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Aguree S, Owora A, Hawkins M, Gletsu-Miller N. Obesity modifies the association between diabetes and iron biomarkers and red cell indices in reproductive-aged women in the United States. J Investig Med 2024; 72:425-437. [PMID: 38445643 DOI: 10.1177/10815589241240059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Obesity and diabetes are associated with impaired iron metabolism. We aimed to examine the independent relationship between diabetes and iron after controlling for body weight (or obesity) in women aged 20-49 years. The National Health and Nutrition Examination Survey data from 2015 to 2018 were used in this investigation. Body composition data, HbAc1, iron biomarkers (serum ferritin (SF), soluble transferrin receptor (sTfR), and body iron index (BII)), mean corpuscular volume (MCV), mean hemoglobin concentration (MCH), red cell distribution width (RDW), and hemoglobin were used. Linear regression models were used to examine how and to what extent body mass index (BMI) modified the relationship between diabetes and iron status biomarkers. A total of 1834 women aged 20-49 were included in the analysis with a mean (SD) age of 32 .2 ± 6.1 years and BMI of 29.5 ± 6.9 kg/m2. The mean SF (p = 0.014) and BII (p < 0.001) were lower, while sTfR (p < 0.001) was higher in women with diabetes than those with no diabetes. Mean estimates for MCV and MCH were lower, while RDW (p = 0.001) was higher in diabetes patients (all p < 0.001). Women with diabetes were more likely to have iron deficiency, anemia, and iron deficiency anemia than those without diabetes (18.1% vs 8.6%, p < 0.001), (24.4% vs 8.4%, p < 0.001), and (14.8% vs 5.2%, p < 0.001), respectively. Among women with obesity, those with diabetes had lower predicted ferritin (β = -0.19, p = 0.016), BII (β = -0.99, p = 0.016), and hemoglobin (β = -0.27, p = 0.042) than those without diabetes. The study shows that diabetes is linked to lower iron stores; this is exacerbated in those with obesity.
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Affiliation(s)
- Sixtus Aguree
- Department of Applied Health Science, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
| | - Arthur Owora
- Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, IN, USA
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Misty Hawkins
- Department of Health and Wellness Design, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Nana Gletsu-Miller
- Department of Applied Health Science, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
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2
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AlQarni AM, Alghamdi AA, Aljubran HJ, Bamalan OA, Abuzaid AH, AlYahya MA, AlAwami AM, Al Shubbar MD, Al Yousif GF. Exploring the Impact of Iron Deficiency Anaemia on Glycated Haemoglobin A1c Levels in Pregnant and Non-Pregnant Women: A Systematic Review. Int J Womens Health 2024; 16:797-809. [PMID: 38765207 PMCID: PMC11100956 DOI: 10.2147/ijwh.s462163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 05/05/2024] [Indexed: 05/21/2024] Open
Abstract
Haemoglobin A1C (HbA1c) is fundamental in monitoring glycaemic control during pregnancy. However, several conditions could affect this test's accuracy, including iron deficiency anaemia (IDA). Hence, this systematic review delves into the underexplored connection between IDA, iron replacement therapy (IRT), and haemoglobin A1C (HbA1c) during pregnancy. An electronic search of the Cochrane, MEDLINE, and Embase databases was conducted by six authors. From a comprehensive search strategy, 968 records were obtained. After applying the inclusion and exclusion criteria, seven studies were included, comprising 365 women selected for analysis. Six studies indicated a positive correlation between IDA and HbA1c levels, while one found no correlation. The average HbA1c level of the included studies in pregnant women was 5.64%. In comparison, it was found that non-pregnant women had lower HbA1c levels. Among the included studies, the mean HbA1c levels decreased from 5.1% to 4.89% after treating pregnant women with IRT. The review emphasises the complexity of interpreting HbA1c levels in pregnant women with IDA, highlighting the influence of pregnancy-induced physiological changes. In addition, this suggests that HbA1c should not be the sole criterion for diabetes management in pregnant women with IDA. Future research should focus on alternative glycaemic monitoring methods unaffected by IDA.
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Affiliation(s)
- Amani M AlQarni
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Amal A Alghamdi
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hussain J Aljubran
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Omar A Bamalan
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdullah H Abuzaid
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohammed A AlYahya
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ahmed M AlAwami
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | - Ghada F Al Yousif
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Crimmins SD, Martin LM, Myers M, Elsamadicy E, Quebedeaux TM, Desai AN, Kopelman JN. Hemoglobin A1c as a Substitute for Oral Glucose Testing in Early Pregnancy Screening. Am J Perinatol 2024; 41:e1895-e1900. [PMID: 37308088 DOI: 10.1055/s-0043-1769796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Current recommendations for individuals with risk factors for gestational diabetes mellitus (GDM) call for screening in early pregnancy. However, there is currently no clear consensus on a specific screening modality. This study evaluates whether a hemoglobin A1c (HbA1c) screening in individuals with risk factors for gestational diabetes (GDM) could be used instead of an early 1-hour glucose challenge test (GCT). We hypothesized that the HbA1c could replace 1-hour GCT in early pregnancy evaluation STUDY DESIGN: This is a prospective observational trial at a single tertiary referral center of women with at least one risk factor for GDM who were screened at <16 weeks of gestation with both 1-hour GCT or HbA1c. Exclusion criteria include: previous diagnosis of diabetes mellitus, multiple gestation, miscarriage, or missing delivery information. The diagnosis of GDM was made by a 3-hour 100-g glucose tolerance test, using the Carpenter-Coustan criteria (at least two results >94, 179, 154, and 139 mg/dL for fasting, 1-, 2-, and 3-hour values, respectively), 1-hour GCT > 200 mg/dL, or HbA1c > 6.5%. RESULTS A total of 758 patients met inclusion criteria. A total of 566 completed a 1-hour GCT and 729 had an HbA1c collected. The median gestational age at testing was 91/7 weeks (range: 40/7-156/7 weeks]. Twenty-one participants were diagnosed with GDM at <16 weeks' GA. The receiver operating characteristic (ROC) curves identified the optimal valves for a positive screen for an HbA1c > 5.6%. The HbA1c had a sensitivity of 84.2%, a specificity of 83.3%, and a false positive rate of 16.7% (p < 0.001). The area under the ROC curve for the HbA1c was 0.898. Gestational age of delivery was slightly earlier with individuals with an elevated HbA1c but no other changes in delivery or neonatal outcomes. Contingent screening improved specificity (97.7%) and decreased false positive rate to 4.4%. CONCLUSION HbA1c may be a good assessment in early pregnancy for gestational diabetes. KEY POINTS · HbA1c is a rational assessment in early pregnancy.. · An HbA1c > 5.6% is associated with gestational diabetes.. · Contingent screening limits the need for additional testing..
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Affiliation(s)
- Sarah D Crimmins
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Rochester Medical Center, Rochester, New York
| | - Lucille M Martin
- Department of Emergency Medicine, Universiy of Maryland Medical Center, Baltimore, Maryland
| | - Madalyn Myers
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Rochester Medical Center, Rochester, New York
| | - Emad Elsamadicy
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Vanderbilt University, Nashville, Tennessee
| | - Tabitha M Quebedeaux
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Louisiana State University, New Orleans, Louisiana
| | - Andrea N Desai
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jerome N Kopelman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland
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Shin KS, Park MS, Lee MY, Cho EH, Woo HY, Park H, Kwon MJ. Baseline glycated albumin level and risk of type 2 diabetes mellitus in Healthy individuals: a retrospective longitudinal observation in Korea. Scand J Clin Lab Invest 2024; 84:168-173. [PMID: 38634263 DOI: 10.1080/00365513.2024.2341412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/07/2024] [Indexed: 04/19/2024]
Abstract
Glycated albumin (GA) reflects glycemic status for the past three weeks. GA level demonstrates a strong correlation with HbA1c level and is used as an adjunctive biomarker for diagnosis and monitoring of type 2 diabetes mellitus (T2DM). In this study, we validated the predictive performance of baseline GA for development of T2DM in healthy individuals in Korea. From August 2013 to September 2014, the medical records of 3,771 healthy Koreans were retrospectively reviewed. Each participant was categorized into tertiles based on initial GA level. During the follow-up period through May 2020, study participants were evaluated for T2DM using HbA1c, fasting glucose level, and a self-reported diagnosis history. Baseline GA level by tertile (T1 to T3) was 10.4 ± 0.8% (mean ± SD), 12.1 ± 0.3%, and 13.7 ± 0.9%, respectively. The median follow-up was 5.97 years, during which 4.9% (186 of 3,771) of the participants developed T2DM. After adjusting for confounding factors, the hazard ratio for the development of T2DM in the highest GA level group (T3) compared to the reference group (T1) was 2.46 (95% CI, 1.7 to 3.58, p < 0.001 for trend) with a Harrell's C index of 0.80 (95% CI, 0.76 to 0.83). Also, within highest group of baseline HbA1c and FG levels, higher GA levels were associated with an increased HRs for T2DM. In conclusion, Our study confirms that the risk of T2DM increases with baseline GA level. Additional follow-up of the cohort is warranted to investigate the correlations between GA and other clinical indicators including diabetic complications.
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Affiliation(s)
- Kang-Su Shin
- Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Min-Seung Park
- Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Mi Yeon Lee
- Division of Biostatistics, Department of R&D Management, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Eun Hye Cho
- Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hee-Yeon Woo
- Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyosoon Park
- Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Min-Jung Kwon
- Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
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5
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Taati B, Ganji R, Moradi L, Vosoughi T, Gisouei A. Therapeutic effect of ferrous sulfate in diabetic patients with iron deficiency anaemia: a randomised controlled trial. Ann Med Surg (Lond) 2024; 86:1989-1996. [PMID: 38576965 PMCID: PMC10990329 DOI: 10.1097/ms9.0000000000001838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/04/2024] [Indexed: 04/06/2024] Open
Abstract
Iron deficiency anaemia (IDA) and diabetes mellitus (DM) are most prevalent disease, that diabetic patients are more prone to IDA. Therefore, the main aim of this study was to investigate the relationship between patients with diabetes and IDA in relation to taking iron pills daily and every other day to reduce the effects related to it. Ninety-one participants were enroled and randomly divided into two groups, with a final analysis cohort of 72 patients. The primary focus was on changes in serum Hb and Ferritin levels. The screening phase lasted 24 weeks, leading to 72 eligible participants meeting the criteria for entry into the study. Additionally, the study examined alternations in Hb and Hb A1C levels after treating patients with iron deficiency. The Hb and ferritin level contrasts between groups were not significant (P = 0.096 and P = 0.500, respectively). The relationship between Hb A1C and Hb levels before and after treatment was positive and significant (r 2 = 0.187). The results of the present study show that although the effectiveness of using oral iron supplements did not have a significant difference in terms of increasing haemoglobin and ferritin, the use of oral iron once every other day was more effective than the use of oral iron every day, and also in this study Like other studies, this result concluded that there is a negative correlation between Hb A1C and Hb, and to check the status of Hb A1C in diabetics, the level of Hb should be considered first.
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Affiliation(s)
- Bahareh Taati
- Department of Clinical Pharmacy, Faculty of Pharmacy
| | - Reza Ganji
- Department of Clinical Pharmacy, Faculty of Pharmacy
| | | | - Tina Vosoughi
- Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz
| | - Amir Gisouei
- Amir Gisouee, Internal Medicine Specialist, Shadegan, Iran
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6
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Bovee LB, Hirsch IB. Should We Bury HbA1c? Diabetes Technol Ther 2024. [PMID: 38350127 DOI: 10.1089/dia.2024.0028] [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: 02/15/2024]
Affiliation(s)
- Laura B Bovee
- University of Washington Medicine Diabetes Institute, Seattle, Washington, USA
| | - Irl B Hirsch
- University of Washington Medicine Diabetes Institute, Seattle, Washington, USA
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7
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Uskach TM, Tereschenko SN. [The Effects of Therapy for Iron Deficiency in Patients With Different Etiologies of Heart Failure and Concomitant Diseases]. KARDIOLOGIIA 2023; 63:87-95. [PMID: 38088117 DOI: 10.18087/cardio.2023.11.n2604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/23/2023] [Indexed: 12/18/2023]
Abstract
Iron deficiency (ID) in patients with heart failure (HF) is a factor for unfavorable course and prognosis of the disease. The significance of ID in the diagnosis and treatment of HF has previously been demonstrated by multiple studies and meta-analyses. Therapy for ID in patients with HF is one of the most relevant and discussed issues. The use of intravenous iron medicinal products for the treatment of ID is currently being actively studied in patients of various categories; attempts are being made to specify the indications for use to produce the greatest effect on the prognosis and quality of life of HF patients.
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Affiliation(s)
- T M Uskach
- Chazov National Medical Research Center, Moscow; Russian Medical Academy of Continuous Professional Education, Moscow
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Ashraf S, Qaiser H, Tariq S, Khalid A, Makeen HA, Alhazmi HA, Ul-Haq Z. Unraveling the versatility of human serum albumin - A comprehensive review of its biological significance and therapeutic potential. Curr Res Struct Biol 2023; 6:100114. [PMID: 38111902 PMCID: PMC10726258 DOI: 10.1016/j.crstbi.2023.100114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 12/20/2023] Open
Abstract
Human serum albumin (HSA) is a multi-domain macromolecule with diverse ligand binding capability because of its ability to allow allosteric modulation despite being a monomeric protein. Physiologically, HSA act as the primary carrier for various exogenous and endogenous compounds and fatty acids, and alter the pharmacokinetic properties of several drugs. It has antioxidant properties and is utilized therapeutically to improve the drug delivery of pharmacological agents for the treatment of several disorders. The flexibility of albumin in holding various types of drugs coupled with a variety of modifications makes this protein a versatile drug carrier with incalculable potential in therapeutics. This review provides a brief outline of the different structural properties of HSA, and its various binding sites, moreover, an overview of the genetic, biomedical, and allosteric modulation of drugs and drug delivery aspects of HSA is also included, which may be helpful in guiding advanced clinical applications and further research on the therapeutic potential of this extraordinary protein.
