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Bwititi P, Wang L, Butkowski E, Nwose EU. Impact of Anaemia on HbA1c Interpretation Among Normogylcaemic Individuals With Diabetes Mellitus: A Clinical Laboratory Observational Study. Cureus 2023; 15:e49901. [PMID: 38174171 PMCID: PMC10763517 DOI: 10.7759/cureus.49901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND AND AIM Over the past decades, glycosylated haemoglobin (HbA1c) has been a gold standard for monitoring diabetes control over a long period, relative to blood glucose level (BGL) which measures short-term results. It is speculated that anaemia and factors that induce haemolysis may cause falsely elevated HbA1c leading to 'false positive' interpretations. This study aimed to investigate how anaemia impacts HbA1c. METHODS This was a pathology-based observational pilot study using archived data of diabetic subjects monitored with both BGL and HbA1c in regional New South Wales (NSW), Australia. A total of 28,487 cases of blood glucose results were pooled and those with HbA1c and anaemia results were evaluated for correlation with the BGL results. Data collection was limited to de-identified information from the laboratory information system, hence details on the ethnicity and medical history were unavailable. Descriptive frequencies and Pearson correlations were performed. RESULTS In the pooled data, 53.36% of individuals were females, and 50.54% had BGL ≥5.6 mmol/L. In the pilot dataset, the majority (64.86%) were males, 18.92% with BGL ≤5.6 mmol/L and 67.57% had HbA1c (≥6.5%). In the entire dataset, BGL was moderately and positively correlated with HbA1c (r = 0.6), whereas in the subset of individuals with normo-BGL and anaemia, the correlation was negative (r = -0.2). DISCUSSION This pilot investigation observed a pertinent issue, which is a negative correlation between glycaemia and HbA1c in patients with anaemia. HbA1c was falsely increased despite normal blood glucose levels in individuals with anaemia. This advances the speculation that anaemia falsely increases HbA1c. Therefore, caution is necessary while interpreting HbA1c results for patients with anaemia, and new methods for interpretation are required.
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Affiliation(s)
- Phillip Bwititi
- Dentistry and Medical Sciences, Charles Sturt University, Wagga Wagga, AUS
| | - Lexin Wang
- Cardiology, Wagga Wagga Medical Centre, Wagga Wagga, AUS
- Cardiology, Liaocheng People's Hospital, Shandong First Medical University, Liaocheng, CHN
| | | | - Ezekiel U Nwose
- Public and Community Health, Novena University, Amai Campus, Ndokwa West, NGA
- Health and Medical Sciences, University of Southern Queensland, Toowoomba, AUS
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Brockamp C, Landgraf R, Müller UA, Müller-Wieland D, Petrak F, Uebel T. Shared Decision Making, Diagnostic Evaluation, and Pharmacotherapy in Type 2 Diabetes. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:804-810. [PMID: 37874122 PMCID: PMC10777312 DOI: 10.3238/arztebl.m2023.0219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/27/2023] [Accepted: 09/27/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Type 2 diabetes is one of the most important widespread diseases worldwide. In Germany, nearly one in five persons over age 65 has type 2 diabetes. The German National Disease Management Guideline for Type 2 Diabetes (NDMG; in German: Nationale Versorgungsleitlinie, NVL) contains updated recommendations for the diagnostic evaluation and pharmacotherapy of this disease as well as information about specific groups of people for whom early detection may be useful. METHODS The guideline has been updated, chapter by chapter, since 2018. Its recommendations are based on systematically searched and evaluated scientific evidence, the clinical expertise of a multidisciplinary panel of experts, and patient perspectives. RESULTS The new chapter on shared decision making includes a description of a structured approach that can be used when individual treatment goals have not been achieved. The diagnosis of diabetes newly requires at least two abnormally elevated laboratory values: e.g., fasting plasma glucose ≥ 126 mg/dL (≥ 7.0 mmol/L), HbA1c ≥ 6.5 % (≥ 48 mmol/mol) and/or casual plasma glucose ≥ 200 mg/dL (≥ 11.1 mmol/L). Cardiovascular and renal risks are to be considered in the choice of drug. Studies have shown that, in persons with cardiovascular disease, treatment with GLP-1 receptor agonists (GLP-1, glucagon-like peptide-1) or SGLT2 inhibitors (SGLT2, sodium-glucose co-transporter-2) was less likely than the comparison intervention to lead to certain patient-relevant endpoints, including all-cause mortality (OR = 0.88 and 0.84, respectively), hospitalization for heart failure (SGLT2 inhibitors: OR = 0.65), and worsening of renal function (OR = 0.61 and 0.59, respectively). CONCLUSION Current evidence continues to support the recommendations on pharmacotherapy of the 2021 guideline. The Guideline Group did not find evidence of adequate certainty to inform recommendations about the screening of persons at risk, HbA1c target values, or screening for sequelae and comorbidities. Better evidence on these matters would be desirable.
