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Andrade MV, de Souza Noronha KVM, Santos AS, Maia JX, Nogueira LT, Cimini CCR, Furtado ME, Coelho L, Marcolino MS, Ribeiro ALP. HBA1C point-of-care testing for diabetes control in a low-income population: A before and after study and cost-parity analysis HbA1c point-of-care testing for diabetes control. Prim Care Diabetes 2023; 17:447-453. [PMID: 37543526 DOI: 10.1016/j.pcd.2023.07.007] [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: 09/30/2022] [Revised: 02/14/2023] [Accepted: 07/29/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE To evaluate the results of a program that offered access to HbA1c POC tests for the glycemic control of patients with diabetes in small and poor municipalities of Minas Gerais, Brazil. METHODS Using a before and after study, we compared four groups: patients submitted to (i) POC tests; (ii) conventional tests; (iii) both tests; and (iv) neither test. The analysis considered three periods: before the program; before the pandemic; and during the pandemic. A cost comparison was conducted under the societal perspective and a cost-parity model was designed. RESULTS 1349 patients previously diagnosed with diabetes were included in the analysis. The rate of consultations and the rate of HbA1c testing were significantly different between all periods and groups. Group iii had a much higher consultation and testing rate. The costs were around 89.45 PPP-USD for POC tests and between 32.44 and 54.66 PPP-USD for conventional tests. Cost-parity analysis suggests that the technology would be acceptable if the annual number of tests was between 247 and 771. CONCLUSION Using POC devices improved access to HbA1c testing but not glycemic control. Even in small towns, the number of tests necessary to achieve cost-parity is low enough to enable their incorporation into the public health system.
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Affiliation(s)
- Mônica Viegas Andrade
- Department of Economics, Center for Development and Regional Planning (CEDEPLAR), Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Pampulha, CEP 31.270-901 Belo Horizonte, Brazil.
| | - Kenya Valéria Micaela de Souza Noronha
- Department of Economics, Center for Development and Regional Planning (CEDEPLAR), Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Pampulha, CEP 31.270-901 Belo Horizonte, Brazil
| | - André Soares Santos
- Department of Economics - Center for Development and Regional Planning (CEDEPLAR), Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Pampulha, CEP 31.270-901, Belo Horizonte, Brazil; Center for Health Technology Assessment of the UFMG Teaching Hospital (NATS-HC/UFMG) -Universidade Federal de Minas Gerais, Av. AlfredoBalena, 110, Santa Efigênia, CEP 30.130-100 Belo Horizonte, Brazil
| | - Junia Xavier Maia
- Centro de Telessaúde Hospital das Clínicas UFMG - Universidade Federal de Minas Gerais, Av. Alfredo Balena, 110, Santa Efigênia, CEP 30.130-100 Belo Horizonte, Brazil
| | - Lucas Tavares Nogueira
- Universidade Presidente Antônio Carlos (UNIPAC), R. Eng. Célso Murta, 600, Olga Correa, CEP 39803-087 Teófilo Otoni, MG, Brazil
| | - Christiane Correa Rodrigues Cimini
- School of Medicine - Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rua do Cruzeiro, no 01, Jardim São Paulo, CEP 39803-371, Teófilo Otoni, MG, Brazil
| | - Maria Eduarda Furtado
- Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rua do Cruzeiro, no 01, Jardim São Paulo, CEP 39803-371 Teófilo Otoni, MG, Brazil
| | - Laryssa Coelho
- School of Medicine - Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rua do Cruzeiro, no 01, Jardim São Paulo, CEP 39803-371, Teófilo Otoni, MG, Brazil
| | - Milena Soriano Marcolino
- Professor at Department of Internal Medicine, School of Medicine, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Santa Efigênia, CEP30.130-100 Belo Horizonte, Brazil; Telehealth Center, Hospital das Clínicas da Universidade Federal de Minas Gerais, Av. Alfredo Balena, 110, Santa Efigênia, CEP 30.130-100 Belo Horizonte, Brazil
| | - Antônio Luiz Pinho Ribeiro
- Cardiology Service and Telehealth Center, Hospital das Clínicas da Universidade Federal de Minas Gerais, Av. Alfredo Balena, 110, Santa Efigênia, CEP 30.130-100 Belo Horizonte, Brazil; Department of Internal Medicine, School ofMedicine, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Santa Efigênia, CEP30.130-100 Belo Horizonte, Brazil.
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Woo J, Whyne EZ, Wright JI, Lehrer HM, Alhalimi TA, Wang T, Saba VC, Dubois SK, Tanaka H, Brown SA, Steinhardt MA. Feasibility and Performance of Hemoglobin A1C Self-Testing During COVID-19 Among African Americans With Type 2 Diabetes. Sci Diabetes Self Manag Care 2022; 48:204-212. [PMID: 35658748 DOI: 10.1177/26350106221100536] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of the study was to determine the feasibility of implementing A1C self-testing at home using the A1CNow® Self Check and to compare the accuracy of the A1CNow to a reference standard in African Americans with type 2 diabetes (T2D). METHODS African American adults with T2D were recruited from 13 different churches (N = 123). Phase 1, conducted during the early phase of the COVID-19 pandemic, examined the feasibility of A1C assessment using the A1CNow performed at home by untrained participants. Phase 2, conducted when in-person research resumed, compared A1C values concurrently measured using the A1CNow and the DCA Vantage™ Analyzer (reference standard) collected by research staff at church testing sites. RESULTS In Phase 1, 98.8% of participants successfully completed at least 1 at-home A1C test; the overall failure rate was 24.7%. In Phase 2, the failure rate of staff-performed A1CNow testing was 4.4%. The Bland-Altman plot reveals that A1CNow values were 0.68% lower than DCA values, and the mean differences (A1CNow minus DCA) ranged from -2.6% to 1.2% with a limit of agreement between -1.9% to 0.5%. CONCLUSIONS A1C self-testing is feasible for use in community settings involving African American adults with T2D. The A1CNow Self-Check underestimated A1C values when compared with the reference standard. Ongoing improvements in point-of-care devices have the potential to expand research and clinical care, especially in underserved communities.
