Cut-off value of glycated hemoglobin A1c for detecting diabetic retinopathy in the Chinese population

BACKGROUND Glycated hemoglobin A1c(HbA1c)is considered the most suitable for diabetes mellitus diagnosis due to its accuracy and convenience.However,the effect of HbA1c on diabetic retinopathy(DR)in the Han and Korean populations in Jilin,China,remains inconclusive.AIM To determine the best cut-off of HbA1c for diagnosing DR among the Chinese.METHODS This cross-sectional study included 1933 participants from the Yanbian area of Jilin Province,China.Trained investigators employed a questionnaire-based survey,physical examination,laboratory tests,and fundus photography for the investigation.The best cut-off value for HbA1c was established via the receiver operating characteristic curve.The factors associated with HbA1c-associated risk factors were determined via linear regression.RESULTS The analysis included 887 eligible Chinese Han and Korean participants,591 of whom were assigned randomly to the training set and 296 to the validation set.The prevalence of DR was 3.27% in the total population.HbA1c of 6.2% was the best cut-off value in the training set,while it was 5.9% in the validation set.In both Chinese Han and Korean populations,an HbA1c level of 6.2% was the best cut-off value.The optimal cut-off values of fasting blood glucose(FBG)≥7 mmol/L and<7 mmol/L were 8.1% and 6.2% respectively in Han populations,while those in Korean populations were 6.9%and 5.3%,respectively.Age,body mass index,and FBG were determined as the risk factors impacting HbA1c levels.CONCLUSION HbA1c may serve as a useful diagnostic indicator for DR.An HbA1c level of 6.2% may be an appropriate cut-off value for DR detection in the Chinese population.

Correlation between cerebral neurotransmitters levels by proton magnetic resonance spectroscopy and HbA1c in patients with type 2 diabetes

BACKGROUND Cognitive dysfunction is the main manifestation of central neuropathy.Although cognitive impairments tend to be overlooked in patients with diabetes mellitus(DM),there is a growing body of evidence linking DM to cognitive dysfunction.Hyperglycemia is closely related to neurological abnormalities,while often disregarded in clinical practice.Changes in cerebral neurotransmitter levels are associated with a variety of neurological abnormalities and may be closely related to blood glucose control in patients with type 2 DM(T2DM).AIM To evaluate the concentrations of cerebral neurotransmitters in T2DM patients exhibiting different hemoglobin A1c(HbA1c)levels.METHODS A total of 130 T2DM patients were enrolled at the Department of Endocrinology of Shanghai East Hospital.The participants were divided into four groups according to their HbA1c levels using the interquartile method,namely Q1(<7.875%),Q2(7.875%-9.050%),Q3(9.050%-11.200%)and Q4(≥11.200%).Clinical data were collected and measured,including age,height,weight,neck/waist/hip circumferences,blood pressure,comorbidities,duration of DM,and biochemical indicators.Meanwhile,neurotransmitters in the left hippocampus and left brainstem area were detected by proton magnetic resonance spectroscopy.RESULTS The HbA1c level was significantly associated with urinary microalbumin(mALB),triglyceride,low-density lipoprotein cholesterol(LDL-C),homeostasis model assessment of insulin resistance(HOMA-IR),and beta cell function(HOMA-β),N-acetylaspartate/creatine(NAA/Cr),and NAA/choline(NAA/Cho).Spearman correlation analysis showed that mALB,LDL-C,HOMA-IR and NAA/Cr in the left brainstem area were positively correlated with the level of HbA1c(P<0.05),whereas HOMA-βwas negatively correlated with the HbA1c level(P<0.05).Ordered multiple logistic regression analysis showed that NAA/Cho[Odds ratio(OR):1.608,95%confidence interval(95%CI):1.004-2.578,P<0.05],LDL-C(OR:1.627,95%CI:1.119-2.370,P<0.05),and HOMA-IR(OR:1.107,95%CI:1.031-1.188,P<0.01)were independent predictors of poor glycemic control.CONCLUSION The cerebral neurotransmitter concentrations in the left brainstem area in patients with T2DM are closely related to glycemic control,which may be the basis for the changes in cognitive function in diabetic patients.

