Glycated Haemoglobin Determination in the Biological Follow-Up of Diabetic Subjects Admitted to the Endocrinology Department of the CNHU-HKM of Cotonou

Introduction: One of the biological markers for monitoring glycaemic control in diabetic patients is glycated protein. The definition of a reference method to improve the accuracy of measurement tools is necessary. The aim of our study was to assess the glycemic control of diabetic patients based on glycated hemoglobin. Patients and Method: This is a descriptive cross-sectional study conducted in April 2021 at the national university hospital center (CNHU-HKM) of Cotonou. All patients who consulted during the period and who gave their consent were included. After collecting the blood samples according to the classical standards of the pre-analytical phase, we measured the blood glucose level and the HbA1c. Results: The mean blood glucose level of the patients was 1.52 ± 0.16 g/L with extremes of 0.80 g/L and 3.5 g/L. The mean HbA1c proportion was 8.39% ± 0.60% with a minimum and maximum value of 5.40% and 16% respectively. We also noted that the mean body mass index (BMI) of the patients was 28.61 ± 1.46 Kg/m2 with extremes of 17.50 Kg/m2 and 46.02 Kg/m2. Oral anti diabetic and hygienic-dietary measures were used by 44 patients (80%) and hygienic-dietary measures (HDM) only used by 9.09%. A frequency of 87.53% of patients had at least one degenerative complication. Retinopathy was the most observed degenerative disease (36.36%) followed by cardiovascular disease (25.45%). Conclusion: This study showed that there is a poor correlation between fasting blood glucose and glycated haemoglobin levels, which could be due to several biological and clinical reasons. It also showed that despite the respect of hygienic dietary measures and a well conducted treatment, it is difficult to obtain a satisfactory glycemic balance in obese patients.

Glycated Haemoglobin in Diagnosis of Diabetes Mellitus and Pre-diabetes among Middle-aged and Elderly Population:Shanghai Changfeng Study

Objective To investigate the optimal glycated haemoglobin （HbAlc） cut off points and evaluate the impact of HbAlc on diabetes and pre-diabetes in middle-aged and elderly population. Methods Subjects were recruited from Shanghai Changfeng Study. A total of 1 973 community-based participants （age_〉45） without known diabetes underwent oral glucose tolerance test （OG3-r） by using a 75-g oral glucose load and HbAlc was measured by using high performance liquid chromatography （HPLC）. Subjects were classified as normal glucose tolerance （NGT）, pre-diabetes（impaired glucose regulation, IGR） and new diagnosed diabetes （NDD） per 1999 WHO criteria. Two tests are compared with receiver operating characteristic curve （ROC）. Results Among 1973 subjects, 271 （13.7%） were diagnosed as NDD and 474 （24.0%） as IGR by using OGTT. HbAlc was 5.7%_＋0.7% in this population. Use of 6.5% as the HbAIC cutoff point has sensitivity of 38.7% and specificity of 98.5%. We recommend 6.0% as a better cutoff value for diagnosis of diabetes in this population （AUC 0.829, 95% CI 0.798-0.860, P〈0.001） with its sensitivity and specificity as 66.1% and 86.8%. For IGR, the results showed low sensitivity （44.9%） and specificity （66.7%） with an AUC of 0.571 for HbAlc when 5.8% was used as the cutoff point. Participants detected with HbAlc_〉6.0% were associated with nearly the same metabolic characteristics, including body mass index （BMI）, blood pressure, lipid profile and urine albumin-creatinine ratio （uACR） compared with diabetic subjects detected by OGTT. Conclusion The optimum HbAlc cutoff point for diabetes in our study population was lower than ADA criteria, and HbAlc may not be used to identify IGR.

Access to insulin delivery devices and glycated haemoglobin in lower-income countries

BACKGROUNDYoung people with type 1 diabetes in low-and-middle income countries facemany challenges in accessing care, with various essential supplies needed forsurvival and long-term health.AIMTo study insulin delivery devices and glycated haemoglobin (HbA1c) testing.METHODSA survey was conducted in 2019 of leading diabetes centres in 41 countriessupported by the Life for a Child Program. The survey covered numerous aspectsconcerning availability and costs at all levels of the health system, local usagepatterns and attitudes, obstacles, and other aspects.RESULTSThirty-seven countries returned the survey (90.2% response rate). Key findingsincluded: Syringe use was most common (83.1%), followed by insulin pens(16.7%) and pumps (0.2%). 48.6% of public health systems did not providesyringes, even with a co-payment. Use of suboptimal syringe/needlecombinations was common. Needles were generally reused in almost all countries(94.3%, n = 35). Aside from donated supplies, there was variable access to HbA1ctesting within public health facilities, and, when available, patients often had tocover the cost. Provision was further compromised by numerous problemsincluding stock-outs, and challenges with understanding the test, equipmentmaintenance, and refrigeration.CONCLUSIONLarge gaps exist for adequate access to appropriate insulin delivery devices andHbA1c testing. Public health systems in low-and-middle income countries shouldincrease affordable provision. There are also needs for specific health professional training and diabetes education;elimination of customs duties and taxes;development of inexpensive, robust HbA1c testing methods that do not requirerefrigeration of testing supplies;differential pricing schemes;and other solutions.