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Affiliation(s)
- Jihun Woo
- Department of Kinesiology and Health Education, College of Education, The University of Texas at Austin, Austin, Texas
| | - Erum Z Whyne
- Department of Kinesiology and Health Education, College of Education, The University of Texas at Austin, Austin, Texas
| | - Jaylen I Wright
- Department of Kinesiology and Health Education, College of Education, The University of Texas at Austin, Austin, Texas
| | - H Matthew Lehrer
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Taha A Alhalimi
- Department of Kinesiology and Health Education, College of Education, The University of Texas at Austin, Austin, Texas
| | - Tianyu Wang
- Department of Kinesiology and Health Education, College of Education, The University of Texas at Austin, Austin, Texas
| | - Victoria C Saba
- Department of Kinesiology and Health Education, College of Education, The University of Texas at Austin, Austin, Texas
| | - Susan K Dubois
- Department of Kinesiology and Health Education, College of Education, The University of Texas at Austin, Austin, Texas.,Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - Hirofumi Tanaka
- Department of Kinesiology and Health Education, College of Education, The University of Texas at Austin, Austin, Texas
| | - Sharon A Brown
- School of Nursing, The University of Texas at Austin, Austin, Texas
| | - Mary A Steinhardt
- Department of Kinesiology and Health Education, College of Education, The University of Texas at Austin, Austin, Texas
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Milinković N, Sarić-Matutinović M, Dmitrašinović G, Ignjatović S. Compliance of the POCT method with the fully automated method for HbA1c determination. ARHIV ZA FARMACIJU 2022. [DOI: 10.5937/arhfarm72-35905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Previous research suggests that point-of-care (POCT) determination of glycated hemoglobin (HbA1c) is a diagnostic test that can be an adequate alternative to measuring HbA1c in the laboratory. The main goal of this study was to examine the analytical characteristics of the novel INCLIX POCT method for HbA1c determination in order to test its performance before introducing this method into routine use. HbA1c is measured in a duplicate in 44 EDTA blood samples parallel on INCLIX POCT device (Sugitech, Inc.) and using automated turbidimetric immunoinhibition test on Olympus AU400 (Beckman Coulter). The within run imprecision was 7.58%, between runs imprecision was 6.63% and 6.22%, and day-to-day imprecision was 8.80% and 7.51%. Total laboratory imprecision was in agreement with those stated by the manufacturer. A statistically significant Pearson correlation coefficient was calculated (r = 0.871, P < 0.01; linear R2 = 0.757). Using Deming regression analysis, the following equation was obtained: y = - 1.80 + 1.304x. Our results indicate statistically significant correlation, linear relationship, and a significant degree of compatibility between the two analyzed methods. However, the negative bias of the HbA1c values determined on the POCT analyzer compared to the Olympus AU400 was confirmed, highlighting the need to standardize the INCLIX method.
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Miñambres I, Sánchez-Hernandez J, Cuixart G, Sánchez-Pinto A, Sarroca J, Pérez A. Characterization of the hypertriglyceridemic waist phenotype in patients with type 2 diabetes mellitus in Spain: an epidemiological study. Rev Clin Esp 2021; 221:576-581. [PMID: 34839890 DOI: 10.1016/j.rceng.2020.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 06/03/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES In patients with type 2 diabetes mellitus (DM2), the presence of increased waist circumference and triglycerides is a reflection of increased visceral fat and insulin resistance. However, information about the prevalence and clinical characteristics of the hypertriglyceridemic waist (HTGW) phenotype in patients with DM2 is scarce. The aim of the present study was to analyze the prevalence and characteristics of DM2 patients with HTGW. METHODS We analyzed 4214 patients with DM2 in this epidemiological, cross-sectional study conducted in primary care centers across Spain between 2011 and 2012. The HTGW phenotype was defined as increased waist circumference according to the International Diabetes Federation criteria for Europids (≥ 94 cm for men and ≥ 80 cm for women) with the presence of triglyceride levels ≥ 150 mg/dL. We compared the demographic, clinical and analytical variables according to the presence or absence of the HTGW phenotype. RESULTS Thirty-five percent of patients presented the HTGW phenotype. Patients with the HTGW phenotype had a higher body mass index (31.14 ± 4.88 vs. 29.2 ± 4.82 kg/m2; p < .001) and glycated hemoglobin levels (7.38 ± 1.2% vs. 7 ± 1.07%; p < .001). The presence of hypertension, peripheral arterial disease, cardiac insufficiency and microvascular complications were higher when compared with patients without the HTGW phenotype. Patients with the HTGW phenotype were less adherent to prescribed diet (69.8 vs. 81%; p < .001), exercise (44.6 vs. 58.2%; p < .001) and presented greater weight increase within the year prior to the study visit (29.4 vs. 22.5%; p < .001). CONCLUSIONS The HTGW phenotype is prevalent in the Spanish DM2 population and identifies a subgroup of patients with higher cardiometabolic risk and prevalence of diabetic complications.
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Affiliation(s)
- I Miñambres
- Departamento de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Departamento de Medicina, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Diabetes y Enfermedades Metabólicas Asociadas CIBER (CIBERDEM), Barcelona, Spain
| | - J Sánchez-Hernandez
- Departamento de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Departamento de Medicina, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - G Cuixart
- Departamento de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - A Sánchez-Pinto
- Unidad de Enfermería, Hospital Vall d'Hebron, Barcelona, Spain
| | | | - A Pérez
- Departamento de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Departamento de Medicina, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Diabetes y Enfermedades Metabólicas Asociadas CIBER (CIBERDEM), Barcelona, Spain.
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Khadanga S, Singh G, Pakhare AP, Joshi R. Diagnostic Accuracy of Point-of-Care Tests Measuring Glycosylated Haemoglobin (HbA1c) for Glycemic Control: A Field Study in India. Cureus 2021; 13:e17920. [PMID: 34660113 PMCID: PMC8513731 DOI: 10.7759/cureus.17920] [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] [Accepted: 09/12/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives This study was performed to estimate diagnostic accuracy of the two commercially available point-of-care tests to identify poor glycemic control defined by HbA1c levels, with high-performance liquid chromatography (HPLC) as a reference. Settings The study was carried at two locations, general medical outpatient department of a teaching medical college in Bhopal (urban), and a primary health care centre in a rural area in the state of Madhya Pradesh, India. Participants All individuals with diabetes mellitus who presented to the health care facility for assessment of glycemic control. We compared HbA1c estimated from two index tests (Hemocue Hb 501, Sweden; SD Biosensor, South Korea) from capillary blood samples with HPLC performed from venous blood, as a reference standard. Primary and secondary outcome measures Diagnostic properties of index tests such as sensitivity, specificity, positive and negative predictive value and diagnostic accuracy for identifying poor glycemic control were primary outcome measures. Lin’s concordance correlation coefficient (CCC) was secondary outcome measure. Results Out of 114 patients, all received reference standard - 103 patients received Hemocue A1C test and 110 patients received SD Biosensor test. Overall both the index tests had similar diagnostic accuracy estimates. The area under the Receiver Operating Curve for SDA1c device was 0.935 (95% CI 0.886-0.983), and for Hemocue device was 0.938 (95% CI 0.893-0.984). The Hemocue device HbA1c value of above 7.0 (positive) correctly predicted poor glycemic control 92% times (81.58% for SD device). There were 4 vs. 11 device failures and 14 vs. 12 failures with SD and Hemocue, respectively. Ambient air temperatures were no different for the device test failures. Conclusions Commercially available point-of-care tests evaluated in this study are comparable and an acceptable alternative to HPLC-based measurements for the assessment of glycemic control. Tests and device failure rates of both the index tests are similar.