Metabolic syndrome does not affect sustained virologic response of direct-acting antivirals while hepatitis C clearance improves hemoglobin A1c

AIM To determine whether successful treatment with direc-tacting antivirals(DAA) is associated with improvements in hemoglobin A1 c(HbA1 c) and if type 2 diabetes mellitus(T2 DM) or metabolic syndrome affects sustained virologic response(SVR).METHODS We performed a retrospective analysis of all hepatitis C virus(HCV) patients at the VA Greater Los Angeles Healthcare System treated with varying DAA therapy between 2014-2016. Separate multivariable logistic regression was performed to determine predictors of HbA1 c decrease ≥ 0.5 after DAA treatment and predictors of SVR 12-wk post treatment(SVR12).RESULTS A total of 1068 patients were treated with DAA therapy between 2014-2016. The presence of T2 DM or metabolic syndrome did not adversely affect SVR12. 106 patients had both HCV and T2 DM. Within that cohort,patients who achieved SVR12 had lower mean HbA1 c pre treatment(7.35 vs 8.60,P = 0.02),and lower mean HbA1 c post-treatment compared to non-responders(6.55 vs 8.61,P = 0.01). The mean reduction in HbA1 c after treatment was greater for those who achieved SVR12 than for non-responders(0.79 vs 0.01,P = 0.03). In adjusted models,patients that achieved SVR12 were more likely to have a HbA1 c decrease of ≥ 0.5 than those that did not achieve SVR12(adjusted OR = 7.24,95%CI: 1.22-42.94). CONCLUSION In HCV patients with T2 DM,successful treatment with DAA was associated with a significant reduction in HbA1 c suggesting that DAA may have a role in improving insulin sensitivity. Furthermore,the presence of T2 DM or metabolic syndrome does not adversely affect SVR12 rates in patients treated with DAA.

Editorial on hemoglobin A1c, blood pressure, and lowdensity lipoprotein cholesterol goals in diabetics

The American Diabetes Association (ADA) 2013 guidelines state that a reasonable hemoglobin A1c goal for many nonpregnant adults with diabetes is less than 7.0% a hemoglobin A1c level of less than 6.5% may be considered in adults with short duration of diabetes, long life expectancy, and no significant cardiovascular disease if this can be achieved without significant hypoglycemia or other adverse effects of treatment. A hemoglobin A1c level less than 8.0% may be appropriate for patients with a history of severe hypoglycemia, limited life expectancy, advanced macrovascular and microvascular complications, extensive comorbidities, and long-standing diabetes in whom the hemoglobin A1c goal is difficult to attain despite multiple glucoselowering drugs including insulin. The ADA 2013 guidelines recommend that the systolic blood pressure in most diabetics with hypertension should be reduced to less than 140 mmHg. These guidelines also recommend use of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in the treatment of hypertension in diabetics unless they are pregnant. Diabetics at high risk for cardiovascular events should have theirserum low-density lipoprotein (LDL) cholesterol lowered to less than 70 mg/dL with statins. Lower-risk diabetics should have their serum LDL cholesterol reduced to less than 100 mg/dL. Combination therapy of a statin with either a fibrate or niacin has not been shown to provide additional cardiovascular benefit above statin therapy alone and is not recommended. Hypertriglyceridemia should be treated with dietary and lifestyle changes. Severe hypertriglyceridemia should be treated with drug therapy to reduce the risk of acute pancreatitis.

