High variability of glycated hemoglobin concentrations in patients with IDDM followed over 9 years. What is the best index of long-term glycemic control?

An anti-inflammatory sterol decreases obesity-related inflammation-induced insulin resistance and metabolic dysregulation

Obesity-related inflammation-induced insulin resistance and metabolic dysregulation were investigated in retrospective analysis of placebo hematologic and metabolic laboratory data from trials associated with increasing chronic low-grade inflammation and body mass index. Studies included healthy subjects and those with progressive stages of metabolic dysregulation, including type 2 diabetes mellitus with uncontrolled hemoglobin A1c. Intrasubject variances in erythroid and metabolic values increased with metabolic dysregulation. Random effects were demonstrated in treatment-naïve diabetes for erythroid, glucose, and HbA1c fluctuations. The anti-inflammatory insulin sensitizer, HE3286, was tested for its ability to decrease obesity-related inflammation-induced insulin resistance and metabolic dysregulation in diabetes. HE3286 significantly decreased erythroid and metabolic variances and improved 1,5-anhydroglucitol (a surrogate of postprandial glucose) compared to the placebo group. HE3286 HbA1c decrease correlated with weight loss and inversely with baseline monocyte chemoattractant protein-1 (MCP-1) in metformin-treated diabetics. Normalization of HbA1c to the 84-day average hemoglobin revealed that HE3286 HbA1c decrease correlated with high baseline MCP-1 and MCP-1 decrease in treatment-naïve diabetics. HE3286 decreased insulin resistance, increased the frequency of decreased day 84 HbA1c in metformin-treated subjects, and decreased day 112 HbA1c in treatment-naïve diabetics. HE3286 may be useful to restore metabolic homeostasis in type 2 diabetes.

Intra-individual variability and longitudinal changes in glycaemic control in patients with Type 1 diabetes mellitus

AIMS

Patients with Type 1 diabetes mellitus (DM) appear to have remarkably stable HbA1c levels, regardless of the need for improvement. The purpose of the present study was therefore to study predictors of intra-individual variability of the HbA1c level together with changes in HbA1c over time.

METHODS

Hospital records of patients with Type 1 DM seen at our diabetes clinic from February 1992 to May 1997 were reviewed for HbA1c measurements and clinical data. In the main study, 214 patients who had been on insulin for more than 1 year, and in a sub-study, 14 patients newly started on insulin, were included.

RESULTS

The coefficient of variation (CV) of the intra-individual HbA1c measurements, after at least 1 year of insulin, was 8.8 +/- 3.7% (mean +/- SD). There was a positive association between the CV and the HbA1c measurement at inclusion in the study (P < 0.05), and also a negative association between the CV and age (P < 0.05). Fifty per cent of the patients had a difference between first and last HbA1c below 1%, and 83.6% had a difference below 2%. In the sub-study, there was a positive association between the mean HbA1c value the first year on insulin (excluding the first 3 months) and the last HbA1c measurement (P < 0.01).

CONCLUSIONS

The HbA1c levels in individual patients remain remarkably stable over time. Furthermore, the HbA1c level shortly after starting insulin is a predictor of future glycaemic control.