Hemoglobin A1c: past, present and future

DM-calendar app as a diabetes self-management education on adult type 2 diabetes mellitus: a randomized controlled trial

Purpose

Era Disruption 4.0 demands development in the management of Diabetes Mellitus (DM) by using application-based intervention that can facilitate nursing intervention. The aim was to evaluate the effect of diabetes mellitus calendar app as a Diabetes Self-Management Education (DSME) program on self-efficacy, HbA1c levels, lipid profile, and insulin in adult type 2 diabetes mellitus (T2DM).

Methods

It was randomized experimental design - simple random sampling used with a total sample of 30 respondents. The instruments used diabetes management self-efficacy scales and standard of operational procedure blood sampling. The statistical tests used were a Paired t-test, Wilcoxon, and an Independent t-test.

Results

DSME with an Android-based DM calendar affected self-efficacy (p < 0.001), HbA1c levels (p = 0.005), cholesterol (p = 0.009), triglyceride (p = 0.000), HDL-c (p = 0.048), LDL-c (p = 0.010), and insulin (p = 0.000) compared with the control group. Education with these electronic media has increased the perception of self-efficacy and improved the behavior of good self-management that can be seen from changes in controlled HbA1c level, lipid profile and insulin.

Conclusion

The results of this study can be used as a reference for providing educational experimental in patients with Type 2 Diabetes Mellitus (T2DM).

Association between Glycated Hemoglobin with the Levels of Serum Proinflammatory Cytokines and Antioxidants in Patients with Type 2 Diabetes Mellitus in Universitas Sumatera Utara Hospital

BACKGROUND:

Hyperglycemia condition in diabetes mellitus (DM) influences proinflammatory cytokine levels and disrupts antioxidant balances. Glycated Hemoglobin is used as a biomarker of glycemic control in DM.

AIM:

This study aimed to analyse the association between glycated Hemoglobin with the levels of serum proinflammatory cytokines (interleukin (IL)-6) and antioxidants (glutathione peroxidase (GPx) and glutathione (GSH)) in type 2 diabetes mellitus (T2DM) patients in Universitas Sumatera Utara (USU) Hospital.

METHODS:

A total of eighty-nine T2DM patients were recruited at USU Hospital. Glycated Hemoglobin levels were measured using routine laboratory tests at USU Hospital. The IL-6, GPx, and GSH levels were measured using enzyme-linked immunosorbent (ELISA) method. The statistical significance was determined using the Kruskal Wallis test, followed by Mann-Whitney test (p < 0.05).

RESULTS:

The mean of glycated hemoglobin (%), IL-6 (pg/ml), GPx (ng/ml), and GSH (ng/ml) levels in T2DM patients were 8.96 ± 2.28, 59.27 ± 16.04, 32.13 ± 12.10, and 7.42 ± 3.50, respectively. Regarding the glycated Hemoglobin levels, 28.09% of patients had controlled diabetes, 24.72% of patients had poorly controlled diabetes, and 47.19% of patients had uncontrolled diabetes. The IL-6 levels of the three study groups based on glycated Hemoglobin levels were related significantly (p < 0.05), but there was no statistically significant difference observed between the GPx and GSH levels (p > 0.05).

CONCLUSION:

The present study suggests that the glycated Hemoglobin was associated with the levels of serum IL-6 levels but not GPx and GSH levels in T2DM patients in USU Hospital.

Update on diabetes diagnosis: a historical review of the dilemma of the diagnostic utility of glycohemoglobin A1c and a proposal for a combined glucose-A1c diagnostic method

The role of glycohemoglobin A1c (A1c) for the diagnosis of diabetes has been debated for over three decades. Recently, the American Diabetes Association (ADA) has recommended adding A1c as an additional criterion for diabetes diagnosis. In view of the continued debate about the diagnostic utility of A1c, and in view of the unabated burden of undiagnosed diabetes, the search for alternative diagnostic methods is discussed. A historical literature review is provided, in view of the new ADA diagnostic guidelines, and a proposal is provided for combining A1c and a glucose measurement as a diagnostic alternative/adjunct to the use of a single criterion. This proposal is based on the non-overlapping of the advantages and disadvantages of these individual tests. The cost-effectiveness of this method remains to be tested.

Investigating concordance in diabetes diagnosis between primary care charts (electronic medical records) and health administrative data: a retrospective cohort study

BACKGROUND

Electronic medical records contain valuable clinical information not readily available elsewhere. Accordingly, they hold important potential for contributing to and enhancing chronic disease registries with the goal of improving chronic disease management; however a standard for diagnoses of conditions such as diabetes remains to be developed. The purpose of this study was to establish a validated electronic medical record definition for diabetes.

METHODS

We constructed a retrospective cohort using health administrative data from the Institute for Clinical Evaluative Sciences Ontario Diabetes Database linked with electronic medical records from the Deliver Primary Healthcare Information Project using data from 1 April 2006-31 March 2008 (N = 19,443). We systematically examined eight definitions for diabetes diagnosis, both established and proposed.

RESULTS

The definition that identified the highest number of patients with diabetes (N = 2,180) while limiting to those with the highest probability of having diabetes was: individuals with ≥2 abnormal plasma glucose tests, or diabetes on the problem list, or insulin prescription, or ≥2 oral anti-diabetic agents, or HbA1c ≥6.5%. Compared to the Ontario Diabetes Database, this definition identified 13% more patients while maintaining good sensitivity (75%) and specificity (98%).

CONCLUSIONS

This study establishes the feasibility of developing an electronic medical record standard definition of diabetes and validates an algorithm for use in this context. While the algorithm may need to be tailored to fit available data in different electronic medical records, it contributes to the establishment of validated disease registries with the goal of enhancing research, and enabling quality improvement in clinical care and patient self-management.

Epigallocatechin gallate delays the onset of type 1 diabetes in spontaneous non-obese diabetic mice

Type 1 diabetes (T1D) results from the autoimmune-mediated destruction of pancreatic β-cells, leading to deficiency of insulin production. Successful islet transplantation can normalise hyperglycaemia in T1D patients; however, the limited availability of the islets, loss of islet cell mass through apoptosis after islet isolation and potential autoimmune destruction of the transplanted islets prevent the widespread use of this procedure. Therefore, the search for novel and cost-effective agents that can prevent or treat T1D is extremely important to decrease the burden of morbidity from this disease. In the present study, we discovered that ( - )-epigallocatechin gallate (EGCG, 0·05 % in drinking-water), the primary polyphenolic component in green tea, effectively delayed the onset of T1D in non-obese diabetic (NOD) mice. At 32 weeks of age, eight (66·7 %) out of twelve mice in the control group developed diabetes, whereas only three (25 %) out of twelve mice in the EGCG-treated group became diabetic (P < 0·05). Consistently, mice supplemented with EGCG had significantly higher plasma insulin levels and survival rate but lower glycosylated Hb concentrations compared with the control animals. EGCG had no significant effects on food or water intake and body weight in mice, suggesting that the glucose-lowering effect was not due to an alteration in these parameters. While EGCG did not modulate insulitis, it elevated the circulating anti-inflammatory cytokine IL-10 level in NOD mice. These findings demonstrate that EGCG may be a novel, plant-derived compound capable of reducing the risk of T1D.