Glycated haemoglobin reduction and fixed ratio combinations of analogue basal insulin and glucagon-like peptide-1 receptor agonists:A systematic review

BACKGROUND Fixed ratio combinations(FRCs)of analogue basal insulin and glucagon-like peptide-1 receptor agonists are a newer addition to the therapeutic armamentarium for the management of type 2 diabetes mellitus.They reduce treatment complexity by combining two injectables in a single daily injectable,thus potentially improving adherence and persistence.Clinicians wanting to use FRCs would need to choose between members of the class.AIM To describe and contrast the glycated haemoglobin reduction of two FRCs of analogue basal insulin and glucagon like peptide-1 receptor agonist in adults with type 2 diabetes mellitus.METHODS The following Population,Intervention,Comparison,Outcome question was used for the primary analysis:Among adult patients with type 2 diabetes mellitus[P],what is the effect of iGlarLixi[I]compared to IDegLira[C]for bringing about glycaemic control(as measured by reduction in glycosylated haemoglobin)[O]?The Prisma Statement was used as a guideline for framing this systematic review.We searched PubMed,EMBASE and Cochrane library databases and Clinicaltrials.gov using various keywords and medical search headings related to type 2 diabetes mellitus,iGlarlixi,IDegLira and glycated haemoglobin A1c.RESULTS All 14 studies identified by the systematic search met the primary efficacy endpoint of reduction in glycated haemoglobin.There were no head-to-head studies between the FRCs of iGlarlixi and IDegLira,and we therefore did an indirect comparison based on a common comparator of insulin glargine U100.Both iGlarLixi and IDegLira effectively reduce glycated haemoglobin when compared to insulin glargine U100.However,using indirect comparisons,IDegLira had a greater haemoglobin A1c reducing ability(0.6%vs 0.3%).The indirect comparison is limited by the differences between the studies;the fasting blood glucose targets were slightly higher for iGlarLixi studies when compared to the IDegLira studies(4.0-5.0 mmol/L and 4.4-5.6 mmol/L),and the IDegLira study used a greater average dose of insulin glargine when compared to the iGlarLixi studies(66 U/d vs 40 U/d).CONCLUSION Both iGlarLixi and IDegLira effectively reduce glycated haemoglobin.Indirect comparisons,using insulin glargine as the common comparator,suggest that IDegLira reduces glycated haemoglobin to a greater extent than iGlarLixi.However,given the limitations of indirect comparisons,robust head to head studies and real-world data would better inform clinician choice and clinical practice guidelines.

Evaluation of Glucose Metabolism in Acute Myocardial Infarction by Glycated Albumin and Glycated Haemoglobin

Objectives To detect whether persisting or transient glucose metabolism disorder is responsible for admission hyperglycemia in patients with acute myocardic infarction （AMI）. Methods Two groups of patients were enrolled： AMI group and control group. Fasting plasma glucose, 2 hours plasma glucose, glycated albumin（GA） and glycated haemoglobin （ HbA1 c） were measured at baseline in both groups and 30 days after AMI attack in AMI group. Results （ 1 ） There were no significant differences in baseline characteristics between both groups; （2） Compared with the control group, the levels of GA and HbA1 c in AMI group at baseline were significantly higher. （ 3 ） At 30 day follow-up in AMI group, both FBG and 2hPG decreased to normal values, HbA1 c did not change, but only GA kept on increasing. Conclusions Hyperglycemia on admission in patients with AMI resulted from both preexisting metabolic disorder and stress reaction as well. GA is the only indicator that could recall the exaggeration of glucose metabolic disorder during AMI attack at 30 day follow-up. （ S Chin J Cardiol 2009; 10（4） ： 186 -189）

Glycated haemoglobin (HbA1c) for postmortem diagnosis of diabetes

The study was conducted at the Estonian Forensic Science Institute in 2008-2014 as continuous part of our previous study of alcohol and premature death in Estonian men.Autopsy data from 504 cases of male deaths (ages 19-79) were collected and blood and urine samples for glycated haemoglobin (HbA1c),liver enzymes and alcohol concentration were analysed.The aim of our research was to find undiagnosed diabetes and diabetes risk cases postmortem on the basis of increased values of HbAlc.HbA1c was within the reference value 4.8%-5.9% (29-42 mmol/mol),in 88.1% (n =444) of cases,below reference value in 2.4% (n =12),in the risk group of diabetes,HbA1c 6.0%-6.4% (42-46 mmol/mol) was within 5.8% (n =29),and HbA1c result of ≥6.5% (48 mmol/mol) manifested in 3.8% (n =19) of cases.The higher the age,the more cases with HbA1c value ≥6.0% (42 mmol/mol) occurred.In the group of external causes of death (n =348),the HbAlc value of ≥6.5% (48 mmol/mol) HbA1c occurred in four cases.The HbA1c value was ≥6.5% (48 mmol/mol) in 78.9% of 156 cases when the cause of death was disease,of which 58% were cardiovascular diseases.The prevalence of diabetes and diabetes risk was found lower compared to population-based study,as majority of the deceased were young and middle-aged males and no females were included.In the case of poisoning with narcotic substances,HbA1c was within the reference range.A negative correlation occurred between alcohol intoxication and HbA1c value.A positive correlation between ALT and HbA1c was found-the higher stage of liver damage correlated with the higher HbA1c level.