the criteria for inclusion were evaluated for HbA1c levels during pregnancy. The oral glucose tolerance test (OGTT) was used for the detection of gestational diabetes between 24 and 28 weeks. The occurrence of GDM in the study population is 23.5%. The participants who had HbA1c ≥ 5.7% developed maternal, fetal, and neonatal complications. In the present study, it was observed that HbA1c ≥ 5.7% has a sensitivity of 89% and specificity of 80%. Conclusion: The HbA1c value estimated during early pregnancy (<14 weeks) is useful in the prediction of GDM and it correlates well with adverse pregnancy outcomes. The cut-off value of 5.7% can be used for the prediction of GDM with good sensitivity and specificity. It can be an additional screening tool for GDM in addition to OGTT. [ABSTRACT FROM AUTHOR]

Context: Chronic kidney disease (CKD) is a worldwide health problem. Recent literature has shown an association of hemoglobin glycation index (HGI) and CKD in patients with dysglycemia. Objective: The aim of this study was to reveal the impact of HGI as a predictor for incident CKD in the general population. Methods: CKD was defined as dipstick proteinuria or estimated glomerular rate (eGFR) < 60 mL/min/1.73 m². Impact of HGI on incident CKD was assessed using the data from CKD-free health examinees (N = 23 467, 4.1% with diabetes) followed for a mean of 5.1 years: Cox proportional hazards model was employed with multivariate adjustment for age, systolic blood pressure, eGFR, fasting plasma glucose, body mass index, log[alanine aminotransferase], log[triglycerides], high-density lipoprotein cholesterol, platelet counts, smoking, and sex. Elevated level of HGI in subjects with CKD was ascertained after propensity score matching of another group of health examinees (N = 2580, 7.6% with diabetes). Results: In the former group, CKD developed in 2540 subjects and HGI was the second most robust predictor for CKD, following low eGFR. With adjustment for the 11 covariates, the hazard ratio of HGI (95% CI) for CKD was 1.293 (1.238 to 1.349) (P < .0001). The population attributable risk of HGI for CKD was 4.2%. In the latter group, among 708 subjects matched 1:1 for 9 covariates, HGI was significantly elevated in subjects with CKD (median [interquartile range] −0.208 [−0.504 to −0.156] vs −0.284 [−0.582 to 0.052], P = .03). Conclusion: HGI was a novel risk factor for CKD in the general population [ABSTRACT FROM AUTHOR]

Background: In this study, we investigated whether different levels of hemoglobin A1c (HbA1c) are associated with different short-term and 1-year mortality rates among diabetic patients undergoing percutaneous coronary intervention. Patients & methods: Clinical events including in-hospital, 1-month and 1-year mortality were compared between three groups based on HbA1c levels of patients (I: ≤5.6%, II: 5.7–6.4%, III: ≥6.5%). Results: Among 165 diabetic individuals, patients with abnormal HbA1c levels (≥6.5%) experienced significantly higher hospitalization days (7.65 ± 1.64 days) compared with those with normal HbA1c (4.94 ± 0.97 days) (p < 0.0001). In-hospital mortality was significantly higher in group III (14.5%) and II (5.5%) compared with group I (0%) (p = 0.008). Conclusion: HbA1c levels may be a reliable predictor of short-term clinical events in diabetic patients. Summary points Patients with higher hemoglobin A1c (HbA1c) levels had more coronary arteries involved detected during angiography. Higher HbA1c was intimately linked with longer hospitalization and higher in-hospital mortality rates. Less clear evidence was obtained regarding HbA1c level and 1-month and 1-year mortality rates. [ABSTRACT FROM AUTHOR]