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Affiliation(s)
- Sajda Ashraf
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75210, Pakistan
| | - Hina Qaiser
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75210, Pakistan
| | - Sumayya Tariq
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75210, Pakistan
| | - Asaad Khalid
- Substance Abuse and Toxicology Research Center, Jazan University, P.O. Box: 114, Jazan, Saudi Arabia
- Medicinal and Aromatic Plants Research Institute, National Center for Research, P.O. Box: 2424, Khartoum, 11111, Sudan
| | - Hafiz A. Makeen
- Pharmacy Practice Research Unit, Clinical Pharmacy Department, Faculty of Pharmacy, Jazan University, Jazan, Saudi Arabia
| | - Hassan A. Alhazmi
- Substance Abuse and Toxicology Research Center, Jazan University, P.O. Box: 114, Jazan, Saudi Arabia
- Department of Pharmaceutical Chemistry and Pharmacognosy, College of Pharmacy, Jazan University, P.O. Box 114, 45142, Jazan, Saudi Arabia
| | - Zaheer Ul-Haq
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75210, Pakistan
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AlQarni AM, Alghamdi AA, Aljubran HJ, Bamalan OA, Abuzaid AH, AlYahya MA. The Effect of Iron Replacement Therapy on HbA1c Levels in Diabetic and Nondiabetic Patients: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:7287. [PMID: 38068338 PMCID: PMC10707099 DOI: 10.3390/jcm12237287] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Several studies have reported that iron-deficiency anemia (IDA) and its treatment might lead to a distorted reading of glycated hemoglobin (HbA1c) value. Hence, this review aims to systematically investigate the effect of iron replacement therapy (IRT) on HbA1c levels, as the literature is deficient in assessing this clinical phenomenon. METHODS An electronic search of the Cochrane, MEDLINE, and Embase databases was conducted by four independent authors. RESULTS Among the 8332 articles identified using the search strategy, 10 records (with a total of 2113 participants) met the inclusion criteria and were analyzed. In nine of the studies, IRT was found to decrease HbA1c levels; in the remaining study, IRT was found to increase HbA1c levels. The effect size of the pooled standardized mean difference in HbA1c levels between the treatment and control groups with IDA was 1.8 (95% CI = -0.5, 2.31). Heterogeneity was assessed using the I2 and χ2 tests, and the resultant values were 98.46% and p = 0.09, respectively. Additionally, the mean difference between the HbA1c levels (pre-IRT and post-IRT) showed a drop in the HbA1c levels which ranged from 1.20 to 0.43 mg/dL. CONCLUSIONS The results suggest that IRT decreases HbA1c levels, and it is helpful in treating IDA patients with poor glycemic control. Accordingly, the results provide an added perspective on antidiabetic medication dosing and physicians' interpretation of initially elevated HbA1c values.
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Affiliation(s)
- Amani M. AlQarni
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia; (A.A.A.); (H.J.A.); (O.A.B.); (A.H.A.); (M.A.A.)
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10
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Wallam S, Abusamaan MS, Clarke W, Mathioudakis N. Factors Associated With Discordant A1C-Estimated and Measured Average Glucose Among Hospitalized Patients With Diabetes. Clin Diabetes 2023; 41:208-219. [PMID: 37092143 PMCID: PMC10115769 DOI: 10.2337/cd22-0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In this retrospective analysis, we explored the correlation between measured average glucose (mAG) and A1C-estimated average glucose (eAG) in hospitalized patients with diabetes and identified factors associated with discordant mAG and eAG at the transition from home to hospital. Having mAG lower than eAG was associated with Black race, other race, increasing length of stay, community hospital setting, surgery, fever, metformin use, certain inpatient diets, home antihyperglycemic treatment, and coded type 1 or type 2 diabetes. Having mAG higher than eAG was associated with certain discharge services (e.g., intensive care unit), higher BMI, hypertension, tachycardia, higher albumin, higher potassium, anemia, inpatient glucocorticoid use, and treatment with home insulin, secretagogues, and glucocorticoids. These factors should be considered when using patients' A1C as an indicator of outpatient glycemic control to determine the inpatient antihyperglycemic regimens.
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Affiliation(s)
- Sara Wallam
- Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mohammed S. Abusamaan
- Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD
| | - William Clarke
- Division of Clinical Chemistry, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nestoras Mathioudakis
- Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD
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11
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Rosano G, Ponikowski P, Vitale C, Anker SD, Butler J, Fabien V, Filippatos G, Kirwan BA, Macdougall IC, Metra M, Ruschitzka F, Kumpeson V, Goehring UM, van der Meer P, Jankowska EA. Intravenous ferric carboxymaltose for iron repletion following acute heart failure in patients with and without diabetes: a subgroup analysis of the randomized AFFIRM-AHF trial. Cardiovasc Diabetol 2023; 22:215. [PMID: 37592272 PMCID: PMC10436432 DOI: 10.1186/s12933-023-01943-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/27/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND In AFFIRM-AHF, treatment of iron deficiency with intravenous ferric carboxymaltose (FCM) reduced the risk of heart failure (HF) hospitalization and improved quality of life (QoL) vs placebo in patients stabilized following an acute HF (AHF) episode, with no effect on cardiovascular (CV) death. Diabetes and iron deficiency frequently accompany AHF. This post hoc analysis explored the effects of diabetes on outcomes in AFFIRM-AHF patients. METHODS Patients were stratified by diabetes yes/no at baseline. The effects of FCM vs placebo on primary (total HF hospitalizations and CV death) and secondary (total CV hospitalizations and CV death; CV death; total HF hospitalizations; time to first HF hospitalization or CV death; and days lost due to HF hospitalizations or CV death) endpoints at Week 52 and change vs baseline in disease-specific QoL (12-item Kansas City Cardiomyopathy Questionnaire [KCCQ-12]) at Week 24 were assessed by subgroup. For each endpoint, the interaction between diabetes status and treatment outcome was explored. RESULTS Of 1108 AFFIRM-AHF patients, 475 (FCM: 231; placebo: 244) had diabetes and 633 (FCM: 327; placebo: 306) did not have diabetes. Patients with diabetes were more commonly male (61.5% vs 50.9%), with a higher frequency of ischemic HF etiology (57.9% vs 39.0%), prior HF history (77.7% vs 66.5%), and comorbidities (including previous myocardial infarction [49.3% vs 32.9%] and chronic kidney disease [51.4% vs 32.4%]) than those without diabetes. The annualized event rate/100 patient-years with FCM vs placebo for the primary endpoint was 66.9 vs 80.9 in patients with diabetes (rate ratio [RR]: 0.83, 95% CI 0.58-1.81) and 51.3 vs 66.9 in patients without diabetes (RR: 0.77, 95% CI 0.55-1.07), with no significant interaction between diabetes status and treatment effect (pinteraction = 0.76). Similar findings were observed for secondary outcomes. Change from baseline in KCCQ-12 overall summary score was numerically greater with FCM vs placebo at almost all time points in both subgroups, with no interaction between diabetes and treatment effect at Week 24. CONCLUSIONS The clinical and QoL benefits observed with intravenous FCM in patients with iron deficiency following stabilization from an AHF episode are independent of diabetes status. Trial registration Clinicaltrials.gov, NCT02937454 (registered 10.18.2016).
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Affiliation(s)
- Giuseppe Rosano
- Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele, Rome, Italy.
| | - Piotr Ponikowski
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland
| | - Cristiana Vitale
- Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele, Rome, Italy
| | - Stefan D Anker
- Department of Cardiology (CVK) of German Heart Center Charité; Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin, Berlin, Germany
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, TX, USA
- University of Mississippi, Jackson, MS, USA
| | | | - Gerasimos Filippatos
- National and Kapodistrian University of Athens Medical School, Athens University Hospital Attikon, Athens, Greece
| | - Bridget-Anne Kirwan
- Department of Clinical Research, SOCAR Research SA, Nyon, Switzerland
- London School of Hygiene and Tropical Medicine, University College London, London, UK
| | | | - Marco Metra
- Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | | | | | - Peter van der Meer
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Ewa A Jankowska
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
- Institute of Heart Diseases, University Hospital, Wroclaw, Poland
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12
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Hu S, Lin S, Feng Q, He X, Xu H, Chen L, Sun N. Iron Complexes with Antarctic Krill-Derived Peptides Show Superior Effectiveness to Their Original Protein-Iron Complexes in Mice with Iron Deficiency Anemia. Nutrients 2023; 15:nu15112510. [PMID: 37299473 DOI: 10.3390/nu15112510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/21/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023] Open
Abstract
Antarctic krill protein-iron complex and peptide-iron complex were acquired to investigate their iron bioavailability, expression of iron-regulated genes, and in vivo antioxidant capacity. Results indicated that the Antarctic krill peptide-iron complex significantly increased the hemoglobin (Hb), serum iron (SI), and iron contents in the liver and spleen in iron-deficiency anemia (IDA) mice (p < 0.05) compared with those of the Antarctic krill protein-iron complex. Despite the gene expressions of the divalent metal transporter 1(DMT1), the transferrin (Tf), and the transferrin receptor (TfR) being better regulated by both Antarctic krill peptide-iron complex and protein-iron complex, the relative iron bioavailability of the Antarctic krill peptide-iron complex group (152.53 ± 21.05%) was significantly higher than that of the protein-iron complex group (112.75 ± 9.60%) (p < 0.05). Moreover, Antarctic krill peptide-iron complex could enhance the antioxidant enzyme activities of superoxidase dismutase (SOD) and glutathione peroxidase (GSH-Px), reduce the malondialdehyde (MDA) level in IDA mice compared with the protein-iron complex, and reduce the cell damage caused by IDA. Therefore, these results indicated that Antarctic krill peptide-iron complex could be used as a highly efficient and multifunctional iron supplement.
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Affiliation(s)
- Shengjie Hu
- School of Food Science and Technology, National Engineering Research Center of Seafood, Dalian Polytechnic University, Dalian 116034, China
| | - Songyi Lin
- School of Food Science and Technology, National Engineering Research Center of Seafood, Dalian Polytechnic University, Dalian 116034, China
- State Key Laboratory of Marine Food Processing and Safety Control, Dalian Polytechnic University, Dalian 116034, China
| | - Qi Feng
- School of Food Science and Technology, National Engineering Research Center of Seafood, Dalian Polytechnic University, Dalian 116034, China
| | - Xueqing He
- School of Food Science and Technology, National Engineering Research Center of Seafood, Dalian Polytechnic University, Dalian 116034, China
| | - Haowei Xu
- School of Food Science and Technology, National Engineering Research Center of Seafood, Dalian Polytechnic University, Dalian 116034, China
| | - Lei Chen
- School of Food Science and Technology, National Engineering Research Center of Seafood, Dalian Polytechnic University, Dalian 116034, China
| | - Na Sun
- School of Food Science and Technology, National Engineering Research Center of Seafood, Dalian Polytechnic University, Dalian 116034, China
- State Key Laboratory of Marine Food Processing and Safety Control, Dalian Polytechnic University, Dalian 116034, China
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Patil S, Biradar SM, Holyachi R, Devarmani S, Reddy S. Assessment of Serum Electrolytes and Glycated Hemoglobin Level in Non-diabetic Iron-Deficient Anaemic Patients. Cureus 2023; 15:e38656. [PMID: 37288229 PMCID: PMC10242358 DOI: 10.7759/cureus.38656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2023] [Indexed: 06/09/2023] Open
Abstract
INTRODUCTION The WHO has recognised iron deficiency anaemia (IDA) as the most common nutritional deficiency in the world, with 30% of the population being affected by this condition. The patient's glycemic status during the past three months is shown by the glycated haemoglobin A1C (HbA1c) test. According to several studies, iron deficiency can increase HbA1C levels without affecting blood sugar levels. HbA1C levels of ≥ 6.5% have been approved by the American Diabetes Association (ADA) as a diagnostic indicator for diabetes mellitus (DM). An imbalance in serum electrolyte levels and anaemia have been linked by several studies. Aim: To analyze the effect of iron deficiency anaemia on HbA1c levels and serum electrolytes in an adult non-diabetic population. METHODS This was a descriptive cross-sectional study conducted in Shri BM Patil Medical College, Hospital and Research Centre, Vijayapura, Karnataka, India from January 2021 to June 2022. A total of 65 moderate to severe normoglycemic iron deficiency anemia patients between 18 to 75 years were enrolled in the study after fulfilling inclusion and exclusion criteria. A detailed history, clinical and biochemical examination was performed including HbA1c levels. The results were pooled and statistical analyses were performed using Statistical Package for Social Sciences (SPSS) version 20 (IBM Corp., Armonk, NY, USA). RESULTS We found elevated HbA1c levels (5.67±1.1%) in non-diabetic iron-deficient anaemia individuals, and elevation was more in women of reproductive age group (30.8%). There was a statistically significant Spearman negative correlation between hemoglobin and HbA1C levels. Also, 16 patients had hyponatremia with a mean haemoglobin (Hb) of 4.8 g/dL and one patient had hyperkalemia with a mean Hb of 3.2 g/dL which was statistically non-significant. CONCLUSION In this study haemoglobin and HbA1c had a statistically significant positive correlation with serum sodium and a negative correlation with serum potassium in moderate to severely iron-deficient anaemic patients, especially females of the reproductive age group.