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Affiliation(s)
| | | | - Ulrich Alfons Müller
- Medical Practice for Endocrinology and Diabetology, Jena, MVZ Dr. med. Kielstein Ambulante Medizinische Versorgung GmbH Erfurt, Germany
| | | | - Frank Petrak
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic Bochum, Ruhr-University Bochum, Germany; Center for Psychotherapy Wiesbaden MVZ GmbH
| | - Til Uebel
- Primary physicians‘ offices Ittlingen and Neckargmünd, Germany, Specialists in diabetology
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3
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Schleicher E, Gerdes C, Petersmann A, Müller-Wieland D, Müller UA, Freckmann G, Heinemann L, Nauck M, Landgraf R. Definition, Classification and Diagnosis of Diabetes Mellitus. Exp Clin Endocrinol Diabetes 2022; 130:S1-S8. [PMID: 35451038 DOI: 10.1055/a-1624-2897] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Erwin Schleicher
- Institute for Clinical Chemistry and Pathobiochemistry - Central Laboratory, University Hospital Tübingen, Germany.,German Center for Diabetes Research (DZD) München-Neuherberg, Germany
| | - Christian Gerdes
- Department of Internal Medicine III, University Hospital Jena, Germany
| | - Astrid Petersmann
- Institute for Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Germany.,Institute for Clinical Chemistry and Laboratory Medicine, University of Oldenburg, Germany
| | | | - Ulrich A Müller
- Practice for Endocrinology and Diabetology, Dr. Kielstein Ambulante Medizinische Versorgung GmbH, Jena, Germany
| | - Guido Freckmann
- Institute for Diabetes Technology, Research and Development Company at the University of Ulm, Germany
| | | | - Matthias Nauck
- Institute for Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, University Medicine, Greifswald, Germany
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Bakker J, de la Garza MA. Naturally Occurring Endocrine Disorders in Non-Human Primates: A Comprehensive Review. Animals (Basel) 2022; 12:407. [PMID: 35203115 PMCID: PMC8868238 DOI: 10.3390/ani12040407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 01/31/2022] [Accepted: 02/03/2022] [Indexed: 01/23/2023] Open
Abstract
Literature concerning veterinary medicine of non-human primates is continuously updated, yet endocrine disorders remain underreported. While case or survey reports of individual endocrinopathies are available, a comprehensive review is not. An exhaustive literature search on this subject via widely used academic search systems, (e.g., Google Scholar, PubMed, BioOne complete and Web of Science), and peer-reviewed publications, proceedings, and newsletters was performed. Selected major endocrine entities will be described with emphasis on clinical signs, morphologic appearances, concomitant diseases, as well as available treatment options. Mostly, no clinical signs were noted and on gross pathology, the endocrine organs were unremarkable. An endocrine-related diagnosis was frequently made as an incidental finding after standard histopathological examination. During the review, the pancreas represented the most affected endocrine organ and diabetes mellitus represented the most clinically significant disorder. Currently, no standard procedure for diagnosing, monitoring, or treating endocrine disorders in non-human primates exists.