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Affiliation(s)
- Sagar Khadanga
- Internal Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Gyanendra Singh
- Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Abhijit P Pakhare
- Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Rajnish Joshi
- Internal Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
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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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Hu J, Amirehsani KA, McCoy TP, Coley SL, Wallace DC. Cardiovascular disease risk in Hispanic American women. Women Health 2021; 61:395-407. [PMID: 33941048 DOI: 10.1080/03630242.2021.1917476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Hispanic American women have an increased risk for the development of cardiovascular disease (CVD). This study examined CVD risk in a sample of immigrant Hispanic women using Framingham point scores and the Atherosclerotic Cardiovascular Disease (ASCVD) Risk Estimator for 10-year CVD risk and prevalence of metabolic syndrome. A cross-sectional study using baseline data from a diabetes self-management intervention study in a sample of 118 Hispanic American women was conducted. Data were c ollected with interviewer-administered surveys, and HbA1C and lipid profiles were obtained through capillary finger stick blood at clinics and churches in rural counties in central North Carolina. A majority (58%) of the women had type 2 diabetes and 61% had metabolic syndrome. Using the Framingham point scores for 10-year CVD risk, 2.5% were determined to have intermediate risk, compared to 7.6% at intermediate risk and 2.5% at high risk using the ASCVD 10-year risk estimator. High rates of CVD risk factors were found among this sample of Hispanic women. Early recognition of risk, mitigation of modifiable risk factors, and effective self-care programs are needed for Hispanic women. Hispanic American women may benefit from community-based CVD educational programs that have been culturally and linguistically tailored.
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Affiliation(s)
- Jie Hu
- College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Karen A Amirehsani
- School of Nursing, The University of North Carolina, Greensboro, North Carolina, USA
| | - Thomas P McCoy
- School of Nursing, The University of North Carolina, Greensboro, North Carolina, USA
| | - Sheryl L Coley
- School of Nursing, The University of North Carolina, Greensboro, North Carolina, USA
| | - Debra C Wallace
- School of Nursing, The University of North Carolina, Greensboro, North Carolina, USA
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Systematic Review on Human Skin-Compatible Wearable Photoplethysmography Sensors. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11052313] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The rapid advances in human-friendly and wearable photoplethysmography (PPG) sensors have facilitated the continuous and real-time monitoring of physiological conditions, enabling self-health care without being restricted by location. In this paper, we focus on state-of-the-art skin-compatible PPG sensors and strategies to obtain accurate and stable sensing of biological signals adhered to human skin along with light-absorbing semiconducting materials that are classified as silicone, inorganic, and organic absorbers. The challenges of skin-compatible PPG-based monitoring technologies and their further improvements are also discussed. We expect that such technological developments will accelerate accurate diagnostic evaluation with the aid of the biomedical electronic devices.
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Malcolm S, Dorvil M, Zou B, DeGennaro V. Estimating 10-year cardiovascular disease risk in urban and rural populations in Haiti. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2020.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Alshehri MM, Alothman SA, Alenazi AM, Rucker JL, Phadnis MA, Miles JM, Siengsukon CF, Kluding PM. The effects of cognitive behavioral therapy for insomnia in people with type 2 diabetes mellitus, pilot RCT part II: diabetes health outcomes. BMC Endocr Disord 2020; 20:136. [PMID: 32891140 PMCID: PMC7487570 DOI: 10.1186/s12902-020-00612-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/18/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Previous studies have shown the negative impact of sleep disturbances, specifically insomnia symptoms, on glucose metabolism for people with type 2 diabetes (T2D). People with insomnia symptoms are at risk of poor glycemic control and suboptimal diabetes self-care behavior (DSCB). Investigating the impact of a safe and effective intervention for individuals with T2D and insomnia symptoms on diabetes' health outcomes is needed. Therefore, the aim of this exploratory study is to examine the effects of Cognitive Behavioral Therapy for Insomnia (CBT-I) on glycemic control, DSCB, and fatigue. METHODS Twenty-eight participants with T2D and insomnia symptoms, after passing an eligibility criteria at a medical research center, were randomly assigned to CBT-I (n = 14) or Health Education (HE; n = 14). The CBT-I and HE groups received 6 weekly one-hour sessions. This Randomized Controlled Trial (RCT) used a non-inferiority framework to test the effectiveness of CBT-I. Validated assessments were administered at baseline and post-intervention to assess glycemic control, DSCB, and fatigue. A Wilcoxon signed-rank test was utilized to compare within-group changes from baseline to post-intervention. A Mann-Whitney test was utilized to measure the between-group differences. Linear regression was used to assess the association between the blood glucose level and the number of days in the CBT-I group. RESULTS The recruitment duration was from October 2018 to May 2019. A total of 13 participants completed the interventions in each group and are included in the final analysis. No adverse events, because of being a part of this RCT, were reported. CBT-I participants showed significantly greater improvement in glycemic control, DSCB, and fatigue. There was a significant association between the number of days in the CBT-I intervention with the blood glucose level before bedtime (B = -0.56, p = .009) and after awakening in the morning (B = -0.57, p = .007). CONCLUSIONS This study demonstrated a clinically meaningful effect of CBT-I on glycemic control in people with T2D and insomnia symptoms. Also, CBT-I positively impacted daytime functioning, including DSCB and fatigue. Future research is needed to investigate the long-term effects of CBT-I on laboratory tests of glycemic control and to understand the underlying mechanisms of any improvements. TRIAL REGISTRATION Clinical Trials Registry ( NCT03713996 ). Retrospectively registered on 22 October 2018.
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Affiliation(s)
- Mohammed M Alshehri
- Physical Therapy and Rehabilitation Science Department, University of Kansas Medical Center, 3901 Rainbow Blvd., Mail Stop 2002, Kansas City, Kansas, 66160, USA.
