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Chen M, Liu J, Xie Z, Chen W, Hu Y, Wen J, Chen J, Chen X, Lin L, Wang R, Lu L. Effect of hemoglobin A1c management levels on coronary physiology evaluated by quantitative flow ratio in patients who underwent percutaneous coronary intervention. J Diabetes Investig 2024; 15:336-345. [PMID: 38009857 PMCID: PMC10906016 DOI: 10.1111/jdi.14114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 10/18/2023] [Accepted: 11/10/2023] [Indexed: 11/29/2023] Open
Abstract
AIMS/INTRODUCTION The coronary physiology and prognosis of patients with different hemoglobin A1c (HbA1c) levels after percutaneous coronary intervention (PCI) are currently unknown. The aim of this study was to assess the effect of different levels of HbA1c control on coronary physiology in patients who underwent PCI for coronary heart disease combined with type 2 diabetes mellitus by quantitative flow ratio (QFR). MATERIALS AND METHODS Patients who successfully underwent PCI and completed 1-year coronary angiographic follow up were enrolled, clinical data were collected, and QFR at immediate and 1-year follow up after PCI was retrospectively analyzed. A total of 257 patients (361 vessels) were finally enrolled and divided into the hemoglobin A1c (HbA1c)-compliance group (103 patients, 138 vessels) and non-HbA1c-compliance group (154 patients, 223 vessels) according to the HbA1c cut-off value of 7%. We compared the results of QFR analysis and clinical outcomes between the two groups. RESULTS At 1-year follow up after PCI, the QFR was significantly higher (0.94 ± 0.07 vs 0.92 ± 0.10, P = 0.019) and declined less (0.014 ± 0.066 vs 0.033 ± 0.095, P = 0.029) in the HbA1c-compliance group. Meanwhile, the incidence of physiological restenosis was lower in the HbA1c-compliance group (2.9% vs 8.5%, P = 0.034). Additionally, the target vessel revascularization rate was lower in the HbA1c-compliance group (6.8% vs 16.9%, P = 0.018). Furthermore, HbA1c ≥7% (OR 2.113, 95% confidence interval 1.081-4.128, P = 0.029) and QFR decline (OR 2.215, 95% confidence interval 1.147-4.277, P = 0.018) were independent risk factors for target vessel revascularization. CONCLUSION Patients with well-controlled HbA1c levels have better coronary physiological benefits and the incidence of adverse clinical outcome events might be reduced.
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Affiliation(s)
- Mingfeng Chen
- Department of CardiologyFujian Provincial HospitalFuzhouChina
| | - Jichen Liu
- Shengli Clinical Medical College of Fujian Medical UniversityFuzhouChina
| | - Zhangxin Xie
- Shengli Clinical Medical College of Fujian Medical UniversityFuzhouChina
- Department of EmergencyFujian Provincial HospitalFuzhouChina
- Fujian Provincial Key Laboratory of Emergency Medicine, Fujian Emergency Medical CenterFujian Provincial Institute of Emergency MedicineFuzhouChina
| | - Wei Chen
- Department of CardiologyFujian Provincial HospitalFuzhouChina
- Shengli Clinical Medical College of Fujian Medical UniversityFuzhouChina
| | - Yanqin Hu
- Shengli Clinical Medical College of Fujian Medical UniversityFuzhouChina
| | - Junping Wen
- Shengli Clinical Medical College of Fujian Medical UniversityFuzhouChina
- Department of EndocrinologyFujian Provincial HospitalFuzhouChina
| | - Jinyan Chen
- Institute for Immunology, Fujian Academy of Medical SciencesFuzhouChina
| | - Xuemei Chen
- Shengli Clinical Medical College of Fujian Medical UniversityFuzhouChina
- Department of Critical Care MedicineFujian Provincial Hospital, Fujian Provincial Center for Critical Care MedicineFuzhouChina
| | - Lirong Lin
- Department of CardiologyFujian Provincial HospitalFuzhouChina
- Shengli Clinical Medical College of Fujian Medical UniversityFuzhouChina
| | - Rehua Wang
- Department of CardiologyFujian Provincial HospitalFuzhouChina
- Shengli Clinical Medical College of Fujian Medical UniversityFuzhouChina
| | - Lihong Lu
- Department of CardiologyFujian Provincial HospitalFuzhouChina
- Shengli Clinical Medical College of Fujian Medical UniversityFuzhouChina
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Thornton‐Swan TD, Armitage LC, Curtis AM, Farmer AJ. Assessment of glycaemic status in adult hospital patients for the detection of undiagnosed diabetes mellitus: A systematic review. Diabet Med 2022; 39:e14777. [PMID: 34951710 PMCID: PMC9302131 DOI: 10.1111/dme.14777] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/22/2021] [Indexed: 12/12/2022]
Abstract
