HbA(1c) levels among American Indian/Alaska Native adults

Are ultrasonographic scoring systems of the salivary gland in primary Sjögren's syndrome suitable for examination of Type2 diabetes mellitus patients with sicca?

OBJECTIVE

This study aimed to compare the salivary gland ultrasonography(SGUS) findings in patients with primary Sjögren's Syndrome (pSS) and diabetes mellitus(DM) patients with sicca symptoms and to examine the relationship between salivary gland ultrasonography (SGUS) findings with clinical and laboratory parameters.

METHODS

In this study, 34 patients with pSS and 34 DM patients with sicca symptoms were included. In all patients, bilateral parotid, and submandibular gland ultrasonography (totally 272 glands) was performed by blinded rheumatologist, using the Hocevar and the Outcome Measures in Rheumatology (OMERACT) scoring system. Clinic and ultrasonographic variables were compared between groups. The association between SGUS score and disease duration was analyzed by correlation analysis.

RESULTS

Patients with pSS presented significantly higher SGUS scores than patients with DM (the Hocevar score; 20.93(± 9.65) vs. 3.82(± 3.71); p < 0.05, the OMERACT score; 5.96(± 2.30) vs. 2.07(± 1.65); p < 0.05, respectively). In patients with pSS, the submandibular gland scores were significantly higher than the parotid gland scores (right; p < 0.05 vs. left; p < 0.01) while DM patients showed significantly higher parotid gland scores (right; p < 0.05 vs. left; p < 0.05). In pSS patients, the SGUS scores were associated with disease duration (r = 0.57; r = 0.50; p < 0.05), symptom duration (r = 50; r = 0.47; p < 0.05), and the European League Against Rheumatism Sjögren's Syndrome Patient Reported Index (ESSPRI)-dryness score (r = 0.35, r = 0.36; p < 0.05). However, in DM patients, the SGUS scores are highly correlated with the ESSPRI-dryness (r = 0.74, r = 0.72; p < 0.05) and HbA1C level (r = 0.91, r = 0.86; p < 0.05).

CONCLUSIONS

This study demonstrated that major salivary gland involvement was more severe and correlated with disease duration, and submandibular gland was dominantly affected in pSS. Contrarily, in DM patients, salivary gland involvement was milder, parotid dominant and related to level of dryness and HbA1C, rather than disease duration when compared to pSS.

The Effects of Flaxseed Consumption on Glycemic Control in Native American Postmenopausal Women with Hyperglycemia and Hyperlipidemia

Glucose control in postmenopausal women is influenced by many factors, such as hormones, lifestyle variables, and genetics. Limited data exist on the effect of whole flaxseed on glucose status in postmenopausal Native American women. The aim of this study was to investigate the glucose management effect of a flaxseed dietary intervention on postmenopausal Native American women. In this study, 55 Native American postmenopausal women (aged 47-63 years) with borderline hyperglycemia (>100 and <126 mg/dL) and mild to moderate hypercholestorolemia (≥200 to ≤380 mmol/L), who were not on hormone replacement therapy, were enrolled. Participants were randomly assigned to one of the three dietary regimens (control, flaxseed, and flaxseed + fiber) for three months, receiving interventions in the form of bread, muffins, and flaxseed powder. Despite daily consumption of flaxseed across diverse food formats, no significant changes in glucose (p = 0.3, p = 0.2), insulin levels (p = 0.59, p = 0.9), or HOMA-IR (p = 0.84, p = 0.66) were observed compared to their respective baseline values within the flaxseed and flaxseed + fiber groups, respectively. Conversely, the control group showed a significant rise in final glucose values from baseline (p = 0.01). However, the incorporation of ground flaxseed into low-glycemic foods holds potential for beneficial effects through maintaining glucose status among postmenopausal Native American women. This research provides critical insights into the effects of flaxseed, emphasizing the need for continued exploration to understand its role in supporting glucose management among postmenopausal Native American women. Further exploration is required to investigate the potential long-term impact and the use of flaxseed in managing glucose levels in this demographic.

Impact of Age on the Effectiveness and Safety of Insulin Glargine 300 U/mL: Results from the REALI European Pooled Data Analysis

INTRODUCTION

Patients aged ≥ 65 years continue to be underrepresented in clinical studies related to type 2 diabetes mellitus (T2DM). Accordingly, the REALI pooled analysis was performed to evaluate the effectiveness and safety of insulin glargine 300 U/mL (Gla-300) across different age subgroups, using data from 14 interventional and non-interventional studies.

METHODS

Pooled efficacy and safety data were collected from 8106 European patients with uncontrolled T2DM who were initiated on or switched to Gla-300 injected once daily for 24 weeks. Patients were categorised into five age subgroups: < 50 (N = 727), 50-59 (N = 2030), 60-69 (N = 3054), 70-79 (N = 1847) and ≥ 80 years (N = 448).