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Affiliation(s)
- Jaco Bakker
- Biomedical Primate Research Centre (BPRC), Animal Science Department (ASD), 2288GJ Rijswijk, The Netherlands
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5
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Definition, Klassifikation und Diagnostik des Diabetes mellitus: Update 2021. DIABETOLOGE 2022. [DOI: 10.1007/s11428-021-00847-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Schleicher E, Gerdes C, Petersmann A, Müller-Wieland D, Müller UA, Freckmann G, Heinemann L, Nauck M, Landgraf R. Definition, Klassifikation und Diagnostik des Diabetes mellitus: Update 2021. DIABETOL STOFFWECHS 2021. [DOI: 10.1055/a-1515-8638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Erwin Schleicher
- Institut für Klinische Chemie und Pathobiochemie – Zentrallabor, Universitätsklinikum Tübingen
- Deutsches Zentrum für Diabetesforschung (DZD) München-Neuherberg
| | | | - Astrid Petersmann
- Institut für Klinische Chemie und Laboratoriumsmedizin, Universitätsmedizin Greifswald
- Institut für Klinische Chemie und Laboratoriumsmedizin, Universität Oldenburg
| | | | - Ulrich A. Müller
- Praxis für Endokrinologie und Diabetologie, Dr. Kielstein Ambulante Medizinische Versorgung GmbH, Jena
| | - Guido Freckmann
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm
| | | | - Matthias Nauck
- Institut für Klinische Chemie und Laboratoriumsmedizin, Universitätsmedizin Greifswald
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, University Medicine, Greifswald, Germany
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Zijlmans DGM, Maaskant A, Sterck EHM, Langermans JAM. Retrospective Evaluation of a Minor Dietary Change in Non-Diabetic Group-Housed Long-Tailed Macaques ( Macaca fascicularis). Animals (Basel) 2021; 11:2749. [PMID: 34573715 PMCID: PMC8472355 DOI: 10.3390/ani11092749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 11/28/2022] Open
Abstract
Macaques in captivity are prone to becoming overweight and obese, which may cause several health problems. A diet that mimics the natural diet of macaques may prevent these problems and improve animal welfare. Adjusting captive diets towards a more natural composition may include increasing fiber content and lowering the glycemic index, i.e., reducing the impact on blood glucose levels. Such a dietary change was implemented in our long-tailed macaque (Macaca fascicularis) breeding colony. The basic diet of monkey chow pellets remained the same, while the supplementary provisioning of bread was replaced by grains and vegetables. This study is a retrospective evaluation, based on electronic health records, that investigated whether this minor dietary change had a beneficial effect on relative adiposity and overweight-related health parameters in 44 non-diabetic, group-housed, female long-tailed macaques. Relative adiposity was measured with a weight-for-height index and blood samples were collected during yearly health checks. Glycemic response and lipid metabolism were evaluated using several biochemical parameters. Relative adiposity and overweight status did not differ after dietary change. Yet, relatively heavy individuals generally lost body weight, while relatively lean individuals gained body weight, leading to a more balanced body weight dynamic. Dietary change did not affect HbA1c and triglyceride levels, while fructosamine and cholesterol levels were significantly reduced. Thus, the minor dietary change had no significant effect on overweight status, but some biochemical parameters related to the risk of diabetes and cardiovascular disease were positively affected. This study emphasizes the importance of evaluating husbandry changes and that critically reviewing husbandry practices can provide valuable insights to improve animal health and welfare.
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Affiliation(s)
- Dian G. M. Zijlmans
- Animal Science Department, Biomedical Primate Research Centre, 2288 GJ Rijswijk, The Netherlands; (A.M.); (E.H.M.S.); (J.A.M.L.)
- Animal Behaviour and Cognition, Department of Biology, Utrecht University, 3508 TB Utrecht, The Netherlands
| | - Annemiek Maaskant
- Animal Science Department, Biomedical Primate Research Centre, 2288 GJ Rijswijk, The Netherlands; (A.M.); (E.H.M.S.); (J.A.M.L.)
- Unit Animals in Science & Society, Department Population Health Sciences, Faculty of Veterinary Medicine, Utrecht University, 3584 CM Utrecht, The Netherlands
| | - Elisabeth H. M. Sterck
- Animal Science Department, Biomedical Primate Research Centre, 2288 GJ Rijswijk, The Netherlands; (A.M.); (E.H.M.S.); (J.A.M.L.)
- Animal Behaviour and Cognition, Department of Biology, Utrecht University, 3508 TB Utrecht, The Netherlands
| | - Jan A. M. Langermans
- Animal Science Department, Biomedical Primate Research Centre, 2288 GJ Rijswijk, The Netherlands; (A.M.); (E.H.M.S.); (J.A.M.L.)
