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Grimholt RM, Fjeld B, Selsås H, Schwettmann L, Klingenberg O. Hb Aalesund ( HBA2: c.400_406delAGCACCG), an Unstable α-Globin Variant Found in a Norwegian Patient Causing Moderate Hemolytic Anemia and Falsely High Hb A 1c Using Ion Exchange High Performance Liquid Chromatography. Hemoglobin 2019; 43:122-125. [PMID: 31145010 DOI: 10.1080/03630269.2019.1614048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A new unstable hemoglobin (Hb) variant, named Hb Aalesund, was detected during Hb A1c measurement in a patient with a nearly compensated hemolytic anemia. Sequencing of the α-globin genes revealed a 7 bp deletion in exon 3 of the HBA2 gene (HBA2: c.400_406delAGCACCG) (NM_000517.4) causing a frameshift and a premature termination codon (PTC) two positions downstream. Apparently, the transcript bypassed nonsense-mediated decay (NMD), and a truncated protein was translated. The unstable Hb variant presumably underwent rapid denaturation, as heterozygosity of Hb Aalesund was associated with mild hemolytic anemia. In addition, the Hb variant interfered with Hb A1c measurement by cation exchange high performance liquid chromatography (HPLC), causing a falsely high Hb A1c result when using the Bio-Rad D10™ Hemoglobin Analyzer fast Hb A1c Program.
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Affiliation(s)
- Runa M Grimholt
- a Department of Medical Biochemistry , Oslo University Hospital, Ullevaal , Oslo , Norway.,b Institute of Clinical Medicine , University of Oslo , Oslo , Norway.,c Department of Life Sciences and Health , OsloMet (Oslo Metropolitan) University , Oslo , Norway
| | - Bente Fjeld
- a Department of Medical Biochemistry , Oslo University Hospital, Ullevaal , Oslo , Norway.,b Institute of Clinical Medicine , University of Oslo , Oslo , Norway
| | - Hilde Selsås
- d Department of Endocrinology , Aalesund Hospital , Aalesund , Norway
| | - Lutz Schwettmann
- e Department of Medical Biochemistry , Aalesund Hospital , Aalesund , Norway.,f Department of Biological Sciences , Norwegian University of Science and Technology , Aalesund , Norway
| | - Olav Klingenberg
- a Department of Medical Biochemistry , Oslo University Hospital, Ullevaal , Oslo , Norway.,b Institute of Clinical Medicine , University of Oslo , Oslo , Norway
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102
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Ngaage LM, Osadebey EN, Tullie ST, Elegbede A, Rada EM, Spanakis EK, Goldberg N, Slezak S, Rasko YM. An Update on Measures of Preoperative Glycemic Control. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2240. [PMID: 31333965 PMCID: PMC6571350 DOI: 10.1097/gox.0000000000002240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 03/08/2019] [Indexed: 12/16/2022]
Abstract
Glycemic control represents a modifiable preoperative risk factor in surgery. Traditionally, hemoglobin A1c (HbA1c) and plasma glucose are utilized as measures of glycemic control. However, studies show mixed results regarding the ability of these conventional measures to predict adverse surgical outcomes. This may be explained by the time window captured by HbA1c and serum glucose: long-term and immediate glycemic control, respectively. Fructosamine, glycosylated albumin, and 1,5-anhydroglucitol constitute alternative metrics of glycemic control that are of growing interest but are underutilized in the field of surgery. These nontraditional measures reflect the temporal variations in glycemia over the preceding days to weeks. Therefore, they may more accurately reflect glycemic control within the time window that most significantly affects surgical outcomes. Additionally, these alternative measures are predictive of negative outcomes, even in the nondiabetic population and in patients with chronic renal disease and anemia, for whom HbA1c performs poorly. Adopting these newer metrics of glycemia may enhance the value of preoperative evaluation, such that the effectiveness of any preoperative glycemic control interventions can be assessed, and adverse outcomes associated with hyperglycemia better predicted. The goal of this review is to provide an update on the preoperative management of glycemia and to describe alternative metrics that may improve our ability to predict and control for the negative outcomes associated with poor glycemic control.
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Affiliation(s)
- Ledibabari M. Ngaage
- From the Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, Md
| | | | - Sebastian T.E. Tullie
- East Kent NHS Foundation Trust, South Thames Foundation School, London, United Kingdom
| | - Adekunle Elegbede
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, University of Maryland Medical Center, Baltimore, Md
| | - Erin M. Rada
- From the Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Elias K. Spanakis
- Division of Diabetes and Endocrinology, Baltimore Veterans Affairs Medical Center, Baltimore, Md
- Department of Internal Medicine, Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, Md
| | - Nelson Goldberg
- From the Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Sheri Slezak
- From the Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Yvonne M. Rasko
- From the Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, Md
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103
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Borries TM, Dunbar A, Bhukhen A, Rismany J, Kilham J, Feinn R, Meehan TP. The impact of telemedicine on patient self-management processes and clinical outcomes for patients with Types I or II Diabetes Mellitus in the United States: A scoping review. Diabetes Metab Syndr 2019; 13:1353-1357. [PMID: 31336491 DOI: 10.1016/j.dsx.2019.02.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 02/04/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The objective of this scoping review was to identify peer-reviewed medical literature on the use of telemedicine in patients with Types I or II DM in the United States, assess its impact on self-management processes and clinical outcomes of care, and to delineate research gaps. METHODS We utilized a structured scoping review protocol to conduct this research. We searched the published medical literature utilizing two databases, PubMed and CINHAL, and we included all original research articles published prior to July 20th, 2018. Using a 4-step systematic approach, we identified, reviewed, extracted and summarized data from all relevant studies. RESULTS We identified 47 articles overall. Telemedicine impact was reported as positive in articles addressing the following components of patient self-management: adherence to blood glucose monitoring, day-to-day decision-making related to self-care, and adherence with medications. The most commonly reported clinical outcome was HbA1c level. Few or no studies evaluated impact on long term clinical outcomes such as blindness, amputation, cardiovascular events, development of chronic kidney disease, or mortality. DISCUSSION This scoping review provides important information about studies conducted in the United States evaluating the impact of telemedicine on patient self-management and on clinical outcomes in patients with DM. CONCLUSIONS Results suggest that telemedicine has a positive impact on self-management processes and on HbA1c levels. However, future evaluative reviews are necessary to confirm and quantitate the impact of telemedicine on self-management processes and primary studies are necessary to evaluate its impact on long term clinical outcomes.
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Affiliation(s)
- Trevor M Borries
- Quinnipiac University Frank H. Netter MD School of Medicine, North Haven, CT, USA.
| | - Ashley Dunbar
- Quinnipiac University Frank H. Netter MD School of Medicine, North Haven, CT, USA.
| | - Arti Bhukhen
- Quinnipiac University Frank H. Netter MD School of Medicine, North Haven, CT, USA.
| | - Joshua Rismany
- Quinnipiac University Frank H. Netter MD School of Medicine, North Haven, CT, USA.
| | - Jessica Kilham
- Quinnipiac University Frank H. Netter MD School of Medicine, North Haven, CT, USA.
| | - Richard Feinn
- Quinnipiac University Frank H. Netter MD School of Medicine, North Haven, CT, USA.
| | - Thomas P Meehan
- Quinnipiac University Frank H. Netter MD School of Medicine, North Haven, CT, USA; Connecticut Center for Primary Care, Farmington, CT, USA.
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De Pergola G, Giagulli VA, Guastamacchia E, Bartolomeo N, Tatoli R, Lampignano L, Silvestris F, Triggiani V. Platelet number is positively and independently associated with glycated hemoglobin in non-diabetic overweight and obese subjects. Nutr Metab Cardiovasc Dis 2019; 29:254-259. [PMID: 30738641 DOI: 10.1016/j.numecd.2018.12.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 12/05/2018] [Accepted: 12/28/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND AIMS A significant increase in platelet count may be a risk factor for atherosclerotic cardiovascular disease. This study investigates the association between platelet number and glucose metabolism, evaluated by glycated hemoglobin (HbA1c) levels, in a apparently healthy population represented by overweight and obese subjects with normal glucose and HbA1c levels. METHODS AND RESULTS As many as 240 subjects, 177 women and 63 men, aged 18-70 years, were enrolled. Body mass index (BMI), waist circumference (WC), systolic and diastolic blood pressure levels, platelet count and fasting blood glucose, insulin, insulin resistance, HbA1c, uric acid, triglyceride, total cholesterol, high and low density lipoprotein cholesterol concentrations were evaluated. Concerning the univariate correlation analyses between platelets number and all other variables, platelet count was significantly (and positively) correlated only with HbA1c (P < 0.05) and female sex (P < 0.01). HbA1c (P < 0.05), female sex (P < 0.001), and diastolic blood pressure (P < 0.01), positively, and age (P < 0.05) and systolic blood pressure (P < 0.05), negatively, were significantly and independently associated to platelet count in a final multiple regression analysis. CONCLUSION This is the first study showing a strong positive and independent relationship between HbA1c and platelet number in non-diabetic overweight and obese subjects.
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Affiliation(s)
- G De Pergola
- Clinical Nutrition Unit, Medical Oncology, Department of Biomedical Science and Human Oncology, University of Bari, School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy.
| | - V A Giagulli
- Outpatient Clinic for Endocrinology and Metabolic Diseases, PTA "F.Jaia" Conversano, ASL, Bari, Italy; Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, Interdisciplinary Department of Medicine, University of Bari, School of Medicine, Policlinico, Piazza GiulioCesare, 70124, Bari, Italy
| | - E Guastamacchia
- Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, Interdisciplinary Department of Medicine, University of Bari, School of Medicine, Policlinico, Piazza GiulioCesare, 70124, Bari, Italy
| | - N Bartolomeo
- Medical Statistics, Department of Biomedical Science and Human Oncology, University of Bari, School of Medicine, Policlinico, Piazza GiulioCesare, 70124, Bari, Italy
| | - R Tatoli
- Clinical Nutrition Unit, Medical Oncology, Department of Biomedical Science and Human Oncology, University of Bari, School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - L Lampignano
- Clinical Nutrition Unit, Medical Oncology, Department of Biomedical Science and Human Oncology, University of Bari, School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - F Silvestris
- Medical Oncology, Department of Biomedical Science and Human Oncology, University of Bari, School of Medicine, Policlinico, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - V Triggiani
- Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, Interdisciplinary Department of Medicine, University of Bari, School of Medicine, Policlinico, Piazza GiulioCesare, 70124, Bari, Italy
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105
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Siaw MYL, Lee JYC. Multidisciplinary collaborative care in the management of patients with uncontrolled diabetes: A systematic review and meta-analysis. Int J Clin Pract 2019; 73:e13288. [PMID: 30369012 DOI: 10.1111/ijcp.13288] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/22/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Diabetes is a chronic and complex disease that requires a multidisciplinary collaborative care approach. OBJECTIVE The primary objective was to evaluate the clinical outcomes of patients with uncontrolled diabetes within a multidisciplinary collaborative care model. The secondary objective was to evaluate the humanistic and economic outcomes of this model of care. METHODS A search using PubMed, SCOPUS, and CINAHL from 2007 to 2017 was conducted. Articles selected included randomised controlled studies on multidisciplinary collaborative care (defined as care provision by ≥ two different care providers) vs usual care (defined as standard care provided solely by physicians) for patients with uncontrolled diabetes. In addition, the eligible article had to report at least two of the three outcomes such as clinical (glycated haemoglobin [HbA1c], systolic blood pressure [SBP], low-density lipoprotein [LDL], and triglyceride [TG]), humanistic (patient-reported measures), and economic (healthcare costs and utilisations) outcomes. Parameters examined included study characteristics, care interventions, patient characteristics, and study outcomes. Primary outcomes using mean differences (MDs) with 95% confidence intervals (CIs) were analysed either by fixed- or random-effects models. RESULTS A total of 16 studies were included in the review. Multidisciplinary collaborative care significantly improved HbA1c (MD = -0.55%, 95% CI = -0.65% to -0.45%, P < 0.001, I2 = 35%) and SBP (MD = -4.89 mm Hg, 95% CI = -6.64 to -3.13 mm Hg, P < 0.001, I2 = 46%) over 3-12 months. The humanistic outcomes in the multidisciplinary collaborative care model were either improved or maintained over time. In comparison to usual care, the healthcare costs and utilisations in the multidisciplinary collaborative care model were comparable without incurring excessive costs. CONCLUSIONS Multidisciplinary collaborative care appeared to positively impact on the clinical, humanistic, and economic outcomes of patients with uncontrolled diabetes.
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Affiliation(s)
- Melanie Yee Lee Siaw
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore City, Singapore
| | - Joyce Yu-Chia Lee
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore City, Singapore
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106
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Yu C, Wang L, Xue H, Lin H, Li Y, Chan SO. Association of glycated hemoglobin with the risk of advanced fibrosis in non-alcoholic fatty liver disease patients without diabetes. Clin Res Hepatol Gastroenterol 2019; 43:58-66. [PMID: 30274911 DOI: 10.1016/j.clinre.2018.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 06/20/2018] [Accepted: 08/13/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Association of diabetes with non-alcoholic steatohepatitis has been well documented. However, it remains unclear whether there is an association between levels of glycated hemoglobin (HbA1c) with severity of non-alcoholic fatty liver disease (NAFLD). This study was aimed to explore the relationship between levels of HbA1c and the risk of advanced fibrosis in patients with NAFLD. METHODS A cross-sectional study was performed on 4826 apparently healthy Chinese, who underwent a health check between January 2015 and December 2016. NAFLD was defined as hepatic steatosis on ultrasonography in the absence of excessive alcohol use or other identifiable causes. The risk of advanced fibrosis was assessed by NAFLD fibrosis Score. RESULTS Among 4826 individuals studied, 1630 were diagnosed with NAFLD. In a multivariable-adjusted model, high HbA1c levels were associated independently with increased prevalence of NAFLD. The adjusted odds ratio [95% confidence interval (95% CI)] for NAFLD, when compared with the highest HbA1c quartile and the lowest HbA1c quartile, was 2.72 (2.07-3.58; P for trend < 0.001). A strong association was also observed between HbA1c level and the risk of fibrosis in patients with NAFLD in multivariable analyses, with the extreme-quartile odds ratio of 2.69 (95% CI: 1.60-4.53; P for trend < 0.001). This association remained significant even in subjects without diabetes. CONCLUSIONS We concluded that high HbA1c level was associated strongly and independently with increased risk of advanced fibrosis in NAFLD patients without diabetes.
