Assessment of Glycemic Control in Patients With Diabetes in Northern Sudan Using Calculated HbA1c

Mathematical model for assessing glycemic control in type 2 diabetes mellitus

Glycated hemoglobin (HbA1c) and glycated albumin (GA) are vital markers for assessing glucose control in diabetes. This cross-sectional study involving 901 diagnosed type 2 diabetics aimed to compare calculated HbA1c, using the formula HbA1c = 2.6 + 0.03 x FBS (mg/dL), with directly measured HbA1c. Simultaneously, the study assessed the agreement between the two methods through regression analysis and explored correlations with various measures of glycemic control. The non-parametric Kolmogorov-Smirnov test indicated a non-normal data distribution, prompting appropriate statistical tests. Spearman's correlation coefficient revealed a strong correlation of calculated HbA1c, calculated GA, and estimated average glucose with measured parameters. Wilcoxon rank sum test indicated a significant difference between directly measured and calculated HbA1c (Z -9.487033, p < 0.0001). Passing Bablok regression analysis showed a significant deviation from linearity. Despite the potential cost benefits in resource-poor settings, caution is advised regarding interchangeable use of calculated and directly measured HbA1c in clinical decision-making. Data shows the importance of robust analytical methods in glycemic control assessment, offering insights for managing type 2 diabetes mellitus.

Impact of Anaemia on HbA1c Interpretation Among Normogylcaemic Individuals With Diabetes Mellitus: A Clinical Laboratory Observational Study

BACKGROUND AND AIM

Over the past decades, glycosylated haemoglobin (HbA1c) has been a gold standard for monitoring diabetes control over a long period, relative to blood glucose level (BGL) which measures short-term results. It is speculated that anaemia and factors that induce haemolysis may cause falsely elevated HbA1c leading to 'false positive' interpretations. This study aimed to investigate how anaemia impacts HbA1c.

METHODS

This was a pathology-based observational pilot study using archived data of diabetic subjects monitored with both BGL and HbA1c in regional New South Wales (NSW), Australia. A total of 28,487 cases of blood glucose results were pooled and those with HbA1c and anaemia results were evaluated for correlation with the BGL results. Data collection was limited to de-identified information from the laboratory information system, hence details on the ethnicity and medical history were unavailable. Descriptive frequencies and Pearson correlations were performed.

RESULTS

In the pooled data, 53.36% of individuals were females, and 50.54% had BGL ≥5.6 mmol/L. In the pilot dataset, the majority (64.86%) were males, 18.92% with BGL ≤5.6 mmol/L and 67.57% had HbA1c (≥6.5%). In the entire dataset, BGL was moderately and positively correlated with HbA1c (r = 0.6), whereas in the subset of individuals with normo-BGL and anaemia, the correlation was negative (r = -0.2).

DISCUSSION

This pilot investigation observed a pertinent issue, which is a negative correlation between glycaemia and HbA1c in patients with anaemia. HbA1c was falsely increased despite normal blood glucose levels in individuals with anaemia. This advances the speculation that anaemia falsely increases HbA1c. Therefore, caution is necessary while interpreting HbA1c results for patients with anaemia, and new methods for interpretation are required.

Comprehensive Review of Anesthetic Evaluation and Management in Obese Female Patients Undergoing In Vitro Fertilization

Obesity has become a global health epidemic with profound implications for various medical specialties, including reproductive medicine. This comprehensive review focuses on the anesthetic evaluation and management of obese patients undergoing in vitro fertilization (IVF) procedures. Obesity, as defined by BMI, is associated with infertility and poses unique challenges for anesthetic care. The review also addresses the timing of anesthesia concerning IVF procedures, the impact of obesity on IVF success rates, and the importance of emotional and psychological support for obese patients undergoing IVF. Challenges and future directions in the field are highlighted, focusing on ongoing research, emerging technologies, and the role of multidisciplinary teams in managing these complex cases. In conclusion, this review underscores the critical role of tailored anesthesia and perioperative care in optimizing outcomes for obese patients undergoing IVF. It provides valuable insights for anesthetic providers, reproductive specialists, and healthcare teams, emphasizing the need for a patient-centered approach to address the unique challenges posed by obesity in the context of assisted reproductive technology.