- Physical Therapy Department, Jazan University, Jazan, Southern Region, Saudi Arabia.
| | - Shaima A Alothman
- Lifestyle and Health Research Center, Princess Nora bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Aqeel M Alenazi
- Physical Therapy Department, Prince Sattam Bin Abdulaziz University, Alkharj, Central Region, Saudi Arabia.
| | - Jason L Rucker
- Physical Therapy and Rehabilitation Science Department, University of Kansas Medical Center, 3901 Rainbow Blvd., Mail Stop 2002, Kansas City, Kansas, 66160, USA
| | - Milind A Phadnis
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - John M Miles
- Endocrinology Department, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Catherine F Siengsukon
- Physical Therapy and Rehabilitation Science Department, University of Kansas Medical Center, 3901 Rainbow Blvd., Mail Stop 2002, Kansas City, Kansas, 66160, USA
| | - Patricia M Kluding
- Physical Therapy and Rehabilitation Science Department, University of Kansas Medical Center, 3901 Rainbow Blvd., Mail Stop 2002, Kansas City, Kansas, 66160, USA
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Miñambres I, Sánchez-Hernández J, Cuixart G, Sánchez-Pinto A, Sarroca J, Pérez A. Characterization of the hypertriglyceridemic waist phenotype in patients with type2 diabetes mellitus in Spain: An epidemiological study. Rev Clin Esp 2020; 221:S0014-2565(20)30207-1. [PMID: 32921435 DOI: 10.1016/j.rce.2020.06.013] [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: 10/31/2019] [Revised: 02/25/2020] [Accepted: 06/03/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVES In patients with type2 diabetes mellitus (DM2), the presence of increased waist circumference and triglycerides is a reflection of increased visceral fat and insulin resistance. However, information about the prevalence and clinical characteristics of the hypertriglyceridemic waist (HTGW) phenotype in patients with DM2 is scarce. The aim of the present study was to analyze the prevalence and characteristics of DM2 patients with HTGW. METHODS We analyzed 4214 patients with DM2 in this epidemiological, cross-sectional study conducted in primary care centers across Spain between 2011 and 2012. The HTGW phenotype was defined as increased waist circumference according to the International Diabetes Federation criteria for Europids (≥94cm for men and ≥80cm for women) with the presence of triglyceride levels ≥150mg/dl. We compared demographic, clinical and analytical variables according to the presence or absence of the HTGW phenotype. RESULTS Thirty-five percent of patients presented the HTGW phenotype. Patients with the HTGW phenotype had a higher body mass index (31.14±4.88 vs. 29.2±4.82kg/m2; P<.001) and glycated hemoglobin levels (7.38±1.2% vs. 7±1.07%; P<.001). The presence of hypertension, peripheral arterial disease, cardiac insufficiency and microvascular complications were higher when compared with patients without the HTGW phenotype. Patients with the HTGW phenotype were less adherent to prescribed diet (69.8 vs. 81%; P<.001), exercise (44.6 vs. 58.2%; P<.001) and presented greater weight increase within the year prior to the study visit (29.4 vs. 22.5%; P<.001). CONCLUSIONS The HTGW phenotype is prevalent in the Spanish DM2 population and identifies a subgroup of patients with higher cardiometabolic risk and prevalence of diabetic complications.
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Affiliation(s)
- I Miñambres
- Departamento de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, España; Departamento de Medicina, Universitat Autònoma de Barcelona (UAB), Barcelona, España; CIBER de Diabetes y enfermedades metabólicas asociadas (CIBERDEM), Barcelona, España
| | - J Sánchez-Hernández
- Departamento de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, España; Departamento de Medicina, Universitat Autònoma de Barcelona (UAB), Barcelona, España
| | - G Cuixart
- Departamento de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - A Sánchez-Pinto
- Unidad de Enfermería, Hospital Vall d'Hebron, Barcelona, España
| | | | - A Pérez
- Departamento de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, España; Departamento de Medicina, Universitat Autònoma de Barcelona (UAB), Barcelona, España; CIBER de Diabetes y enfermedades metabólicas asociadas (CIBERDEM), Barcelona, España.
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12
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Berbudi A, Rahmadika N, Tjahjadi AI, Ruslami R. Performance of Point-of-Care Testing Compared with the Standard Laboratory Diagnostic Test in the Measurement of HbA1c in Indonesian Diabetic and Nondiabetic Subjects. J Diabetes Res 2020; 2020:2037565. [PMID: 32733964 PMCID: PMC7369652 DOI: 10.1155/2020/2037565] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/29/2020] [Accepted: 06/19/2020] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE This study is aimed at investigating if point-of-care testing for HbA1c (POCT-HbA1c) using the HemoCue® HbA1c 501 system could be an alternative method for diabetes screening and monitoring to replace the HbA1c measurement in a standard diagnostic laboratory. DESIGN This was a cross-sectional study to assess the agreement between POCT and a standard laboratory measurement method for determining the level of HbA1c. Setting and Participants. In total, 108 participants were recruited to participate in this study, consisting of 61 diabetics and 47 nondiabetics. The diabetic group comprised 37 females and 24 males, diagnosed with type 2 diabetes mellitus (DM) and undergoing diabetes treatment at several community health care centres in Bandung, West Java. The nondiabetic group consisted of 15 female and 32 male patients of several community health care centres and healthy volunteers. Sample Collection and Analysis. A venous blood sample was taken for routine HbA1c analysis by the diagnostic laboratory method. For the POCT-HbA1c, a blood sample was taken from the fingertip at the same time and analysed with the HemoCue® HbA1c 501 system. Outcome Measures. The HbA1c results of both methods were compared and analysed with a Bland-Altman agreement plot. The sensitivity and specificity of the POCT-HbA1c data were also compared with those of the standard diagnostic results. RESULTS Based on the Bland-Altman plot, the HbA1c level for 100 out of 108 (92.59%) subjects analysed by the POCT-HbA1c was within the range of the 95% limit of agreement. Compared with the standard diagnostic assay, the sensitivity of the POCT-HbA1c was 97.83% and its specificity was 77.42%. CONCLUSIONS The high sensitivity and accuracy of POCT-HbA1c indicate that it is a potential method for diabetes screening and monitoring to replace the routine diagnostic laboratory HbA1c measurement, especially when a rapid result is required.
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Affiliation(s)
- Afiat Berbudi
- Department of Biomedical Sciences, Parasitology Division, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Infectious Disease Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Nofri Rahmadika
- Infectious Disease Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Adi Imam Tjahjadi
- Infectious Disease Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Department of Biomedical Sciences, Microbiology Division, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Rovina Ruslami
- Infectious Disease Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Department of Biomedical Sciences, Pharmacology and Therapy Division, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
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A model for point of care testing for non-communicable disease diagnosis in resource-limited countries. GLOBAL HEALTH EPIDEMIOLOGY AND GENOMICS 2019; 4:e7. [PMID: 31555457 PMCID: PMC6749552 DOI: 10.1017/gheg.2019.6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 08/15/2019] [Accepted: 08/18/2019] [Indexed: 12/29/2022]
Abstract
Non-communicable disease diagnosis frequently relies on biochemical measurements but laboratory infrastructure in low-income settings is often insufficient and distances to clinics may be vast. We present a model for point of care (POC) epidemiology as used in our study of chronic disease in the Haiti Health Study, in rural and urban Haiti. Point of care testing (POCT) of creatinine, cholesterol, and hemoglobin A1c as well as physical measurements of weight, height, and waist circumference allowed for diagnosis of diabetes, chronic kidney disease, dyslipidemias, and obesity. Methods and troubleshooting techniques for the data collection of this study are presented. We discuss our method of community-health worker (CHW) training, community engagement, study design, and field data collection. We also discuss the machines used and our quality control across CHWs and across geographical regions. Pitfalls tended to include equipment malfunction, transportation issues, and cultural differences. May this paper provide information for those attempting to perform similar diagnostic and screening studies using POCT in resource poor settings.