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Affiliation(s)
- Shirish Patil
- General Medicine, BLDE (DU) Shri B M Patil Medical College Hospital and Research Centre, Vijayapura, IND
| | - Siddanagouda M Biradar
- General Medicine, BLDE (DU) Shri B M Patil Medical College Hospital and Research Centre, Vijayapura, IND
| | - Renuka Holyachi
- Anaesthesiology, BLDE (DU) Shri B M Patil Medical College Hospital and Research Centre, Vijayapura, IND
| | - Shashidhar Devarmani
- General Medicine, BLDE (DU) Shri B M Patil Medical College Hospital and Research Centre, Vijayapura, IND
| | - Sethu Reddy
- Internal Medicine, BLDE (DU) Shri B M Patil Medical College Hospital and Research Centre, Vijayapura, IND
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14
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A case of a novel hemoglobin variant, Hb A2-Karatsu, discovered following a falsely elevated HbA1c value. Clin Chim Acta 2022; 537:154-157. [DOI: 10.1016/j.cca.2022.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/10/2022] [Accepted: 10/17/2022] [Indexed: 11/19/2022]
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15
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Patel NJ, Tozzo V, Higgins JM, Stone JH. The Effects of Daily Prednisone and Tocilizumab on Hemoglobin A 1c During the Treatment of Giant Cell Arteritis. Arthritis Rheumatol 2022; 75:586-594. [PMID: 36383175 DOI: 10.1002/art.42405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/17/2022] [Accepted: 11/08/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To study the longitudinal effects of both glucocorticoids and tocilizumab, an interleukin-6 receptor inhibitor, on hemoglobin A1c (HbA1c ) levels during glucocorticoid tapering. METHODS We analyzed patients with complete data from the Tocilizumab in Giant Cell Arteritis (GiACTA) trial to investigate the impact of both glycemic and nonglycemic factors on changes in HbA1c levels over the 52-week trial. Giant cell arteritis (GCA) patients were randomized to receive either tocilizumab or placebo in addition to glucocorticoids. We used a multivariable mixed-effects model to evaluate associations of HbA1c level with daily glucocorticoid dose, randomization to receive tocilizumab, and red blood cell count in patients with and those without diabetes mellitus at baseline, over 52 weeks. RESULTS In 209 patients, the median HbA1c level decreased by 0.50% (P < 0.01) in the group that received both tocilizumab and glucocorticoids (tocilizumab/glucocorticoid) and by 0.10% (P < 0.01) in the glucocorticoid-only group. Randomization to tocilizumab/glucocorticoid was associated with lower HbA1c (β = -0.209% in those without diabetes, P < 0.01; β = -0.290% in those with diabetes, P = 0.23). These changes had a sizable impact on glucose tolerance classification: 42.5% of patients in the tocilizumab/glucocorticoid group improved from prediabetes status to normal, compared to only 12.5% of patients treated with glucocorticoids alone. Daily glucocorticoid dose was associated with HbA1c level in patients with baseline diabetes (β = 0.018%/mg, P < 0.01) and those without baseline diabetes (β = 0.005%/mg, P < 0.01). CONCLUSION Tocilizumab treatment was associated with a substantial reduction in HbA1c level, independent of glucocorticoid exposure, which may be achieved through a combination of glycemic and nonglycemic effects.
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Affiliation(s)
- Naomi J Patel
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston
| | - Veronica Tozzo
- Department of Pathology and Center for Systems Biology, Massachusetts General Hospital, and Department of Systems Biology, Harvard Medical School, Boston, Massachusetts
| | - John M Higgins
- Department of Pathology and Center for Systems Biology, Massachusetts General Hospital, and Department of Systems Biology, Harvard Medical School, Boston, Massachusetts
| | - John H Stone
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston
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Jyothsna P, Suchitra MM, Kusuma Kumari M, Chandrasekhar C, Rukmangadha N, Alok S, Siddhartha Kumar B. Effect of Iron Deficiency Anemia on Glycated Albumin Levels: A Comparative Study in Nondiabetic Subjects with Iron Deficiency Anemia. J Lab Physicians 2022. [DOI: 10.1055/s-0042-1757589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Abstract
Objective Glycated hemoglobin A1c (HbA1c), used for monitoring glycemia control, is altered in iron deficiency anemia (IDA). Glycated albumin (GA) is considered an alternate biomarker to HbA1c. However, effect of IDA on GA needs to be studied.
Materials and Methods Thirty nondiabetic cases with IDA and 30 healthy controls were included. Fasting plasma glucose (FPG), creatinine, urea, albumin, total protein, ferritin, iron, unsaturated iron binding capacity, hemoglobin (Hb), HbA1c, complete hemogram, and GA were estimated. Transferrin saturation and total iron binding capacity (TIBC) were calculated. Statistical analysis was done using unpaired two-tailed t-test/Mann–Whitney U-test and Pearson's correlation/Spearman-rank correlation, as appropriate.
Results Total protein, albumin, Hb, iron, ferritin, and transferrin saturation were significantly lower while FPG, GA, TIBC, and HbA1c were significantly higher in cases compared to controls. HbA1C and GA have a significant negative correlation with iron, transferrin saturation, and ferritin. Significant negative correlations of GA with albumin (r = –0.754; p < 0.001) and Hb (r = –0.435; p = 0.001) and that of HbA1c with albumin (r = –0.271; p = 0.03) and Hb (r = –0.629; p < 0.001) while significant positive correlation of Hb with albumin (r = 0.395; p = 0.002) and HbA1c with FPG (r = 0.415; p = 0.001) were observed.
Conclusion Low albumin levels increase plasma protein glycation, including albumin. Hence, elevated GA levels indicate false elevation of GA in scenario of lowered albumin observed in IDA, similar to HbA1c. Thus, using GA in diabetes mellitus with IDA should be avoided or used with caution to prevent potentially inappropriate treatment intensification and risk of hypoglycemia.
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Affiliation(s)
- Pralayakaveri Jyothsna
- Department of Biochemistry, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Musturu M. Suchitra
- Department of Biochemistry, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Medooru Kusuma Kumari
- Department of Biochemistry, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - C. Chandrasekhar
- Department of Hematology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Nandyala Rukmangadha
- Department of Pathology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Sachan Alok
- Department of Endocrinology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
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Vehik K, Boulware D, Killian M, Rewers M, McIndoe R, Toppari J, Lernmark Å, Akolkar B, Ziegler AG, Rodriguez H, Schatz DA, Krischer JP, Hagopian W. Rising Hemoglobin A1c in the Nondiabetic Range Predicts Progression of Type 1 Diabetes As Well As Oral Glucose Tolerance Tests. Diabetes Care 2022; 45:2342-2349. [PMID: 36150054 PMCID: PMC9587339 DOI: 10.2337/dc22-0828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/15/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Biomarkers predicting risk of type 1 diabetes (stage 3) among children with islet autoantibodies are greatly needed to prevent diabetic ketoacidosis and facilitate prevention therapies. RESEARCH DESIGN AND METHODS Children in the prospective The Environmental Determinants of Diabetes in the Young (TEDDY) study (n = 707) with confirmed diabetes-associated autoantibodies (GAD antibody, IA-2A, and/or insulin autoantibody) and two or more HbA1c measurements were followed to diabetes or median age 11.1 years. Once confirmed autoantibody positive, HbA1c was measured quarterly. Cox models and receiver operative characteristic curve analyses revealed the prognostic utility for risk of stage 3 on a relative HbA1c increase from the baseline visit or an oral glucose tolerance test (OGTT) 2-h plasma glucose (2-hPG). This HbA1c approach was then validated in the Type 1 Diabetes TrialNet Pathway to Prevention Study (TrialNet) (n = 1,190). RESULTS A 10% relative HbA1c increase from baseline best marked the increased risk of stage 3 in TEDDY (74% sensitive; 88% specific). Significant predictors of risk for HbA1c change were age and HbA1c at the baseline test, genetic sex, maximum number of autoantibodies, and maximum rate of HbA1c increase by time of change. The multivariable model featuring a HbA1c ≥10% increase and these additional factors revealed increased risk of stage 3 in TEDDY (hazard ratio [HR] 12.74, 95% CI 8.7-18.6, P < 0.0001) and TrialNet (HR 5.09, 95% CI 3.3-7.9, P < 0.0001). Furthermore, the composite model using HbA1c ≥10% increase performed similarly to an OGTT 2-hPG composite model (TEDDY area under the curve [AUC] 0.88 and 0.85, respectively) and to the HbA1c model in TrialNet (AUC 0.82). CONCLUSIONS An increase of ≥10% in HbA1c from baseline is as informative as OGTT 2-hPG in predicting risk of stage 3 in youth with genetic risk and diabetes-associated autoantibodies.
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Affiliation(s)
- Kendra Vehik
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - David Boulware
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL
| | | | - Marian Rewers
- Barbara Davis Center for Childhood Diabetes, University of Colorado, Aurora, CO
| | - Richard McIndoe
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Georgia Regents University, Augusta, GA
| | - Jorma Toppari
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, and Department of Pediatrics, Turku University Hospital, Turku, Finland
| | - Åke Lernmark
- Department of Clinical Sciences, Lund University/Clinical Research Centre, Skane University Hospital, Malmö, Sweden
| | - Beena Akolkar
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | - Anette-G. Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München, and Klinikum rechts der Isar, Technische Universität München, and Forschergruppe Diabetes e.V. Neuherberg, Germany
| | - Henry Rodriguez
- USF Diabetes and Endocrinology Center, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Desmond A. Schatz
- Diabetes Center of Excellence, University of Florida, Gainesville, FL
| | - Jeffrey P. Krischer
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL
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Kasujja FX, Mayega RW, Daivadanam M, Kiracho EE, Kusolo R, Nuwaha F. Glycated haemoglobin and fasting plasma glucose tests in the screening of outpatients for diabetes and abnormal glucose regulation in Uganda: A diagnostic accuracy study. PLoS One 2022; 17:e0272515. [PMID: 35925994 PMCID: PMC9352087 DOI: 10.1371/journal.pone.0272515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/20/2022] [Indexed: 11/18/2022] Open
Abstract
Background and objectives To understand the utility of glycated haemoglobin (HBA1C) in screening for diabetes and Abnormal Glucose Regulation (AGR) in primary care, we compared its performance to that of the fasting plasma glucose (FPG) test. Methods This was a prospective diagnostic accuracy study conducted in eastern Uganda. Patients eligible for inclusion were consecutive adults, 30–75 years, receiving care at the outpatient department of a general hospital in eastern Uganda. We determined the sensitivity, specificity and optimum cut-off points for HBA1C and FPG tests using the oral glucose tolerance test (OGTT) as a clinical reference standard. Results A total of 1659 participants underwent FPG testing of whom 310 were also HBA1C and OGTT tested. A total of 113 tested positive for diabetes and 168 for AGR on the OGTT. At recommended cut-off points for diabetes, the HBA1C and FPG tests had comparable sensitivity [69.8% (95% CI 46.3–86.1) versus 62.6% (95% CI 41.5–79.8), respectively] and specificity [98.6% (95% CI 95.4–99.6) versus 99.4% (95% CI 98.9–99.7), respectively]. Similarly, the sensitivity of HBA1C and the FPG tests for Abnormal Glucose Regulation (AGR) at ADA cut-offs were comparable [58.9% (95% CI 46.7–70.2) vs 47.7% (95% CI 37.3–58.4), respectively]; however, the HBA1C test had lower specificity [70.7% (95% CI 65.1–75.8)] than the FPG test [93.5% (95% CI 88.6–96.4)]. At the optimum cut-offs points for diabetes [45.0 mmol/mol (6.3%) for HBA1C and 6.4 mmol/L (115.2 mg/dl) for FPG], HBA1C and FPG sensitivity [71.2% (95% CI 46.9–87.8) versus 72.7% (95% CI 49.5–87.8), respectively] and specificity [95.1% (95% CI91.8 97.2) versus 98.7% (95% CI 98.0 99.2), respectively] were comparable. Similarly, at the optimum cut-off points for AGR [42.0 mmol/mol (6.0%) for the HBA1C and 5.5 mmol/l (99.0 mg/dl) for the FPG test], HBA1C and FPG sensitivity [42.3% (95% CI 31.8–53.6) and 53.2 (95% CI 43.1–63.1), respectively] and specificity [89.1% (95% CI 84.1 92.7) and 92.7% (95% CI 91.0 94.1), respectively] were comparable. Discussion HBA1C is a viable alternative diabetes screening and confirmatory test to the FPG test; however, the utility of both tests in screening for prediabetes in this outpatient population is limited.
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Affiliation(s)
- Francis Xavier Kasujja
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
- Chronic Diseases and Cancer Theme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- * E-mail:
| | - Roy William Mayega
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Meena Daivadanam
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
- Department of Women’s and Children’s Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - Elizabeth Ekirapa Kiracho
- Department of Health Policy, Planning, and Management, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ronald Kusolo
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Fred Nuwaha
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
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Guo ZH, Tian HL, Zhang XQ, Zhang DH, Wang ZM, Wang K, Su WW, Chen F. Effect of anemia and erythrocyte indices on hemoglobin A1c levels among pregnant women. Clin Chim Acta 2022; 534:1-5. [PMID: 35803335 DOI: 10.1016/j.cca.2022.07.002] [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: 05/21/2022] [Revised: 06/27/2022] [Accepted: 07/04/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Anemia is a common disorder among pregnant women; however, the effect of anemia on hemoglobin A1c (HbA1c) levels has not been adequately explored. We aim to examine the influence of anemia on the HbA1c concentration and investigate the relationship between erythrocyte indices and HbA1c levels during pregnancy. METHODS We performed a retrospective analysis of 1369 pregnant Chinese women. The clinical and analytical data were collected. Independent t-test and Analysis of Variance were used for comparative studies, and multiple linear regression analysis was used to identify the association between erythrocyte indices and HbA1c. RESULTS The differences in HbA1c between non-anemia and mild anemia were negligible, and the differences in HbA1c between non-anemia and moderate anemia were well within the allowable variability for clinical practice (≥0.5% absolute changes). Mean corpuscular hemoglobin (MCH) correlated with HbA1c significantly, independent of pregnancy, trimester, and anemia. The distinction of HbA1c levels between grades of Hb became no significant (P = 0.955), while differences between trimesters persisted after adjusting for MCH. CONCLUSION Mild and moderate anemia should not be the primary concern when using HbA1c to monitor blood glucose in pregnancy. MCH showed negative correlations with HbA1c independently, suggesting a previously unknown mechanism affecting HbA1c levels.