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Affiliation(s)
- Chao Yu
- Center for Health Examination, The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, PR China; Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangdong, PR China.
| | - Liqing Wang
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, PR China
| | - Hongliang Xue
- Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangdong, PR China
| | - Hongmei Lin
- Center for Health Examination, The 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, PR China
| | - Yanping Li
- Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangdong, PR China
| | - Sun-On Chan
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong, PR China
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107
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Krhač M, Lovrenčić MV. Update on biomarkers of glycemic control. World J Diabetes 2019; 10:1-15. [PMID: 30697366 PMCID: PMC6347654 DOI: 10.4239/wjd.v10.i1.1] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/14/2018] [Accepted: 12/05/2018] [Indexed: 02/05/2023] Open
Abstract
Attaining and maintaining good glycemic control is a cornerstone of diabetes care. The monitoring of glycemic control is currently based on the self-monitoring of blood glucose (SMBG) and laboratory testing for hemoglobin A1c (HbA1c), which is a surrogate biochemical marker of the average glycemia level over the previous 2-3 mo period. Although hyperglycemia is a key biochemical feature of diabetes, both the level of and exposure to high glucose, as well as glycemic variability, contribute to the pathogenesis of diabetic complications and follow different patterns in type 1 and type 2 diabetes. HbA1c provides a valuable, standardized and evidence-based parameter that is relevant for clinical decision making, but several biological and analytical confounders limit its accuracy in reflecting true glycemia. It has become apparent in recent years that other glycated proteins such as fructosamine, glycated albumin, and the nutritional monosaccharide 1,5-anhydroglucitol, as well as integrated measures from direct glucose testing by an SMBG/continuous glucose monitoring system, may provide valuable complementary data, particularly in circumstances when HbA1c results may be unreliable or are insufficient to assess the risk of adverse outcomes. Long-term associations of these alternative biomarkers of glycemia with the risk of complications need to be investigated in order to provide clinically relevant cut-off values and to validate their utility in diverse populations of diabetes patients.
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Affiliation(s)
- Maja Krhač
- Division of Laboratory Medicine, Department of Medical Biochemistry and Laboratory Medicine, Merkur University Hospital, Zagreb 10000, Croatia
| | - Marijana Vučić Lovrenčić
- Division of Laboratory Medicine, Department of Medical Biochemistry and Laboratory Medicine, Merkur University Hospital, Zagreb 10000, Croatia
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108
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Feinberg T, Wieland LS, Miller LE, Munir K, Pollin TI, Shuldiner AR, Amoils S, Gallagher L, Bahr-Robertson M, D'Adamo CR. Polyherbal dietary supplementation for prediabetic adults: study protocol for a randomized controlled trial. Trials 2019; 20:24. [PMID: 30616613 PMCID: PMC6323847 DOI: 10.1186/s13063-018-3032-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 11/01/2018] [Indexed: 12/15/2022] Open
Abstract
Background Prediabetes describes a state of hyperglycemia outside of normal limits that does not meet the criteria for diabetes diagnosis, is generally symptomless, and affects an estimated 38% of adults in the United States. Prediabetes typically precedes the diagnosis of type 2 diabetes, which accounts for increased morbidity and mortality. Although the use of dietary and herbal supplements is popular worldwide, and a variety of single herbal medicines have been examined for glycemic management, the potential of increasingly common polyherbal formulations to return glycemic parameters to normal ranges among adults with prediabetes remains largely unexplored. The purpose of this study is to evaluate the efficacy of a commercially available, polyherbal dietary supplement on glycemic and lipid parameters in prediabetic individuals. Methods In this multi-site, double-blinded, randomized controlled clinical trial, 40 participants with prediabetes will be randomized to either a daily oral polyherbal dietary supplement (GlucoSupreme™ Herbal; Designs for Health®, Suffield, CT, USA; containing cinnamon bark (Cinnamomum cassia), banaba leaf (Lagerstroemia speciosa standardized to 1% corosolic acid), kudzu root (Pueraria lobata standardized to 40% isoflavones), fenugreek seed (Trigonella foenum-graceum standardized to 60% saponins), gymnema leaf (Gymnema sylvestre standardized to 25% gymnemic acid), American ginseng root (Panax quinquefolius standardized to 5% ginsenosides), and berberine HCl derived from bark (Berberis aristata)) or placebo for 12 weeks. Short-, medium-, and comparatively long-term markers of glycemic control (blood glucose and fasting insulin, fructosamine, and glycated hemoglobin/A1c, respectively), and other glycemic parameters (GlycoMark, β-cell function, and insulin sensitivity/resistance) will be obtained. Lipid profile (total cholesterol, LDL, HDL, and triglycerides), inflammation (hs-CRP), progression to type 2 diabetes mellitus, as well as safety indices (ALT, AST) will be obtained. An intention-to-treat analysis will be used to assess changes in study outcomes. Discussion Treatment options for adults with prediabetes are currently limited. This study aims to evaluate the safety and efficacy of a commercially available dietary supplement in the popular, but as yet insufficiently studied, category of polyherbal formulas for the management of glycemic parameters and other biomarkers associated with prediabetes. Trial registration ClinicalTrials.gov, ID: NCT03388762. Retrospectively registered on 4 January 2018. Electronic supplementary material The online version of this article (10.1186/s13063-018-3032-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Termeh Feinberg
- University of Maryland School of Medicine Center for Integrative Medicine, Baltimore, MD, USA. .,Yale University School of Medicine Center for Medical Informatics, New Haven, CT, USA.
| | - L Susan Wieland
- University of Maryland School of Medicine Center for Integrative Medicine, Baltimore, MD, USA
| | | | - Kashif Munir
- University of Maryland School of Medicine Center for Diabetes and Endocrinology, Baltimore, MD, USA
| | - Toni I Pollin
- University of Maryland School of Medicine Department of Medicine, Baltimore, MD, USA
| | - Alan R Shuldiner
- University of Maryland School of Medicine Department of Medicine, Baltimore, MD, USA
| | - Steve Amoils
- Alliance Integrative Medicine, Cincinatti, OH, USA
| | | | - Mary Bahr-Robertson
- University of Maryland School of Medicine Center for Integrative Medicine, Baltimore, MD, USA
| | - Christopher R D'Adamo
- University of Maryland School of Medicine Center for Integrative Medicine, Baltimore, MD, USA
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109
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Sameer AS, Banday MZ, Nissar S, Saeed SA. A Comparison of Biomarkers in the Assessment of Glycemic Control in Diabetes: Reviewing the Evidence. Curr Diabetes Rev 2019; 15:471-479. [PMID: 30961503 DOI: 10.2174/1389557519666190408197922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 03/21/2019] [Accepted: 04/02/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Diabetes Mellitus (DM) is a chronic life-long progressive multisystem heterogeneous metabolic disorder with complex pathogenesis. INTRODUCTION Hyperglycemia is not only one of the classical signs of DM, but it also serves as the pivotal prerequisite for the diagnosis of the disease. However, with the advancement in the field of analytical biochemistry, a number of alternative and specific biomarkers have been discovered which can be used for better diagnosis of the DM. In this review, we have discussed various aspects of DM and different biomarkers used in assessing glycemia. METHODOLOGY A thorough literature survey was conducted to identify various studies that reported the use of conventional and non-conventional markers for the assessment of glycemia in DM patients. CONCLUSION The accurate detection and hence diagnosis of DM has become easy and more specific with the use of various biomarkers.
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Affiliation(s)
- Aga S Sameer
- Department of Basic Medical Sciences, College of Medicine, King Saud Bin Abdul Aziz University for Health Sciences, National Guard Health Affairs, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Centre (KAIMRC), King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Mujeeb Z Banday
- Department of Biology, United Arab Emirates University (UAEU), Al Ain, Abu Dhabi, United Arab Emirates
| | - Saniya Nissar
- Department of Clinical Biochemistry, University of Kashmir, Hazratbal, Srinagar, Kashmir, India
| | - Sheikh A Saeed
- Department of Basic Medical Sciences, College of Medicine, King Saud Bin Abdul Aziz University for Health Sciences, National Guard Health Affairs, Jeddah, Saudi Arabia
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Chilelli NC, Cosma C, Burlina S, Plebani M, Lapolla A. Antioxidant capacity in patients with type 2 diabetes: a preliminary investigation on gender-specific differences in an Italian population. Clin Chem Lab Med 2018; 56:101-104. [PMID: 29140790 DOI: 10.1515/cclm-2017-0721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 10/09/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Nino Cristiano Chilelli
- Diabetology and Dietetics, Department of Medicine, University of Padova, Via dei Colli 4, 35143 Padova, Italy, Phone: +39 049 8216848, Fax: +39 049 8216838
| | - Chiara Cosma
- Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy
| | - Silvia Burlina
- Diabetology and Dietetics, Department of Medicine, University of Padova, Padova, Italy
| | - Mario Plebani
- Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy
| | - Annunziata Lapolla
- Diabetology and Dietetics, Department of Medicine, University of Padova, Padova, Italy
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111
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Edelman SV, Argento NB, Pettus J, Hirsch IB. Clinical Implications of Real-time and Intermittently Scanned Continuous Glucose Monitoring. Diabetes Care 2018; 41:2265-2274. [PMID: 30348844 DOI: 10.2337/dc18-1150] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 08/14/2018] [Indexed: 02/03/2023]
Abstract
Two types of continuous glucose monitoring (CGM) systems are now available: real-time CGM (rtCGM) and intermittently scanned (isCGM). Current rtCGM systems automatically transmit a continuous stream of glucose data to the user, provide alerts and active alarms, and transmit glucose data (trend and numerical) in real time to a receiver, smart watch, or smartphone. The current isCGM system provides the same type of glucose data but requires the user to purposely scan the sensor to obtain information, and it does not have alerts and alarms. Both CGM technologies have significant advantages over self-monitoring of blood glucose; however, differences in the features and capabilities of the two approaches must be considered when guiding patient selection of the system that meets their individual needs.
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Affiliation(s)
- Steven V Edelman
- University of California, San Diego, and Taking Control of Your Diabetes, San Diego, CA
| | | | - Jeremy Pettus
- Clinical and Translational Research Institute and University of California, San Diego, San Diego, CA
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Chalew S, Hamdan M. Racial disparity in HbA1c persists when fructosamine is used as a surrogate for mean blood glucose in youth with type 1 diabetes. Pediatr Diabetes 2018; 19:1243-1248. [PMID: 29808574 PMCID: PMC6925540 DOI: 10.1111/pedi.12696] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 04/13/2018] [Accepted: 05/16/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Blacks have been reported to have higher hemoglobin A1c (HbA1c) than Whites even after adjustment for differences in blood glucose levels. Potentially glucose-independent racial disparity in HbA1c is an artifact of glucose ascertainment methods. In order to test this possibility, we examined the relationship of HbA1c with race after adjustment for concurrent fructosamine level as a surrogate for mean blood glucose (MBG). METHODS Youth with type 1 diabetes self-identified as either Black or White had blood drawn for HbA1c, fructosamine complete blood count, ferritin, and soluble transferrin receptor (sTfR) at a clinic visit. MBG was calculated as the average of self-monitored capillary glucoses over the preceding 30 days. The effect of race on HbA1c was evaluated in a general linear model adjusting for either MBG or fructosamine, along with other covariates. RESULTS Fructosamine was correlated with both HbA1c (r = 0.73, P < .0001), MBG (r = 0.46, P < .0001), red cell distribution width coefficient of variation (RDW-CV) (r = 0.31, P = .0045), Fe (r = 0.27, P = .017), and sTfR (r = 0.32, P = .0042). HbA1c was approximately 0.7% higher in Blacks than Whites after adjustment for fructosamine along with age, gender, RDW-CV, Fe, sTfR. CONCLUSIONS Blacks tend to have higher HbA1c than Whites even after statistical adjustment for fructosamine levels as a surrogate for MBG. Thus, HbA1c tends to overestimate corresponding MBG or fructosamine levels in Black patients. Racial differences should be taken into consideration when using HbA1c as a guide to diagnosis and therapy of diabetes in mixed-race populations.
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Affiliation(s)
- Stuart Chalew
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics; Louisiana State University Health Science Center, Children's Hospital of New Orleans; New Orleans Louisiana
| | - Mahmoud Hamdan
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics; Louisiana State University Health Science Center, Children's Hospital of New Orleans; New Orleans Louisiana
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Murphree DH, Arabmakki E, Ngufor C, Storlie CB, McCoy RG. Stacked classifiers for individualized prediction of glycemic control following initiation of metformin therapy in type 2 diabetes. Comput Biol Med 2018; 103:109-115. [PMID: 30347342 DOI: 10.1016/j.compbiomed.2018.10.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 10/14/2018] [Accepted: 10/15/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Metformin is the preferred first-line medication for management of type 2 diabetes and prediabetes. However, over a third of patients experience primary or secondary therapeutic failure. We developed machine learning models to predict which patients initially prescribed metformin will achieve and maintain control of their blood glucose after one year of therapy. MATERIALS AND METHODS We performed a retrospective analysis of administrative claims data for 12,147 commercially-insured adults and Medicare Advantage beneficiaries with prediabetes or diabetes. Several machine learning models were trained using variables available at the time of metformin initiation to predict achievement and maintenance of hemoglobin A1c (HbA1c) < 7.0% after one year of therapy. RESULTS AUC performances based on five-fold cross-validation ranged from 0.58 to 0.75. The most influential variables driving the predictions were baseline HbA1c, starting metformin dosage, and presence of diabetes with complications. CONCLUSIONS Machine learning models can effectively predict primary or secondary metformin treatment failure within one year. This information can help identify effective individualized treatment strategies. Most of the implemented models outperformed traditional logistic regression, highlighting the potential for applying machine learning to problems in medicine.