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Arreguin-Cano JA, Ayerdi-Nájera B, Tacuba-Saavedra A, Navarro-Tito N, Dávalos-Martínez A, Emigdio-Vargas A, Barrera-Rodríguez E, Blanco-García N, Gutiérrez-Venegas G, Ventura-Molina E, León-Dorantes G. MMP-2 salivary activity in type 2 diabetes mellitus patients. Diabetol Metab Syndr 2019; 11:113. [PMID: 31892956 PMCID: PMC6937721 DOI: 10.1186/s13098-019-0510-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 12/20/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) and periodontitis are chronic inflammatory diseases with a bidirectional relationship. The uncontrolled levels of glucose in T2DM patients change the pathophysiology and balance of inflammatory mediators. Matrix Metalloproteinase-2 (MMP-2) is a zinc-dependent endopeptidase that is responsible for tissue remodeling and degradation of the extracellular matrix in periodontal tissue. Therefore, the uncontrolled levels of glucose in T2DM could lead to an imbalance in MMP-2 activity in saliva, favoring the development of periodontitis. METHODS Ninety-seven T2DM patients from Hospital Dr. Donato Alarcon were included in the study. Following clinical examination, the patients were classified into four groups according to the presence and degree of periodontal disease and glycemic control. Blood and whole saliva samples (WSS) were collected from each patient. Blood samples were used for Hba1c and polymorphonuclear cells count determination, while WSS were used to determine MMP-2 activity, TIMP-1 and nitrite. MMP-2 activity was determined by zymography. TIMP-1 were determined by Western blotting, and nitric oxide (NO) levels were determined by the Griess method. RESULTS Of the 97 patients with T2DM, 66 had periodontitis of different severities: 18 patients had mild periodontitis, 15 had moderate and 33 had severe. Salivary MMP-2 activity, HbA1c and TIMP-1 were positively correlated with the severity of periodontitis. On the other hand, the increase in HbA1c was negatively correlated with MMP-2 activity and quantity of TIMP-1 but was positively correlated with nitrite levels. CONCLUSIONS T2DM with glycemic uncontrol conditions, distinct clinical alterations in periodontal tissue were identified, including a decrease in the gingival redness, increased the clinical attachment loss and imbalance of MMP-2/TIMP-1, as the possible causes of disorders promoting the progression of periodontitis. Accelerated periodontitis development with poor glycemic uncontrol likely results from the altered response of host defenses and decreased activity of polymorphonuclear cells. Taken together, these findings identify MMP-2 as a promising molecular market for periodontitis.
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Affiliation(s)
- Juan Antonio Arreguin-Cano
- Unit of Clinical and Epidemiological Innovation of the State of Guerrero, Secretary of Health of the State of Guerrero, Av. Juan R. Escudero No. 158 Col. C.D. Renacimiento, 39715 Acapulco, Guerrero Mexico
| | - Brenda Ayerdi-Nájera
- Unit of Clinical and Epidemiological Innovation of the State of Guerrero, Secretary of Health of the State of Guerrero, Av. Juan R. Escudero No. 158 Col. C.D. Renacimiento, 39715 Acapulco, Guerrero Mexico
| | - Arvey Tacuba-Saavedra
- Laboratory of Cellular Biology of Cancer, School of Chemical Sciences-Biological, University Autonomy of Guerrero, Chilpancingo, Guerrero Mexico
| | - Napoleón Navarro-Tito
- Laboratory of Cellular Biology of Cancer, School of Chemical Sciences-Biological, University Autonomy of Guerrero, Chilpancingo, Guerrero Mexico
| | - Alfonso Dávalos-Martínez
- Unit of Clinical and Epidemiological Innovation of the State of Guerrero, Secretary of Health of the State of Guerrero, Av. Juan R. Escudero No. 158 Col. C.D. Renacimiento, 39715 Acapulco, Guerrero Mexico
| | - Abel Emigdio-Vargas
- Unit of Clinical and Epidemiological Innovation of the State of Guerrero, Secretary of Health of the State of Guerrero, Av. Juan R. Escudero No. 158 Col. C.D. Renacimiento, 39715 Acapulco, Guerrero Mexico
| | - Elia Barrera-Rodríguez
- Unit of Clinical and Epidemiological Innovation of the State of Guerrero, Secretary of Health of the State of Guerrero, Av. Juan R. Escudero No. 158 Col. C.D. Renacimiento, 39715 Acapulco, Guerrero Mexico
| | - Nubia Blanco-García
- Unit of Clinical and Epidemiological Innovation of the State of Guerrero, Secretary of Health of the State of Guerrero, Av. Juan R. Escudero No. 158 Col. C.D. Renacimiento, 39715 Acapulco, Guerrero Mexico
| | - Gloria Gutiérrez-Venegas
- Laboratory of Biochemistry, School of Dentistry, National Autonomous University of Mexico, Mexico City, Mexico
| | - Elías Ventura-Molina
- Intelligent Computing Laboratory, Computer Research Center, Polytechnic Institute in Computing, Mexico City, Mexico
| | - Gladys León-Dorantes
- Unit of Clinical and Epidemiological Innovation of the State of Guerrero, Secretary of Health of the State of Guerrero, Av. Juan R. Escudero No. 158 Col. C.D. Renacimiento, 39715 Acapulco, Guerrero Mexico
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15
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DeGennaro Jr V, Malcolm S, Crompton L, Vaddiparti K, Mramba LK, Striley C, Cottler L, Taylor K, Leverence R. Community-based diagnosis of non-communicable diseases and their risk factors in rural and urban Haiti: a cross-sectional prevalence study. BMJ Open 2018; 8:e020317. [PMID: 29678978 PMCID: PMC5914767 DOI: 10.1136/bmjopen-2017-020317] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/25/2018] [Accepted: 03/28/2018] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To estimate the prevalence of hypertension, diabetes and chronic kidney disease and their risk factors in a rural and urban region of Haiti. SETTING AND PARTICIPANTS Community health workers enumerated 2648 households (909 rural and 1739 urban) via a multistage cluster random sampling method from July 2015 to May 2016, completed 705 rural and 1419 urban assessments for adults aged 25-65 years. OUTCOME MEASURES We performed a WHO STEPS based questionnaire, measured two blood pressure values, weight, height, abdominal circumference and point of care test finger stick blood sample for haemoglobin A1c, creatinine and cholesterol (total, high density lipoprotein (HDL) and triglycerides). RESULTS After adjusting for age and sex, the overall prevalence rates of hypertension, diabetes and chronic kidney disease were 15.6% (±2.93%), 19.7% (±1.57%) and 12.3% (±2.72%), respectively. Of the three non-communicable diseases (NCDs), only diabetes showed a significant difference between rural and urban sites (p=0.000), with the rural site (23.1%) having a higher prevalence than the urban site (16.4%). When comparing male and female participants, females were significantly more likely than males to have an NCD (p≤0.011). Females had a higher prevalence of most of the risk factors when compared with males. The urban location had a higher prevalence than the rural location for four risk factors that showed a significant difference between location (p≤0.037). CONCLUSIONS Women in Haiti had significantly higher prevalence rates of most NCDs and risk factors than men, and urban populations frequently, but not always, had higher rates of NCDs risk factors than the rural population. Further, it was shown that using point of care blood tests combined with community health workers, it is feasible to screen for NCDs and risk factors in remote areas which otherwise have limited access to healthcare.