- Unit Animals in Science & Society, Department Population Health Sciences, Faculty of Veterinary Medicine, Utrecht University, 3584 CM Utrecht, The Netherlands
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Nauck M, Gerdes C, Petersmann A, Müller-Wieland D, Müller UA, Freckmann G, Heinemann L, Schleicher E, Landgraf R. Definition, Klassifikation und Diagnostik des Diabetes mellitus: Update 2020. DIABETOLOGE 2021. [DOI: 10.1007/s11428-021-00763-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Huang SH, Huang PJ, Li JY, Su YD, Lu CC, Shih CL. Hemoglobin A1c Levels Associated with Age and Gender in Taiwanese Adults without Prior Diagnosis with Diabetes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073390. [PMID: 33805890 PMCID: PMC8038122 DOI: 10.3390/ijerph18073390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 11/16/2022]
Abstract
Several studies have reported that Hemoglobin A1c (HbA1c) levels increase with age for people without diabetes. However, HbA1c levels associated with age and gender have not been well investigated for Taiwanese adults. The objective of this study was to investigate the sex-specific association between HbA1c levels and age for Taiwanese adults without diabetes. The data were collected from the Taiwan Biobank database with inclusive criteria being participants without diabetes. The association between HbA1c values and age was conducted by linear regression analysis, HbA1c values between sexes were compared by two-sample t-test, and HbA1c levels among age groups were compared using one-way ANOVA. The results showed that HbA1c levels were positively correlated with age, and the levels for males were significantly higher than for females among all participants. However, there was no significantly positive correlation between HbA1c levels and age in males for age group of 50–70 years. The levels of males were significantly higher than females for age groups of 30–39 and 40–49 years. There were significant differences in HbA1c levels among age groups for all participants, males, and females except for the two age groups of 50–59 and 60–70 years in males. Age and gender were important factors affecting HbA1c levels. Our results suggested that the HbA1c cut-point levels for the diagnosis of diabetes should vary by age and gender.
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Affiliation(s)
- Shih-Hao Huang
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (S.-H.H.); (P.-J.H.)
- Department of Orthopedics, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan; (J.-Y.L.); (Y.-D.S.)
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Peng-Ju Huang
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (S.-H.H.); (P.-J.H.)
- College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Jhong-You Li
- Department of Orthopedics, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan; (J.-Y.L.); (Y.-D.S.)
| | - Yu-De Su
- Department of Orthopedics, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan; (J.-Y.L.); (Y.-D.S.)
| | - Cheng-Chang Lu
- Department of Orthopedics, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan; (J.-Y.L.); (Y.-D.S.)
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Correspondence: (C.-C.L.); (C.-L.S.)
| | - Chia-Lung Shih
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (S.-H.H.); (P.-J.H.)
- Clinical Medicine Research Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City 600, Taiwan
- Correspondence: (C.-C.L.); (C.-L.S.)
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Veyhe AS, Andreassen J, Halling J, Grandjean P, Skaalum Petersen M, Weihe P. Prevalence of prediabetes and type 2 diabetes in two non-random populations aged 44-77 years in the Faroe Islands. J Clin Transl Endocrinol 2019; 16:100187. [PMID: 31032180 PMCID: PMC6477859 DOI: 10.1016/j.jcte.2019.100187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 03/15/2019] [Accepted: 03/18/2019] [Indexed: 11/20/2022] Open
Abstract
AIMS The prevalence of type 2 diabetes is increasing worldwide but little known about the status in the Faroe Islands. The aim was therefore to determine the prevalence of type 2 diabetes mellitus and prediabetes in two non-random populations aged 44-77 years. METHODS This cross-sectional survey was conducted between 2011 and 2012 and included two sub-populations, namely 518 Septuagenarians aged 74-77 years (84% of the invited) and 401 Mark aged 44-73 years (87% of the invited). Subjects were screened for glycosylated haemoglobin, type A1c, non-fasting random plasma glucose, fasting plasma glucose followed by an oral glucose tolerance test. The screening was based on a diagnostic algorithm that included screening, diagnostic and confirmatory steps. RESULTS Each group was analysed separately. In the Septuagenarian group 20.4% had type 2 diabetes, with 5.2% being newly detected and a total of 59% had prediabetes. In the Mark group 4.1% had diabetes, with 2.1% being newly detected and 22.3% had prediabetes. Diabetes increased with age and was significantly more prevalent among men. Women had lower mean fasting plasma glucose concentrations and men had lower values for 2-hours plasma glucose. Significant predictors associated with diabetes mellitus included obesity (BMI ≥ 30, abnormal waist/hip ratio and vegetable consumption. CONCLUSIONS Among the Faroese populations studied, the prevalence of type 2 diabetes increased with age and was more prevalent among men. The detected prevalence was comparable to other Nordic countries for all age-groups.