AIM In-hospital blood glucose testing is commonplace, particularly in acute care. In-hospital screening for hyperglycaemia may present a valuable opportunity for early diabetes diagnosis by identifying at-risk individuals. This systematic review investigates the extent to which random blood glucose testing in acute and inpatient hospital settings predicts undiagnosed diabetes. METHODS Two databases were systematically searched for studies in which adult patients received an in-hospital random blood glucose test, followed by a diagnostic HbA1c test. The primary outcome was the proportion of hyperglycaemic individuals diagnosed with diabetes by HbA1c. RESULTS A total of 3245 unique citations were identified, and 12 were eligible for inclusion. Ten different blood glucose thresholds, ranging from 5.5 to 11.1 mmol/L, were used to detect hyperglycaemia, indicating that there is no consistent clinical definition for hyperglycaemia. The proportion of participants with hyperglycaemia in each study ranged from 3.3% to 62.1%, with a median (Q1 , Q3 ) of 34.5% (5.95%, 61.1%). The proportion of hyperglycaemic participants found to have a diabetes-range HbA1c varied from 4.1% to 90%, with a median (Q1 , Q3 ) of 18.9% (11.5%, 61.1%). Meta-analysis was not possible due to substantial heterogeneity between study protocols. CONCLUSIONS All studies consistently identified a proportion of hyperglycaemic hospital patients as having a diabetes-range HbA1c, showing that in-hospital blood glucose screening can facilitate diabetes diagnosis. The proportion of hyperglycaemic participants with undiagnosed diabetes varied substantially, indicating a need for further research and consistency in defining in-hospital hyperglycaemia. This may aid the development of a standardised screening protocol to identify people with possible undiagnosed diabetes.
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Affiliation(s)
| | - Laura C. Armitage
- Exeter CollegeUniversity of OxfordOxfordUK
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - Aisling M. Curtis
- Clinical Medical SchoolUniversity of OxfordOxfordUK
- Green Templeton CollegeUniversity of OxfordOxfordUK
| | - Andrew J. Farmer
- Exeter CollegeUniversity of OxfordOxfordUK
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
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Evaluation of the prevalence of inappropriate hba1c examination requests at the General Hospital of Dokter Saiful Anwar Malang. Int J Diabetes Dev Ctries 2021. [DOI: 10.1007/s13410-021-00996-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Rodgers LR, Hill AV, Dennis JM, Craig Z, May B, Hattersley AT, McDonald TJ, Andrews RC, Jones A, Shields BM. Choice of HbA1c threshold for identifying individuals at high risk of type 2 diabetes and implications for diabetes prevention programmes: a cohort study. BMC Med 2021; 19:184. [PMID: 34412655 PMCID: PMC8377980 DOI: 10.1186/s12916-021-02054-w] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/07/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) is common and increasing in prevalence. It is possible to prevent or delay T2D using lifestyle intervention programmes. Entry to these programmes is usually determined by a measure of glycaemia in the 'intermediate' range. This paper investigated the relationship between HbA1c and future diabetes risk and determined the impact of varying thresholds to identify those at high risk of developing T2D. METHODS We studied 4227 participants without diabetes aged ≥ 40 years recruited to the Exeter 10,000 population cohort in South West England. HbA1c was measured at study recruitment with repeat HbA1c available as part of usual care. Absolute risk of developing diabetes within 5 years, defined by HbA1c ≥ 48 mmol/mol (6.5%), according to baseline HbA1c, was assessed by a flexible parametric survival model. RESULTS The overall absolute 5-year risk (95% CI) of developing T2D in the cohort was 4.2% (3.6, 4.8%). This rose to 7.1% (6.1, 8.2%) in the 56% (n = 2358/4224) of participants classified 'high-risk' with HbA1c ≥ 39 mmol/mol (5.7%; ADA criteria). Under IEC criteria, HbA1c ≥ 42 mmol/mol (6.0%), 22% (n = 929/4277) of the cohort was classified high-risk with 5-year risk 14.9% (12.6, 17.2%). Those with the highest HbA1c values (44-47 mmol/mol [6.2-6.4%]) had much higher 5-year risk, 26.4% (22.0, 30.5%) compared with 2.1% (1.5, 2.6%) for 39-41 mmol/mol (5.7-5.9%) and 7.0% (5.4, 8.6%) for 42-43 mmol/mol (6.0-6.1%). Changing the entry