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Affiliation(s)
- Vincent DeGennaro Jr
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
- Innovating Health International, Port-au-Prince, Haiti
| | - Stuart Malcolm
- Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lindsay Crompton
- London School of Hygiene and Tropical Medicine, London, London, UK
| | - Krishna Vaddiparti
- College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Lazarus K Mramba
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Catherine Striley
- College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Linda Cottler
- College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Kellee Taylor
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
- Innovating Health International, Port-au-Prince, Haiti
| | - Robert Leverence
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
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Abstract
Diabetes is a highly prevalent disease also implicated in the development of several other serious complications like cardiovascular or renal disease. HbA1c testing is a vital step for effective diabetes management, however, given the low compliance to testing frequency and, commonly, a subsequent delay in the corresponding treatment modification, HbA1c at the point of care (POC) offers an opportunity for improvement of diabetes care. In this review, based on data from 1999 to 2016, we summarize the evidence supporting a further implementation of HbA1c testing at POC, discuss its limitations and propose recommendations for further development.
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Affiliation(s)
- Oliver Schnell
- Forschergruppe Diabetes e.V., Neuherberg Munich, Germany
| | | | - Jianping Weng
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital Sun Yat-Sen University, Guangzhou, China
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Hirst JA, McLellan JH, Price CP, English E, Feakins BG, Stevens RJ, Farmer AJ. Performance of point-of-care HbA1c test devices: implications for use in clinical practice - a systematic review and meta-analysis. Clin Chem Lab Med 2017; 55:167-180. [PMID: 27658148 DOI: 10.1515/cclm-2016-0303] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 07/19/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Point-of-care (POC) devices could be used to measure hemoglobin A1c (HbA1c) in the doctors' office, allowing immediate feedback of results to patients. Reports have raised concerns about the analytical performance of some of these devices. We carried out a systematic review and meta-analysis using a novel approach to compare the accuracy and precision of POC HbA1c devices. METHODS Medline, Embase and Web of Science databases were searched in June 2015 for published reports comparing POC HbA1c devices with laboratory methods. Two reviewers screened articles and extracted data on bias, precision and diagnostic accuracy. Mean bias and variability between the POC and laboratory test were combined in a meta-analysis. Study quality was assessed using the QUADAS2 tool. RESULTS Two researchers independently reviewed 1739 records for eligibility. Sixty-one studies were included in the meta-analysis of mean bias. Devices evaluated were A1cgear, A1cNow, Afinion, B-analyst, Clover, Cobas b101, DCA 2000/Vantage, HemoCue, Innovastar, Nycocard, Quo-Lab, Quo-Test and SDA1cCare. Nine devices had a negative mean bias which was significant for three devices. There was substantial variability in bias within devices. There was no difference in bias between clinical or laboratory operators in two devices. CONCLUSIONS This is the first meta-analysis to directly compare performance of POC HbA1c devices. Use of a device with a mean negative bias compared to a laboratory method may lead to higher levels of glycemia and a lower risk of hypoglycaemia. The implications of this on clinical decision-making and patient outcomes now need to be tested in a randomized trial.
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Ben Haider NY, Ziyab AH. Prevalence of prediabetes and its association with obesity among college students in Kuwait: A cross-sectional study. Diabetes Res Clin Pract 2016; 119:71-4. [PMID: 27484296 DOI: 10.1016/j.diabres.2016.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 06/24/2016] [Accepted: 07/16/2016] [Indexed: 11/17/2022]
Abstract
This cross-sectional study sought to estimate the prevalence of prediabetes and assess its association with obesity among young adults in Kuwait; a country with a high prevalence of obesity and diabetes. The estimated prevalence of prediabetes was 6.3% (95% CI: 4.8-8.1) and obesity was associated with elevated prediabetes prevalence.
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Affiliation(s)
- Nour Y Ben Haider
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait.
| | - Ali H Ziyab
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait.
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Kollannoor-Samuel G, Shebl FM, Segura-Pérez S, Chhabra J, Vega-López S, Pérez-Escamilla R. Effects of Food Label Use on Diet Quality and Glycemic Control Among Latinos With Type 2 Diabetes in a Community Health Worker-Supported Intervention. Am J Public Health 2016; 106:1059-66. [PMID: 27077337 PMCID: PMC4880245 DOI: 10.2105/ajph.2016.303091] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine the impact of an intervention led by community health workers (CHWs) on food label use and to assess whether food label use and diet quality mediate the intervention's impact on glycemic control. METHODS From 2006 to 2010, 203 Latinos (intervention group, n = 100; control group, n = 103) in Hartford County, Connecticut, with type 2 diabetes were randomized to an intervention that included 17 CHW-led home-based sessions over a 12-month period in addition to the standard of care available in both study arms. Data on food label use, diet quality, covariates, and glycated hemoglobin (HbA1c) were collected at baseline and at 3, 6, 12, and 18 months. Data were analyzed via mixed effects and multilevel structural equation modeling. RESULTS Food label use in the intervention (vs control) group was significantly higher at 3, 12, and 18 months (odds ratio = 2.99; 95% confidence interval = 1.69, 5.29). Food label use and diet quality were positive mediators of improved HbA1c levels. CONCLUSIONS Culturally tailored interventions led by CHWs could increase food label use. Also, CHW-delivered food label education may lead to better diet quality and improve glycemic control among Latinos with type 2 diabetes.