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Affiliation(s)
- Zong-Hui Guo
- Department of Medical Laboratory, PKU Care Luzhong Hospital, Zibo, People's Republic of China.
| | - Huai-Liang Tian
- Department of Medical Laboratory, PKU Care Luzhong Hospital, Zibo, People's Republic of China
| | - Xiao-Qian Zhang
- Department of Medical Laboratory, PKU Care Luzhong Hospital, Zibo, People's Republic of China
| | - Deng-Han Zhang
- Department of Medical Laboratory, PKU Care Luzhong Hospital, Zibo, People's Republic of China
| | - Zhi-Min Wang
- Department of Medical Laboratory, PKU Care Luzhong Hospital, Zibo, People's Republic of China
| | - Kun Wang
- Department of Medical Laboratory, PKU Care Luzhong Hospital, Zibo, People's Republic of China
| | - Wen-Wen Su
- Department of Medical Laboratory, PKU Care Luzhong Hospital, Zibo, People's Republic of China
| | - Fei Chen
- Department of Medical Laboratory, PKU Care Luzhong Hospital, Zibo, People's Republic of China
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Abstract
A high hemoglobin glycation index (HGI) has been repeatedly associated with greater risk for hypoglycemia in people with diabetes and greater risk for chronic vascular disease in people with or without diabetes. This review explores how different sources of analytical and biological variation in HbA1c and blood glucose individually and collectively affect the clinical information value of HGI. We conclude that HGI is a complex quantitative trait that is a clinically practical biomarker of risk for both hypoglycemia and chronic vascular disease.
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Affiliation(s)
- James M Hempe
- Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
| | - Daniel S Hsia
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
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21
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Gulia M, Gupta M, Singh Lehl S, Singla M, Tahlan A, Kaur J. Mean platelet volume and glycaemic control in patients with new-onset Type 2 diabetes mellitus. J R Coll Physicians Edinb 2022; 52:105-109. [DOI: 10.1177/14782715221107948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Type 2 diabetes mellitus (T2DM) is a metabolic disorder associated with vascular complications that are attributable to dysregulated platelet reactivity as measured by mean platelet volume (MPV). This study aimed at determining a relationship between MPV and glycaemic control in new-onset T2DM. Materials and methods: This was a prospective study conducted on 236 new-onset T2DM patients divided in two groups as group A, glycosylated haemoglobin A1c (HbA1c < 7.9%; n = 70) and group B, HbA1c ⩾ 8% ( n = 107) who were followed up for 6 months for change in platelet and glycaemic parameters. Results: At 6-month follow-up, there was a significant decrease in HbA1c and MPV (group A (HbA1c: 7.40 ± 0.40 vs 7.03 ± 0.23%, p < 0.03; MPV: 9.65 fl ± 0.74 vs 9.46 fl ± 0.71, p < 0.001) and group B (HbA1c: 10.59 ± 1.89% vs 9.29 ± 1.50%, p < 0.001; MPV: 10.89 fL ± 1.29 vs. 10.23 fL ± 1.40, p< 0.001)). The percentage decline in HbA1c was more in group B (11.81 ± 5.87 vs 4.76 ± 4.58, p < 0.01). There was a positive correlation between ΔMPV and ΔHbA1c in group B; however, we did not observe significant correlation for group A. Conclusion: We interpret that in people with diabetes with baseline HbA1c ⩾ 8%, with improvement in glycaemic control, there is a significant decrease in MPV. We propose that a routine MPV testing can be used as a potential marker for glycaemic control in T2DM.
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Affiliation(s)
- Manisha Gulia
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Monica Gupta
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Sarabmeet Singh Lehl
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Mandeep Singla
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Anita Tahlan
- Department of Pathology, Government Medical College and Hospital, Chandigarh, India
| | - Jasbinder Kaur
- Department of Biochemistry, Government Medical College and Hospital, Chandigarh, India
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22
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A Review on the Recent Advancements on Therapeutic Effects of Ions in the Physiological Environments. PROSTHESIS 2022. [DOI: 10.3390/prosthesis4020026] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This review focuses on the therapeutic effects of ions when released in physiological environments. Recent studies have shown that metallic ions like Ag+, Sr2+, Mg2+, Mn2+, Cu2+, Ca2+, P+5, etc., have shown promising results in drug delivery systems and regenerative medicine. These metallic ions can be loaded in nanoparticles, mesoporous bioactive glass nanoparticles (MBGNs), hydroxyapatite (HA), calcium phosphates, polymeric coatings, and salt solutions. The metallic ions can exhibit different functions in the physiological environment such as antibacterial, antiviral, anticancer, bioactive, biocompatible, and angiogenic effects. Furthermore, the metals/metalloid ions can be loaded into scaffolds to improve osteoblast proliferation, differentiation, bone development, fibroblast growth, and improved wound healing efficacy. Moreover, different ions possess different therapeutic limits. Therefore, further mechanisms need to be developed for the highly controlled and sustained release of these ions. This review paper summarizes the recent progress in the use of metallic/metalloid ions in regenerative medicine and encourages further study of ions as a solution to cure diseases.
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AYDIN B, GÖNDEREN A. Integrity loss of glycosylated hemoglobin with deepening anemia. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1098573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: Iron deficiency anemia (IDA) has been shown to cause a false increase in glycosylated hemoglobin (HBA1c), but how much increase in hemoglobin (Hgb) causes a certain decrease in HBA1c remains unknown. Knowledge of this ratio will enable more accurate clinical diagnosis and follow-up of diabetes. This study aimed to investigate whether IDA causes a decrease in HBA1c and if it does, how much of a decrease it causes.
Material and Method: One hundred and twenty-two patients with IDA made up the study group and sixty-two health volunteers formed the control group. 270 mg ferrous sulphate (=80 mg elemental iron) were administered to the study group each day, orally for 3 months, and a control of age/sex matched healthy participants were monitored. Hgb, serum iron, serum iron binding capacity (SIBC), ferritin and HbA1c levels of all participants were measured and compared at baseline and at the third month of the study.
Results: There was a significant decrease in HbA1c and SIBC levels at baseline and 3 months in the study group (p
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Affiliation(s)
- Bünyamin AYDIN
- KÜTAHYA SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, TIP FAKÜLTESİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, İÇ HASTALIKLARI ANABİLİM DALI, ENDOKRİNOLOJİ BİLİM DALI
| | - Aysun GÖNDEREN
- KÜTAHYA SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, TIP FAKÜLTESİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, İÇ HASTALIKLARI ANABİLİM DALI, HEMATOLOJİ BİLİM DALI
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Aydın B, Özçelik S, Kilit TP, Eraslan S, Çelik M, Onbaşı K. Relationship between glycosylated hemoglobin and iron deficiency anemia: A common but overlooked problem. Prim Care Diabetes 2022; 16:312-317. [PMID: 35000894 DOI: 10.1016/j.pcd.2022.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/19/2021] [Accepted: 01/01/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Both diabetes mellitus (DM) and iron deficiency anemia (IDA) are prevalent in every area of the world, and so, the possibility of these two diseases co-existing is also very high. It is our belief that clinical results of any correlation between iron status of the body and glycosylated haemoglobin (HbA1c) would be beneficial to many patients, therefore in this study, the effect of IDA on HbA1c was investigated. MATERIALS - METHODS A total of 146 patients with DM and IDA were evaluated prospectively. While the patients were administered 270 mg/day of ferrous sulphate (80 mg elemental iron) orally for three months for the treatment of IDA, no interventions were made for the treatment of DM. Patient levels of hemoglobin (Hb), hematocrit, red blood cells (RBC), mean corpuscular volume (MCV), platelet, white blood cells (WBC), serum iron, serum iron binding capacity (SIBC), ferritin, fasting plasma glucose (FPG), HbA1c, body mass index (BMI), C-reactive protein (CRP) values were measured at baseline and at the third month of treatment with iron, and were compared. RESULTS The median age of our patients was 45 (40-50) and median duration of diabetes was 3 years (1,75-5). While the baseline median Hb was 10.4 (mg/dL) (9.5-11.1), MCV was 74 (fL) (70.8-77), ferritin was 4 (ug/L) (3-6) at three months, Hb was measured at 12.6 (mg/dL) (12.1-13.2), MCV was measured at 82 (fL) (80-86), ferritin was measured at 15 (ug/L) (9-21.2) and was significantly higher compared to baseline values (p < 0.001). The baseline median HBA1c of patients was 7.09 ± 0.51 (%) and three month HBA1c was 6.69 ± 0.53 (%), which was significantly lower than when comparing baseline values with values at third month (p < 0.001). Baseline and three month values for FPG were 118 (mg/dL) (108-132) and 116 (mg/dL) (106-125) respectively, and there was no significant difference (p:0.07). A 2.2 mg/dL (1.5-3.5) increase in median Hb level accompanied a 0.4 % (0.2-0.6) decrease in median HbA1c levels (Spearman rho = -0.362; p < 0.001). CONCLUSION Our study has shown conclusivly that IDA is related to increased HbA1c concentrations and HbA1c decreases significantly following treatment with iron. IDA should be considered before making any decisions regarding diagnosis or treatment according to HbA1c.
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Affiliation(s)
- Bünyamin Aydın
- University of Health Sciences, Kütahya Evliya Çelebi Training and Research Hospital, Division of Endocrinology and Metabolism, Kütahya, Turkey
| | - Serhat Özçelik
- University of Health Sciences, Kartal Dr. Lütfi Kırdar City Hospital, Department of Endocrinology and Metabolism, İstanbul, Turkey.
| | - Türkan Paşalı Kilit
- University of Health Sciences, Kütahya Evliya Çelebi Training and Research Hospital, Division of Internal Medicine, Kütahya, Turkey
| | - Sertaç Eraslan
- University of Health Sciences, Kütahya Evliya Çelebi Training and Research Hospital, Division of Internal Medicine, Kütahya, Turkey
| | - Mehmet Çelik
- Trakya University Faculty of Medicine, Department of Endocrinology and Metabolism, Edirne, Turkey
| | - Kevser Onbaşı
- University of Health Sciences, Kütahya Evliya Çelebi Training and Research Hospital, Division of Endocrinology and Metabolism, Kütahya, Turkey
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Rao LV, Pratt GW, Bi C, Kroll MH. Large-scale retrospective analyses of the effect of iron deficiency anemia on hemoglobin A1c concentrations. Clin Chim Acta 2022; 529:21-24. [DOI: 10.1016/j.cca.2022.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/01/2022] [Accepted: 02/08/2022] [Indexed: 12/31/2022]
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Body Composition, Anemia, and Kidney Function among Guatemalan Sugarcane Workers. Nutrients 2021; 13:nu13113928. [PMID: 34836182 PMCID: PMC8621317 DOI: 10.3390/nu13113928] [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: 09/09/2021] [Revised: 10/23/2021] [Accepted: 10/24/2021] [Indexed: 01/01/2023] Open
Abstract
Rates of anemia among agricultural workers, who are also at risk for kidney injury and chronic kidney disease of unknown cause (CKDu), are unknown. We evaluated body composition through the sum of three skinfolds among 203 male sugarcane cutters and assessed the relationship of variables related to nutrition, anemia (hemoglobin < 13 g/dL), and elevated hemoglobin A1c (HbA1c ≥ 5.7%) with estimated glomerular filtration rate (eGFR) using linear regression. Eleven percent of workers were at the level of essential body fat (2-5%). Anemia was present among 13% of workers, 70% of which were normochromic normocytic, a type of anemia suggesting potential underlying chronic disease. Anemia was more common among those with lower BMI and fat free mass. The prevalence of elevated HbA1c was 21%. A moderate negative correlation was found between hemoglobin and HbA1c (Pearson's r = -0.32, p <0.01) which suggests that HbA1c values should be interpreted with caution in populations that have high rates of anemia. Twelve percent of workers had reduced kidney function with an eGFR < 90 mL/min/1.73 m2. On average, the eGFR was 18 mL/min per 1.73 m2 lower [(95% CI:-24, -12), p <0.01)] for those with anemia than those without, and 8 mL/min per 1.73 m2 lower among those with elevated HbA1c [(95% CI: -13, -2), p < 0.01]. Results will inform future studies examining the role of anemia in the evaluation of CKDu and interventions to improve nutrition for workers in low-resource settings.
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Loy SL, Lin J, Cheung YB, Sreedharan AV, Chin X, Godfrey KM, Tan KH, Shek LPC, Chong YS, Leow MKS, Khoo CM, Lee YS, Chan SY, Lek N, Chan JKY, Yap F. Influence of red blood cell indices on HbA1c performance in detecting dysglycaemia in a Singapore preconception cohort study. Sci Rep 2021; 11:20850. [PMID: 34675297 PMCID: PMC8531017 DOI: 10.1038/s41598-021-00445-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 10/12/2021] [Indexed: 12/16/2022] Open
Abstract
Abnormalities of red blood cell (RBC) indices may affect glycated haemoglobin (HbA1c) levels. We assessed the influence of haemoglobin (Hb) and mean corpuscular volume (MCV) on the performance of HbA1c in detecting dysglycaemia among reproductive aged women planning to conceive. Women aged 18-45 years (n = 985) were classified as normal (12 ≤ Hb ≤ 16 g/dL and 80 ≤ MCV ≤ 100 fL) and abnormal (Hb < 12 g/dL and/or MCV < 80 fL). The Area Under the Receiver Operating Characteristic (AUROC) curve was used to determine the performance of HbA1c in detecting dysglycaemic status (prediabetes and diabetes). There were 771 (78.3%) women with normal RBC indices. The AUROCs for the normal and abnormal groups were 0.75 (95% confidence interval 0.69, 0.81) and 0.80 (0.70, 0.90), respectively, and were not statistically different from one another [difference 0.04 (- 0.16, 0.08)]. Further stratification by ethnicity showed no difference between the two groups among Chinese and Indian women. However, Malay women with normal RBC indices displayed lower AUROC compared to those with abnormal RBC indices (0.71 (0.55, 0.87) vs. 0.98 (0.93, 1.00), p = 0.002). The results suggest that the performance of HbA1c in detecting dysglycaemia was not influenced by abnormal RBC indices based on low Hb and/or low MCV. However, there may be ethnic variations among them.