criterion to prevention programmes from 39 to 42 mmol/mol (5.7-6.0%) reduced the proportion classified high-risk by 61%, and increased the positive predictive value (PPV) from 5.8 to 12.4% with negligible impact on the negative predictive value (NPV), 99.6% to 99.1%. Increasing the threshold further, to 44 mmol/mol (6.2%), reduced those classified high-risk by 59%, and markedly increased the PPV from 12.4 to 23.2% and had little impact on the NPV (99.1% to 98.5%). CONCLUSIONS A large proportion of people are identified as high-risk using current thresholds. Increasing the risk threshold markedly reduces the number of people that would be classified as high-risk and entered into prevention programmes, although this must be balanced against cases missed. Raising the entry threshold would allow limited intervention opportunities to be focused on those most likely to develop T2D.
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Affiliation(s)
- Lauren R Rodgers
- Institute of Health Research, University of Exeter Medical School, South Cloisters, St Lukes Campus, Exeter, EX1 2LU, UK.
| | - Anita V Hill
- NIHR Exeter Clinical Research Facility, Royal Devon & Exeter NHS Foundation Trust & University of Exeter Medical School, Exeter, UK
| | - John M Dennis
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, EX2 5DW, UK
| | - Zoe Craig
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, West Yorkshire, UK
| | - Benedict May
- College of Mathematics Engineering and Physical Science, University of Exeter, Exeter, UK
| | - Andrew T Hattersley
- Department of Diabetes and Endocrinology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Timothy J McDonald
- Academic Department of Blood Sciences, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Rob C Andrews
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, EX2 5DW, UK
| | - Angus Jones
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, EX2 5DW, UK
| | - Beverley M Shields
- Institute of Biomedical and Clinical Science, College of Medicine and Health, University of Exeter, Exeter, EX2 5DW, UK
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Hopkins KL, Hlongwane KE, Otwombe K, Dietrich J, Cheyip M, Olivier J, van Rooyen H, Doherty T, Gray GE. The substantial burden of non-communicable diseases and HIV-comorbidity amongst adults: Screening results from an integrated HIV testing services clinic for adults in Soweto, South Africa. EClinicalMedicine 2021; 38:101015. [PMID: 34308316 PMCID: PMC8283339 DOI: 10.1016/j.eclinm.2021.101015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/15/2021] [Accepted: 06/18/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND South Africa is disproportionately impacted by non-communicable diseases (NCDs) and HIV/AIDS. We investigated the prevalence of known/unknown NCD risk factors, HIV, and NCD risk factor-HIV comorbidity; and treatment status on known diseases to determine the prevalence of controlled/uncontrolled disease. METHODS This cross-sectional study (June 2018-March 2019) within an integrated testing centre in Soweto, South Africa, screened adults (aged ≥18 years) for body mass index (BMI), hypertension (HT), rapid glucose and cholesterol, and HIV. Results were stratified by age group, sex, HIV-status, and self-reported ART use. Analysis included Fisher's exact, chi-squared, Kruskal Wallis, and Student's T-tests. FINDINGS Of 780 enrolled participants, 19.2% were HIV-positive, 37.5% were overweight/obese, 18.0% hypertensive, 10.8% hyperglycaemic, and 8.1% had hypercholesterolaemia. Significantly more women had overweight/obese BMI than men (46.8% vs 19.7%; p<0.0001), and women aged 25-34 years had significantly more hypercholesterolaemia than same-aged men (18.2% vs 5.6%; p = 0.02). HIV-positive participants had significantly more hyperglycaemia than HIV-negative participants (16.1% vs 9.6%; p = 0.02), and those on ART (63.9%) had significantly more hypercholesterolaemia than those not on ART (21.7% vs. 4.9%; p = 0.002). Of participants with HT, hyperglycaemia, and hypercholesterolaemia; 72.4%, 96.1%, and 93.3% were newly diagnosed. All participants with previously diagnosed NCDs remained with uncontrolled disease. INTERPRETATION There is a high burden of HIV, NCD risk factors, and comorbidity in Soweto, and amongst young adults (18-34 years), especially women. Lowering age requirements for glucose/cholesterol screening to 18+ years, regardless of BMI, HIV-status, or ART use, may yield timely NCD diagnosis/management.