RESULTS

Mean baseline haemoglobin A1c (HbA1c) decreased linearly from the youngest (9.10%) to the oldest (8.46%) age subgroup. Following Gla-300 initiation, there were similar HbA1c reductions across age groups, with a least squares mean (95% confidence interval) change in HbA1c from baseline to week 24 of - 1.09% (- 1.18 to - 1.00), - 1.08% (- 1.14 to - 1.03), - 1.12% (- 1.17 to - 1.07), - 1.18% (- 1.24 to - 1.12) and - 1.11% (- 1.23 to - 0.99) in the < 50, 50-59, 60-69, 70-79 and ≥ 80 years subgroups, respectively. The incidences and event rates of reported hypoglycaemia were overall low. Compared to younger age subgroups, lower incidences of symptomatic hypoglycaemia occurring at any time of the day (5.9 vs. 7.6-9.4% for the younger subgroups) or during the night (0.5 vs. 1.6-2.5%) were recorded in patients aged ≥ 80 years. By contrast, the highest incidence of severe hypoglycaemia occurring any time of the day was reported in the subgroup aged ≥ 80 years (1.1 vs. 0.1-0.6% for the younger age subgroups).

CONCLUSION

Gla-300 initiated in patients with uncontrolled T2DM provides glycaemic improvement with a favourable safety profile across a wide range of ages.

A Cross-Sectional Study on Ultrasonographic Measurements of Parotid Glands in Type 2 Diabetes Mellitus

Background

Diabetes mellitus is a metabolic disease which is seen increasing globally and is diagnosed and monitored on basis of invasive blood investigations. Salivary glands are affected in diabetes mellitus. The objective of this study was to assess ultrasonographic measurements of parotid glands and correlate with the glycosylated hemoglobin levels in type 2 diabetic mellitus and duration of type 2 diabetic mellitus and treatment regimens.

Materials and Methods

This study was conducted on 50 subjects of type 2 diabetes mellitus and on 50 healthy controls. After HbA_1C analysis of selected individuals, 100 individuals were grouped into group I (above 5.7) and group II (below 5.7). Ultrasonographic measurements (length (L), transverse dimension (TD), depth lateral to the mandible (DLM), and depth dorsal to the mandible (DDM)) of bilateral parotid glands were calculated. Statistical analysis was done using the chi-square test of significance and Spearman correlation coefficients.

Results

On correlation with measurement of right (L, DLM, DDM) and left (TD, DLM, DDM) of parotid glands with duration of type 2 diabetes mellitus, we found a moderate positive relationship, whereas as for right (TD) and left (L), we found a low-positive relationship. Similarly, for right (L, TD, DLM, DDM) and left (TD, DDM) parotid glands with HbA_1C, we found a low-positive relationship, whereas for left parotid gland (L, DLM) with HbA_1C, we found a moderate positive relationship. The mean DLM of right and left parotids in the insulin group was found to be slightly more than that in the combined group which was statistically insignificant.

Conclusion

Ultrasonographic measurements of parotid glands were found to be higher in study subjects as compared to control subjects, and they increased with increased HbA_1C levels; also, there was no difference in treatment regimen. Ultrasonography could be a prospective diagnostic test for detection and monitoring of diabetes mellitus, and still further studies are required for this.

Reconsidering the HbA1c Cutoff for Diabetes Diagnosis Based on a Large Chinese Cohort

INTRODUCTION

The HbA1c has been considered as the 'gold standard' in diabetes diagnosis and management, however, age, gender and body mass index (BMI) might have certain effects on HbA1c. We are aiming to further investigate the correlation between age and HbA1c, and whether it was affected by gender and BMI.

METHODS

A cross-sectional survey including 135,893 nondiabetic individuals who took the physical examination between 2013 and 2017 was conducted. The subjects were grouped by gender, age and BMI, and the interactive and independent effects of the 3 factors on the HbA1c were detected. The median and 95% confidence interval (CI) of HbA1c levels were calculated.

RESULTS

The HbA1c levels gradually increased along with age, both in female and male, and there is a positive association between BMI and the HbA1c. The difference on HbA1c in gender was associated with both age and BMI, the age-related increase in HbAlc was accentuated in the subgroup with higher BMI, and there was a marked accentuation of the positive association between BMI and HbA1c as age increased. In almost all the young and middle-aged (aged 20-59) subgroups, the 97.5^th percentiles of HbA1c levels were lower than 6.5%, suggesting that the single HbA1c cutoff value is probably not applicable to the young and middle-aged population.

CONCLUSIONS

We recommend that the effects of age, gender and BMI should be taken into consideration when using HbA1c for the diagnosis and management of diabetes, especially in the young and middle-aged population.