Background: It is hypothesized that whole salivary prostaglandin E2 (PgE2) levels are higher in patients with type-2 diabetes mellitus (type-2 DM) than non-diabetic individuals with periodontal inflammation; and that whole salivary expression of PgE2 is correlated with hemoglobin A1C (HbA1c) levels. The aim of the present study was to compare whole salivary PgE2 levels among patients with type-2 DM and non-diabetic individuals with periodontal inflammation. Methods: Sociodemographic data, duration since the diagnosis and management of type-2 DM, most recent hemoglobin A1C (HbA1c level), and any familial history of DM was retrieved from patient's healthcare records. Participants were divided into four groups: Group-1: type-2 diabetics with periodontal inflammation; Group-2: type-2 diabetics without periodontal inflammation; Group-3: non-diabetics with periodontal inflammation; and Group-4: non-diabetics without periodontal inflammation. Plaque and gingival indices (PI and GI), probing depth (PD), clinical attachment loss (CAL) and marginal bone loss (MBL) were measured. Unstimulated whole saliva samples were collected and PgE2 levels were measured. Group-comparisons were done and P < 0.05 were considered statistically significant. Results: One-hundred-sixty individuals were included. Mean HbA1c levels were higher in Group-1 than groups 2 (P < 0.05), 3 (P < 0.05) and 4 (P < 0.05). The PI (P < 0.05), GI (P < 0.05) and PD (P < 0.05) were higher in Group-1 than groups 2 and 4. The CAL was higher in Group-1 than groups 2 (P < 0.05) and 3 (P < 0.05). The PD (P < 0.05), PI (P < 0.05) and GI (P < 0.05) were higher in Group-3 than Group-4. The MBL was higher in Group-1 than groups 2 (P < 0.05), 3 (P < 0.05) and 4 (P < 0.05). The PgE2 levels were higher in Group-1 than groups 2 (P < 0.05), 3 (P < 0.05) and 4 (P < 0.05). Conclusion: Hyperglycemia in patients with type-2 DM is associated with increased expression of whole salivary PgE2 levels and worsened periodontal inflammation compared with individuals with well-controlled type-2 DM and non-diabetic individuals. [ABSTRACT FROM AUTHOR]

Introductions: Cystic fibrosis-related diabetes (CFRD) is associated with pulmonary decline, compromised nutritional status, and earlier mortality. Onset is often insidious, so screening for early detection of glycemic abnormalities is important. Continuous glucose monitoring (CGM) has been validated in people with CF and has been shown to detect early glycemic variability otherwise missed on 2-hour oral glucose tolerance testing (OGTT). We previously reported that CGM measures of hyperglycemia and glycemic variability are superior to hemoglobin A1c (HbA1c) in distinguishing those with and without CFRD. However, little is known about the long-term predictive value of CGM measures of glycemia for both the development of CFRD and their effect on key clinical outcomes such as weight maintenance and pulmonary function. In addition, there have been no studies investigating advanced glycation endproducts (AGE) assessed by skin autofluorescence in people with CF. Methods: In this prospective observational study, CGM and HbA1c were measured at 2 to 3 time points 3 months apart in 77 adults with CF. Participants who did not have CFRD at the time of enrollment underwent OGTT at the baseline visit, and all participants had AGE readings at baseline. Follow up data including anthropometric measures, pulmonary function and CFRD status were collected by review of medical records 1- and 2-years after the baseline visits. We applied multivariable linear regression models correlating glycemic measures to change in key clinical outcomes (weight, BMI, FEV1) accounting for age, gender and elexacaftor/tezacaftor/ivacaftor (ETI) use. We also conducted logistic regression analyses comparing baseline glycemic data to development of CFRD during the 2-year follow up period. Results: Of the 77 participants, 25 had pre-existing CFRD at the time of enrollment, and six participants were diagnosed with CFRD by the OGTT performed at the baseline visit. When adjusting for age, gender, and ETI use, multiple CGM measures correlated with weight and BMI decline after one year but not after two years. CGM and HbA1c at baseline did not predict decline in FEV1 (p>0.05 for all). In the 46 participants without a diagnosis of CFRD at baseline, two participants were diagnosed with CFRD over the following two years, but CGM measures at baseline did not predict progression to CFRD. Baseline AGE values were higher in individuals with CFRD and correlated with multiple measures of dysglycemia (HbA1c, AG, SD, CV, TIR, % time >140, >180, >250) as well as weight. AGE values also correlated with FEV1 decline at year 1 and weight decline at year 1 and year 2. Conclusions: Several key CGM measures of hyperglycemia and glycemic variability were predictive of future decline in weight and BMI over one year in this population of adults with CF with and without CFRD. None of the baseline glycemic variables predicted progression to CFRD over 2 years. To our knowledge, this is the first report correlating AGE levels with key clinical and glycemic measures in CF. Limitations of these analyses include the small number of participants who developed CFRD (n=2) during the follow up period and the initiation of ETI by many participants, affecting their trajectory in weight and pulmonary function. These results provide additional data supporting the potential role for CGM in identifying clinically significant dysglycemia in CF. Future studies are needed to investigate CGM as a diagnostic and screening tool for CFRD and to understand the implications of AGE measures in this patient population. [ABSTRACT FROM AUTHOR]