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Affiliation(s)
- Dennis H Murphree
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA.
| | - Elaheh Arabmakki
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA
| | - Che Ngufor
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA
| | - Curtis B Storlie
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA
| | - Rozalina G McCoy
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, 55905, USA; Division of Health Care Policy & Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, USA
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114
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Hatada M, Tran TT, Tsugawa W, Sode K, Mulchandani A. Affinity sensor for haemoglobin A1c based on single-walled carbon nanotube field-effect transistor and fructosyl amino acid binding protein. Biosens Bioelectron 2018; 129:254-259. [PMID: 30297174 DOI: 10.1016/j.bios.2018.09.069] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 09/13/2018] [Accepted: 09/19/2018] [Indexed: 01/11/2023]
Abstract
Haemoglobin A1c (HbA1c) is a significant glycaemic marker for diabetes mellitus. The level of HbA1c reflects the mean blood glucose level over the prior 2-3 months and it is useful for the assessment of therapeutic effectiveness and for diagnosis. In this study, we report the label-free affinity sensor for HbA1c based on the chemiresistor-type field-effect transistor, which has a simple sensor configuration. Single-walled carbon nanotubes (SWNTs) were used as the transducing element. The fructosyl amino acid binding protein from Rhizobium radiobacter (SocA), which binds to α-fructosyl amino acid specifically, was used as the biorecognition element for fructosyl valine (FV), the product of the proteolytic hydrolysis of HbA1c. The developed sensor shows the ability to measure as low as 1.2 nM FV, which is 14-fold more sensitive compared to the previously reported fluorescence-based sensor using SocA. This sensor also exhibits high specificity where no significant response is observed from either fructosyl lysine (FK) or glucose, which are potential interferents. FK is the ε-fructosyl amino acid from glycated albumin, another glycated protein, whereas glucose is naturally present at very high concentration in the blood. We propose that the modulation of the surface charges on the SWNTs caused by the conformational change in SocA upon ligand binding leads to the proportionate changes in the number of carriers in the SWNT channel.
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Affiliation(s)
- Mika Hatada
- Department of Biotechnology and Life Science, Graduate School of Engineering, Tokyo University of Agriculture and Technology, 2-24-16 Naka-cho, Koganei, Tokyo 184-8588, Japan
| | - Thien-Toan Tran
- Department of Bioengineering, University of California, Riverside, CA 92521, USA
| | - Wakako Tsugawa
- Department of Biotechnology and Life Science, Graduate School of Engineering, Tokyo University of Agriculture and Technology, 2-24-16 Naka-cho, Koganei, Tokyo 184-8588, Japan
| | - Koji Sode
- Department of Biotechnology and Life Science, Graduate School of Engineering, Tokyo University of Agriculture and Technology, 2-24-16 Naka-cho, Koganei, Tokyo 184-8588, Japan; Joint Department of Biomedical Engineering, The University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC 27599, USA.
| | - Ashok Mulchandani
- Department of Chemical and Environmental Engineering, and Materials Science and Engineering Program, University of California, Riverside, CA 92521, USA.
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Davis PJ, Liu M, Sherman S, Natarajan S, Alemi F, Jensen A, Avramovic S, Schwartz MD, Hayes RB. HbA1c, lipid profiles and risk of incident type 2 Diabetes in United States Veterans. PLoS One 2018; 13:e0203484. [PMID: 30212478 PMCID: PMC6136717 DOI: 10.1371/journal.pone.0203484] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 08/21/2018] [Indexed: 01/24/2023] Open
Abstract
United States Veterans are at excess risk for type 2 diabetes, but population differentials in risk have not been characterized. We determined risk of type 2 diabetes in relation to prediabetes and dyslipidemic profiles in Veterans at the VA New York Harbor (VA NYHHS) during 2004-2014. Prediabetes was based on American Diabetes Association hemoglobin A1c (HbA1c) testing cut-points, one of several possible criteria used to define prediabetes. We evaluated transition to type 2 diabetes in 4,297 normoglycemic Veterans and 7,060 Veterans with prediabetes. Cox proportional hazards regression was used to relate HbA1c levels, lipid profiles, demographic, anthropometric and comorbid cardiovascular factors to incident diabetes (Hazard Ratio [HR] and 95% confidence intervals). Compared to normoglycemic Veterans (HbA1c: 5.0-5.6%; 31-38 mmol/mol), risks for diabetes were >2-fold in the moderate prediabetes risk group (HbA1c: 5.7-5.9%; 39-41 mmol/mol) (HR 2.37 [1.98-2.85]) and >5-fold in the high risk prediabetes group (HbA1c: 6.0-6.4%; 42-46 mmol/mol) (HR 5.59 [4.75-6.58]). Risks for diabetes were increased with elevated VLDL (≥40mg/dl; HR 1.31 [1.09-1.58]) and TG/HDL (≥1.5mg/dl; HR 1.34 [1.12-1.59]), and decreased with elevated HDL (≥35mg/dl; HR 0.80 [0.67-0.96]). Transition to diabetes in Veterans was related in age-stratified risk score analyses to HbA1c, VLDL, HDL and TG/HDL, BMI, hypertension and race, with 5-year risk differentials of 62% for the lowest (5-year risk, 13.5%) vs. the highest quartile (5-year risk, 21.9%) of the risk score. This investigation identified substantial differentials in risk of diabetes in Veterans, based on a readily-derived risk score suitable for risk stratification for type 2 diabetes prevention.
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Affiliation(s)
- P. Jordan Davis
- Department of Population Health, NYU School of Medicine, New York, NY, United States of America
| | - Mengling Liu
- Department of Population Health, NYU School of Medicine, New York, NY, United States of America
| | - Scott Sherman
- Department of Population Health, NYU School of Medicine, New York, NY, United States of America
- VA New York Harbor Healthcare System, New York, NY, United States of America
| | - Sundar Natarajan
- Department of Population Health, NYU School of Medicine, New York, NY, United States of America
- VA New York Harbor Healthcare System, New York, NY, United States of America
| | - Farrokh Alemi
- George Mason University, Fairfax, VA, United States of America
| | - Ashley Jensen
- VA New York Harbor Healthcare System, New York, NY, United States of America
| | - Sanja Avramovic
- George Mason University, Fairfax, VA, United States of America
| | - Mark D. Schwartz
- Department of Population Health, NYU School of Medicine, New York, NY, United States of America
- VA New York Harbor Healthcare System, New York, NY, United States of America
| | - Richard B. Hayes
- Department of Population Health, NYU School of Medicine, New York, NY, United States of America
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Sapkota S, Brien JAE, Aslani P. Blood glucose monitoring in type 2 diabetes - Nepalese patients' opinions and experiences. Glob Health Action 2018; 10:1322400. [PMID: 28585892 PMCID: PMC5496077 DOI: 10.1080/16549716.2017.1322400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Blood glucose monitoring forms a vital component of diabetes care. Monitoring conducted at home using glucometers, and in laboratories by professionals, are two common methods of blood glucose monitoring in clinical practice. Objective: To investigate Nepalese patients’ perceptions and practices of blood glucose monitoring in diabetes. Methods: In-depth interviews were conducted with 48 Nepalese participants with type 2 diabetes in Sydney and Kathmandu. The interviews were audio-recorded, transcribed verbatim and thematically analysed. Results: In Australia, most participants perceived home monitoring as useful; and both home and laboratory monitoring were conducted at fairly regular intervals. In Nepal, only a small number conducted home monitoring and the laboratory method formed the primary method of day-to-day monitoring. The laboratory method was preferred due to easy access to laboratories, lack of faith in glucometers and perceptions that home monitoring is costlier. However, overall monitoring was irregular in Nepal. In addition to the healthcare system which enabled cheaper self-monitoring in Australia, Nepalese in Australia also tended to have a better understanding about the purpose of home monitoring. Conclusions: This study has highlighted the disparity in perceptions and practices related to blood glucose monitoring. Understanding the importance of blood glucose monitoring and access to affordable resources are critical facilitators for conducting regular monitoring. Both patient and health-system factors play a key role in ensuring continued diabetes monitoring and management.
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Affiliation(s)
- Sujata Sapkota
- a Faculty of Pharmacy , The University of Sydney , Sydney , NSW , Australia
| | - Jo-Anne E Brien
- a Faculty of Pharmacy , The University of Sydney , Sydney , NSW , Australia.,b St. Vincent's Hospital Clinical School , UNSW , Sydney , NSW , Australia
| | - Parisa Aslani
- a Faculty of Pharmacy , The University of Sydney , Sydney , NSW , Australia
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Li W, Xie B, Qiu S, Huang X, Chen J, Wang X, Li H, Chen Q, Wang Q, Tu P, Zhang L, Yan S, Li K, Maimaitiming J, Nian X, Liang M, Wen Y, Liu J, Wang M, Zhang Y, Ma L, Wu H, Wang X, Wang X, Liu J, Cai M, Wang Z, Guo L, Chen F, Wang B, Monica S, Carlsson PO, Sun Z. Non-lab and semi-lab algorithms for screening undiagnosed diabetes: A cross-sectional study. EBioMedicine 2018; 35:307-316. [PMID: 30115607 PMCID: PMC6154869 DOI: 10.1016/j.ebiom.2018.08.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/06/2018] [Accepted: 08/06/2018] [Indexed: 12/29/2022] Open
Abstract
Background The terrifying undiagnosed rate and high prevalence of diabetes have become a public emergency. A high efficiency and cost-effective early recognition method is urgently needed. We aimed to generate innovative, user-friendly nomograms that can be applied for diabetes screening in different ethnic groups in China using the non-lab or noninvasive semi-lab data. Methods This multicenter, multi-ethnic, population-based, cross-sectional study was conducted in eight sites in China by enrolling subjects aged 20–70. Sociodemographic and anthropometric characteristics were collected. Blood and urine samples were obtained 2 h following a standard 75 g glucose solution. In the final analysis, 10,794 participants were included and randomized into model development (n = 8096) and model validation (n = 2698) group with a ratio of 3:1. Nomograms were developed by the stepwise binary logistic regression. The nomograms were validated internally by a bootstrap sampling method in the model development set and externally in the model validation set. The area under the receiver operating characteristic curve (AUC) was used to assess the screening performance of the nomograms. Decision curve analysis was applied to calculate the net benefit of the screening model. Results The overall prevalence of undiagnosed diabetes was 9.8% (1059/10794) according to ADA criteria. The non-lab model revealed that gender, age, body mass index, waist circumference, hypertension, ethnicities, vegetable daily consumption and family history of diabetes were independent risk factors for diabetes. By adding 2 h post meal glycosuria qualitative to the non-lab model, the semi-lab model showed an improved Akaike information criterion (AIC: 4506 to 3580). The AUC of the semi-lab model was statistically larger than the non-lab model (0.868 vs 0.763, P < 0.001). The optimal cutoff probability in semi-lab and non-lab nomograms were 0.088 and 0.098, respectively. The sensitivity and specificity were 76.3% and 81.6%, respectively in semi-lab nomogram, and 72.1% and 67.3% in non-lab nomogram at the optimal cut off point. The decision curve analysis also revealed a bigger decrease of avoidable OGTT test (52 per 100 subjects) in the semi-lab model compared to the non-lab model (36 per 100 subjects) and the existed New Chinese Diabetes Risk Score (NCDRS, 35 per 100 subjects). Conclusion The non-lab and semi-lab nomograms appear to be reliable tools for diabetes screening, especially in developing countries. However, the semi-lab model outperformed the non-lab model and NCDRS prediction systems and might be worth being adopted as decision support in diabetes screening in China.
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Affiliation(s)
- Wei Li
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast Uiversity, Nanjing, China
| | - Bo Xie
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast Uiversity, Nanjing, China
| | - Shanhu Qiu
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast Uiversity, Nanjing, China
| | - Xin Huang
- School of Public Health, Southeast University, Nanjing, China
| | - Juan Chen
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast Uiversity, Nanjing, China
| | - Xinling Wang
- Department of Endocrinology, People's Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, China
| | - Hong Li
- Department of Endocrinology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Qingyun Chen
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Qing Wang
- Department of Endocrinology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Ping Tu
- Department of Endocrinology, The Third Hospital of Nanchang, Nanchang, China
| | - Lihui Zhang
- Department of Endocrinology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Sunjie Yan
- Department of Endocrinology, The First Affiliated Hospital of Fujian Medical University, Diabetes Research Institute of Fujian Province, Fuzhou, China
| | - Kaili Li
- Department of Endocrinology, Xinjiang Uygur Autonomous Region Hospital of traditional Chinese Medicine, Urumqi, China
| | - Jimilanmu Maimaitiming
- Department of Endocrinology, People's Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, China
| | - Xin Nian
- Department of Endocrinology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Min Liang
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yan Wen
- Department of Endocrinology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Jiang Liu
- Department of Endocrinology, The Third Hospital of Nanchang, Nanchang, China
| | - Mian Wang
- Department of Endocrinology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yongze Zhang
- Department of Endocrinology, The First Affiliated Hospital of Fujian Medical University, Diabetes Research Institute of Fujian Province, Fuzhou, China
| | - Li Ma
- Department of Endocrinology, Xinjiang Uygur Autonomous Region Hospital of traditional Chinese Medicine, Urumqi, China
| | - Hang Wu
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast Uiversity, Nanjing, China
| | - Xuyi Wang
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast Uiversity, Nanjing, China
| | - Xiaohang Wang
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast Uiversity, Nanjing, China
| | - Jingbao Liu
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast Uiversity, Nanjing, China
| | - Min Cai
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast Uiversity, Nanjing, China
| | - Zhiyao Wang
- Suzhou MetroHealth Medical Technology, Co., LTD, Suzhou, China
| | - Lin Guo
- Suzhou MetroHealth Medical Technology, Co., LTD, Suzhou, China
| | - Fangqun Chen
- Suzhou MetroHealth Medical Technology, Co., LTD, Suzhou, China
| | - Bei Wang
- School of Public Health, Southeast University, Nanjing, China
| | - Sandberg Monica
- Department of Medical Cell Biology, Uppsala University, SE-75123 Uppsala, Sweden
| | - Per-Ola Carlsson
- Department of Medical Cell Biology, Uppsala University, SE-75123 Uppsala, Sweden.
| | - Zilin Sun
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast Uiversity, Nanjing, China.