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Key Words
- 2hPG, 2-hour plasma glucose
- BMI, body mass index
- CDC, Centers for Disease Control and Prevention
- Diagnostic criteria
- FPG, fasting plasma glucose
- Faroe Islands
- HbA1c, glycosylated heamoglobin type A1c
- IFG, impaired fasting glycaemia
- IGT, impaired glucose tolerance
- Impaired glucose regulation
- K-T2D, Previously Known Type 2 Diabetes
- M, Mark
- N-T2D, newly diagnosed diabetes
- NGT, normal glucose tolerance
- OCP, organochlorine pollutant
- OGTT, oral glucose tolerance test
- Prediabetes
- Prevalence
- RPG, random plasma glucose
- S, Septuagenarians
- SD, standard deviation
- T2D, type 2 diabetes
- Type 2 diabetes mellitus
- WHO, World Health Organization
- WHR, waist/hip ratio
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Affiliation(s)
- Anna Sofía Veyhe
- Department of Occupational Medicine and Public Health, The Faroese Hospital System, Tórshavn, Faroe Islands
- Center of Health Sciences, Faculty of Health Science and Nursing, University of the Faroe Islands, Tórshavn, Faroe Islands
| | - Jens Andreassen
- National Hospital of the Faroe Islands, Tórshavn, Faroe Islands
| | - Jónrit Halling
- Department of Science and Technology, University of the Faroe Islands, Tórshavn, Faroe Islands
| | - Philippe Grandjean
- Institute of Public Health, University of Southern Denmark, Odense, Denmark
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, United States
| | - Maria Skaalum Petersen
- Department of Occupational Medicine and Public Health, The Faroese Hospital System, Tórshavn, Faroe Islands
- Center of Health Sciences, Faculty of Health Science and Nursing, University of the Faroe Islands, Tórshavn, Faroe Islands
| | - Pál Weihe
- Department of Occupational Medicine and Public Health, The Faroese Hospital System, Tórshavn, Faroe Islands
- Center of Health Sciences, Faculty of Health Science and Nursing, University of the Faroe Islands, Tórshavn, Faroe Islands
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Masuch A, Friedrich N, Roth J, Nauck M, Müller UA, Petersmann A. Preventing misdiagnosis of diabetes in the elderly: age-dependent HbA1c reference intervals derived from two population-based study cohorts. BMC Endocr Disord 2019; 19:20. [PMID: 30755204 PMCID: PMC6371438 DOI: 10.1186/s12902-019-0338-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 01/09/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Measurement of gylcated hemoglobin A1c (HbA1c) plays a central role in monitoring quality of antidiabetic therapy and in the diagnosis of diabetes. Several studies report increased levels of HbA1c in nondiabetic elderly. However, this observation did not reach incorporation into daily clinical practice or the respective guidelines. The present study aimed to evaluate HbA1c levels in relation to age in two independent population-based cohorts and to derive age-specific reference intervals. METHODS Four thousand two hundred sixty three participants from the Study of Health in Pomerania (SHIP-0) and 4402 participants from the independent study SHIP-Trend were included. HbA1c was determined by means of high-performance liquid chromatography. Multivariable linear regression models were performed. Reference intervals for HbA1c were determined. RESULTS Reference intervals were derived from a healthy subpopulation with the upper reference limit (URL) for HbA1c of 42.1 mmol/Mol (6.0%) for individuals aged 20-39 years increasing to 43.2 mmol/Mol (6.1%) for individuals aged 40-59 years. For people aged ≥60 years the URL was 47.5 mmol/Mol (6.5%). In both study populations an increase in HbA1c with age was observed. ANOVA revealed up to 8.5 mmol/Mol (0.77%) or 7.3 mmol/Mol (0.68%) higher estimated mean levels of HbA1c in the oldest compared to the youngest age group in SHIP-0 or SHIP-trend, respectively. Linear regression analyses confirmed the positive associations of HbA1c with age which was independent of BMI CONCLUSION: The present study confirmed the previously observed increase of HbA1c with increasing age in non-diabetic individuals. As a consequence age-dependent reference values for HbA1c were derived from two large and well defined reference populations. Implementation of them into daily practice may improve patient care and diagnosis of diabetes and reduce the risk of misdiagnosis and subsequent overtreatment of diabetes in elderly patients.