Background: Over one-third of patients living with diabetes will develop ocular disease during their lifetime. The present study analyzes the association between metabolic and anthropometric markers, associated comorbidities, and intraocular pressure (IOP) in patients with type 2 diabetes mellitus (DM). Methods: The retrospective study included 87 adult patients with type 2 DM who underwent routine eye examinations and blood/urine tests. Results: 67.9% of the patients had an IOP > 14.5 mmHg and only 41.3% had an HbA1c < 7%. In a multivariate regression analysis, the mean IOP was associated with diabetes duration in subjects with a disease duration < 15 years and an HbA1c < 7% (adjusted R2 = 0.29, p = 0.008). Also, patients with shorter diabetes duration and optimal glucose control had a lower mean IOP than patients with a higher HbA1c (mean IOP 15.1 mmHG vs. 18.9 mmHg, p = 0.04). The patient's age, anthropometric or metabolic markers, associated comorbidities like hypertension (HTN) or retinal angiosclerosis, and diabetes therapies were not associated with IOP in this study. Conclusion: Diabetes progression is directly associated with increased IOP. Avoiding clinical inertia and optimizing glycemic control could prevent or delay the increase of IOP. Routine eye examination should include measuring IOP, not only diabetic retinopathy screening. [ABSTRACT FROM AUTHOR]

Hyperglycemia is a known risk factor for tendon degeneration due to oxidative stresses from production of advanced glycosylation end products. In patients with diabetes mellitus (DM), analysis of glycated hemoglobin (HbA 1c) provides a 3-month window into a patient's glucose control. No guidelines exist for ideal preoperative HbA 1c and glucose control prior to arthroscopic rotator cuff repair. This study evaluated if a critical HbA 1c level is associated with reoperation following arthroscopic rotator cuff repair. We retrospectively evaluated patients with DM who underwent primary arthroscopic rotator cuff repair from January 2014 to December 2018 at a single institution. Patients required a preoperative HbA 1c within 3 months of surgery. Medical records were queried to evaluate for reoperation and identify the subsequent procedures performed. Univariate statistical analysis was performed to assess factors associated with reoperation (P <.05 considered significant). Threshold, area under the curve (AUC), analysis was performed to assess if a critical HbA 1c value was associated with reoperation. A total of 402 patients met inclusion criteria. Patients had an average age of 65.5 years (range 40-89) at time of surgery; 244 (60.6%) patients were male; and average body mass index was 32.96 ± 5.81. Mean HbA 1c was 7.36 (range 5.2-12). Thirty-three patients (8.2%) underwent subsequent reoperation. Six patients (1.5%) underwent capsular release and lysis of adhesions, 20 patients (5.0%) underwent a revision rotator cuff surgery, combination revision rotator cuff repair and lysis of adhesions, graft-augmented revision repair, or superior capsular reconstruction, and 7 patients (1.7%) underwent revision to reverse shoulder arthroplasty (1.7%). There were no cases of reoperation for infection. On AUC analysis, no critical HbA 1c value was identified to predispose to reoperation. Interestingly, elevated preoperative American Society of Anesthesiologists (ASA) physical status classification score (2.8 vs. 2.28, P =.001) was associated with a higher reoperation rate. In patients with DM, preoperative HbA 1c is not a predictive factor for surgical failure requiring reoperation. Stable glycemic control is important to a patient's overall health and may play a role in minimizing postoperative medical complications, but an elevated preoperative HbA 1c should not be a strict surgical contraindication for arthroscopic rotator cuff repair. In patients with DM, an elevated ASA score is associated with an increased rate of subsequent reoperation; diabetic patients should be counseled accordingly. [ABSTRACT FROM AUTHOR]