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Paramasivam SS, Chinna K, Singh AKK, Ratnasingam J, Ibrahim L, Lim LL, Tan ATB, Chan SP, Tan PC, Omar SZ, Bilous RW, Vethakkan SR. Continuous glucose monitoring results in lower HbA 1c in Malaysian women with insulin-treated gestational diabetes: a randomized controlled trial. Diabet Med 2018; 35:1118-1129. [PMID: 29663517 DOI: 10.1111/dme.13649] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/10/2018] [Indexed: 02/05/2023]
Abstract
AIMS To determine if therapeutic, retrospective continuous glucose monitoring (CGM) improves HbA1c with less hypoglycaemia in women with insulin-treated gestational diabetes mellitus (GDM). METHODS This prospective, randomized controlled, open-label trial evaluated 50 women with insulin-treated GDM randomized to either retrospective CGM (6-day sensor) at 28, 32 and 36 weeks' gestation (Group 1, CGM, n = 25) or usual antenatal care without CGM (Group 2, control, n = 25). All women performed seven-point capillary blood glucose (CBG) profiles at least 3 days per week and recorded hypoglycaemic events (symptomatic and asymptomatic CBG < 3.5 mmol/l; non-fasting < 4.0 mmol/l). HbA1c was measured at 28, 33 and 37 weeks. In Group 1, both CGM and CBG data were used to manage diabetes, whereas mothers in Group 2 were managed based on CBG data alone. RESULTS Baseline characteristics (age, pre-pregnancy BMI, HbA1c , total insulin dose) were similar between groups. There was a lower increase in HbA1c from 28 to 37 weeks' gestation in the CGM group [∆HbA1c : CGM + 1 mmol/mol (0.09%), control + 3mmol/mol (0.30%); P = 0.024]. Mean HbA1c remained unchanged throughout the trial in the CGM group, but increased significantly in controls as pregnancy advanced. Mean HbA1c in the CGM group was lower at 37 weeks compared with controls [33 ± 4 mmol/mol (5.2 ± 0.4%) vs. 38 ± 7 mmol/mol (5.6 ± 0.6%), P < 0.006]. Some 92% of the CGM group achieved an HbA1c ≤ 39 mmol/mol (≤ 5.8%) at 37 weeks compared with 68% of the control group (P = 0.012). Neither group experienced severe hypoglycaemia. CONCLUSION CGM use may be beneficial in insulin-treated GDM because it improves HbA1c compared with usual antenatal care without increasing severe hypoglycaemia. (Clinical Trials Registry No.: NCT02204657).
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Affiliation(s)
- S S Paramasivam
- Department of Medicine, University Malaya Medical Centre, Kuala Lumpur
| | - K Chinna
- Department of Social and Preventive Medicine, University Malaya Medical Centre, Kuala Lumpur
| | - A K K Singh
- Department of Medicine, Serdang Hospital, Selangor
| | - J Ratnasingam
- Department of Medicine, University Malaya Medical Centre, Kuala Lumpur
| | - L Ibrahim
- Department of Medicine, University Malaya Medical Centre, Kuala Lumpur
| | - L L Lim
- Department of Medicine, University Malaya Medical Centre, Kuala Lumpur
| | - A T B Tan
- Department of Medicine, University Malaya Medical Centre, Kuala Lumpur
| | - S P Chan
- Department of Medicine, University Malaya Medical Centre, Kuala Lumpur
| | - P C Tan
- Department of Obstetrics and Gynaecology, University Malaya Medical Centre, Kuala Lumpur
| | - S Z Omar
- Department of Medicine, Serdang Hospital, Selangor
| | - R W Bilous
- Newcastle University Malaysia (NUMed), Johor, Malaysia
| | - S R Vethakkan
- Department of Medicine, University Malaya Medical Centre, Kuala Lumpur
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Gil J, Sicras-Mainar A, Zucchelli E. Uncontrolled diabetes and health care utilisation: panel data evidence from Spain. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:785-795. [PMID: 28799036 DOI: 10.1007/s10198-017-0920-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 07/25/2017] [Indexed: 05/24/2023]
Abstract
Despite size and relevance of uncontrolled diabetes, robust evidence on its effects on health care utilisation is very limited, especially among European countries. We employed longitudinal administrative data from Spain (2004-2010) to explore the relationship between uncontrolled type 2 diabetes and health care utilisation. We used a biomarker (glycated haemoglobin, HbA1c) to detect the presence of uncontrolled diabetes and explore its effects on both primary and secondary health care. We estimated a range of panel count data models, including negative binomials with random effects, dynamic and hurdle specifications to account for unobserved heterogeneity, previous utilisation and selection. We found uncontrolled diabetes in between 27 and 30% of patients of both genders. Our estimates suggested that although women appeared to systematically consume more health care compared to men, their consumption levels did not seem to be influenced by uncontrolled diabetes. Conversely, among men uncontrolled diabetes increased the average number of GP visits per year by between 3 and 3.4%, specialist visits by 5.3-6.1%, depending on specifications, and also extended annual hospital length of stay by 15%. We also found some evidence of heterogeneity in utilisation based on the level of uncontrolled diabetes among male individuals. Overall, our results suggested the need for different diabetes management plans depending on gender and levels of glycaemic control.
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Affiliation(s)
- Joan Gil
- Department of Economics and BEAT, University of Barcelona (UB), 696 Diagonal Ave, 08034, Barcelona, Spain.
| | | | - Eugenio Zucchelli
- Division of Health Research (DHR), Lancaster University, Lancaster, UK
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Shen C, Wen J, Pan X, Su J, Du W, Pan E, Zhang Q, Zhang N, Sheng H, Liu C, Wang H, Wu M, Qin Y. Age at menarche and age at natural menopause as predictors of glycemic control in type 2 diabetic patients. J Diabetes Complications 2018; 32:623-629. [PMID: 29884473 DOI: 10.1016/j.jdiacomp.2018.04.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/20/2018] [Accepted: 04/24/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To investigate the influence of age at menarche (AM) and age at natural menopause (ANM) on glycemic control in patients with type 2 diabetes mellitus (T2DM). METHODS A cross-sectional study was undertaken in Jiangsu, China. Logistic regression was used to evaluate the association between AM/ANM and glycemic control. RESULTS 1195 (14.3%) premenopausal and 7149 (85.7%) postmenopausal women were included in this study. With the increase of AM per 1 year, patients had a low risk of uncontrolled FPG (≥7 mmol/L) and uncontrolled HbA1c (≥7%), as well as poor glycemic control (FPG ≥7 mmol/L and HbA1c ≥7%) after adjusting for age and BMI (model I, P < 0.05) with odds ratio (OR) 0.965, 0.978 and 0.962 respectively. Whereas after adjusting for age, BMI, education, duration of diabetes, smoking, drinking and antidiabetic treatment (model II) as well as further plus diabetic familial history and physical activity (model III), the association between AM and glycemic control was not significant (P > 0.05). Compared with premenopausal women, postmenopausal women had a low risk of uncontrolled FPG and uncontrolled HbA1c after adjusting for confounders in model II (P < 0.05). Furthermore, both patients with early ANM (<45 years) and late ANM (>55 years) had a high risk of uncontrolled HbA1c as well as poor glycemic control even adjusted for full confounders in model III (P < 0.05 for all). CONCLUSION Early AM, early and late ANM were significantly associated with worse glycemic control. Ascertaining the AM and ANM in women with T2DM may help to identify the risk predisposed to worse glycemic control.
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Affiliation(s)
- Chong Shen
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Jinbo Wen
- Department of Chronic Disease Prevention and Control, Huai'an City Center for Disease Control and Prevention, Huai'an 223001, China
| | - Xiaoqun Pan
- Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - Jian Su
- Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - Wencong Du
- Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - Enchun Pan
- Department of Chronic Disease Prevention and Control, Huai'an City Center for Disease Control and Prevention, Huai'an 223001, China
| | - Qin Zhang
- Department of Chronic Disease Prevention and Control, Huai'an City Center for Disease Control and Prevention, Huai'an 223001, China
| | - Ning Zhang
- Changshu County Center for Disease Control and Prevention, Suzhou 215500, China
| | - Hongyan Sheng
- Changshu County Center for Disease Control and Prevention, Suzhou 215500, China
| | - Chunlan Liu
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Hui Wang
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Ming Wu
- Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China.
| | - Yu Qin
- Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China.
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Vajravelu ME, Lee JM. Identifying Prediabetes and Type 2 Diabetes in Asymptomatic Youth: Should HbA1c Be Used as a Diagnostic Approach? Curr Diab Rep 2018; 18:43. [PMID: 29868987 PMCID: PMC7799173 DOI: 10.1007/s11892-018-1012-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Because the incidence of type 2 diabetes and prediabetes in children is rising, routine screening of those at risk is recommended. In 2010, the ADA made the recommendation to include hemoglobin A1c (HbA1c) as a diagnostic test for diabetes, in addition to the oral glucose tolerance test or fasting plasma glucose. Our objective was to assess the pediatric literature with regard to HbA1c test performance and discuss advantages and disadvantages of use of the test for diagnostic purposes. RECENT FINDINGS HbA1c has a number of advantages, including elimination of the need for fasting, lower variability, assay standardization, and long-term association with future development of diabetes. It also has many drawbacks. It can be affected by a number of non-glycemic factors, including red blood cell turnover, hemoglobinopathies, medications, race, and age. In particular, it performs differently in children compared with adults, generally with lower sensitivity for prediabetes (as low as 0-5% in children vs 23-27% in adults) and lower area under the receiver operating characteristic curve (AUC) (0.53 vs 0.73 for prediabetes), and it has lower efficacy at a higher cost, compared with other tests of glycemia. Finally, HbA1c may perform very differently across diverse populations according to race/ethnicity; in Chinese populations, the proportion of individuals classified with prediabetes based on HbA1c predominates compared with IFG (77% for HbA1c vs 27.7% for IFG), whereas in US populations, it is the opposite (24.8% for HbA1c vs 80.1% for FPG). HbA1c is controversial because although it is convenient, it is not a true measure of glycemia. The interpretation of HbA1c results requires a nuanced understanding that many primary care physicians who are ordering the test in greater numbers do not possess. Alternative markers of glycemia may hold promise for the future but are not yet endorsed for use in practice. Further studies are needed to determine appropriate thresholds for screening tests and the long-term impact of screening and identification.
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Affiliation(s)
- Mary Ellen Vajravelu
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, 11NW30, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Joyce M Lee
- University of Michigan, 300 NIB, Room 6E14, Campus Box 5456, Ann Arbor, MI, 48109, USA.