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Affiliation(s)
- Annette Masuch
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
| | - Nele Friedrich
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
- German Center for Cardiovascular Research (DZHK e.V.), partner site Greifswald, Greifswald, Germany
| | - Johannes Roth
- Department Internal Medicine III, Endocrinology and Metabolic Diseases, University Hospital Jena, Jena, Germany
- Present address: Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
- German Center for Cardiovascular Research (DZHK e.V.), partner site Greifswald, Greifswald, Germany
| | - Ulrich Alfons Müller
- Department Internal Medicine III, Endocrinology and Metabolic Diseases, University Hospital Jena, Jena, Germany
| | - Astrid Petersmann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
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13
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Wojszel ZB, Kasiukiewicz A. A Retrospective Time Trend Study Of Diabetes Overtreatment In Geriatric Patients. Diabetes Metab Syndr Obes 2019; 12:2023-2032. [PMID: 31632112 PMCID: PMC6782028 DOI: 10.2147/dmso.s221179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/13/2019] [Indexed: 12/19/2022] Open
Abstract
PURPOSE We assessed changes in diabetes mellitus (DM) overtreatment prevalence in geriatric patients that had taken place after the introduction of the rule of therapy individualization in the Polish diabetes treatment guidelines. PATIENTS AND METHODS This time-trend assessment comprised two retrospective cross-sectional cohort studies of type 2 DM patients admitted to a geriatric ward in 2009-2010 (1st round) and in 2014-2015 (2nd round). A high-risk group was defined as patients on antihyperglycemic medications prior to admission, who were 80+ years old, diagnosed with dementia, end-stage renal disease, or had a history of macrovascular complications. The primary outcome measure was glycosylated A1C hemoglobin (HbA1C) ≤7.0% (53 mmol/mol). RESULTS 213 patients in the 1st round and 83 in the 2nd round were included. Groups did not differ in age, gender, health and functional characteristics. The percentage of dementia (36.1% versus 18.8%, P=0.002) and of the high-risk cases (79.3% versus 67.7%, P=0.05) was higher in the 2nd round of the study. During the study, tight glycemic control prevalence in the high-risk group decreased significantly from 73.1% to 58.5%, P=0.04 (odds ratio 0.68, 95% CI 0.47-0.97), and the median value of HbA1c increased significantly from 6.4%, IQR 5.7-7.3 (46 mmol/mol, IQR 39-56) to 6.7%, IQR 6.1-7.9 (50 mmol/mol, IQR 43-63), P=0.03. CONCLUSION Despite the principle of individualization of DM therapy that was in force, after a five-year observation, the problem of DM overtreatment still concerned a large percentage of geriatric patients, although a positive trend was noted in this respect.
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Affiliation(s)
- Zyta Beata Wojszel
- Department of Geriatrics, Medical University of Bialystok, Bialystok, Poland
- Department of Geriatrics, Hospital of the Ministry of Interior in Bialystok, Bialystok, Poland
- Correspondence: Zyta Beata Wojszel Department of Geriatrics, Medical University of Bialystok, Fabryczna street 27, Bialystok15-471, PolandTel +48 85 8694 982Fax +48 85 8694974 Email
| | - Agnieszka Kasiukiewicz
- Department of Geriatrics, Medical University of Bialystok, Bialystok, Poland
- Department of Geriatrics, Hospital of the Ministry of Interior in Bialystok, Bialystok, Poland
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