Age and glycemic control among low-income Latinos

Younger adult patients with diabetes often have poorer glycemic control (HbA1c) than older patients. It is not known if this relationship holds true in the Latino population. Objective was to explore the relationship between age and HbA1c in a Mexican American population and what plausible factors might mediate this relationship. We analyzed data from 387 patients with diabetes self-identified as Mexican American recruited as a part of a cross-sectional study of safety net patients in two cities. Patients completed questionnaires and their last HbA1c was extracted from the medical record. We conducted multivariate regression analyses and Baron and Kenny tests of mediation. Participants were young with mean age of 53 ± 12 years. Younger age was associated with a higher HbA1c and having a higher fat diet. High fat diet partially mediated the relationship between age and HbA1c (p < 0.001 to p < 0.01). Age's indirect effect on HbA1c through diet was significant (Sobel = -2.44, p = 0.01). Younger Mexican American patients had higher HbA1c compared to older patients. Having a diet high in fat partially explained this relationship. Future epidemiological studies are needed to understand the multifaceted relationship between age and glycemic control.

HbA1c Levels among Primary Healthcare Patients with Type 2 Diabetes Mellitus in Oman

OBJECTIVES

To investigate whether younger patients with type 2 diabetes mellitus have higher glycated hemoglobin A1c (HbA1c) levels compared to older patients, and to determine the factors associated with higher HbA1c levels.

METHODS

Data from 1,266 patients from all over Oman were used to obtain the mean HbA1c level, odds ratios (OR), and 95% confidence intervals (CI) from multiple logistic regression models with age groups, sex, duration of diabetes, diabetes treatment, body mass index, estimated glomerular filtration rate (eGFR), tobacco use, and healthcare index as predictors of good (HbA1c <7%) vs. poor (≥7%) glycemic control.

RESULTS

Mean HbA1c levels were 8.9, 8.3, and 7.8 in the age groups 20-39, 40-59 and 60+ years, respectively. After controlling for all other covariates, the OR of good glycemic control increased with age, 40-59 years old (OR=1.7; 95% CI 1.1 to 2.6) and 60+ year (OR=2.5; 95% CI 1.6 to 4.0), female gender (OR=1.5; 95% CI 1.2 to 2.0) and in patients with eGFR ≥60 mL/min/1.73 m(2) (OR=1.9; 95% CI 1.1 to 3.3). Longer duration of diabetes (≥5 years) and treatment with oral agents or insulin were inversely related to good glycemic control.

CONCLUSION

Younger Omani adults exhibit worse glycemic levels compared to older adults posing a formidable challenge to diabetes care teams.

Patient age: a neglected factor when considering disease management in adults with type 2 diabetes

OBJECTIVE

The average age at diagnosis for type 2 diabetes is decreasing. However, because age is most often controlled for in clinical research, little is known regarding how adult age is associated with diabetes disease-related variables.

METHODS

In a community based study with type 2 diabetes patients (N=506), after adjusting for potentially confounding variables, we examined associations between patients' age and: stress, depression, diabetes-related distress, self-efficacy, diet, exercise, and glycemic control. We then explored to what extent age interacts with these variables in their association with glycemic control.

RESULTS

Younger age was independently associated with: greater chronic stress and negative life events, higher levels of diabetes-related distress, higher depressed affect, eating healthier foods and exercising less frequently, lower diabetes self-efficacy, and higher HbA1c. Interactions showed that younger patients with high stress and/or low self-efficacy were more likely to have higher HbA1c levels than older patients.

CONCLUSIONS

Results suggest younger adult patients with type 2 diabetes represent a unique patient subgroup with specific needs and health risks based on their developmental stage and life context.

PRACTICE IMPLICATIONS

Treatment programs need to target younger adult patients and may need to utilize different media or modalities (e.g., social media) to reach this group.

Ethnic disparities: control of glycemia, blood pressure, and LDL cholesterol among US adults with type 2 diabetes

OBJECTIVE

To examine ethnic disparities in the quality of diabetes care among adults with diabetes in the US through a systematic qualitative review.

DATA SOURCES

Material published in the English language was searched from 1993 through June 2003 using PubMed, Web of Science, Cumulative Index to Nursing and Allied Health, the Cochrane Library, Combined Health Information Database, and Education Resources Information Center.

STUDY SELECTION AND DATA EXTRACTION

Studies of patients with diabetes in which at least 50% of study participants were ethnic minorities and studies that made ethnic group comparisons were eligible. Research on individuals having prediabetes, those <18 years of age, or women with gestational diabetes were excluded. Reviewers used a reproducible search strategy. A standardized abstraction and grading of articles for publication source and content were used. Data on glycemia, blood pressure, and low-density lipoprotein cholesterol (LDL-C) were extracted in patients with diabetes. A total of 390 studies were reviewed, with 78 meeting inclusion criteria.

DATA SYNTHESIS

Ethnic minorities had poorer outcomes of care than non-Hispanic whites. These disparities were most pronounced for glycemic control and least evident for LDL-C control. Most studies showed blood pressure to be poorly controlled among ethnic minorities.

CONCLUSIONS

Control of risk factors for diabetes (glycemia, blood pressure, LDL-C) is challenging and requires routine assessment. These findings indicate that additional efforts are needed to promote diabetes quality of care among minority populations.