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Affiliation(s)
- Grace Kollannoor-Samuel
- Grace Kollannoor-Samuel, Fatma M. Shebl, and Rafael Pérez-Escamilla are with the Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT. Sofia Segura-Pérez is with the Center for Community Nutrition, Hispanic Health Council, Hartford, CT. Jyoti Chhabra is with Hartford Hospital, Hartford, CT. Sonia Vega-López is with the School of Nutrition and Health Promotion, Arizona State University, Phoenix
| | - Fatma M Shebl
- Grace Kollannoor-Samuel, Fatma M. Shebl, and Rafael Pérez-Escamilla are with the Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT. Sofia Segura-Pérez is with the Center for Community Nutrition, Hispanic Health Council, Hartford, CT. Jyoti Chhabra is with Hartford Hospital, Hartford, CT. Sonia Vega-López is with the School of Nutrition and Health Promotion, Arizona State University, Phoenix
| | - Sofia Segura-Pérez
- Grace Kollannoor-Samuel, Fatma M. Shebl, and Rafael Pérez-Escamilla are with the Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT. Sofia Segura-Pérez is with the Center for Community Nutrition, Hispanic Health Council, Hartford, CT. Jyoti Chhabra is with Hartford Hospital, Hartford, CT. Sonia Vega-López is with the School of Nutrition and Health Promotion, Arizona State University, Phoenix
| | - Jyoti Chhabra
- Grace Kollannoor-Samuel, Fatma M. Shebl, and Rafael Pérez-Escamilla are with the Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT. Sofia Segura-Pérez is with the Center for Community Nutrition, Hispanic Health Council, Hartford, CT. Jyoti Chhabra is with Hartford Hospital, Hartford, CT. Sonia Vega-López is with the School of Nutrition and Health Promotion, Arizona State University, Phoenix
| | - Sonia Vega-López
- Grace Kollannoor-Samuel, Fatma M. Shebl, and Rafael Pérez-Escamilla are with the Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT. Sofia Segura-Pérez is with the Center for Community Nutrition, Hispanic Health Council, Hartford, CT. Jyoti Chhabra is with Hartford Hospital, Hartford, CT. Sonia Vega-López is with the School of Nutrition and Health Promotion, Arizona State University, Phoenix
| | - Rafael Pérez-Escamilla
- Grace Kollannoor-Samuel, Fatma M. Shebl, and Rafael Pérez-Escamilla are with the Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT. Sofia Segura-Pérez is with the Center for Community Nutrition, Hispanic Health Council, Hartford, CT. Jyoti Chhabra is with Hartford Hospital, Hartford, CT. Sonia Vega-López is with the School of Nutrition and Health Promotion, Arizona State University, Phoenix
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Miñambres I, Mediavilla JJ, Sarroca J, Pérez A. Meeting individualized glycemic targets in primary care patients with type 2 diabetes in Spain. BMC Endocr Disord 2016; 16:10. [PMID: 26887662 PMCID: PMC4756540 DOI: 10.1186/s12902-016-0090-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 02/09/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Information about the achievement of glycemic targets in patients with type 2 diabetes according to different individualization strategies is scarce. Our aim was to analyze the allocation of type 2 diabetic patients into individualized glycemic targets according to different strategies of individualization and to assess the degree of achievement of adequate control. METHODS Cross-sectional analysis on 5382 type 2 diabetic patients in primary care setting in Spain between 2011 and 2012. Targets of HbA1c were assigned based on different strategies of individualization of glycemic targets: 1) the ADA/EASD consensus 2) The Spanish Diabetes Society (SED) consensus 3) a strategy that accounts for the risk of hypoglycemia (HYPO) considering the presence of a hypoglycemia during the last year and type of hypoglycemic treatment. Concordance between the different strategies was analyzed. RESULTS A total of 15.9, 17.1 and 67 % applied to ADA/EASD recommendation of HbA1c target of <6.5, < 7 and <8 % (48, 53 and 64 mmol/mol), and 31.9 and 67.4 % applied to the SED glycemic target of <6.5 and <7.5 % (<48 and 58 mmol/mol). Using the HYPO strategy, 53.5 % had a recommended HbA1c target <7 % (53 mmol/mol). There is a 94 % concordance between the ADA/EASD and SED strategies, and a concordance of 41-42 % between these strategies and HYPO strategy. Using the three different strategies, the overall proportion of patients achieving glycemic targets was 56-68 %. CONCLUSIONS Individualization of glycemic targets increases the number of patients who are considered adequately controlled. The proposed HYPO strategy identifies a similar proportion of patients that achieve adequate glycemic control than ADA/EASD or SED strategies, but its concordance with these strategies in terms of patient classification is bad.
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Affiliation(s)
- I Miñambres
- Department of Endocrinology and Nutrition Services, Hospital de la Santa Creu i Sant Pau, C/ Sant Quintí, 89, 08026, Barcelona, Spain
- Research Institute, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - A Pérez
- Department of Endocrinology and Nutrition Services, Hospital de la Santa Creu i Sant Pau, C/ Sant Quintí, 89, 08026, Barcelona, Spain.
- Research Institute, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
- Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
- Diabetes and Metabolic Diseases CIBER (CIBERDEM), Barcelona, Spain.
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Rausch S, Hennenlotter J, Wiesenreiter J, Hohneder A, Heinkele J, Schwentner C, Stenzl A, Todenhöfer T. Assessment of a new point-of-care system for detection of prostate specific antigen. BMC Urol 2016; 16:4. [PMID: 26785797 PMCID: PMC4719541 DOI: 10.1186/s12894-016-0119-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 01/04/2016] [Indexed: 11/10/2022] Open
Abstract
Background Measurement of the prostate specific antigen (PSA) remains an important tool in prostate cancer (PC) diagnosis. Due to limited availability of laboratory devices in an outpatient setting, compact and easy-to-handle point-of-care (POC) systems are desirable. Recently, a chip for PSA measurement on the concile® Ω100 POC reader platform was introduced. To investigate the clinical applicability, we evaluated the system in a consecutive cohort of patients undergoing PSA measurement in our outpatient clinic. Methods Between 07/2014 and 01/2015, PSA was analyzed in a total of 198 patients by the POC reader system and in parallel by an Immulite 2000® and Centaur® standard laboratory system, respectively. By standard (Immulite®) measurement, 67 (34,2 %) had PSA > 4 ng/ml and 131 (65,8 %) had PSA ≤ 4 ng/ml. Results were correlated by linear regression analyses for all patients and within PSA subgroups. For patients with available prostate histology after PSA measurement (n = 68), receiver-operating characteristic curves were created and area under the curve (AUC), sensitivity and specificity for the prediction of PC at best cut-off value were calculated. Results The coefficients of determination (r2) for the POC device compared to laboratory testing were 0.72 (Immulite®) and 0.63 (Centaur®), respectively (both p < 0.0001). In the PSA range of ≤4 ng/ml, the observed correlations were 0.75 and 0.70, respectively. For the POC test system, AUC for detection of PC was calculated with 0.745 while the standard laboratory tests showed 0.778 (Immulite®) and 0.771 (Centaur®). At best cut-off of 3.64 ng/ml, PSA analysis by the POC system showed a sensitivity of 85.7 % and a specificity of 66.7 %. Conclusions The POC system obtained good concordance to elaborate laboratory measurement. In a screening scenario, the system provides quick and reliable PSA measurement, especially in the PSA range up to 4 ng/ml.