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Selby PJ, Banks RE, Gregory W, Hewison J, Rosenberg W, Altman DG, Deeks JJ, McCabe C, Parkes J, Sturgeon C, Thompson D, Twiddy M, Bestall J, Bedlington J, Hale T, Dinnes J, Jones M, Lewington A, Messenger MP, Napp V, Sitch A, Tanwar S, Vasudev NS, Baxter P, Bell S, Cairns DA, Calder N, Corrigan N, Del Galdo F, Heudtlass P, Hornigold N, Hulme C, Hutchinson M, Lippiatt C, Livingstone T, Longo R, Potton M, Roberts S, Sim S, Trainor S, Welberry Smith M, Neuberger J, Thorburn D, Richardson P, Christie J, Sheerin N, McKane W, Gibbs P, Edwards A, Soomro N, Adeyoju A, Stewart GD, Hrouda D. Methods for the evaluation of biomarkers in patients with kidney and liver diseases: multicentre research programme including ELUCIDATE RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2018. [DOI: 10.3310/pgfar06030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BackgroundProtein biomarkers with associations with the activity and outcomes of diseases are being identified by modern proteomic technologies. They may be simple, accessible, cheap and safe tests that can inform diagnosis, prognosis, treatment selection, monitoring of disease activity and therapy and may substitute for complex, invasive and expensive tests. However, their potential is not yet being realised.Design and methodsThe study consisted of three workstreams to create a framework for research: workstream 1, methodology – to define current practice and explore methodology innovations for biomarkers for monitoring disease; workstream 2, clinical translation – to create a framework of research practice, high-quality samples and related clinical data to evaluate the validity and clinical utility of protein biomarkers; and workstream 3, the ELF to Uncover Cirrhosis as an Indication for Diagnosis and Action for Treatable Event (ELUCIDATE) randomised controlled trial (RCT) – an exemplar RCT of an established test, the ADVIA Centaur® Enhanced Liver Fibrosis (ELF) test (Siemens Healthcare Diagnostics Ltd, Camberley, UK) [consisting of a panel of three markers – (1) serum hyaluronic acid, (2) amino-terminal propeptide of type III procollagen and (3) tissue inhibitor of metalloproteinase 1], for liver cirrhosis to determine its impact on diagnostic timing and the management of cirrhosis and the process of care and improving outcomes.ResultsThe methodology workstream evaluated the quality of recommendations for using prostate-specific antigen to monitor patients, systematically reviewed RCTs of monitoring strategies and reviewed the monitoring biomarker literature and how monitoring can have an impact on outcomes. Simulation studies were conducted to evaluate monitoring and improve the merits of health care. The monitoring biomarker literature is modest and robust conclusions are infrequent. We recommend improvements in research practice. Patients strongly endorsed the need for robust and conclusive research in this area. The clinical translation workstream focused on analytical and clinical validity. Cohorts were established for renal cell carcinoma (RCC) and renal transplantation (RT), with samples and patient data from multiple centres, as a rapid-access resource to evaluate the validity of biomarkers. Candidate biomarkers for RCC and RT were identified from the literature and their quality was evaluated and selected biomarkers were prioritised. The duration of follow-up was a limitation but biomarkers were identified that may be taken forward for clinical utility. In the third workstream, the ELUCIDATE trial registered 1303 patients and randomised 878 patients out of a target of 1000. The trial started late and recruited slowly initially but ultimately recruited with good statistical power to answer the key questions. ELF monitoring altered the patient process of care and may show benefits from the early introduction of interventions with further follow-up. The ELUCIDATE trial was an ‘exemplar’ trial that has demonstrated the challenges of evaluating biomarker strategies in ‘end-to-end’ RCTs and will inform future study designs.ConclusionsThe limitations in the programme were principally that, during the collection and curation of the cohorts of patients with RCC and RT, the pace of discovery of new biomarkers in commercial and non-commercial research was slower than anticipated and so conclusive evaluations using the cohorts are few; however, access to the cohorts will be sustained for future new biomarkers. The ELUCIDATE trial was slow to start and recruit to, with a late surge of recruitment, and so final conclusions about the impact of the ELF test on long-term outcomes await further follow-up. The findings from the three workstreams were used to synthesise a strategy and framework for future biomarker evaluations incorporating innovations in study design, health economics and health informatics.Trial registrationCurrent Controlled Trials ISRCTN74815110, UKCRN ID 9954 and UKCRN ID 11930.FundingThis project was funded by the NIHR Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 6, No. 3. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Peter J Selby
- Clinical and Biomedical Proteomics Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Rosamonde E Banks
- Clinical and Biomedical Proteomics Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Walter Gregory
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Jenny Hewison
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - William Rosenberg
- Institute for Liver and Digestive Health, Division of Medicine, University College London, London, UK
| | - Douglas G Altman
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Jonathan J Deeks
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Christopher McCabe
- Department of Emergency Medicine, University of Alberta Hospital, Edmonton, AB, Canada
| | - Julie Parkes
- Primary Care and Population Sciences Academic Unit, University of Southampton, Southampton, UK
| | | | | | - Maureen Twiddy
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Janine Bestall
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Tilly Hale
- LIVErNORTH Liver Patient Support, Newcastle upon Tyne, UK
| | - Jacqueline Dinnes
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Marc Jones
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | | | | | - Vicky Napp
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Alice Sitch
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sudeep Tanwar
- Institute for Liver and Digestive Health, Division of Medicine, University College London, London, UK
| | - Naveen S Vasudev
- Clinical and Biomedical Proteomics Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Paul Baxter
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Sue Bell
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - David A Cairns
- Clinical and Biomedical Proteomics Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | | | - Neil Corrigan
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Francesco Del Galdo
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Peter Heudtlass
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Nick Hornigold
- Clinical and Biomedical Proteomics Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Claire Hulme
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Michelle Hutchinson
- Clinical and Biomedical Proteomics Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Carys Lippiatt
- Department of Specialist Laboratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Roberta Longo
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Matthew Potton
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Stephanie Roberts
- Clinical and Biomedical Proteomics Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Sheryl Sim
- Clinical and Biomedical Proteomics Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Sebastian Trainor
- Clinical and Biomedical Proteomics Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Matthew Welberry Smith
- Clinical and Biomedical Proteomics Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - James Neuberger
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Paul Richardson
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - John Christie
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Neil Sheerin
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - William McKane
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Paul Gibbs
- Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | | | - Naeem Soomro
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Grant D Stewart
- NHS Lothian, Edinburgh, UK
- Academic Urology Group, University of Cambridge, Cambridge, UK
| | - David Hrouda
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
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Mohammad JM, Robabeh S, Shahin K, Saeed T, Maryam A. Auditory function and motor proficiency in type 1 diabetic children: A case-control study. Int J Pediatr Otorhinolaryngol 2018; 109:7-12. [PMID: 29728188 DOI: 10.1016/j.ijporl.2018.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/16/2018] [Accepted: 03/16/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The aim of the study was to evaluate the auditory and motor functions in children with insulin dependent diabetes mellitus (IDDM). METHODS This case-control study, 65 diabetic children, receiving care in Diabetes Center of 17 Sharivar Hospital, were enrolled. 130 controls were matched to cases by age and sex. The authors performed audio-vestibular tests, including pure tone audiometry (PTA), distortion product otoacoustic emission (DPOAE), auditory brainstem response (ABR), bedside head-impulse test and dynamic visual acuity test. Motor function was evaluated using of Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2). RESULTS The results showed higher thresholds of air conduction PTA and a prolonged peak latency of wave V (ABR) in diabetic children as compared to controls (all Ps < 0.001). The odds of normal response in DPOAE of cases decreased by 0.44-0.82 - fold. Although clinical vestibular outcomes were worse in cases, differences were not significant. In BOT-2, the cases had statistically significant lower scores (standard score = -0.58, P < 0.05) than the controls for the Total Motor Composite. Also diabetic girls had more skill motor impairment compared to boys with IDDM. CONCLUSION Based on our study, metabolic disturbances present in Type I diabetes cause disturbances in different parts of auditory and balance functions.
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Affiliation(s)
- Jalali Mir Mohammad
- Rhino-Sinus Ear Skull Base Research Center, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran.
| | - Soleimani Robabeh
- Kavosh Behavioral, Cognitive and Addiction Research Center, Shafa Hospital, Guilan University of Medical Sciences, Rasht, Iran.
| | - Koohmanai Shahin
- 17 Sharivar Hospital, Guilan University of Medical Sciences, Rasht, Iran.
| | - Tizno Saeed
- Otolaryngologic Resident, Rhino-Sinus Ear Skull Base Research Center, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran.
| | - Akbari Maryam
- Otolaryngologic Resident, Rhino-Sinus Ear Skull Base Research Center, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran.
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Qin YH, Yan GL, Ma CL, Tang CC, Ma GS. Effects of hyperglycaemia and elevated glycosylated haemoglobin on contrast-induced nephropathy after coronary angiography. Exp Ther Med 2018; 16:377-383. [PMID: 29896264 DOI: 10.3892/etm.2018.6183] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 04/06/2018] [Indexed: 01/19/2023] Open
Abstract
In patients undergoing percutaneous coronary intervention after acute myocardial infarction, hyperglycaemia on admission is associated with an increased risk of contrast-induced nephropathy (CIN). However, the effects of hyperglycaemia and elevated glycosylated haemoglobin (HbA1c) on CIN have remained to be fully elucidated. Therefore, a prospective cohort study was performed, comprising 258 patients who underwent coronary angiography between May 2017 and November 2017 at Zhongda Hospital affiliated with Southeast University (Nanjing, China). According to the diagnostic criteria for CIN (increase of serum creatinine by >44.2 µmol/l or by 25% within 48-72 h of using contrast agent), the patients were divided into two groups: CIN (45 cases) and non-CIN (213 cases). For all patients, the baseline data, medical history, laboratory parameters, medication history and intraoperative situation were recorded and assessed using single-factor analysis and multiple logistic regression analysis to analyse the risk factors of CIN. The incidence of CIN in the hyperglycaemia group (blood glucose on admission, >11.1 mmol/l) was 25%, compared with 13.8% in the non-hyperglycaemia group (P=0.026). Furthermore, the incidence of CIN in the elevated HbA1c group (HbA1c on admission, upper limit of normal) was 26.1%, compared with 14.3% in the group without elevated HbA1c (P=0.027). Hyperglycaemia was present on hospital admission in 84 of 258 patients (32.6%). The percentage of patients with elevated HbA1c was 26.7%. Age, estimated glomerular filtration rate, pre-operative blood cholesterol, hyperglycaemia on admission and elevated HbA1c were all identified to be associated with CIN. According to the multivariate logistic regression analysis, hyperglycaemia was an independent predictor of CIN (odds ratio, 2.815; 95% confidence interval, 1.042-4.581; P=0.029). In the acute coronary syndrome (ACS) and diabetes subgroups, hyperglycaemia was significantly associated with CIN. In the ACS subgroup, the incidence of CIN was 38.1%. It was indicated that hyperglycaemia is an independent risk factor for CIN, particularly in patients with ACS or diabetes. Trial registration no. ChiCTR-OOC-17011466.
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Affiliation(s)
- Yu-Han Qin
- Medical Department of Southeast University, Nanjing, Jiangsu 210009, P.R. China
| | - Gao-Liang Yan
- Department of Cardiology, Zhongda Hospital Affiliated to Southeast University, Nanjing, Jiangsu 210009, P.R. China
| | - Chang-Le Ma
- Medical Department of Southeast University, Nanjing, Jiangsu 210009, P.R. China
| | - Cheng-Chun Tang
- Department of Cardiology, Zhongda Hospital Affiliated to Southeast University, Nanjing, Jiangsu 210009, P.R. China
| | - Gen-Shan Ma
- Department of Cardiology, Zhongda Hospital Affiliated to Southeast University, Nanjing, Jiangsu 210009, P.R. China
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Ding L, Xu Y, Liu S, Bi Y, Xu Y. Hemoglobin A1c and diagnosis of diabetes. J Diabetes 2018; 10:365-372. [PMID: 29292842 DOI: 10.1111/1753-0407.12640] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 12/11/2017] [Accepted: 12/27/2017] [Indexed: 02/06/2023] Open
Abstract
The prevalence of diabetes is increasing markedly worldwide, especially in China. Hemoglobin A1c is an indicator of mean blood glucose concentrations and plays an important role in the assessment of glucose control and cardiovascular risk. In 2010, the American Diabetes Association included HbA1c ≥6.5% into the revised criteria for the diagnosis of diabetes. However, the debate as to whether HbA1c should be used to diagnose diabetes is far from being settled and there are still unanswered questions regarding the cut-off value of HbA1c for diabetes diagnosis in different populations and ethnicities. This review briefly introduces the history of HbA1c from discovery to diabetes diagnosis, key steps towards using HbA1c to diagnose diabetes, such as standardization of HbA1c measurements and controversies regarding HbA1c cut-off points, and the performance of HbA1c compared with glucose measurements in the diagnosis of diabetes.
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Affiliation(s)
- Lin Ding
- State Key Laboratory of Medical Genomics, Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, National Clinical Research Center for Metabolic Diseases, Collaborative Innovation Center of Systems Biomedicine, and Shanghai Clinical Center for Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Yu Xu
- State Key Laboratory of Medical Genomics, Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, National Clinical Research Center for Metabolic Diseases, Collaborative Innovation Center of Systems Biomedicine, and Shanghai Clinical Center for Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Shanshan Liu
- State Key Laboratory of Medical Genomics, Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, National Clinical Research Center for Metabolic Diseases, Collaborative Innovation Center of Systems Biomedicine, and Shanghai Clinical Center for Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Yufang Bi
- State Key Laboratory of Medical Genomics, Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, National Clinical Research Center for Metabolic Diseases, Collaborative Innovation Center of Systems Biomedicine, and Shanghai Clinical Center for Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Yiping Xu
- Department of Research and Development, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
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Diagnostic Accuracy of Protein Glycation Sites in Long-Term Controlled Patients with Type 2 Diabetes Mellitus and Their Prognostic Potential for Early Diagnosis. Pharmaceuticals (Basel) 2018; 11:ph11020038. [PMID: 29710851 PMCID: PMC6027301 DOI: 10.3390/ph11020038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 04/24/2018] [Accepted: 04/24/2018] [Indexed: 12/23/2022] Open
Abstract
Current screening tests for type 2 diabetes mellitus (T2DM) identify less than 50% of undiagnosed T2DM patients and provide no information about how the disease will develop in prediabetic patients. Here, twenty-nine protein glycation sites were quantified after tryptic digestion of plasma samples at the peptide level using tandem mass spectrometry and isotope-labelled peptides as internal standard. The glycation degrees were determined in three groups, i.e., 48 patients with a duration of T2DM exceeding ten years, 48 non-diabetic individuals matched for gender, BMI, and age, and 20 prediabetic men. In long-term controlled diabetic patients, 27 glycated peptides were detected at significantly higher levels, providing moderate diagnostic accuracies (ACCs) from 61 to 79%, allowing a subgrouping of patients in three distinct clusters. Moreover, a feature set of one glycated peptides and six established clinical parameters provided an ACC of 95%. The same number of clusters was identified in prediabetic males (ACC of 95%) using a set of eight glycation sites (mostly from serum albumin). All patients present in one cluster showed progression of prediabetic state or advanced towards diabetes in the following five years. Overall, the studied glycation sites appear to be promising biomarkers for subgrouping prediabetic patients to estimate their risk for the development of T2DM.
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Conca T, Saint-Pierre C, Herskovic V, Sepúlveda M, Capurro D, Prieto F, Fernandez-Llatas C. Multidisciplinary Collaboration in the Treatment of Patients With Type 2 Diabetes in Primary Care: Analysis Using Process Mining. J Med Internet Res 2018; 20:e127. [PMID: 29636315 PMCID: PMC5915667 DOI: 10.2196/jmir.8884] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 01/31/2018] [Accepted: 02/18/2018] [Indexed: 11/13/2022] Open
Abstract
Background Public health in several countries is characterized by a shortage of professionals and a lack of economic resources. Monitoring and redesigning processes can foster the success of health care institutions, enabling them to provide a quality service while simultaneously reducing costs. Process mining, a discipline that extracts knowledge from information system data to analyze operational processes, affords an opportunity to understand health care processes. Objective Health care processes are highly flexible and multidisciplinary, and health care professionals are able to coordinate in a variety of different ways to treat a diagnosis. The aim of this work was to understand whether the ways in which professionals coordinate their work affect the clinical outcome of patients. Methods This paper proposes a method based on the use of process mining to identify patterns of collaboration between physician, nurse, and dietitian in the treatment of patients with type 2 diabetes mellitus and to compare these patterns with the clinical evolution of the patients within the context of primary care. Clustering is used as part of the preprocessing of data to manage the variability, and then process mining is used to identify patterns that may arise. Results The method is applied in three primary health care centers in Santiago, Chile. A total of seven collaboration patterns were identified, which differed primarily in terms of the number of disciplines present, the participation intensity of each discipline, and the referrals between disciplines. The pattern in which the three disciplines participated in the most equitable and comprehensive manner had a lower proportion of highly decompensated patients compared with those patterns in which the three disciplines participated in an unbalanced manner. Conclusions By discovering which collaboration patterns lead to improved outcomes, health care centers can promote the most successful patterns among their professionals so as to improve the treatment of patients. Process mining techniques are useful for discovering those collaborations patterns in flexible and unstructured health care processes.