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Affiliation(s)
- See Ling Loy
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, 229899, Singapore.
- Duke-NUS Medical School, Singapore, 169857, Singapore.
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, 117609, Singapore.
| | - Jinjie Lin
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore, 229899, Singapore
| | - Yin Bun Cheung
- Program in Health Services and Systems Research and Center for Quantitative Medicine, Duke-NUS Medical School, Singapore, 169857, Singapore
- Tampere Center for Child, Adolescent and Maternal Health Research, Tampere University, 33014, Tampere, Finland
| | | | - Xinyi Chin
- Duke-NUS Medical School, Singapore, 169857, Singapore
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore, 229899, Singapore
| | - Keith M Godfrey
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service Foundation Trust, Southampton, SO16 6YD, UK
| | - Kok Hian Tan
- Duke-NUS Medical School, Singapore, 169857, Singapore
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, 229899, Singapore
| | - Lynette Pei-Chi Shek
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, 117609, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, 119074, Singapore
| | - Yap Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, 117609, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, 119228, Singapore
| | - Melvin Khee-Shing Leow
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, 117609, Singapore
- Cardiovascular and Metabolic Disorder Programme, Duke-NUS Medical School, Singapore, 169857, Singapore
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore, 308433, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 636921, Singapore
| | - Chin Meng Khoo
- Cardiovascular and Metabolic Disorder Programme, Duke-NUS Medical School, Singapore, 169857, Singapore
- Department of Medicine, National University Hospital, Singapore, 119074, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore
| | - Yung Seng Lee
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, 117609, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, 119074, Singapore
| | - Shiao-Yng Chan
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, 117609, Singapore
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
| | - Ngee Lek
- Duke-NUS Medical School, Singapore, 169857, Singapore
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore, 229899, Singapore
| | - Jerry Kok Yen Chan
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, 229899, Singapore
- Duke-NUS Medical School, Singapore, 169857, Singapore
| | - Fabian Yap
- Duke-NUS Medical School, Singapore, 169857, Singapore.
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore, 229899, Singapore.
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 636921, Singapore.
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Ben-David E, Hull R, Banerjee D. Diabetes mellitus in dialysis and renal transplantation. Ther Adv Endocrinol Metab 2021; 12:20420188211048663. [PMID: 34631007 PMCID: PMC8495524 DOI: 10.1177/20420188211048663] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/29/2021] [Indexed: 12/31/2022] Open
Abstract
Diabetes mellitus is the commonest cause of end-stage kidney failure worldwide and is a proven and significant risk factor for the development of cardiovascular disease. Renal impairment has a significant impact on the physiology of glucose homeostasis as it reduces tissue sensitivity to insulin and reduces insulin clearance. Renal replacement therapy itself affects glucose control: peritoneal dialysis may induce hyperglycaemia due to glucose-rich dialysate and haemodialysis often causes hypoglycaemia due to the relatively low concentration of glucose in the dialysate. Autonomic neuropathy which is common in chronic kidney disease (CKD) and diabetes increases the risk for asymptomatic hypoglycaemia. Pharmacological options for improving glycaemic control are limited due to alterations to drug metabolism. Impaired glucose tolerance and diabetes are also common in the post-kidney-transplant setting and increase the risk of graft failure and mortality. This review seeks to summarise the literature and tackle the intricacies of glycaemic management in patients with CKD who are either on maintenance haemodialysis or have received a kidney transplant. It outlines changes to glycaemic targets, monitoring of glycaemic control, the use of oral hypoglycaemic agents, the management of severe hyperglycaemia in dialysis and kidney transplantation patients.
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Affiliation(s)
- Eyal Ben-David
- Renal and Transplantation Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Richard Hull
- Renal and Transplantation Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Debasish Banerjee
- Renal and Transplantation Unit, St George's University Hospitals NHS Foundation Trust, Room G2.113, Second Floor, Grosvenor Wing, Blackshaw Road, Tooting, London SW17 0QT, UK
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Hempe JM, Yang S, Liu S, Hsia DS. Standardizing the haemoglobin glycation index. ENDOCRINOLOGY DIABETES & METABOLISM 2021; 4:e00299. [PMID: 34558807 PMCID: PMC8502217 DOI: 10.1002/edm2.299] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/11/2021] [Accepted: 09/08/2021] [Indexed: 02/02/2023]
Abstract
Aims A high haemoglobin glycation index (HGI) is associated with greater risk for hypoglycaemia and chronic vascular disease. Standardizing how the HGI is calculated would normalize results between research studies and hospital laboratories and facilitate the clinical use of HGI for assessing risk. Methods The HGI is the difference between an observed HbA1c and a predicted HbA1c obtained by inserting fasting plasma glucose (FPG) into a regression equation describing the linear relationship between FPG and HbA1c in a reference population. We used data from the 2005–2016 U.S. National Health and Nutrition Examination Survey (NHANES) to identify a reference population of 18,675 diabetes treatment–naïve adults without self‐reported diabetes. The reference population regression equation (predicted HbA1c = 0.024 FPG + 3.1) was then used to calculate the HGI and divide participants into low (<−0.150), moderate (−0.150 to <0.150) and high (≥0.150) HGI subgroups. Diabetes status was classified by OGTTs. Results As previously reported in multiple studies, a high HGI was associated with black race independent of diabetes status, and with older age, higher BMI and higher CRP in normal and prediabetic but not diabetic participants. The mean HGI was 0.6% higher in self‐reported diabetic adults. The HGI was not associated with plasma insulin, HOMA‐IR or 2 h OGTT in participants classified as normal, prediabetic or diabetic. Conclusions The regression equation derived from this demographically diverse diabetes treatment–naïve adult NHANES reference population is suitable for standardizing how the HGI is calculated for both clinical use and in research to mechanistically explain population variation in the HGI and why a high HGI is associated with greater risk for chronic vascular disease.
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Affiliation(s)
- James M Hempe
- Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Shengping Yang
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Shuqian Liu
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Daniel S Hsia
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
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Bhattacharya S, Nagendra L, Krishnamurthy A, Lakhani OJ, Kapoor N, Kalra B, Kalra S. Early Gestational Diabetes Mellitus: Diagnostic Strategies and Clinical Implications. Med Sci (Basel) 2021; 9:59. [PMID: 34698239 PMCID: PMC8544345 DOI: 10.3390/medsci9040059] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 12/16/2022] Open
Abstract
Preexisting diabetes mellitus (DM) should be ruled out early in pregnancy in those at risk. During screening, a significant proportion of women do not reach the threshold for overt DM but fulfill the criteria used for diagnosing conventional gestational DM (cGDM). There is no consensus on the management of pregnancies with intermediate levels of hyperglycemia thus diagnosed. We have used the term early gestational DM (eGDM) for this condition and reviewed the currently available literature. Fasting plasma glucose (FPG), oral glucose tolerance test, and glycated hemoglobin (HbA1c) are the commonly employed screening tools in early pregnancy. Observational studies suggest that early pregnancy FPG and Hba1c correlate with the risk of cGDM and adverse perinatal outcomes. However, specific cut-offs, including those proposed by the International Association of the Diabetes and Pregnancy Study Group, do not reliably predict the development of cGDM. Emerging data, though indicate that FPG ≥ 92 mg/dL (5.1 mmol/L), even in the absence of cGDM, signals the risk for perinatal complication. Elevated HbA1c, especially a level ≥ 5.9%, also correlates with the risk of cGDM and worsened outcome. HbA1c as a diagnostic test is however besieged with the usual caveats that occur in pregnancy. The studies that explored the effects of intervention present conflicting results, including a possibility of fetal malnutrition and small-for-date baby in the early treatment group. Diagnostic thresholds and glycemic targets in eGDM may differ, and large multicenter randomized controlled trials are necessary to define the appropriate strategy.
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Affiliation(s)
| | - Lakshmi Nagendra
- Department of Endocrinology, K.S Hegde Medical Academy, Mangalore 575018, India;
| | | | - Om J. Lakhani
- Department of Endocrinology, Zydus Hospital, Ahmedabad 380058, India;
| | - Nitin Kapoor
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore 632004, India;
| | - Bharti Kalra
- Department of Obstetrics, Bharti Hospital, Karnal 132001, India;
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal 132001, India;
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Kubiak RW, Kratz M, Motala AA, Galagan S, Govere S, Brown ER, Moosa MYS, Drain PK. Clinic-based diabetes screening at the time of HIV testing and associations with poor clinical outcomes in South Africa: a cohort study. BMC Infect Dis 2021; 21:789. [PMID: 34376173 PMCID: PMC8353828 DOI: 10.1186/s12879-021-06473-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 07/09/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND HIV clinical care programs in high burden settings are uniquely positioned to facilitate diabetes diagnosis, which is a major challenge. However, in sub-Saharan Africa, data on the burden of diabetes among people living with HIV (PLHIV) and its impact on HIV outcomes is sparse. METHODS We enrolled adults presenting for HIV testing at an outpatient clinic in Durban. Those who tested positive for HIV-infection were screened for diabetes using a point-of-care hemoglobin A1c (HbA1c) test. We used log-binomial, Poisson, and Cox proportional hazard models adjusting for confounders to estimate the relationship of diabetes (HbA1c ≥ 6.5%) with the outcomes of HIV viral suppression (< 50 copies/mL) 4-8 months after antiretroviral therapy initiation, retention in care, hospitalization, tuberculosis, and death over 12 months. RESULTS Among 1369 PLHIV, 0.5% (n = 7) reported a prior diabetes diagnosis, 20.6% (95% CI 18.5-22.8%, n = 282) screened positive for pre-diabetes (HbA1c 5.7-6.4%) and 3.5% (95% CI 2.7-4.6%, n = 48) for diabetes. The number needed to screen to identify one new PLHIV with diabetes was 46.5 persons overall and 36.5 restricting to those with BMI ≥ 25 kg/m2. Compared to PLHIV without diabetes, the risk of study outcomes among those with diabetes was not statistically significant, although the adjusted hazard of death was 1.79 (95% CI 0.41-7.87). CONCLUSIONS Diabetes and pre-diabetes were common among adults testing positive for HIV and associated with death. Clinic-based diabetes screening could be targeted to higher risk groups and may improve HIV treatment outcomes.
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Affiliation(s)
- Rachel W Kubiak
- Department of Epidemiology, Health Sciences Building, University of Washington, Seattle, WA, USA.
| | - Mario Kratz
- Department of Epidemiology, Health Sciences Building, University of Washington, Seattle, WA, USA
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Ayesha A Motala
- Department of Diabetes and Endocrinology, University of KwaZulu-Natal, Durban, South Africa
| | - Sean Galagan
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Elisabeth R Brown
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Mahomed-Yunus S Moosa
- Department of Infectious Diseases, University of KwaZulu-Natal, Durban, South Africa
| | - Paul K Drain
- Department of Epidemiology, Health Sciences Building, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
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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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Qiu HY, Hou NN, Shi JF, Liu YP, Kan CX, Han F, Sun XD. Comprehensive overview of human serum albumin glycation in diabetes mellitus. World J Diabetes 2021; 12:1057-1069. [PMID: 34326954 PMCID: PMC8311477 DOI: 10.4239/wjd.v12.i7.1057] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/06/2021] [Accepted: 06/04/2021] [Indexed: 02/06/2023] Open
Abstract
The presence of excess glucose in blood is regarded as a sweet hurt for patients with diabetes. Human serum albumin (HSA) is the most abundant protein in human plasma, which undergoes severe non-enzymatic glycation with glucose in patients with diabetes; this modifies the structure and function of HSA. Furthermore, the advanced glycation end products produced by glycated HSA can cause pathological damage to the human body through various signaling pathways, eventually leading to complications of diabetes. Many potential glycation sites on HSA have different degrees of sensitivity to glucose concentration. This review provides a comprehensive assessment of the in vivo glycation sites of HSA; it also discusses the effects of glycation on the structure and function of HSA. Moreover, it addresses the relationship between HSA glycation and diabetes complications. Finally, it focuses on the value of non-enzymatic glycation of HSA in diabetes-related clinical applications.