Glycated hemoglobin A1C and diabetes mellitus in critically ill patients

BACKGROUND:Hyperglycemia has been detected in many critically ill patients in the department of emergency medicine.But its mechanism and prognosis have not been well elucidated.In this study,we measured the serum level of glycated hemoglobin A1C(HbA1c) in critically ill patients to evaluate the effects of hyperglycemia on the prognosis of the patients.METHODS:A total of 826 critically ill patients,who had been treated at the Department of Emergency Medicine of Chaoyang Hospital during October 2006 and November 2007,were divided into a diabetes mellitus group(n=184) and a non-diabetes mellitus group(642) according to whether they had diabetes mellitus.Fasting glucose and HbA1 c were measured in all patients.Those in the diabetes mellitus group were further assigned to a drug therapy subgroup and a non-drug therapy subgroup;the serum level of HbA1 c and its relationship with short-term outcome were evaluated.RESULTS:Fasting glucose increased in 78.8% of the patients(88.6%in the diabetes mellitus group,and 75.9%in the non-diabetes mellitus group,P<0.05),and HbA1 c was elevated in 45.5% of the patients(78.3% in the diabetes mellitus group,and 36.1%in the non-diabetes mellitus group,P<0.01).Fasting glucose,HbA1 c and 28-day mortality were improved more significantly(P<0.01) in the drug therapy subgroup than in the non-drug therapy subgroup.The 28-day mortality was more significantly different in patients with fasting blood glucose >8.33 mmol/L than in those with fasting blood glucose <8.33 mmol/L.CONCLUSIONS:Hyperglycemia of critically ill patients could not totally attribute to stress response,especially in those who have no history of diabetes mellitus.Prognosis of hyperglycemia may vary among critically ill patients.

Hemoglobin Fukuoka caused unexpected hemoglobin A1c results: A case report

BACKGROUND Glycated hemoglobin(Hb)(HbA1c)is an indicator that is used to diagnose and monitor the treatment of diabetes.Many factors can affect the detection of HbA1c.One of the most important of these factors is the Hb variant.Here,we report a rare Hb variant and evaluate its effect on HbA1c.CASE SUMMARY A 35-year-old man was suspected of harboring an Hb variant following the measurement of HbA1c with the Variant II Turbo 2.0 Hb detection system during a routine examination.Subsequently,we used the Arkray HA-8160 and ARCHITECT c4000 system to reanalyze HbA1c.Finally,the Hb variant was detected with a Capillary2FP analyzer that operates on the principle of capillary electrophoresis.We also used gene sequencing to investigate the mutation site.The value of HbA1c detected with the Variant II Turbo 2.0 system was 52.7%.However,the Arkray HA-8160 system did not display a result while the ARCHITECT c16000 system showed a result of 5.4%.The Capillary2FP analyzer did not reveal any abnormal Hb zones.However,gene sequencing identified the presence of a mutation in the Hbβ2 chain[CD2(CAC>TAC),His>Tyr,HBB:c.7C>T];the genotype was Hb Fukuoka.CONCLUSION Hb variants could cause abnormal HbA1c results.For patients with Hb variants,different methods should be used to detect HbA1c.

Development of Disposable Single-Use Biosensor for Fructosyl Valine and Glycated Hemoglobin A1c

A novel amperometric biosensor prototype was fabricated using screen printing technique. The disposable single-use strips were made from conductive carbon ink and modified with fructosyl amino acid oxidase. The electrodes and conducting paths were made solely with carbon ink and characterized by conductivity and cyclic voltammetry. The biosensor showed high current output, large linearity, and effectiveness for fructosyl valine as well as human blood samples. Amperometric studies were carried out using both fructosyl valine and human blood samples. With 5 uL sample volume, the biosensor showed strong amperometric response with good linearity for a wide range (0 to 8 mM). Diabetic and healthy blood samples showed sufficient difference in their amperometric responses that correlate well with their different hemoglobin A1c levels. These results demonstrate the feasibility of using this type of inexpensive single-use biosensor strips as the basis for determining hemoglobin A1c levels for diabetic patients.

