Evaluation of hemoglobin A1c measurement from filter paper using high-performance liquid chromatography and immunoturbidimetric assay

A Comparison Between the Therapeutic Effect of Metformin Alone versus a Combination Therapy with Insulin in Uncontrolled, Non-Adherence Patients with Type 2 Diabetes: Six Months Follow-Up

PURPOSE

The study aimed to compare the metabolic effects of an intensive dose of metformin alone among non-adherence patients with type 2 diabetes versus in combination with insulin among adherence patients.

METHODS

The prospective cohort study was carried out on a sample of 140 patients above 18 years old, divided into two groups. The first group (n=70) was recommended metformin monotherapy in an intensive dose of 2-3 g/day, whereas the second group (n=70) was prescribed metformin (1-2g/day) in combination with insulin. FPG, HbA1c, BMI, blood pressure, TC, TG, HDL-C, LDL-C, creatinine, and eGFR were measured for each patient at baseline and after a follow-up of 6 months of active treatment.

RESULTS

After six months of active treatment using monotherapy with an intensive dose of metformin, only 11.43% of patients achieved the target levels of HBA1c below 7%. In the group of patients treated using a combination of metformin with insulin, after six months of active treatment, 45.72% achieved HBA1c levels below 7% (p<0.0001). Compared with an intensive dose of metformin alone, the combination of insulin and metformin was associated with improved glycemic control (change of fasting blood glucose: 2.49 mmol/l vs 1.30 mmol/l, p=0.0016). Metformin use alone, as compared with insulin, was associated with a significant increase in HDL-C (+0.03 mmol/l vs -0.14 mmol/l, p=0.0485). Increased baseline obesity and increased baseline glycemia were the factors related to the likelihood of failing to achieve the target levels for HbA1c.

CONCLUSION

Metformin proved to be more effective in controlling hyperglycemia when combined with insulin therapy. Our study shows how many health benefits loss patients who, despite systematic diabetes education, do not agree to change their treatment in the form of adding a second drug, including insulin.

Determination of haemoglobin A1c levels using high-performance liquid chromatography of bloodstains

This study aimed to determine haemoglobin A1c (HbA1c) levels in bloodstains shed on glass and fabric surfaces on specified test dates. Blood samples were taken from 26 patients (13 diabetic and 13 non-diabetic). Initial HbA1c levels were detected by using high-performance liquid chromatography (HPLC), and bloodstains were created on both cotton fabric and glass surfaces. Samples were processed at different ages (0, 7, 14, 28 and 56 days) by diluting distilled water and then measuring HbA1c levels by HPLC again. In all stains, HbA1c levels could be determined by using HPLC, but there was a moderate rise in accordance with the age of the stains. A statistically significant difference was found for bloodstains on clothes compared to those on glass surfaces. Receiver operating curve analysis found a sensitivity of 1.0 and specificity of 0.923 (cut-off 6.55) for glass surfaces on the seventh day; a sensitivity of 1.0, a specificity of 0.846 (cut-off 6.45) for clothes on the seventh day; a sensitivity of 1.0 and a specificity of 0.923 (cut-off 6.85) for clothes on the 56th day; and a sensitivity of 1.0 and a specificity of 0.846 (cut-off 7.55) for glass surfaces on the 56th day. In conclusion, this study found that HbA1c levels could be measured with high reliability from forensic bloodstains by using HPLC. Thus, in cases where DNA data banks cannot identify individuals, it would make sense to turn to those who have a medical history of diabetes among the suspects with the results of high HbA1c levels.