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Affiliation(s)
- Tania Conca
- Computer Science Department, School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cecilia Saint-Pierre
- Computer Science Department, School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Valeria Herskovic
- Computer Science Department, School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marcos Sepúlveda
- Computer Science Department, School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Daniel Capurro
- Department of Internal Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Florencia Prieto
- Department of Family Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos Fernandez-Llatas
- Institute of Information and Communication Technologies, Universitat Politècnica de València, Valencia, Spain
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Li H, Shu Y, Hu B, Dai Y, Lin Y, Shan Y, Wang Y, Cai W, Lu Z. Characteristics of paramedian pontine arteries disease and its association with hemoglobinA1c. Brain Behav 2018; 8:e00946. [PMID: 29670826 PMCID: PMC5893347 DOI: 10.1002/brb3.946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 01/21/2018] [Accepted: 01/23/2018] [Indexed: 11/11/2022] Open
Abstract
Objectives The association of branch atherosclerotic disease (BAD) and diabetes mellitus (DM) in the territory of posterior circulation is rarely discussed. Intracranial BAD was divided into two different types: paramedian pontine arteries (PPA) disease (PPD) and lenticulostriate arteries (LSA) disease. The goal of the study was to evaluate the clinical characteristics of PPD and its association with hemoglobinA1c (HbA1c) in China. Materials and Methods Radiologically confirmed PPD was defined as an isolated unilateral infarction extending to the ventral surface of the pons. Small deep cerebral infarctions are usually caused by two different pathological changes of arteries: BAD and lipohyalinotic degeneration (LD). We compared the vascular risk factors between BAD and LD in PPA territory. A total of 159 stroke patients were analyzed (PPD, n = 75; LD, n = 84). Patients with PPD were also categorized into two groups according to follow-up modified Rankin Scale (FmRS) scores. Logistic regression analyses were used for the evaluation of independent risk factors of PPD and prognosis. Results Comparison between PPD and LD revealed statistical significance in fasting glucose, HbA1c, estimated glomerular filtration rate (eGFR), and uric acid (p = .011, p = .005, p = .027, p = .018, respectively). Compared with LD, PPD was only related to HbA1c (p = .011) in logistic regression analysis. There were statistically significant differences between the two groups based on the stratification of FmRS scores in fasting glucose, HbA1c, homocysteine, eGFR, and the occurrence of DM. After multivariate analysis, only HbA1c was related with poor prognosis of PPD (p = .002). Conclusions The subtypes and prognosis of small deep brain infarcts are significantly influenced by elevated HbA1c level in PPA territory. DM might play an important role in the pathogenesis of PPD.
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Affiliation(s)
- Haiyan Li
- Department of NeurologyThe Third Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Yaqing Shu
- Department of NeurologyThe Third Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Biao Hu
- Guangdong Provincial Bioengineering Institute (Guangzhou Sugarcane Industry Research Institute)GuangzhouChina
| | - Yongqiang Dai
- Department of NeurologyThe Third Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Yinyao Lin
- Department of NeurologyThe Third Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Yilong Shan
- Department of NeurologyThe Third Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Yuge Wang
- Department of NeurologyThe Third Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Wei Cai
- Department of NeurologyThe Third Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Zhengqi Lu
- Department of NeurologyThe Third Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
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Clarke SF, Foster JR. A history of blood glucose meters and their role in self-monitoring of diabetes mellitus. Br J Biomed Sci 2018. [DOI: 10.1080/09674845.2012.12002443] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- S. F. Clarke
- History Committee, Institute of Biomedical Science, 12 Coldbath Square, London EC1R 5HL
| | - J. R. Foster
- History Committee, Institute of Biomedical Science, 12 Coldbath Square, London EC1R 5HL
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131
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Shimizu I, Hiramatsu Y, Omori Y, Nakabayashi M. Comparison of HbA1c and glycated albumin as a control marker for newborn complications in diabetic women in a multicentre study in Japan (Japan glycated albumin study group: study 2). Ann Clin Biochem 2018; 55:639-646. [DOI: 10.1177/0004563218763695] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background To clarify the relationship between glycated haemoglobin and glycated albumin concentrations during pregnancy with neonatal outcomes, a multicentre study was conducted by the Japanese Society of Diabetes and Pregnancy. Methods A total of 136 patients (type 1: n = 47, type 2: n = 89) who enrolled in the study were diagnosed based on the Japanese Diabetes Society diagnostic criteria for diabetes mellitus. Thresholds for glycated haemoglobin and glycated albumin were set at 5.8% and 15.8%, respectively, as the upper limits of the reference interval in pregnant women. Result Random plasma glucose decreased linearly, and reached the reference interval at 40 weeks. Glycated albumin concentrations also decreased in the same manner. But glycated haemoglobin concentrations were out of the reference interval during the study. The frequency of the neonatal complications did not show significant differences between the glycated haemoglobin ⩾5.8% group and the glycated haemoglobin <5.8% group. On the other hand, the frequency of neonatal complications showed higher tendency of neonatal complications in the incidence of polycythaemia ( P = 0.094) and heavy-for-date ( P = 0.071) in the glycated albumin ⩾15.8% group compared with the glycated albumin <15.8 group. The respiratory disorder in type 1 diabetes was significantly higher than type 2 diabetes. Conclusions For the treatment of pregnant women with diabetes, glycated albumin would be a better marker than glycated haemoglobin. However, glycated albumin is also affected by obesity and albumin, and it is desirable to make a comprehensive judgment with glycated haemoglobin, random plasma glucose and other glycaemic index.
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Affiliation(s)
- Ikki Shimizu
- Department of Diabetes, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Yuji Hiramatsu
- Department of Obstetrics & Gynecology, Okayama University Graduate School, Okayama, Japan
| | - Yasue Omori
- Diabetes Center, Ebina General Hospital, Kanagawa, Japan
| | - Masao Nakabayashi
- Aiiku Maternal and Child Health Center, Imperial Gift Foundation, Tokyo, Japan
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Matsushita K, Harada K, Miyazaki T, Miyamoto T, Iida K, Tanimoto S, Yagawa M, Takei M, Nagatomo Y, Hosoda T, Yoshino H, Yamamoto T, Nagao K, Takayama M. Effects of glycemic control on in-hospital mortality among acute heart failure patients with reduced, mid-range, and preserved ejection fraction. Heart Vessels 2018. [DOI: 10.1007/s00380-018-1152-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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133
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Lovre D, Shah S, Sihota A, Fonseca VA. Managing Diabetes and Cardiovascular Risk in Chronic Kidney Disease Patients. Endocrinol Metab Clin North Am 2018; 47:237-257. [PMID: 29407054 PMCID: PMC5806139 DOI: 10.1016/j.ecl.2017.10.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We discuss mechanisms of increased cardiovascular disease (CVD) in patients with chronic kidney disease (CKD) and strategies for managing cardiovascular (CV) risk in these patients. Our focus was mainly on decreasing CV events and progression of microvascular complications by reducing levels of glucose and lipids. We searched PubMed with no limit on the date of the article. All articles were discussed among all authors. We chose pertinent articles, and searched their references in turn for additional relevant publications.
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Affiliation(s)
- Dragana Lovre
- Section of Endocrinology, Tulane University Health Sciences Center, 1430 Tulane Avenue, #8553, New Orleans, LA 70112, USA; Section of Endocrinology, Southeast Louisiana Veterans Health Care Systems, 2400 Canal Street, New Orleans, LA 70119, USA.
| | - Sulay Shah
- Section of Endocrinology, Tulane University Health Sciences Center, 1430 Tulane Avenue, #8553, New Orleans, LA 70112, USA
| | - Aanu Sihota
- Section of Endocrinology, Tulane University Health Sciences Center, 1430 Tulane Avenue, #8553, New Orleans, LA 70112, USA
| | - Vivian A Fonseca
- Section of Endocrinology, Tulane University Health Sciences Center, 1430 Tulane Avenue, #8553, New Orleans, LA 70112, USA; Section of Endocrinology, Southeast Louisiana Veterans Health Care Systems, 2400 Canal Street, New Orleans, LA 70119, USA
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134
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Whitehouse CR, Sharts-Hopko NC, Smeltzer SC, Horowitz DA. Supporting Transitions in Care for Older Adults With Type 2 Diabetes Mellitus and Obesity. Res Gerontol Nurs 2018; 11:71-81. [PMID: 29498747 PMCID: PMC6026545 DOI: 10.3928/19404921-20180223-02] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 01/15/2018] [Indexed: 01/08/2023]
Abstract
The aim of the current study was to compare outcomes for older adults with type 2 diabetes mellitus and obesity following participation in a transitional care intervention that included diabetes self-management education (DSME) and homecare. The three groups analyzed comprised an inpatient DSME plus homecare group (n = 35); an inpatient DSME only group (n = 100); and a group who received usual care (n = 45). Outcomes of interest included rehospitalization rates and hemoglobin A1C (A1C) for up to 1-year post hospital discharge. Rates of rehospitalization and A1C improved for older adults who received nurse-led inpatient DSME and homecare during transitions of care from hospital to home. Rehospitalization rates up to 90 days were decreased for the DSME plus homecare group (10%) compared to DSME only (20%) and usual care groups (26.7%) (p < 0.05). A decrease of -0.4 and -2.3 A1C units was observed for the DSME group and DSME plus homecare group, respectively, at 90 days. These results support a transitional care educational intervention for older adults with type 2 diabetes mellitus and obesity. TARGETS Older adults with type 2 diabetes mellitus and obesity. INTERVENTION DESCRIPTION Transitional care intervention including diabetes self-management education and homecare. MECHANISMS OF ACTION Inpatient diabetes education and homecare helps improve rates of rehospitalization and hemoglobin A1C during care transitions from hospital to home. OUTCOMES Rehospitalization rates, glycemic control (i.e., A1C level). [Res Gerontol Nurs. 2018; 11(2):71-81.].
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135
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Efficacy and safety of American ginseng (Panax quinquefolius L.) extract on glycemic control and cardiovascular risk factors in individuals with type 2 diabetes: a double-blind, randomized, cross-over clinical trial. Eur J Nutr 2018; 58:1237-1245. [PMID: 29478187 DOI: 10.1007/s00394-018-1642-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 02/17/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE Despite the lack of evidence, a growing number of people are using herbal medicine to attenuate the burden of diabetes. There is an urgent need to investigate the clinical potential of herbs. Preliminary observations suggest that American ginseng (Panax quinquefolius [AG]) may reduce postprandial glycemia. Thus, we aimed to evaluate the efficacy and safety of AG as an add-on therapy in individuals with type 2 diabetes (T2DM) controlled by conventional treatment. METHODS 24 individuals living with T2DM completed the study (F:M = 11:13; age = 64 ± 7 year; BMI = 27.8 ± 4.6 kg/m2; HbA1c = 7.1 ± 1.2%). Utilizing a double-blind, cross-over design, the participants were randomized to receive either 1 g/meal (3 g/day) of AG extract or placebo for 8 weeks while maintaining their original treatment. Following a ≥ 4-week washout period, the participants were crossed over to the opposite 8-week treatment arm. The primary objective was HbA1c, and secondary endpoints included fasting blood glucose and insulin, blood pressure, plasma lipids, serum nitrates/nitrites (NOx), and plasominogen-activating factor-1 (PAI-1). Safety parameters included liver and kidney function. RESULTS Compared to placebo, AG significantly reduced HbA1c (- 0.29%; p = 0.041) and fasting blood glucose (- 0.71 mmol/L; p = 0.008). Furthermore, AG lowered systolic blood pressure (- 5.6 ± 2.7 mmHg; p < 0.001), increased NOx (+ 1.85 ± 2.13 µmol/L; p < 0.03), and produced a mean percent end-difference of - 12.3 ± 3.9% in LDL-C and - 13.9 ± 5.8% in LDL-C/HDL. The safety profiles were unaffected. CONCLUSIONS AG extract added to conventional treatment provided an effective and safe adjunct in the management of T2DM. Larger studies using physiologically standardized ginseng preparations are warranted to substantiate the present findings and to demonstrate therapeutic effectiveness of AG. CLINICALTRIALS. GOV IDENTIFIER NCT02923453.
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136
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The influence of pharmacist-led adherence support on glycaemic control in people with type 2 diabetes. Int J Clin Pharm 2018; 40:354-359. [DOI: 10.1007/s11096-018-0606-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 02/13/2018] [Indexed: 10/18/2022]
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Poitras VJ, Hudson RW, Tschakovsky ME. Exercise intolerance in Type 2 diabetes: is there a cardiovascular contribution? J Appl Physiol (1985) 2018; 124:1117-1139. [PMID: 29420147 DOI: 10.1152/japplphysiol.00070.2017] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Physical activity is critically important for Type 2 diabetes management, yet adherence levels are poor. This might be partly due to disproportionate exercise intolerance. Submaximal exercise tolerance is highly sensitive to muscle oxygenation; impairments in exercising muscle oxygen delivery may contribute to exercise intolerance in Type 2 diabetes since there is considerable evidence for the existence of both cardiac and peripheral vascular dysfunction. While uncompromised cardiac output during submaximal exercise is consistently observed in Type 2 diabetes, it remains to be determined whether an elevated cardiac sympathetic afferent reflex could sympathetically restrain exercising muscle blood flow. Furthermore, while deficits in endothelial function are common in Type 2 diabetes and are often cited as impairing exercising muscle oxygen delivery, no direct evidence in exercise exists, and there are several other vasoregulatory mechanisms whose dysfunction could contribute. Finally, while there are findings of impaired oxygen delivery, conflicting evidence also exists. A definitive conclusion that Type 2 diabetes compromises exercising muscle oxygen delivery remains premature. We review these potentially dysfunctional mechanisms in terms of how they could impair oxygen delivery in exercise, evaluate the current literature on whether an oxygen delivery deficit is actually manifest, and correspondingly identify key directions for future research.