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Affiliation(s)
- Kathryn L. Hopkins
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg 1864, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Khuthadzo E. Hlongwane
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg 1864, South Africa
| | - Kennedy Otwombe
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg 1864, South Africa
| | - Janan Dietrich
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg 1864, South Africa
- Health Systems Research Unit, South African Medical Research Council, South Africa
| | - Mireille Cheyip
- Centres for Disease Control and Prevention, Pretoria, South Africa
| | - Jacobus Olivier
- Centres for Disease Control and Prevention, Pretoria, South Africa
| | - Heidi van Rooyen
- SAMRC-Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, South Africa
- Human and Social Development Programme, Human Sciences Research Council, South Africa
| | - Tanya Doherty
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Health Systems Research Unit, South African Medical Research Council, South Africa
| | - Glenda E. Gray
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg 1864, South Africa
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Office of the President, South African Medical Research Council, Cape Town, South Africa
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Pearsall R, Shaw RJ, McLean G, Connolly M, Hughes KA, Boyle JG, Park J, Smith DJ, Mackay D. Health screening, cardiometabolic disease and adverse health outcomes in individuals with severe mental illness. BJPsych Open 2019; 5:e97. [PMID: 31699180 PMCID: PMC6854356 DOI: 10.1192/bjo.2019.76] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Poor physical health in severe mental illness (SMI) remains a major issue for clinical practice. AIMS To use electronic health records of routinely collected clinical data to determine levels of screening for cardiometabolic disease and adverse health outcomes in a large sample (n = 7718) of patients with SMI, predominantly schizophrenia and bipolar disorder. METHOD We linked data from the Glasgow Psychosis Clinical Information System (PsyCIS) to morbidity records, routine blood results and prescribing data. RESULTS There was no record of routine blood monitoring during the preceding 2 years for 16.9% of the cohort. However, monitoring was poorer for male patients, younger patients aged 16-44, those with schizophrenia, and for tests of cholesterol, triglyceride and glycosylated haemoglobin. We estimated that 8.0% of participants had diabetes and that lipids levels, and use of lipid-lowering medication, was generally high. CONCLUSIONS Electronic record linkage identified poor health screening and adverse health outcomes in this vulnerable patient group. This approach can inform the design of future interventions and health policy.