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Affiliation(s)
- Hong-Yan Qiu
- Department of Endocrinology, The Affiliated Hospital of Weifang Medical University, Weifang 261031, Shandong Province, China
| | - Ning-Ning Hou
- Department of Endocrinology, The Affiliated Hospital of Weifang Medical University, Weifang 261031, Shandong Province, China
| | - Jun-Feng Shi
- Department of Endocrinology, The Affiliated Hospital of Weifang Medical University, Weifang 261031, Shandong Province, China
| | - Yong-Ping Liu
- Department of Endocrinology, The Affiliated Hospital of Weifang Medical University, Weifang 261031, Shandong Province, China
| | - Cheng-Xia Kan
- Department of Endocrinology, The Affiliated Hospital of Weifang Medical University, Weifang 261031, Shandong Province, China
| | - Fang Han
- Department of Pathology, The Affiliated Hospital of Weifang Medical University, Weifang 261031, Shandong Province, China
| | - Xiao-Dong Sun
- Department of Endocrinology, The Affiliated Hospital of Weifang Medical University, Weifang 261031, Shandong Province, China
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Chowdhury TA, Wahba M, Mallik R, Peracha J, Patel D, De P, Fogarty D, Frankel A, Karalliedde J, Mark PB, Montero RM, Pokrajac A, Zac-Varghese S, Bain SC, Dasgupta I, Banerjee D, Winocour P, Sharif A. Association of British Clinical Diabetologists and Renal Association guidelines on the detection and management of diabetes post solid organ transplantation. Diabet Med 2021; 38:e14523. [PMID: 33434362 DOI: 10.1111/dme.14523] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/24/2020] [Accepted: 01/09/2021] [Indexed: 01/06/2023]
Abstract
Post-transplant diabetes mellitus (PTDM) is common after solid organ transplantation (SOT) and associated with increased morbidity and mortality for allograft recipients. Despite the significant burden of disease, there is a paucity of literature with regards to detection, prevention and management. Evidence from the general population with diabetes may not be translatable to the unique context of SOT. In light of emerging clinical evidence and novel anti-diabetic agents, there is an urgent need for updated guidance and recommendations in this high-risk cohort. The Association of British Clinical Diabetologists (ABCD) and Renal Association (RA) Diabetic Kidney Disease Clinical Speciality Group has undertaken a systematic review and critical appraisal of the available evidence. Areas of focus are; (1) epidemiology, (2) pathogenesis, (3) detection, (4) management, (5) modification of immunosuppression, (6) prevention, and (7) PTDM in the non-renal setting. Evidence-graded recommendations are provided for the detection, management and prevention of PTDM, with suggested areas for future research and potential audit standards. The guidelines are endorsed by Diabetes UK, the British Transplantation Society and the Royal College of Physicians of London. The full guidelines are available freely online for the diabetes, renal and transplantation community using the link below. The aim of this review article is to introduce an abridged version of this new clinical guideline ( https://abcd.care/sites/abcd.care/files/site_uploads/Resources/Position-Papers/ABCD-RA%20PTDM%20v14.pdf).
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Affiliation(s)
| | | | | | | | - Dipesh Patel
- Diabetes & Endocrinology, Royal Free NHS foundation Trust, UCL, London, UK
| | | | | | | | - Janaka Karalliedde
- Guy's and St Thomas NHS Foundation Trust and King's College London, London, UK
| | | | | | - Ana Pokrajac
- West Hertfordshire Hospitals NHS Trust, Watford, UK
| | | | | | - Indranil Dasgupta
- Heartlands Hospital, Birmingham, UK
- Warwick Medical School, Warwick, UK
| | - Debasish Banerjee
- Renal and Transplant Unit, St George's University Hospitals NHS Foundation Trust and MCSRI, St George's University of London, London, UK
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Ferrario L, Schettini F, Avogaro A, Bellia C, Bertuzzi F, Bonetti G, Ceriello A, Ciaccio M, Corsi Romanelli M, Dozio E, Falqui L, Girelli A, Nicolucci A, Perseghin G, Plebani M, Valentini U, Zaninotto M, Castaldi S, Foglia E. Glycated Albumin for Glycemic Control in T2DM Population: A Multi-Dimensional Evaluation. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:453-464. [PMID: 34079308 PMCID: PMC8166313 DOI: 10.2147/ceor.s304868] [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: 02/02/2021] [Accepted: 04/23/2021] [Indexed: 12/16/2022] Open
Abstract
Purpose To investigate the glycated albumin (GA) introduction implications, as an add-on strategy to traditional glycemic control (Hb1Ac and fasting plasma glucose – FPG) instruments, considering insulin-naïve individuals with type 2 diabetes mellitus (T2DM), treated with oral therapies. Methods A Health Technology Assessment was conducted in Italy, as a multi-dimensional approach useful to validate any innovative technology. The HTA dimensions, derived from the EUnetHTA Core Model, were deployed by means of literature evidence, health economics tools and qualitative questionnaires, filled-in by 15 professionals. Results Literature stated that the GA introduction could lead to a higher number of individuals achieving therapeutic success after 3 months of therapy (97.0% vs 71.6% without GA). From an economic point of view, considering a projection of 1,955,447 T2DM insulin-naïve individuals, potentially treated with oral therapy, GA introduction would imply fewer individuals requiring a therapy switch (−89.44%), with a 1.06% in costs reduction, on annual basis, thus being also the preferable solution from a cost-effectiveness perspective (cost-effectiveness value: 237.74 vs 325.53). According to experts opinions, lower perceptions on GA emerged with regard to equity aspects (0.13 vs 0.72, p-value>0.05), whereas it would improve both individuals (2.17 vs 1.33, p-value=0.000) and caregivers quality of life (1.50 vs 0.83, p-value=0.000). Even if in the short term, GA required additional investments in training courses (−0.80 vs 0.10, p-value = 0.036), in the long run, GA could become the preferable technology (0.30 vs 0.01, p-value=0.018) from an organisational perspective. Conclusion Adding GA to traditional glycaemic control instruments could improve the clinical pathway of individuals with T2DM, leading to economic and organisational advantages for both hospitals and National Healthcare Systems.
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Affiliation(s)
- Lucrezia Ferrario
- Centre for Health Economics, Social and Health Care Management, Università Carlo Cattaneo - LIUC, Castellanza, Italy
| | - Fabrizio Schettini
- Centre for Health Economics, Social and Health Care Management, Università Carlo Cattaneo - LIUC, Castellanza, Italy
| | - Angelo Avogaro
- Department of Medicine, University-Hospital of Padova, Padova, Italy
| | - Chiara Bellia
- Section of Clinical Biochemistry and Clinical Molecular Medicine, Department of Biopathology and Medical Biotechnologies, University of Palermo, Palermo, Italy
| | - Federico Bertuzzi
- Diabetology Unit, Grande Ospedale Metropolitano Niguarda Hospital, Milan, Italy
| | | | - Antonio Ceriello
- Department of Cardiovascular and Metabolic Diseases, Multimedica Research Institute, Milan, Italy
| | - Marcello Ciaccio
- Section of Clinical Biochemistry and Clinical Molecular Medicine, Department of Biopathology and Medical Biotechnologies, University of Palermo, Palermo, Italy.,Department of Laboratory Medicine, University-Hospital of Palermo, Palermo, Italy
| | - Massimiliano Corsi Romanelli
- Service of Laboratory Medicine 1-Clinical Pathology, Policlinico San Donato, Milan, Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Elena Dozio
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Luca Falqui
- Department of Medicine, Diabetes and Endocrinology, Multimedica Research Institute, Milan, Italy
| | - Angela Girelli
- Diabetes Care Unit, Spedali Civili Hospital, Brescia, Italy
| | - Antonio Nicolucci
- Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Gianluca Perseghin
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Milan, Italy.,Department of Medicine and Rehabilitation, Unit of Metabolic Medicine, Policlinico di Monza, Monza, Italy
| | - Mario Plebani
- Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy
| | | | - Martina Zaninotto
- Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy
| | - Silvana Castaldi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,Fondazione Ca' Granda Ospedale Maggiore Policlinico Research Institute of Milano, Milano, Italy
| | - Emanuela Foglia
- Centre for Health Economics, Social and Health Care Management, Università Carlo Cattaneo - LIUC, Castellanza, Italy
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Nwadiugwu MC, Bastola DR, Haas C, Russell D. Identifying Glycemic Variability in Diabetes Patient Cohorts and Evaluating Disease Outcomes. J Clin Med 2021; 10:jcm10071477. [PMID: 33918347 PMCID: PMC8038275 DOI: 10.3390/jcm10071477] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 12/13/2022] Open
Abstract
Glycemic variability (GV) is an obstacle to effective blood glucose control and an autonomous risk factor for diabetes complications. We, therefore, explored sample data of patients with diabetes mellitus who maintained better amplitude of glycemic fluctuations and compared their disease outcomes with groups having poor control. A retrospective study was conducted using electronic data of patients having hemoglobin A1C (HbA1c) values with five recent time points from Think Whole Person Healthcare (TWPH). The control variability grid analysis (CVGA) plot and coefficient of variability (CV) were used to identify and cluster glycemic fluctuation. We selected important variables using LASSO. Chi-Square, Fisher’s exact test, Bonferroni chi-Square adjusted residual analysis, and multivariate Kruskal–Wallis tests were used to evaluate eventual disease outcomes. Patients with very high CV were strongly associated (p < 0.05) with disorders of lipoprotein (p = 0.0014), fluid, electrolyte, and acid–base balance (p = 0.0032), while those with low CV were statistically significant for factors influencing health status such as screening for other disorders (p = 0.0137), long-term (current) drug therapy (p = 0.0019), and screening for malignant neoplasms (p = 0.0072). Reducing glycemic variability may balance alterations in electrolytes and reduce differences in lipid profiles, which may assist in strategies for managing patients with diabetes mellitus.
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Affiliation(s)
- Martin C. Nwadiugwu
- Department of Biomedical Informatics, University of Nebraska at Omaha, Omaha, NE 68182, USA
- Correspondence: (M.C.N.); (D.R.B.)
| | - Dhundy R. Bastola
- Department of Biomedical Informatics, University of Nebraska at Omaha, Omaha, NE 68182, USA
- Correspondence: (M.C.N.); (D.R.B.)
| | - Christian Haas
- Department of Information Systems and Quantitative Analysis, University of Nebraska at Omaha, Omaha, NE 68182, USA;
| | - Doug Russell
- Think Whole Person Healthcare, Omaha, NE 68106, USA;
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Shirvani T, Javadivala Z, Azimi S, Shaghaghi A, Fathifar Z, Devender Bhalla HDR, Abdekhoda M, Nadrian H. Community-based educational interventions for prevention of type II diabetes: a global systematic review and meta-analysis. Syst Rev 2021; 10:81. [PMID: 33743839 PMCID: PMC7980624 DOI: 10.1186/s13643-021-01619-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/23/2021] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Our objective was to estimate the change in community-based education interventions throughout the world that may effectuate in risk parameters of type II diabetes (T2D), including the diabetes incidence rate, fasting blood glucose, hemoglobin A1C, body mass index, waist circumference, and systolic and diastolic blood pressure. METHODS A comprehensive search for globally eligible studies was conducted on PubMed, Embase, ProQuest, CINAHL nursing & allied health source, Cochrane Library, Google Scholar, conference proceedings, and reference lists. Data were extracted using JBI standardized data extraction tool. The primary outcome variables were diabetes incidence rate, fasting blood sugar (FBS), hemoglobin A1c (HbAlc), body mass index (BMI), waist circumference (WC), systolic/diastolic blood pressure (s/d BP). Random-effects meta-analysis and sub-group analyses were conducted. RESULTS Nineteen interventional studies were included in the review, and ten studies were pooled in the meta-analysis (n = 16,106, mean age = 41.5 years). The incidence rate of T2D was reported in three trials, within which the risk of developing T2D was reduced by 54.0% in favor of community-based educational interventions, (RR = 0.54, 95% CI = 0.38-0.75; p < 0.001). In eleven (n = 11,587) and six (n = 6416) studies, the pooled mean differences were - 0.33 (95% CI: - 0.45 to - 0.20, p < 0.0001) and - 0.15 (95% CI: - 0.28 to - 0.03, p < 0.0001) for FBS and HbA1c levels, respectively. Positive significant effects were observed on reducing BMI [pooled mean difference = - 0.47 (95% CI: - 0.66 to - 0.28), I2 = 95.7%, p < 0.0001] and WC [pooled mean difference = - 0.66 (95% CI: - 0.89 to - 0.43), I2 = 97.3%, p < 0.0001]. The use of theoretical frameworks was found to provide a 48.0% change in fasting blood sugar. CONCLUSIONS Based on a comprehensive data collection of about 16,106 participants and reasonable analyses, we conclude that educational interventions may reduce diabetes incidence by 54.0%, particularly through reductions in fasting blood glucose, body mass index, and waist circumference. The diabetes risk parameters may favorably improve irrespective of the duration of intervention, at as low as 6 months. The application of theoretical frameworks while designing educational interventions is also encouraged. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018115877.
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Affiliation(s)
- Tayebeh Shirvani
- Department of Health Education and Promotion, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zeinab Javadivala
- Department of Health Education and Promotion, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Somayeh Azimi
- Department of Health Education and Promotion, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abdolreza Shaghaghi
- Department of Health Education and Promotion, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zahra Fathifar
- Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - H D R Devender Bhalla
- Iranian Epilepsy Association, Tehran, Iran.,Pôle Universitaire Euclide Intergovernmental UN Treaty 49006/49007, Bangui, Central African Republic
| | - Mohammadhiwa Abdekhoda
- Department of Health Informatics, Faculty of Health Informatics and Management, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Haidar Nadrian
- Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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Bindayel IA. Influence of iron deficiency anemia on glycated hemoglobin levels in non-diabetic Saudi women. J Int Med Res 2021; 49:300060521990157. [PMID: 33641472 PMCID: PMC7923997 DOI: 10.1177/0300060521990157] [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] [Indexed: 12/02/2022] Open
Abstract
Objective Studies of patients with iron deficiency anemia (IDA) have shown a relationship between high glycated hemoglobin (HbA1c) and low hemoglobin (Hb) concentration. The present study was conducted to determine the influence of IDA on HbA1c in non-diabetic women. Methods Fifty-nine Saudi women (20 to 50 years old) were enrolled and categorized into groups according to their circulating hemoglobin concentration: Non-IDA (Hb ≥7.45 mmol/L; n = 38) and IDA (Hb ≤7.44 mmol/L; n = 21). The IDA group was further subdivided according to the severity of the IDA, as follows: mild (Hb 6.83 to 7.44 mmol/L; n = 9) and moderate–severe (Hb <6.83 mol/L; n = 12). HbA1c, Hb, ferritin, fasting blood glucose, and red blood cell (RBC) count were measured in each participant. Results HbA1c did not significantly differ between the groups, but the absolute HbA1c level was significantly lower in the mild and moderate–severe anemia groups than the non-anemic group, and was positively associated with Hb, ferritin, and RBC count. In addition, the HbA1c level was inversely associated with the Hb concentration. Conclusions HbA1c is significantly associated with parameters related to IDA in non-diabetic Saudi women. Therefore, assessment of IDA-related parameters is recommended prior to making a diagnosis of diabetes.