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Affiliation(s)
- Steffen Rausch
- Department of Urology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
| | - Joerg Hennenlotter
- Department of Urology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
| | - Josef Wiesenreiter
- Department of Urology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
| | - Andrea Hohneder
- Department of Urology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
| | - Julian Heinkele
- Department of Urology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
| | - Christian Schwentner
- Department of Urology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
| | - Arnulf Stenzl
- Department of Urology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany.
| | - Tilman Todenhöfer
- Department of Urology, Eberhard-Karls-University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany. .,Vancouver Prostate Centre, University of British Columbia, 2660 Oak Street, Vancouver, V6H 3Z6, Canada.
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Quinn AD, Dixon D, Meenan BJ. Barriers to hospital-based clinical adoption of point-of-care testing (POCT): A systematic narrative review. Crit Rev Clin Lab Sci 2015; 53:1-12. [DOI: 10.3109/10408363.2015.1054984] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
A1C point-of-care (POC) instruments benefit patients with diabetes by facilitating clinician decision making that results in significant glycemic improvements. Three National Glycohemoglobin Standardization Program (NGSP)-certified POC products are available in the United States: the handheld A1CNow (formerly manufactured by Bayer Diabetes Care but now made by Chek Diagnostics) and two bench-top models called the Axis-Shield Afinion Analyzer and the Siemens DCA Vantage. This article compares the three available NGSP-certified POC products in terms of accuracy, precision, ease of use, cost, and additional features. Its goal is to aid health care facilities in conveniently identifying the A1C POC product that best meets their needs. It additionally reviews evidence that supports the continued use of A1C POC instruments in the clinical arena.
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Affiliation(s)
- Heather P. Whitley
- Auburn University Harrison School of Pharmacy, Department of Pharmacy Practice, Auburn, AL
- Baptist Health, Montgomery Family Medicine Residency Program, Montgomery, AL
| | - Ee Vonn Yong
- Auburn University Harrison School of Pharmacy, Department of Pharmacy Practice, Auburn, AL
| | - Casey Rasinen
- Auburn University Harrison School of Pharmacy, Department of Pharmacy Practice, Auburn, AL
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Pérez A, Mediavilla J, Miñambres I, González-Segura D. Glycemic control in patients with type 2 diabetes mellitus in Spain. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.rceng.2014.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Pérez A, Mediavilla JJ, Miñambres I, González-Segura D. Glycemic control in patients with type 2 diabetes mellitus in Spain. Rev Clin Esp 2014; 214:429-36. [PMID: 25016415 DOI: 10.1016/j.rce.2014.05.028] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 05/12/2014] [Accepted: 05/25/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the degree of glycemic control in patients with type 2 diabetes in Spain and identify factors associated with glycemic control. PATIENTS AND METHODS This was a cross-sectional, multicenter, epidemiological study that used consecutive sampling and was conducted in primary care practices in Spain. A total of 5591 patients with type 2 diabetes mellitus lasting more than 1 year and who were treated with hypoglycemic agents for more than 3 months were included in the study. At a single visit, HbA1c levels were measured (A1cNow+ system) and demographic and clinical variables related to diabetes and its treatment were recorded. During the visit, CV risk factors (CVRF), the presence of target-organ damage (TOD), the presence of hypoglycemia and body weight changes within the previous year were recorded. RESULTS We analyzed data from 5382 patients (mean age 66.7 [10.8] years, mean duration of the diabetes 8.8 [6.3] years). TOD was present in 43.6% of the patients and 59.1% were taking 2 or more drugs. The patients' mean HbA1c was 7.1 (1.1)%, and 48.6% had HbA1c levels <7.0%. The patients with HbA1c levels ≥7.0% had longer-standing diabetes, a higher prevalence of TOD and CVRF, used more complex therapies, experienced more hypoglycemic episodes in the previous year and had more weight gain. In the multivariate analysis, the absence of insulin treatment, the absence of abdominal obesity and atherogenic dyslipidemia, a duration of the diabetes <10 years and an age >70 years were associated with improved glycemic control. CONCLUSIONS Patients with poorly controlled type 2 diabetes mellitus are highly prevalent in Spain. Factors associated with poorer glycemic control include the complexity of both the disease and the hypoglycemic therapy, a history of hypoglycemia and weight gain.
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Affiliation(s)
- A Pérez
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM) , Barcelona, España.
| | | | - I Miñambres
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
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Jiang F, Hou X, Lu J, Zhou J, Lu F, Kan K, Tang J, Bao Y, Jia W. Assessment of the performance of A1CNow(+) and development of an error grid analysis graph for comparative hemoglobin A1c measurements. Diabetes Technol Ther 2014; 16:363-9. [PMID: 24766632 PMCID: PMC4029042 DOI: 10.1089/dia.2013.0289] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND This study investigated the performance of the A1CNow(+®) test (Bayer Diabetes Care, Sunnyvale, CA) in a large population of Chinese patients with diabetes. SUBJECTS AND METHODS Hemoglobin A1c (HbA1c) levels in 1,618 Chinese patients with diabetes 10-94 years of age were measured with both the A1CNow(+) test, from a fingerstick blood sample, and the high-performance liquid chromatography (HPLC) test, using a venous blood sample, within 24 h. The reportable ranges of the HbA1c values were 4.0-13.0% (A1CNow(+)) and 4.1-16.8% (HPLC). An error grid analysis (EGA) method was developed to quantify the accuracy of the A1CNow(+) results against the HPLC reference results. RESULTS The A1CNow(+) results were highly correlated with the HPLC reference results (r=0.945, P<0.01). Passing-Bablok regression analysis showed a good linear agreement between the two variables, and the linear regression equation fitted as y=-0.10+1.00x (P=0.21). The Bland-Altman difference plot presented that the mean bias of the A1CNow(+) results minus the HPLC reference results was -0.09% (P<0.001); the 95% confidence intervals for the limits of agreement were -1.28% to 1.09%, with 96.5% of the data points lying within this zone. The results of the EGA showed that 80.2% of the A1CNow(+) results were accurate, 17.7% were acceptable, 1.9% may lead to inappropriate treatment, and 0.3% may lead to severe clinical consequence. CONCLUSIONS The A1CNow(+) test values demonstrated a slight negative bias from the HPLC values. The majority of A1CNow(+) test values were accurate when compared with results from the reference method.
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Affiliation(s)
- Fusong Jiang
- Medicine School of Soochow University, Suzhou, Jiangsu, China
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
| | - Xuhong Hou
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
| | - Jun Lu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
| | - Jian Zhou
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
| | - Fengdi Lu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
| | - Kai Kan
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
| | - Junling Tang
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
| | - Yuqian Bao
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
| | - Weiping Jia
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
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