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Affiliation(s)
- Robert Pearsall
- Consultant Psychiatrist and Honorary Clinical Senior Lecturer in Psychiatry, Institute of Health and Wellbeing, University of Glasgow, UK
| | - Richard J Shaw
- Research Associate, Institute of Health and Wellbeing, University of Glasgow, UK
| | - Gary McLean
- Research Associate, Institute of Health and Wellbeing, University of Glasgow, UK
| | - Moira Connolly
- Consultant Psychiatrist, Department of Psychiatry, Gartnavel Royal Hospital, Glasgow, UK
| | - Kate A Hughes
- Consultant Endocrinologist, Physician and Honorary Senior Lecturer, Department of Medicine, Glasgow Royal Infirmary, UK
| | - James G Boyle
- Consultant Diabetologist and Honorary Clinical Associate Professor, School of Medicine, University of Glasgow, UK
| | - John Park
- RN (Mental Health), Lead Research Nurse, Department of Psychiatry, Stobhill Hospital, UK
| | - Daniel J Smith
- Professor of Psychiatry, Institute of Health and Wellbeing, University of Glasgow, UK
| | - Daniel Mackay
- Reader in Public Health, Institute of Health and Wellbeing, University of Glasgow, UK
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Kindarara DM, Silva GE. Prevalence and Associated Risk Factors of Diabetes in the African Immigrant Population of Sacramento County, California. THE DIABETES EDUCATOR 2019; 45:225-239. [PMID: 30819051 DOI: 10.1177/0145721719834245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose The purpose of this study was to determine the prevalence and associated risk factors of diabetes in the African immigrant population in Sacramento County, California. Methods A cross-sectional study was conducted in Sacramento County, California, from June to August 2018. The convenience sample included 126 African immigrants aged 21 years and older. Sociodemographic and clinical characteristics were collected. Hemoglobin A1C (A1C) level, blood pressure, height, and weight were measured per standard methods. Data were analyzed using descriptive statistics and χ2 test at value of P < .05. Results Of 126 adult individuals included in this study, 32 (25.4%) had diabetes, of whom 25 (19.8%) were previously diagnosed and 7 (5.6%) represented new cases of diabetes. Also, 36 (28.6%) had prediabetes, of whom 24 (19.1%) had previously been told they had prediabetes and 12 (9.5%) represented new cases of prediabetes. Diabetes and prediabetes were significantly higher among participants in the age group of 36 to 60 years, married, employed full-time, and those with hypertension, high blood cholesterol, and participating in 0 to 2 days per week of moderate physical activities. Only one-fifth of all participants with previously known diabetes or previously on treatment had a good glycemic control status. Conclusions The present study found a high prevalence of prediabetes, diabetes, and multiple risk factors of diabetes in the African immigrant population, as well as a poor glycemic control among those with diabetes, calling for urgent attention. Strategies aimed to improving a healthy lifestyle in the African immigrant population are necessary to reduce the burden of diabetes.
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Affiliation(s)
- Désiré M Kindarara
- School of Nursing, College of Health and Human Services, California State University, Sacramento (CSUS), Sacramento, California
- School of Medicine, Department of Public Health Sciences, University of California Davis (UCD), Davis, California
- VA Medical Center, Sacramento, California
| | - Graciela E Silva
- University of Arizona, College of Nursing and College of Public Health, Tucson, Arizona
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Affiliation(s)
- Ravinder Sodi
- Department of Blood Sciences, Royal Lancaster Infirmary & Furness General Hospital, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK
- Lancaster Medical School, University of Lancaster, Lancaster, UK
| | | | - Srilatha Dampetla
- Department of Medicine, Royal Lancaster Infirmary, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK
| | - Joseph M Pappachan
- Department of Medicine, Royal Lancaster Infirmary, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK
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Campbell L, Pepper T, Shipman K. HbA1c: a review of non-glycaemic variables. J Clin Pathol 2018; 72:12-19. [PMID: 30361394 DOI: 10.1136/jclinpath-2017-204755] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 09/23/2018] [Accepted: 10/02/2018] [Indexed: 12/28/2022]
Abstract
Identification of the correlation between HbA1c and diabetic complications has yielded one of the most clinically useful biomarkers. HbA1c has revolutionised the diagnosis and monitoring of diabetes mellitus. However, with widespread adoption of HbA1c has come increasing recognition that non-glycaemic variables can also affect HbA1c, with varying clinical significance. Furthermore, the identification of a discrepancy between predicted and measured HbA1c in some individuals, the so-called 'glycation gap', may be clinically significant. We aimed to review the current body of evidence relating to non-glycaemic variables to quantify any significance and provide subsequent suggestions. A PubMed-based literature search was performed, using a variety of search terms, to retrieve articles detailing the non-glycaemic variables suggested to affect HbA1c. Articles were reviewed to assess the relevance of any findings in clinical practice and where possible guidance is given. A range of non-glycaemic variables have statistically significant effects on HbA1c. While the clinical implications are generally irrelevant, a small number of non-glycaemic variables do have clinically significant effects and alternative biomarkers should be considered instead of, or in addition to, HbA1c. There are a small number of non-glycaemic variables which have a clinically significant effect on HbA1c, However, the vast majority of non-glycaemic variables have no clinical relevance. While clinicians should have an awareness of those non-glycaemic variables with clinical significance, in the vast majority of clinical scenarios HbA1c should continue to be used with confidence.