The progression from prediabetes to type-2 diabetes depends on multiple pathophysiological, clinical, and epidemiological factors that generally overlap. Both insulin resistance and decreased insulin secretion are considered to be the main causes. The diagnosis and approach to the prediabetic patient are heterogeneous. There is no agreement on the diagnostic criteria to identify prediabetic subjects or the approach to those with insufficient responses to treatment, with respect to regression to normal glycemic values or the prevention of complications. The stratification of prediabetic patients, considering the indicators of impaired fasting glucose, impaired glucose tolerance, or HbA1c, can help to identify the sub-phenotypes of subjects at risk for T2DM. However, considering other associated risk factors, such as impaired lipid profiles, or risk scores, such as the Finnish Diabetes Risk Score, may improve classification. Nevertheless, we still do not have enough information regarding cardiovascular risk reduction. The sub-phenotyping of subjects with prediabetes may provide an opportunity to improve the screening and management of cardiometabolic risk in subjects with prediabetes. [ABSTRACT FROM AUTHOR]

Background: Pre-diabetes is a level before diabetes involvement. Pre-diabetes is prevalent, and if the blood glucose parameters of pre-diabetic patients do not reduce, patients will be involved with type 2 diabetes. In this study, we aimed to investigate the value of hemoglobin A1c (HbA1c) level for predicting diabetes and retinopathy involvement in pre-diabetics. Materials and Methods: This prospective study was performed on pre-diabetics referred to the endocrinology clinic of Loghman Hakim Hospital (Tehran-Iran) from 2020-20211. The patients were assessed on age, sex, familial history of diabetes, systolic and diastolic blood pressure, and laboratory studies, including fasting blood sugar (FBS), oral glucose tolerance test (OGTT), HbA1c, lipid profile, aspartate aminotransferase (AST), and alanine transaminase (ALT). All participants underwent ocular examination by an expert ophthalmologist for retinopathy assessment. After one year, all participants were again assessed for all mentioned factors. Results: Pre-diabetics are five-fold more likely to be involved with diabetes after one year than patients with normal HbA1c. We found that patients with pre-diabetes HbA1c are 7.94 fold more at risk of retinopathy involvement than pre-diabetic patients with normal HbA1c (all p-values<0.05). Conclusion: A high level of HbA1c in pre-diabetics increases the risks of retinopathy and diabetes involvement. [ABSTRACT FROM AUTHOR]

Background: It is unknown whether high hemoglobin A1c (HbA1c) is associated with increases in the risk of cardiovascular disease among individuals with elevated genetic susceptibility. We aimed to investigate the association between HbA1c and atrial fibrillation (AF), coronary artery disease (CAD), and ischemic stroke according to the polygenic risk score (PRS). Methods: The UK Biobank cohort included 502,442 participants aged 40–70 years who were recruited from 22 assessment centers across the United Kingdom from 2006 to 2010. This study included 305,605 unrelated individuals with available PRS and assessed new-onset AF, CAD, and ischemic stroke. The participants were divided into tertiles based on the validated PRS for each outcome. Within each PRS tertiles, the risks of incident events associated with HbA1c levels were investigated and compared with HbA1c < 5.7% and low PRS. Data were analyzed from November 2022 to May 2023. Results: Of 305,605 individuals, 161,605 (52.9%) were female, and the mean (SD) age was 56.6 (8.1) years. During a median follow-up of 11.9 (interquartile range 11.1–12.6) years, the incidences of AF, CAD, and ischemic stroke were 4.6, 2.9 and 1.1 per 100 person-years, respectively. Compared to individuals with HbA1c < 5.7% and low PRS, individuals with HbA1c ≥ 6.5% and high PRS had a 2.67-times higher risk for AF (hazard ratio [HR], 2.67; 95% confidence interval (CI), 2.43–2.94), 5.71-times higher risk for CAD (HR, 5.71; 95% CI, 5.14–6.33) and 2.94-times higher risk for ischemic stroke (HR, 2.94; 95% CI, 2.47–3.50). In the restricted cubic spline models, while a U-shaped trend was observed between HbA1c and the risk of AF, dose-dependent increases were observed between HbA1c and the risk of CAD and ischemic stroke regardless PRS tertile. Conclusions: Our results suggest that the nature of the dose-dependent relationship between HbA1c levels and cardiovascular disease in individuals with different PRS is outcome-specific. This adds to the evidence that PRS may play a role together with glycemic status in the development of cardiovascular disease. [ABSTRACT FROM AUTHOR]