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Affiliation(s)
- Veronica J Poitras
- School of Kinesiology and Health Studies, Queen's University , Kingston, Ontario , Canada.,Department of Physiology, Queen's University , Kingston, Ontario , Canada.,Children's Hospital of Eastern Ontario, Research Institute , Ottawa, Ontario , Canada
| | - Robert W Hudson
- Department of Medicine, Division of Endocrinology, Queen's University , Kingston, Ontario , Canada
| | - Michael E Tschakovsky
- School of Kinesiology and Health Studies, Queen's University , Kingston, Ontario , Canada
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Lin CH, Kuo YH, Shih CC. Antidiabetic and hypolipidemic activities of eburicoic acid, a triterpenoid compound from Antrodia camphorata, by regulation of Akt phosphorylation, gluconeogenesis, and PPARα in streptozotocin-induced diabetic mice. RSC Adv 2018; 8:20462-20476. [PMID: 35542324 PMCID: PMC9080793 DOI: 10.1039/c8ra01841c] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/24/2018] [Indexed: 11/22/2022] Open
Abstract
The study is designed to examine the potential effects and underlying mechanisms of eburicoic acid (TRR), a compound from Antrodia camphorata, in streptozotocin (STZ)-induced diabetic mice. Diabetic mice were randomly divided into six groups and given TRR orally by gavage (at three dosage rates) or fenofibrate (Feno) (250 mg kg−1 body weight) or metformin (Metf) (300 mg kg−1 body weight) or vehicle for 2 weeks. STZ-induced diabetic mice were found to have increased blood glucose, HbA1C, plasma triglyceride (TG) and total cholesterol (TC) levels, but reduced blood insulin, adiponectin, and leptin levels as compared with the CON group. TRR was found to lower blood glucose and HbA1C, but increase insulin levels. Plasma TG and TC levels were significantly lowered in TRR, Feno, or Metf-treated STZ-induced diabetic mice as compared with the vehicle-treated STZ group, indicating that TRR, Feno, and Metf ameliorated hyperlipidemia. The islet cells of STZ-induced diabetic mice exhibited a marked reduction from their classic round-shape as compared to the CON mice. The TRR-treated STZ mice revealed restoration of the size of Langerhans islet cells with β-cell repair as compared with the vehicle-treated STZ mice, implying that TRR ameliorated STZ-induced diabetic states within the pancreas. STZ-induction was found to decrease the expressions of membrane glucose transporter 4 (GLUT4), and phosphorylation of Akt in skeletal muscles, and administration of TRR reversed all the decreases. Moreover, administration of TRR increased blood insulin levels and enhanced hepatic expression levels of phospho-Akt and phospho-FoxO1 but decreased the mRNA levels of glucose-6-phosphatase (G6 Pase) and phosphoenolpyruvate carboxykinase (PEPCK) to suppress hepatic glucose production, thus leading to TRR's antidiabetic activity. Additionally, TRR caused an increase in the expression levels of fatty acid oxidation gene peroxisome proliferator-activated receptor α (PPARα), but a decrease in lipogenic fatty acid synthase (FAS) and PPARγ expressions in the liver. TRR treatment suppressed hepatic mRNA levels of sterol regulatory element binding protein (SREBP) 1c and SREBP2, leading to decreased plasma triglyceride and total cholesterol levels. These findings indicate that TRR may effectively enhance therapeutic potential in the treatment of type 1 diabetes mellitus and/or hyperlipidemia. The study is designed to examine the potential effects and underlying mechanisms of eburicoic acid (TRR), a compound from Antrodia camphorata, in streptozotocin (STZ)-induced diabetic mice.![]()
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Affiliation(s)
- Cheng-Hsiu Lin
- Department of Internal Medicine
- Fengyuan Hospital
- Ministry of Health and Welfare
- Taichung City 42055
- Taiwan
| | - Yueh-Hsiung Kuo
- Department of Chinese Pharmaceutical Sciences and Chinese Medicine Resources
- China Medical University
- Taichung City 40402
- Taiwan
| | - Chun-Ching Shih
- Graduate Institute of Biotechnology and Biomedical Engineering
- College of Health Science
- Central Taiwan University of Science and Technology
- Taichung City 40601
- Taiwan
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139
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McCaughey EJ, Li J, Badrick TC, Westbrook JI, Georgiou A. How well do general practitioners manage laboratory test results for patients with diabetes mellitus and cardiovascular disease?: A systematic review. Int J Qual Health Care 2017; 29:769-778. [PMID: 29025125 DOI: 10.1093/intqhc/mzx105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 07/28/2017] [Indexed: 11/13/2022] Open
Abstract
Purpose To evaluate how well general practitioners (GPs) manage and respond to laboratory results for patients with diabetes mellitus (DM) and cardiovascular disease (CVD). Data sources MEDLINE, CINAHL, Embase, EBM reviews, ProQuest and Scopus. Study selection Peer-reviewed journal articles published between 2000 and 2015 that assessed GPs' management of laboratory results for patients with DM or CVD. Data extraction Study design and demographics, laboratory tests and key findings relating to GP management of laboratory results were extracted from studies. Results of data synthesis Thirteen articles were included, comprising seven studies which utilized surveys, four observational studies, one cohort study and one randomized controlled trial. Findings indicate that GPs often overestimate the risk of complications associated with DM and CVD based on laboratory results and have unrealistically high expectations regarding the precision of laboratory tests. Considerable variation existed in the use of repeat testing for diagnostic confirmation and in GPs' identification of the difference between two consecutive results required to indicate a change in patient condition. GPs also often failed to initiate appropriate treatment for patients with DM and CVD based on laboratory results. Feedback to GPs about their test ordering patterns and educational messages on laboratory results improved clinical outcomes. Conclusion Evidence about how well GPs manage results and its impact on patient outcomes remains weak and inconclusive. This review identified a number of areas where interventions could support GPs to improve the interpretation and management of laboratory test results, including feedback to GPs and educational messages on test result reports.
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Affiliation(s)
- Euan J McCaughey
- Neuroscience Research Australia, 139 Barker Street, Randwick, Sydney, NSW 2031, Australia.,Faculty of Medicine, University of New South Wales, Kensington, Sydney, NSW 2052, Australia.,Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW 2109, Australia
| | - Julie Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW 2109, Australia
| | - Tony C Badrick
- Royal College of Pathologists Australasia Quality Assurance Program, St Leonards, NSW 2065, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW 2109, Australia
| | - Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW 2109, Australia
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Abstract
BACKGROUND Diabetes health care relies on the HbA1c (A1c) assay and associated average glucose (AG) to evaluate and control chronic glycemia. However, the A1c assay is plagued with significant noise, lag time, and specificity issues. Current studies support the significant health care advantage of clinical action based on real-time blood glucose (BG) metrics. We seek to improve diabetes management by directly relating such metrics to AG levels as mediated by recently discovered recurrent endocrine cycles. METHODS Several studies collected multiple months of BG data on 111 subjects totaling 261 893 CGM measurements and 29 278 meter readings. These data are a rich source of multiday metrics in terms of the CGM and SMBG daily profiles. The recurrent endocrine patterns expose key metric relationships for monitoring AG related to A1c using CGM and SMBG data. Consequently, day-to-day tracking of AG is expressed as a simple two-parameter function of fasting BG for all studies. RESULTS Consequently, when applied to 2518 qualified days of 64 subjects, the function predicts daily AG values with 2% relative standard error. All studies produced compatible results. By restricting one parameter to a constant, the error increased to 3%. CONCLUSIONS The recurrent endocrine patterns revealed a persistent structure hidden within the multiday fluctuations that becomes a simple meter-compatible equation that accurately measures real-time trending of AG using fasting BG values. This enables a digital health monitoring service and self-monitoring device that reveals immediate disease progression as well as the impact of interventions and medications better than possible with the A1c assay.
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Affiliation(s)
- James M. Minor
- Newark, DE, USA
- James M. Minor, PhD, 81 White Clay Crescent, Newark, DE 19711, USA. Emails: , SLSguy.com
| | | | - Richard M. Bergenstal
- International Diabetes Center, Department of Medicine, University of Minnesota, St. Louis Park, MN, USA
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Raghav A, Ahmad J, Alam K, Khan AU. New insights into non-enzymatic glycation of human serum albumin biopolymer: A study to unveil its impaired structure and function. Int J Biol Macromol 2017; 101:84-99. [DOI: 10.1016/j.ijbiomac.2017.03.086] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 03/13/2017] [Accepted: 03/15/2017] [Indexed: 12/31/2022]
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Guedes V, Bettencourt-Silva R, Queirós J, Esteves MDL, Teles MJ, Carvalho D. Hemoglobin Himeji and inconsistent hemoglobin A1c values: a case report. J Med Case Rep 2017; 11:201. [PMID: 28743307 PMCID: PMC5527397 DOI: 10.1186/s13256-017-1377-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 07/02/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Hemoglobin A1c is used to evaluate the glycemic control in patients with diabetes and is a risk marker for chronic complications of diabetes. Hemoglobin variants are reported to falsely lower or increase hemoglobin A1c test results. We present a case report of a patient with diabetes with discrepancy between fasting plasma glucose and hemoglobin A1c due to the presence of hemoglobin Himeji, a clinically silent and very rare hemoglobinopathy. CASE PRESENTATION A 76-year-old white woman, born and living in Portugal, with type 2 diabetes presented to the family physician for a routine visit. She had no active complaints, including history or symptoms of hypoglycemia, and her physical examination was unremarkable. A review of her laboratory data showed fasting plasma glucose of 190 mg/dL and a hemoglobin A1c of 4.1%. The remaining blood test results were clinically insignificant; a further review of her laboratory data over the past 4 years revealed that her fasting plasma glucose had ranged from 130 to 250 mg/dL and hemoglobin A1c was consistently lower than 5%. A study of hemoglobins detected 32.8% of abnormal hemoglobin. Genetic sequencing identified a heterozygous mutation compatible with hemoglobin Himeji (c.422C>A; p.Ala141Asp). We tracked her family (three sons, six grandchildren, and two greatgrandchildren) for the presence of this hemoglobin variant, but none had this hemoglobinopathy. CONCLUSIONS Despite the advantages of hemoglobin A1c in the follow-up and treatment of diabetes, the factors that interfere with its results must be known to ensure a correct estimation of the degree of glycemic control and a proper management of the disease. Therefore, health professionals should suspect the existence of hemoglobin variants when: the hemoglobin A1c value is above 15% or below the lower limit of its reference interval; there is a significant modification in its result coinciding with a change in assay methods; and there is a low correlation between plasma glucose and hemoglobin A1c. In patients with hemoglobin Himeji, alternate ways of monitoring glycemic control (fructosamine or glycated serum albumin) should be used.
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Affiliation(s)
- Vânia Guedes
- Family Medicine, Unidade de Saúde Familiar Faria Guimarães, Rua Faria Guimarães 915/931, 4200-292 Porto, Portugal
| | - Rita Bettencourt-Silva
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar de São João E.P.E, Porto, Portugal
- Faculty of Medicine, Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
| | - Joana Queirós
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar de São João E.P.E, Porto, Portugal
| | - Maria da Luz Esteves
- Family Medicine, Unidade de Saúde Familiar Egas Moniz, Santa Maria da Feira, Portugal
| | - Maria José Teles
- Department of Clinical Pathology, Centro Hospitalar de São João E.P.E, Porto, Portugal
| | - Davide Carvalho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar de São João E.P.E, Porto, Portugal
- Faculty of Medicine, Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
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Honma A, Ogawa C, Sugahara M, Fujimura S, Kita K. Influence of Varying Dietary Protein Levels on Glycation of Albumin, Tryptophan and Valine in the Plasma of Chickens. J Poult Sci 2017; 54:242-246. [PMID: 32908432 PMCID: PMC7477214 DOI: 10.2141/jpsa.0160146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 02/14/2017] [Indexed: 01/28/2023] Open
Abstract
Glycation is a chemical reaction in which reducing sugars bind non-enzymatically to compounds containing amino groups. Avian species like chickens are hyperglycemic animals and have high body temperature compared to mammalian species, which enables avian species to accelerate the glycation of proteins and amino acids with glucose. Although varying dietary crude protein (CP) levels alter plasma concentrations of proteins and amino acids, the influence of varying CP levels on the glycation of plasma proteins and amino acids has not been studied so far. In the present study, therefore, glycation of albumin, tryptophan and valine in the plasma of chickens fed diets with varying CP levels (0, 10, 20, 40 and 60%) was examined. At the end of the experimental period, blood samples were collected and plasma concentrations of glycoalbumin, glycated tryptophan (tryptophan-Amadori product and (1R, 3S) - 1 - (D - gluco - 1, 2, 3, 4, 5 - pentahydroxypentyl) - 1, 2, 3, 4 - tetrahydro - β - carboline - 3 - carboxylic acid (PHP-THβC)), and valine-Amadori product were measured. Although plasma albumin concentration was reduced along with the decrease in dietary CP levels from 20% to 0%, glycoalbumin in the plasma was increased under such dietary conditions. Similar increase in the ratios of tryptophan-Amadori product to tryptophan and valine-Amadori product to valine in the plasma of chickens fed a protein-free diet was observed. These results suggest that dietary protein deficiency might enhance the non-enzymatic glycation of plasma proteins and amino acids in chickens.
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Affiliation(s)
- Ayaka Honma
- Faculty of Agriculture, Iwate University, Morioka, Iwate 020-8550, Japan
| | - Chiaki Ogawa
- Faculty of Agriculture, Iwate University, Morioka, Iwate 020-8550, Japan
| | - Misaki Sugahara
- Faculty of Agriculture, Iwate University, Morioka, Iwate 020-8550, Japan
| | - Shinobu Fujimura
- Faculty of Agriculture, Niigata University, Ikarashi, Niigata 950-2181, Japan
| | - Kazumi Kita
- Faculty of Agriculture, Iwate University, Morioka, Iwate 020-8550, Japan
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Cánovas R, Parrilla M, Blondeau P, Andrade FJ. A novel wireless paper-based potentiometric platform for monitoring glucose in blood. LAB ON A CHIP 2017; 17:2500-2507. [PMID: 28653727 DOI: 10.1039/c7lc00339k] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A novel low-cost, compact and sensitive paper-based platform for the accurate monitoring of glucose in biological fluids is presented. Paper-based working and reference electrodes are combined to build a whole potentiometric cell, which also fits a sampling module for simple and fast determination of glucose in a single drop of blood. The working electrode is built using a platinized filter paper coated with a Nafion membrane that entraps the enzyme glucose oxidase; the reference electrode is made by casting a polyvinylbutyral-based membrane onto a conductive paper. The system works by detecting the hydrogen peroxide generated as a result of the enzymatic reaction. Selectivity is achieved due to the permselective behaviour of Nafion, while a significant enhancement of the sensitivity is reached by exploiting the Donnan-coupled formal potential. Under optimum conditions, a sensitivity of -95.9 ± 4.8 mV per decade in the 0.3-3 mM range is obtained. Validation of the measurements has been performed against standard methods in human serum and blood. Final integration with a wireless reader allows for truly in situ measurements with a less than 2 minute procedure including a two-point calibration, washing and measurement. This low-cost analytical device opens up new prospects for rapid diagnostic results in non-laboratory settings.