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Affiliation(s)
- Iman Abdullah Bindayel
- Department of Community Health Sciences, College of Applied Medical Sciences, 37850King Saud University, Riyadh, Saudi Arabia
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39
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Kong LR, Zhang Y, Wu F, Wen XQ, He DH, Zhou CQ, Wang L. Correlation between glycosylated serum albumin and glycosylated haemoglobin in the southwest Chinese population: Establishment of a regression model. J Diabetes Complications 2021; 35:107796. [PMID: 33303295 DOI: 10.1016/j.jdiacomp.2020.107796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 09/24/2020] [Accepted: 11/01/2020] [Indexed: 10/22/2022]
Abstract
AIMS To correlate glycated albumin (GA) and glycosylated haemoglobin (HbA1c) and establish a novel formula for estimating HbA1c from GA. METHODS We retrospectively enrolled 20,381 cases and excluded HbA1c and GA outliers by residual analysis. HbA1c ranged from 4.0-12.0% and GA from 7.5-45%. The HbA1c range of 4.0-8.0% in both sexes was stratified into eight groups with an increase of 0.5%, and the means of GA and HbA1c were compared. HbA1c was divided into 38 groups with increments of 0.1% (range, 4.3-8.0%), and the correlation between HbA1c and GA was investigated. RESULTS There was no significant sex-based difference between HbA1c and GA. The analysis showed that when HbA1c was 6.2% or GA was 12.28%, the linear relationship between the two parameters was not continuous. When HbA1c was <6.2% or GA < 12.28%, we devised the formula: HbA1c = 1.136 × GA - 7.289 (R2 = 0.824). For HbA1c ≥ 6.2% or GA ≥ 12.28%, the equation was: HbA1c = 0.252 × GA + 3.163 (R2 = 0.948). CONCLUSION A discontinuous linear relationship exists between HbA1c and GA when HbA1c is 6.2% or GA is 12.28%, although with a significant turning point. The GA value can be used to estimate the HbA1c value with the two regression equations to accurately estimate the long-term average blood glucose level of patients.
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Affiliation(s)
- Li-Rui Kong
- Department of Clinical Laboratory, Traditional Chinese Medicine Hospital of Pidu District, Chengdu, Sichuan 611730, People's Republic of China; The Third Clinical Medical College of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 611730, People's Republic of China
| | - Yan Zhang
- Department of Clinical Laboratory, Traditional Chinese Medicine Hospital of Pidu District, Chengdu, Sichuan 611730, People's Republic of China; The Third Clinical Medical College of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 611730, People's Republic of China
| | - Feng Wu
- Department of Clinical Laboratory, Traditional Chinese Medicine Hospital of Pidu District, Chengdu, Sichuan 611730, People's Republic of China; The Third Clinical Medical College of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 611730, People's Republic of China
| | - Xue-Qin Wen
- Department of Clinical Laboratory, Traditional Chinese Medicine Hospital of Pidu District, Chengdu, Sichuan 611730, People's Republic of China; The Third Clinical Medical College of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 611730, People's Republic of China
| | - Da-Hai He
- Department of Clinical Laboratory, Traditional Chinese Medicine Hospital of Pidu District, Chengdu, Sichuan 611730, People's Republic of China; The Third Clinical Medical College of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 611730, People's Republic of China
| | - Chao-Qiong Zhou
- Department of Clinical Laboratory, Traditional Chinese Medicine Hospital of Pidu District, Chengdu, Sichuan 611730, People's Republic of China; The Third Clinical Medical College of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 611730, People's Republic of China
| | - Lin Wang
- Department of Clinical Laboratory, Traditional Chinese Medicine Hospital of Pidu District, Chengdu, Sichuan 611730, People's Republic of China; The Third Clinical Medical College of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 611730, People's Republic of China.
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40
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Ke Y, Shannon NB, Yek J, Sim E, Abdullah HR. A Newly Proposed HbA1C-Hemoglobin Ratio - A Better Predictor of Outcomes in Cardiac Surgery When Compared to HbA1C and Anemia Alone. Semin Thorac Cardiovasc Surg 2021; 33:750-759. [DOI: 10.1053/j.semtcvs.2020.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/05/2020] [Indexed: 12/20/2022]
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41
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Færch K, Amadid H, Bruhn L, Clemmensen KKB, Hulman A, Ried-Larsen M, Blond MB, Jørgensen ME, Vistisen D. Discordance Between Glucose Levels Measured in Interstitial Fluid vs in Venous Plasma After Oral Glucose Administration: A Post-Hoc Analysis From the Randomised Controlled PRE-D Trial. Front Endocrinol (Lausanne) 2021; 12:753810. [PMID: 34675886 PMCID: PMC8525890 DOI: 10.3389/fendo.2021.753810] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/15/2021] [Indexed: 01/08/2023] Open
Abstract
AIMS The oral glucose tolerance test (OGTT) is together with haemoglobin A1c (HbA1c) gold standard for diagnosing prediabetes and diabetes. The objective of this study was to assess the concordance between glucose values obtained from venous plasma versus interstitial fluid after oral glucose administration in 120 individuals with prediabetes and overweight/obesity. METHODS 120 adults with prediabetes defined by HbA1c 39-47 mmol/mol and overweight or obesity who participated in the randomised controlled PRE-D trial were included in the study. Venous plasma glucose concentrations were measured at 0, 30, 60 and 120 minutes during a 75 g oral glucose tolerance test (OGTT) performed on three different occasions within a 26 weeks period. During the OGTT, the participants wore a CGM device (IPro2, Medtronic), which assessed glucose concentrations every five minutes. RESULTS A total of 306 OGTTs with simultaneous CGM measurements were obtained. Except in fasting, the CGM glucose values were below the OGTT values throughout the OGTT period with mean (SD) differences of 0.2 (0.7) mmol/L at time 0 min, -1.1 (1.3) at 30 min, -1.4 (1.8) at 60 min, and -0.5 (1.1) at 120 min). For measurements at 0 and 120 min, there was a proportional bias with an increasing mean difference between CGM and OGTT values with increasing mean of the two measurements. CONCLUSIONS Due to poor agreement between the OGTT and CGM with wide 95% limits of agreement and proportional bias at 0 and 120 min, the potential for assessing glucose tolerance in prediabetes using CGM is questionable.
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Affiliation(s)
- Kristine Færch
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
- *Correspondence: Kristine Færch,
| | - Hanan Amadid
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Lea Bruhn
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | | | - Adam Hulman
- Steno Diabetes Center Aarhus, Aarhus, Denmark
| | - Mathias Ried-Larsen
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
- Institute of Sports and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Martin Bæk Blond
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marit Eika Jørgensen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- University of Southern Denmark, Copenhagen, Denmark
| | - Dorte Vistisen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Experience in Nutrition Management of Diabetes-Affected COVID-19 Patients. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1321:69-80. [PMID: 33656714 DOI: 10.1007/978-3-030-59261-5_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
When diabetic patients are ill, their bodies react by releasing hormones to combat the illness. These hormones can be triggered by some states, such as infections. Some illnesses that most likely have an influence on blood glucose levels include common cold or flu, COVID-19, bronchitis, or chest infections. So, it is important for diabetic patients affected by COVID-19 to eat a healthy balanced diet to maintain stable blood glucose levels and enhance their immune functions. The immune response has often been demonstrated to be attenuated by insufficient nutrition in many model systems as well as in human studies. We summarize and propose potential nutritional therapeutic options available for the treatment of this novel coronavirus in diabetic patients.
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43
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Alghamdi AS, Alqadi A, Jenkins RO, Haris PI. The Influence of Gender and Menopausal Status on Hba1c Variation in a Big Data Study of a Saudi Population. Curr Diabetes Rev 2021; 17:365-372. [PMID: 32729424 DOI: 10.2174/1573399816999200729143238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/03/2020] [Accepted: 07/14/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Glycated haemoglobin (HbA1c) is the gold standard measurement in the screening, diagnosis and monitoring of diabetes mellitus. Saudi Arabia has a high prevalence of diabetes mellitus that is expected to rise, and the HbA1c test is commonly used in the screening, diagnosis and monitoring of diabetes. OBJECTIVE This study aims to assess the impact of age and gender on HbA1c levels, and the influence of menopausal status on HbA1c variation in a large group of Saudis. METHODS Age, gender, and HbA1c results of 168,614 Saudi adult individuals were obtained from their medical records. Patients' records were extracted irrespective of their status regarding the presence of diabetes and the status of glycaemic control. Linear regression models were used for predicting HbA1c from age and gender, and their interaction term. HbA1c levels were compared between genders in different age groups and different HbA1c categories. RESULTS There was a statistically significant positive correlation between age and HbA1c levels, where for each ten years increase in age, HbA1c increased by 0.35%. Although the overall mean HbA1c in women was significantly lower than in men (P < 0.001), women showed a significant increase in HbA1c with older age compared to men (B = 0.014, P < 0.001). Furthermore, the mean HbA1c levels in the age group > 50 years was significantly higher than before that age (P < 0.001). Thus, HbA1c increased by 1.118% in age > 50 years group compared to age ≤ 50 years, and this increase in HbA1c was significantly higher in women compared to men (B = 0.495, P < 0.001). CONCLUSION HbA1c levels are lower in women before the estimated menopausal age, which should be taken into consideration when using HbA1c for screening, diagnosis, and monitoring of diabetes in Saudi adult women. The short lifespan of red blood cells, due to loss of blood through menstruation, in women before menopause age, is a possible reason for these variations.
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Affiliation(s)
- Abdullah S Alghamdi
- Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom
| | | | - Richard O Jenkins
- Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom
| | - Parvez I Haris
- Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom
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Pilla R, Palleti SK, Rayana R, Skss SR, Abdul Razzack A, Kalla S. Glycated Haemoglobin (HbA1c) Variations in Nondiabetics With Nutritional Anemia. Cureus 2020; 12:e11479. [PMID: 33329975 PMCID: PMC7735166 DOI: 10.7759/cureus.11479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Diabetes is prevalent in the Indian population, to the extent that the diabetes burden matches that of nutritional anemia. We aimed to determine the effects of iron and vitamin B12 deficiency anemia on glycated haemoglobin (HbA1c) concentrations in individuals without diabetes. MATERIAL AND METHODS The study comprises 100 patients with iron deficiency anemia, 100 with vitamin B12 deficiency anemia, and 100 healthy volunteers as a control group. Each of the first two groups was subdivided into two groups depending on the severity of anemia based on Hb levels. We treated with iron replenishment in the iron deficiency group and B12 replenishment in the B12 deficiency group for three months. We noted HbA1c levels before and after the therapy. Data were entered into the SPSS package. For comparing pre and post-therapy levels, we used the Paired 't' test. RESULTS The mean HbA1c before treatment were 6.1% ± 0.23% and 5.5% ± 0.24%, and the values after treatment were 5.1% ± 0.14% and 4.6% ± 0.2% in severe iron deficiency anemia subgroup and mild to moderate subgroup, respectively. The mean HbA1c in the iron-deficiency anemia control group was 5.2% ± 0.2%. The mean HbA1c levels before treatment were 5.9% ± 0.3% and 5.6% ± 0.19%, and after treatment were 5.0% ± 0.15% and 4.9% ± 0.16% in severe and mild to moderate B12 deficiency anemia, respectively. The mean HbA1c in the vitamin B12 deficiency anemia control group was 5.1% ± 0.2%. CONCLUSION HbA1c in both types of anemia subjects showed a significant decrease with appropriate therapy. Physicians should consider rechecking patient haemoglobin values and correcting a patient's anemia before determining the patient's glycemic status using HbA1c to avoid misinterpretation of their diabetes status.
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Affiliation(s)
- Rakesh Pilla
- Internal Medicine, Maharajah's Institute of Medical Sciences, Vizianagaram, IND
| | | | - Renuka Rayana
- Internal Medicine, Andhra Medical College, Visakhapatnam, IND
| | - Satish Reddy Skss
- Internal Medicine, Maharajah's Institute of Medical Sciences, Vizianagaram, IND
| | | | - Sruti Kalla
- Internal Medicine, Maharajah's Institute of Medical Sciences, Vizianagaram, IND
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Copur S, Onal EM, Afsar B, Ortiz A, van Raalte DH, Cherney DZ, Rossing P, Kanbay M. Diabetes mellitus in chronic kidney disease: Biomarkers beyond HbA1c to estimate glycemic control and diabetes-dependent morbidity and mortality. J Diabetes Complications 2020; 34:107707. [PMID: 32861562 DOI: 10.1016/j.jdiacomp.2020.107707] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/07/2020] [Accepted: 08/08/2020] [Indexed: 12/13/2022]
Abstract
Diabetes mellitus (DM) is the leading cause of chronic kidney disease (CKD). Optimal glycemic control contributes to improved outcomes in patients with DM, particularly for microvascular damage, but blood glucose levels are too variable to provide an accurate assessment and instead markers averaging long-term glycemic load are used. The most established glycemic biomarker of long-term glycemic control is HbA1c. Nevertheless, HbA1c has pitfalls that limit its accuracy to estimate glycemic control, including the presence of altered red blood cell survival, hemoglobin glycation and suboptimal performance of HbA1c assays. Alternative methods to evaluate glycemic control in patients with DM include glycated albumin, fructosamine, 1-5 anhydroglucitol, continuous glucose measurement, self-monitoring of blood glucose and random blood glucose concentration measurements. Accordingly, our aim was to review the advantages and pitfalls of these methods in the context of CKD.