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Affiliation(s)
- Leon Campbell
- Department of Medicine, Western Sussex Hospitals NHS Foundation Trust, Worthing, UK
| | - Tessa Pepper
- Department of Medicine, Western Sussex Hospitals NHS Foundation Trust, Worthing, UK
| | - Kate Shipman
- Department of Chemical Pathology, Western Sussex Hospitals NHS Foundation Trust, Worthing, England
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Nakanga WP, Crampin A, Nyirenda M. Should haemoglobin A1C be used for diagnosis of diabetes mellitus in Malawi? Malawi Med J 2016; 28:28-30. [PMID: 27217915 PMCID: PMC4864390 DOI: 10.4314/mmj.v28i1.7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023] Open
Affiliation(s)
- W P Nakanga
- Malawi Epidemiology and Intervention Research Unit (MEIRU), Lilongwe, Malawi
| | - A Crampin
- Malawi Epidemiology and Intervention Research Unit (MEIRU), Lilongwe, Malawi
| | - M Nyirenda
- Malawi Epidemiology and Intervention Research Unit (MEIRU), Lilongwe, Malawi
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Kim SY, Friedmann P, Seth A, Fleckman AM. Monitoring HIV-infected Patients with Diabetes: Hemoglobin A1c, Fructosamine, or Glucose? CLINICAL MEDICINE INSIGHTS-ENDOCRINOLOGY AND DIABETES 2014; 7:41-5. [PMID: 25520565 PMCID: PMC4259549 DOI: 10.4137/cmed.s19202] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 10/09/2014] [Accepted: 10/11/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Published studies report inappropriately low hemoglobin A1C (HbA1c) values that underestimate glycemia in HIV patients. METHODS We reviewed the charts of all HIV patients with diabetes mellitus (DM) at our clinic. Fifty-nine patients had HbA1c data, of whom 26 patients also had fructosamine data. We compared the most recent HbA1c to finger-stick (FS) glucose averaged over three months, and fructosamine to FS averaged over six weeks. Predicted average glucose (pAG) was calculated as reported by Nathan et al: pAG (mg/dL) = 28.7 × A1C% − 46.7. Data were analyzed using the Statistical Analysis System (SAS) and Kruskal–Wallis test. RESULTS HbA1c values underestimated (UE) actual average glucose (aAG) in 19% of these patients and overestimated (OE) aAG in 27%. HbA1c estimated aAG within the established range in only 54% of the patients. There were no statistical differences in the types of HIV medication used in patients with UE, OE, or accurately estimated (AE) glycemia. A Spearman correlation coefficient between HbA1c and aAG was r = 0.53 (P < 0.0001). Correlation between fructosamine and aAG was r = 0.47 (P = 0.016). CONCLUSIONS The correlations between HbA1c and aAG and between fructosamine and aAG were weaker than expected, and fructosamine was not more accurate than HbA1c.
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Affiliation(s)
- So-Young Kim
- Department of Medicine, Beth Israel Medical Center, New York, NY, USA
| | - Patricia Friedmann
- Office of Grants and Research Administration, Beth Israel Medical Center, New York, NY, USA
| | - Amit Seth
- Division of Endocrinology and Friedman Diabetes Institute, Albert Einstein College of Medicine/Beth Israel Medical Center, New York, NY, USA
| | - Adrienne M Fleckman
- Division of Endocrinology and Friedman Diabetes Institute, Albert Einstein College of Medicine/Beth Israel Medical Center, New York, NY, USA
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