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Affiliation(s)
- Rocío Cánovas
- Department of Analytical and Organic Chemistry, Universitat Rovira i Virgili, 43007, Tarragona, Spain.
| | - Marc Parrilla
- Department of Analytical and Organic Chemistry, Universitat Rovira i Virgili, 43007, Tarragona, Spain.
| | - Pascal Blondeau
- Department of Analytical and Organic Chemistry, Universitat Rovira i Virgili, 43007, Tarragona, Spain.
| | - Francisco J Andrade
- Department of Analytical and Organic Chemistry, Universitat Rovira i Virgili, 43007, Tarragona, Spain.
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Lim LL, Brnabic AJM, Chan SP, Ibrahim L, Paramasivam SS, Ratnasingam J, Vethakkan SR, Tan ATB. Relationship of glycated hemoglobin, and fasting and postprandial hyperglycemia in type 2 diabetes mellitus patients in Malaysia. J Diabetes Investig 2017; 8:453-461. [PMID: 27863088 PMCID: PMC5497026 DOI: 10.1111/jdi.12596] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 11/03/2016] [Accepted: 11/07/2016] [Indexed: 11/30/2022] Open
Abstract
AIMS/INTRODUCTION Studies on the relative contributions of fasting and postprandial hyperglycemia (FH and PPH) to glycated hemoglobin (HbA1c ) in patients with type 2 diabetes have yielded inconsistent results. We aimed to assess the relationship by using continuous glucose monitoring in a multi-ethnic cohort. MATERIALS AND METHODS A total of 100 adults with type 2 diabetes were assessed with 6-day continuous glucose monitoring and HbA1c . Area under the curve (AUC) ≥5.6 mmol/L was defined as AUCTOTAL . AUC equal to or greater than each preprandial glucose for 4-h duration was defined as AUCPPH . The total PPH (AUCTPPH ) was the sum of the various AUCPPH. The postprandial contribution to overall hyperglycemia was calculated as (AUCTPPH / AUCTOTAL ) × 100%. RESULTS The present study comprised of Malay, Indian, and Chinese type 2 diabetes patients at 34, 34 and 28% respectively. Overall, the mean PPH significantly decreased as HbA1c advanced (mixed model repeated measures adjusted, beta-estimate = -3.0, P = 0.009). Age (P = 0.010) and hypoglycemia (P = 0.006) predicted the contribution difference. In oral antidiabetic drug-treated patients (n = 58), FH contribution increased from 54% (HbA1c 6-6.9%) to 67% (HbA1c ≥10%). FH predominance was significant in poorly-controlled groups (P = 0.028 at HbA1c 9-9.9%; P = 0.015 at HbA1c ≥10%). Among insulin users (n = 42), FH predominated when HbA1c was ≥10% before adjustment for hypoglycemia (P = 0.047), whereas PPH was numerically greater when HbA1c was <8%. CONCLUSIONS FH and PPH contributions were equal in well-controlled Malaysian type 2 diabetes patients in real-world practice. FH predominated when HbA1c was ≥9 and ≥10% in oral antidiabetic drug- and insulin-treated patients, respectively. A unique observation was the greater PPH contribution when HbA1c was <8% despite the use of basal and mealtime insulin in this multi-ethnic cohort, which required further validation.
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Affiliation(s)
- Lee Ling Lim
- Division of EndocrinologyDepartment of Internal MedicineUniversity of MalayaKuala LumpurMalaysia
| | | | - Siew Pheng Chan
- Division of EndocrinologyDepartment of Internal MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Luqman Ibrahim
- Division of EndocrinologyDepartment of Internal MedicineUniversity of MalayaKuala LumpurMalaysia
| | | | - Jeyakantha Ratnasingam
- Division of EndocrinologyDepartment of Internal MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Shireene Ratna Vethakkan
- Division of EndocrinologyDepartment of Internal MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Alexander Tong Boon Tan
- Division of EndocrinologyDepartment of Internal MedicineUniversity of MalayaKuala LumpurMalaysia
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146
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X-ray structures of fructosyl peptide oxidases revealing residues responsible for gating oxygen access in the oxidative half reaction. Sci Rep 2017; 7:2790. [PMID: 28584265 PMCID: PMC5459902 DOI: 10.1038/s41598-017-02657-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 04/18/2017] [Indexed: 01/07/2023] Open
Abstract
Current enzymatic systems for quantifying glycated hemoglobin are based on the FAD-containing enzyme fructosyl peptide oxidase (FPOX). FPOX has substrate specificity for fructosyl-α N-valyl-histidine derived from proteolytic digestion of the N-terminus of the HbA1c β-chain. This study reports the X-ray structures of the wild-type and Asn56Ala (N56A) mutant of Phaeosphaeria nodorum fructosyl peptide oxidase (PnFPOX) to elucidate the residues responsible for the oxidative half-reaction. N56A showed decreased oxidase activity compared to the wild -type, while its dye-mediated dehydrogenase activity was higher than that of wild type. In wild-type PnFPOX, Asn56 forms a hydrogen bond with Lys274, thereby preventing it from forming a salt bridge with Asp54. By contrast, Lys274 of PnFPOX N56A moves toward Asp54, and they approach each other to form a salt bridge at a distance of 2.92-3.35 Å. Site-directed mutagenesis studies and protein channel analysis suggest that Asp54 assists in accepting oxygen properly at the position of the bound water molecule in the main oxygen channel. These results reveal that Asn56 in PnFPOX is essential for maintaining an effective oxygen accession path, and support the role of Asp54 as a gate keeper that cooperates with Lys274 to enable oxygen to reach the active site properly.
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147
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Zaharieva D, Yavelberg L, Jamnik V, Cinar A, Turksoy K, Riddell MC. The Effects of Basal Insulin Suspension at the Start of Exercise on Blood Glucose Levels During Continuous Versus Circuit-Based Exercise in Individuals with Type 1 Diabetes on Continuous Subcutaneous Insulin Infusion. Diabetes Technol Ther 2017; 19:370-378. [PMID: 28613947 PMCID: PMC5510047 DOI: 10.1089/dia.2017.0010] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Exercise causes glycemic disturbances in individuals with type 1 diabetes (T1D). Continuous moderate-intensity aerobic exercise (CON) generally lowers blood glucose (BG) levels and often leads to hypoglycemia. In comparison, circuit-based exercise (CIRC) may attenuate the drop in BG. The goal of this study is to contrast the effects of basal insulin suspension at the onset of two different forms of exercise (CON vs. CIRC). METHODS Twelve individuals (six men and six women) with T1D on insulin pump therapy were recruited for the study. All participants completed a maximal aerobic fitness test and two 40-min exercise sessions, consisting of either continuous treadmill walking or a circuit workout. Basal insulin infusion was stopped at the onset of exercise and resumed in recovery. After providing an initial reference value, volunteers were blinded to their [BG] and were asked to estimate their levels during exercise. RESULTS Oxygen consumption (47.5 ± 7.5 vs. 54.5 ± 13.5 mL·kg-1·min-1, P = 0.03) and heart rate (122 ± 20 vs. 144 ± 20 bpm, P = 0.003) were lower in CON vs. CIRC. Despite the lower workload, BG levels dropped more with CON vs. CIRC (delta BG = -3.8 ± 1.5 vs. -0.5 ± 3.0 mmol/L for CON vs. CIRC, respectively, P = 0.001). Participants were able to estimate their BG more accurately during CON (r = 0.83) vs. CIRC (r = 0.33) based on a regression analysis. CONCLUSION Despite a lower intensity of exercise, with full basal insulin suspension at the start of exercise, CON results in a larger drop in BG vs. CIRC. These findings have implications for single hormone-based artificial pancreas development for exercise. While this study does not negate the importance of frequent capillary BG monitoring during exercise, it does suggest that if persons are knowledgeable about their pre-exercise BG levels, they can accurately perceive the changes in BG during CON, but not during CIRC.
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Affiliation(s)
- Dessi Zaharieva
- School of Kinesiology and Health Science, Faculty of Health, Muscle Health Research Centre and Physical Activity and Chronic Disease Unit, York University, Toronto, Canada
| | - Loren Yavelberg
- School of Kinesiology and Health Science, Faculty of Health, Muscle Health Research Centre and Physical Activity and Chronic Disease Unit, York University, Toronto, Canada
| | - Veronica Jamnik
- School of Kinesiology and Health Science, Faculty of Health, Muscle Health Research Centre and Physical Activity and Chronic Disease Unit, York University, Toronto, Canada
| | - Ali Cinar
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, Illinois
- Chemical and Biological Engineering, Illinois Institute of Technology, Chicago, Illinois
| | - Kamuran Turksoy
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, Illinois
| | - Michael C. Riddell
- School of Kinesiology and Health Science, Faculty of Health, Muscle Health Research Centre and Physical Activity and Chronic Disease Unit, York University, Toronto, Canada
- LMC Diabetes & Endocrinology, Toronto, Canada
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148
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Haines D, Miranda HG, Flynn BC. The Role of Hemoglobin A1c as a Biomarker and Risk Assessment Tool in Patients Undergoing Non-cardiac and Cardiac Surgical Procedures. J Cardiothorac Vasc Anesth 2017; 32:488-494. [PMID: 29199050 DOI: 10.1053/j.jvca.2017.05.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Indexed: 01/10/2023]
Affiliation(s)
- Daniel Haines
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS
| | | | - Brigid C Flynn
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS.
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149
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Zhou L, Yang L, Zhou X, Lv X, Song J, Meng S, Yue J, Yang S, Ji L. A comparison of HbA 1c concentration in people with Type 2 diabetes at sea level and high altitude in China: an observational study. Diabet Med 2017; 34:862-864. [PMID: 28370237 DOI: 10.1111/dme.13356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2017] [Indexed: 11/29/2022]
Affiliation(s)
- L Zhou
- Department of Endocrinology and Metabolism, Peking University of People's Hospital, Beijing, China
| | - L Yang
- Department of Endocrinology, People's Hospital of Tibet Autonomous Region in Lhasa, Tibet, China
| | - X Zhou
- Department of Endocrinology and Metabolism, Peking University of People's Hospital, Beijing, China
| | - X Lv
- Department of Endocrinology, People's Hospital of Tibet Autonomous Region in Lhasa, Tibet, China
| | - J Song
- Department of Endocrinology, People's Hospital of Tibet Autonomous Region in Lhasa, Tibet, China
| | - S Meng
- Department of Endocrinology, People's Hospital of Tibet Autonomous Region in Lhasa, Tibet, China
| | - J Yue
- Department of Endocrinology, People's Hospital of Tibet Autonomous Region in Lhasa, Tibet, China
| | - S Yang
- Department of Endocrinology, People's Hospital of Tibet Autonomous Region in Lhasa, Tibet, China
| | - L Ji
- Department of Endocrinology and Metabolism, Peking University of People's Hospital, Beijing, China
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150
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Wu M, Wen J, Qin Y, Zhao H, Pan X, Su J, Du W, Pan E, Zhang Q, Zhang N, Sheng H, Liu C, Shen C. Familial History of Diabetes is Associated with Poor Glycaemic Control in Type 2 Diabetics: A Cross-sectional Study. Sci Rep 2017; 7:1432. [PMID: 28469277 PMCID: PMC5431173 DOI: 10.1038/s41598-017-01527-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 03/31/2017] [Indexed: 12/27/2022] Open
Abstract
To investigate the association of familial history (FH) of diabetes with the glycaemic control status of patients with type 2 diabetes (T2D), a cross-sectional study using stratified cluster sampling was conducted with 20,340 diabetic patients in Jiangsu, China. In total, 21.3% of the subjects reported a FH of diabetes. Patients with a FH of diabetes showed a higher risk of poor glycaemic control (59.7%) than those without a diabetic FH (49.8%), with an odds ratio (OR) of 1.366 (P < 0.001). Glycaemic control status did not significantly differ between the T2D patients with parental FH and those with sibling FH. Compared with patients with paternal FH, patients with maternal FH had a higher risk of poor glycaemic control (OR = 1.611, P = 0.013). Stratified analyses showed that a FH of diabetes was significantly associated with poor glycaemic control among T2D patients with a low education level (P < 0.05). In the <60 years old, overweight, and low level of physical activity groups, patients with a maternal history of diabetes showed a higher risk of poor glycaemic control than those without a FH (P < 0.05). In conclusion, FH of diabetes, especially a maternal history, had an independently adverse effect on the glycaemic control of T2D patients.
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Affiliation(s)
- Ming Wu
- Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China
| | - Jinbo Wen
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Yu Qin
- Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China
| | - Hailong Zhao
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Xiaoqun Pan
- Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China
| | - Jian Su
- Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China
| | - Wencong Du
- Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China
| | - Enchun Pan
- Department of Chronic Disease Prevention and Control, Huai'an City Center for Disease Control and Prevention, Huai'an, 223001, China
| | - Qin Zhang
- Department of Chronic Disease Prevention and Control, Huai'an City Center for Disease Control and Prevention, Huai'an, 223001, China
| | - Ning Zhang
- Changshu County Center for Disease Control and Prevention, Suzhou, 215500, China
| | - Hongyan Sheng
- Changshu County Center for Disease Control and Prevention, Suzhou, 215500, China
| | - Chunlan Liu
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
| | - Chong Shen
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.
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