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Affiliation(s)
- Sidar Copur
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Emine M Onal
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Baris Afsar
- Department of Medicine, Division of Nephrology, Suleyman Demirel University School of Medicine, Isparta, Turkey
| | - Alberto Ortiz
- Dialysis Unit, School of Medicine, IIS-Fundacion Jimenez Diaz, Universidad Autónoma de Madrid, Avd. Reyes Católicos 2, 28040 Madrid, Spain
| | - Daniel H van Raalte
- Diabetes Center, Department of Internal Medicine, Amsterdam University Medical Center, location VUMC, Amsterdam, the Netherlands
| | - David Z Cherney
- Toronto General Hospital Research Institute, UHN, Toronto, Canada; Departments of Physiology and Pharmacology and Toxicology, University of Toronto, Ontario, Canada
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, Copenhagen, Denmark; University of Copenhagen, Copenhagen, Denmark
| | - Mehmet Kanbay
- Department of Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey.
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Liberda EN, Zuk AM, Martin ID, Tsuji LJS. Fisher's Linear Discriminant Function Analysis and its Potential Utility as a Tool for the Assessment of Health-and-Wellness Programs in Indigenous Communities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217894. [PMID: 33126498 PMCID: PMC7663610 DOI: 10.3390/ijerph17217894] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/22/2020] [Accepted: 10/25/2020] [Indexed: 11/16/2022]
Abstract
Diabetes mellitus is a growing public health problem affecting persons in both developed and developing nations. The prevalence of type 2 diabetes mellitus (T2DM) is reported to be several times higher among Indigenous populations compared to their non-Indigenous counterparts. Discriminant function analysis (DFA) is a potential tool that can be used to quantitatively evaluate the effectiveness of Indigenous health-and-wellness programs (e.g., on-the-land programs, T2DM interventions), by creating a type of pre-and-post-program scoring system. As the communities of the Eeyou Istchee territory, subarctic Quebec, Canada, have varying degrees of isolation, we derived a DFA tool for point-of-contact evaluations to aid in monitoring and assessment of health-and-wellness programs in rural and remote locations. We developed several DFA models to discriminate between those with and without T2DM status using age, fasting blood glucose, body mass index, waist girth, systolic and diastolic blood pressure, high-density lipoprotein, triglycerides, and total cholesterol in participants from the Eeyou Istchee. The models showed a ~97% specificity (i.e., true positives for non-T2DM) in classification. This study highlights how varying risk factor models can be used to discriminate those without T2DM with high specificity among James Bay Cree communities in Canada.
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Affiliation(s)
- Eric N. Liberda
- School of Occupational and Public Health, Ryerson University, Toronto, ON M5B 2K3, Canada
- Correspondence: ; Tel.: +1-416-979-5000
| | - Aleksandra M. Zuk
- Department of Physical and Environmental Sciences, University of Toronto, Toronto, ON M1C 1A4, Canada; (A.M.Z.); (I.D.M.); (L.J.S.T.)
- School of Nursing, Faculty of Health Sciences, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Ian D. Martin
- Department of Physical and Environmental Sciences, University of Toronto, Toronto, ON M1C 1A4, Canada; (A.M.Z.); (I.D.M.); (L.J.S.T.)
| | - Leonard J. S. Tsuji
- Department of Physical and Environmental Sciences, University of Toronto, Toronto, ON M1C 1A4, Canada; (A.M.Z.); (I.D.M.); (L.J.S.T.)
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Mahgoob MH, Moussa MM. Glycated albumin versus HbA1c as indicators of glycemic control in type I diabetic children with iron deficiency anemia. Clin Pediatr Endocrinol 2020; 29:151-157. [PMID: 33088014 PMCID: PMC7534525 DOI: 10.1297/cpe.29.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/10/2020] [Indexed: 11/13/2022] Open
Abstract
We evaluated the clinical usefulness of glycated albumin (GA) and glycated hemoglobin
(HbA1c) as indicators of glycemic control in type I diabetic (T1DM) children with and
without iron deficiency anemia (IDA). Our prospective cross-sectional study was conducted
on 147 T1DM children who were classified into Group I (with IDA) and Group II (without
anemia). The participants were classified as controlled and uncontrolled based on mean
blood glucose (MBG) in the past 30 days. The 5–12-yr-olds with MBG above 200 and
12–15-yr-olds with levels above 180 md/dl were considered uncontrolled. HbA1c increased
significantly in the participants with IDA compared to those without anemia (p < 0.01).
HbA1c in those with IDA showed insignificant difference between the controlled and
uncontrolled (p = 0.5), while GA was significantly higher in the uncontrolled than the
controlled (p = 0.3). Receiver operating characteristic (ROC) curve analysis showed that
GA had 87.2% sensitivity and 75.8% specificity at a cut-off point of 16.9%. HbA1c at a
cut-off point of 7.09% showed 80% sensitivity and 57.6% specificity. For prediction of
uncontrolled diabetes in children with IDA, we concluded that HbA1c increases
significantly in diabetic children with IDA. GA may be a useful alternative biomarker for
evaluating the glycemic control in such children.
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Murakami H, Yasui‐Furukori N, Otaka H, Nakayama H, Murabayashi M, Mizushiri S, Matsumura K, Tanabe J, Matsuhashi Y, Yanagimachi M, Sugawara N, Shimoda K, Daimon M. Coping styles associated with glucose control in individuals with type 2 diabetes mellitus. J Diabetes Investig 2020; 11:1215-1221. [PMID: 32017452 PMCID: PMC7477505 DOI: 10.1111/jdi.13225] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 01/21/2020] [Accepted: 02/02/2020] [Indexed: 01/26/2023] Open
Abstract
AIMS/OBJECTIVES Glycemic control varies according to stress level and the efficacy of control measures, affecting the outcomes of diabetes. Although detailed coping styles have not been well studied in patients with type 2 diabetes mellitus, problem-focused coping strategies are believed to be related to better control of blood glucose. Associations between coping profiles/dimensions and blood glucose control were examined in individuals with type 2 diabetes. MATERIALS AND METHODS The participants included 503 Japanese patients (mean age 63.9 ± 12.6 years) with type 2 diabetes. The average glycated hemoglobin A1c (HbA1c) levels were calculated from HbA1c levels measured more than four times within the 12 months before the assessment. Coping profiles were assessed using the Brief Scale for Coping Profile. Lifestyle factors were also included in the analyses. RESULTS Factors other than age were not associated with HbA1c levels in patients who used insulin. Conversely, habitual alcohol consumption, single status, the adaptive emotion-focused coping dimension, and changing mood and changing one's point of view profiles were associated with HbA1c levels. CONCLUSIONS These findings suggest that adaptive emotion-focused coping supports glycemic control in type 2 diabetes patients who do not use insulin. Additional studies using a longitudinal design are required to further examine the relationships between psychological factors and glycemic control.
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Affiliation(s)
- Hiroshi Murakami
- Department of Endocrinology and MetabolismHirosaki University Graduate School of MedicineHirosakiJapan
| | - Norio Yasui‐Furukori
- Department of NeuropsychiatryHirosaki University Graduate School of MedicineHirosakiJapan
- Department of PsychiatryDokkyo Medical University School of MedicineMibuJapan
| | - Hideyuki Otaka
- Department of Endocrinology and MetabolismHirosaki University Graduate School of MedicineHirosakiJapan
| | - Hirofumi Nakayama
- Department of Endocrinology and MetabolismHirosaki University Graduate School of MedicineHirosakiJapan
| | - Masaya Murabayashi
- Department of Endocrinology and MetabolismHirosaki University Graduate School of MedicineHirosakiJapan
| | - Satoru Mizushiri
- Department of Endocrinology and MetabolismHirosaki University Graduate School of MedicineHirosakiJapan
| | - Koki Matsumura
- Department of Endocrinology and MetabolismHirosaki University Graduate School of MedicineHirosakiJapan
| | - Jutaro Tanabe
- Department of Endocrinology and MetabolismHirosaki University Graduate School of MedicineHirosakiJapan
| | - Yuki Matsuhashi
- Department of Endocrinology and MetabolismHirosaki University Graduate School of MedicineHirosakiJapan
| | - Miyuki Yanagimachi
- Department of Endocrinology and MetabolismHirosaki University Graduate School of MedicineHirosakiJapan
| | - Norio Sugawara
- Department of PsychiatryDokkyo Medical University School of MedicineMibuJapan
- Department of Clinical EpidemiologyTranslational Medical CenterNational Center of Neurology and PsychiatryKodairaJapan
| | - Kazutaka Shimoda
- Department of PsychiatryDokkyo Medical University School of MedicineMibuJapan
| | - Makoto Daimon
- Department of Endocrinology and MetabolismHirosaki University Graduate School of MedicineHirosakiJapan
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Chen YJ, Chen JT, Tai MC, Liang CM, Chen YY, Chen WL. Serum Iron and Risk of Diabetic Retinopathy. Nutrients 2020; 12:nu12082297. [PMID: 32751778 PMCID: PMC7469039 DOI: 10.3390/nu12082297] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/25/2020] [Accepted: 07/29/2020] [Indexed: 12/16/2022] Open
Abstract
Background: Diabetic retinopathy (DR) is indicated as a major cause of blindness in the world. Emerging evidence supports the interaction of iron metabolism with diabetes. However, little research is available concerning the relationship between iron metabolism and DR. The intent of this paper is to describe the correlation between serum iron and the occurrence of DR. Methods: A total of 5321 participants who underwent related examinations as part of the National Health and Nutrition Examination Survey (2005–2008) were included. DR was defined by the criteria of the Early Treatment for Diabetic Retinopathy Study based on nonmydriatic fundus photography. The cutoff point of serum iron for DR was explored by the receiver operating characteristics curve. The relationship of serum iron with the occurrence of DR was explored by multivariate logistic regression models. Results: Participants with DR had significantly lower serum iron than the control group. Serum iron was negatively correlated with the occurrence of DR after the adjustment of pertinent variables (an odds ratio (OR) of 0.995 (95% CI: 0.992–0.999)). After dividing serum iron into quartiles, the third quartile was associated with DR with an OR of 0.601 (95% CI: 0.418–0.863). Furthermore, the cutoff point of serum iron had an inverse relationship for the occurrence of DR with an OR of 0.766 (95% CI: 0.597–0.984). Conclusion: Serum iron has an inverse association with the occurrence of DR in diabetic adults. The assessment of serum iron levels might be a part of follow-up visits with diabetic patients.
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Affiliation(s)
- Ying-Jen Chen
- Department of Ophthalmology, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei 114, Taiwan; (Y.-J.C.); (J.-T.C.); (M.-C.T.); (C.-M.L.)
| | - Jiann-Torng Chen
- Department of Ophthalmology, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei 114, Taiwan; (Y.-J.C.); (J.-T.C.); (M.-C.T.); (C.-M.L.)
| | - Ming-Cheng Tai
- Department of Ophthalmology, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei 114, Taiwan; (Y.-J.C.); (J.-T.C.); (M.-C.T.); (C.-M.L.)
| | - Chang-Min Liang
- Department of Ophthalmology, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei 114, Taiwan; (Y.-J.C.); (J.-T.C.); (M.-C.T.); (C.-M.L.)
| | - Yuan-Yuei Chen
- Department of Pathology, Tri-Service General Hospital Songshan Branch, and School of Medicine, National Defense Medical Center, Taipei 114, Taiwan;
- Department of Pathology, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei 114, Taiwan
| | - Wei-Liang Chen
- Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei 114, Taiwan
- Division of Environmental Health & Occupational Medicine, Department of Family & Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
- Department of Biochemistry, National Defense Medical Center, Taipei 114, Taiwan
- Correspondence: ; Tel.: +886-2-87923311 (ext. 16567); Fax: +886-2-87927057
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Çetinkaya Altuntaş S, Evran M, Gürkan E, Sert M, Tetiker T. HbA1c level decreases in iron deficiency anemia. Wien Klin Wochenschr 2020; 133:102-106. [PMID: 32377869 DOI: 10.1007/s00508-020-01661-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 04/09/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Hemoglobin A1c (HbA1c) is the major form of glycosylated hemoglobin. There are conflicting data on changes in HbA1c levels in patients with iron deficiency anemia (IDA). The present study aimed to investigate the effects of HbA1c levels in the presence of IDA, the effects of iron treatment on HbA1c levels, as well as the relationship between the severity of anemia and HbA1c levels in patients without diabetes. DESIGN AND METHODS A total of 263 patients without diabetes mellitus (DM) who were admitted to Cukurova University, Faculty of Medicine, Department of Endocrinology and Hematology or who were followed up in this clinic and diagnosed as having IDA were included in the study. A total of 131 patients had IDA. The control group comprised 132 age-matched and sex-matched healthy individuals. RESULTS The mean HbA1c level was significantly lower in the group with IDA (5.4%) than in the healthy control group (5.9%; p < 0.05). When the patients were divided into three groups according to the severity of anemia through Hb levels, HbA1c levels were observed to decrease as the severity of the anemia increased (5.5%, 5.4%, and 5%, respectively; p > 0.05). The HbA1c levels of the patients with IDA were higher after iron therapy (from 5.4 ± 0.5 to 5.5 ± 0.3; p = 0.057). The mean hemoglobin (Hb), hematocrit (Hct), mean cell volume (MCV), mean corpusculer hemoglobin (MCH), and ferritin values also increased after iron therapy (p < 0.05). CONCLUSION The study results showed that IDA was associated with low HbA1c levels, and increased after iron therapy. Based on the study findings, it is necessary to consider the possible effects of IDA on HbA1c levels.
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Affiliation(s)
- Seher Çetinkaya Altuntaş
- Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology, Recep Tayyip Erdoğan University, 053100, Rize, Turkey.
| | - Mehtap Evran
- Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology, Cukurova University, Adana, Turkey
| | - Emel Gürkan
- Cukurova University Medical Faculty, Department of Internal Medicine, Division of Hematology, Adana, Turkey
| | - Murat Sert
- Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology, Cukurova University, Adana, Turkey
| | - Tamer Tetiker
- Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology, Cukurova University, Adana, Turkey
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