An elevated platelet count may contribute to significant thrombotic events and pose a risk for diabetic microvascular complications. Albuminuria, one of the hallmarks of diabetes, is thought to be a risk factor for endothelial dysfunction. In this study, we investigated the association between relative thrombocytosis and an increased urine albumin-to-creatinine ratio in healthy adult participants. Using multivariate analyses on data from the Korea National Health and Nutrition Examination Survey V–VI, 12,525 eligible native Koreans aged ≥ 20 were categorized into platelet count quintiles by sex. The highest platelet count quintile included younger, more obese participants with elevated white blood cell counts, poor lipid profiles, and a better estimated glomerular filtration rate. Restricted cubic spline regression analysis revealed significant associations between platelet count and fasting blood glucose, glycated hemoglobin, and urine albumin-to-creatinine ratio. Adjusted logistic regression models indicated that heightened fasting blood glucose and platelet count were linked to risk of microalbuminuria (fasting blood glucose, odds ratio = 1.026, 95%CI = 1.011–1.042; platelet count, odds ratio = 1.004, 95%CI = 1.002–1.006). Particularly, an increased platelet count was notably associated with microalbuminuria progression in subjects with impaired fasting glucose. These findings suggest that an elevated platelet count, even below diagnostic thrombocytosis levels, independently correlates with an increased risk of vascular endothelial dysfunction in patients with impaired fasting glucose. [ABSTRACT FROM AUTHOR]

Background: Diabetes frequently results in the need for multiple medication therapies, known as 'Polypharmacy'. This situation can incur significant costs and increase the likelihood of medication errors. This study evaluated the prescriptions of patients with diabetes regarding polypharmacy to assess its effect on the control of hemoglobin A1c (HbA1c) levels and prescription costs. Methods: A cross-sectional national study was conducted based on data from linking the Iranians Health Insurance Service prescriptions in 2015 and 2016 with the STEPS 2016 survey in Iran. The association of the individual and sociodemographic factors, as well as polypharmacy, as independent variables, with control of HbA1c levels and the cost of the prescriptions were assessed among diabetic patients using logistic and linear regression, respectively. Results: Among 205 patients using anti-diabetic medications, 47.8% experienced polypharmacy. The HbA1c of 74 patients (36.1%) was equal to or less than 7, indicating controlled diabetes. HbA1c control showed no significant association with gender. However, prescription costs were notably lower in females (β = 0.559 [0.324-0.964], P = 0.036). No significant correlation was found between the area of residence and prescription costs, but HbA1c was significantly more controlled in urban areas (OR = 2.667 [1.132-6.282], P = 0.025). Prescription costs were significantly lower in patients without polypharmacy (β = 0.211, [0.106-0.423], P < 0.001), though there was no significant association between polypharmacy and HbA1c levels. Conclusion: Our results demonstrated that diabetics with polypharmacy paid significantly more for their prescriptions without experiencing a positive effect on the control of HbA1c levels. [ABSTRACT FROM AUTHOR]