The effect of weight loss on fasting blood sugars and hemoglobin A1c in overweight and obese diabetics and non-diabetics

BACKGROUND: Diet and exercise are recommended first line treatment for overweight, obese, and diabetic patients with the goal of decreasing weight and improving glycemic control. The goal of this study was to determine the effect that a low calorie diet and behavioral modification program, as implemented by a medically supervised weight loss program, would have on the fasting blood sugar and hemoglobin A1c in overweight or obese diabetic and over-weight or obese non-diabetic participants. METHODS: Charts from 2009 to 2010 were reviewed for 310 diabetic and non-diabetic patients enrolled in the Via Christi Weight Management (VCWM) program in Wichita, Kansas. Data were collected before and after patients underwent a program of meal replacements and weekly physical activity lasting 12 weeks. Variables included pre and post treatment fasting blood sugars, hemoglobin A1c, body mass index, percent body weight lost, and diabetes status. RESULTS: Diabetic participants lost an average of 11.7% of their initial body weight (IBW), and non-diabetic patients lost 12.5% of their IBW over the treatment course. Post-treatment average fasting blood glucose (FBG) decreased in both diabetics and non-diabetics by 15.53 mg/dL and 8.46 mg/dL, respectively (p = 0.08). Diabetic patients experienced a significant decrease of 0.83% from pre to post-treatment in hemoglobin A1c. For diabetic and non-diabetic groups, the changes in FBG were correlated with the change in weight. CONCLUSIONS: Diet and exercise, as prescribed by the VCWM program, is effective in reducing hemoglobin A1c in diabetics and reducing fasting blood sugars in both diabetic and non-diabetic patients.

Utility of a hemoglobin A1C obtained at the first prenatal visit

AIM： To evaluate the utility of the hemoglobin A1C （HbA1C） at the frst prenatal visit as a triaging tool in patients at high risk for gestational diabetes （GDM）.METHODS： The HbA1C was obtained at the frst prenatal visit prior to 20 wk. Women with a HbA1C ≥ 6.5% （group one） were instructed on diet and daily self-monitoring of blood glucose. Women with a HbA1C between 5.7%-6.4% （group two） were offered testing or daily self-monitoring of blood glucose. Women with a HbA1C 〈 5.7% （group three） were tested at 24-28 wk. Patients were tested for GDM using the two step testing and Carpenter and Coustan values as cutoffs. Medication was started if patients failed to meet glycemic goals of fasting ≤ 95 mg/dL （5.3 mmol/L） and 2 h postprandial ≤ 120 mg/dL （6.7 mmol/L）.RESULTS： In group one （n = 16）, 15/16 （95%） re-quired medication to achieve euglycemia. The mean gestational age at which medication was required was early at 14 ± 6 wk. Postpartum, 14/16 patients （87%） remained diabetic. Group two contained 82 patients. Sixty-sixpatients （80%） were given a diagnosis of GDM and 52 patients （64%） required medication. The mean gestational age at which medication was started in group two was 20 ± 7.8 wk. There were 205 patients in group three, 18 patients （8.7%） were diagnosed with GDM and 13 patients （6%） required medication. In comparison to group three, patients in group one were 220 times more likely to require medication （95%CI： 26.9- 〉 999, P 〈 0.0001）. Patients in group two were 26 times more likely to require medication （95%CI： 12.5-54.3, P 〈 0.0001）.

Scleredema Diabeticorum in a Patient with the Normal Range of the Hemoglobin A1c Level and Impaired Glucose Tolerance

Scleredema diabeticorum is an uncommon skin disorder showing a diffuse, symmetrical, and non-pitting persistent in-duration developing initially on the nape. It usually occurs in patients with poorly controlled or insulin-resistant diabetes mellitus. We present a 57-year-old woman with scleredema diabeticorum with hemoglobin A1c 6.1% (normal, 4.7% - 6.2%) and impaired glucose tolerance. Alcian blue staining at pH 7.0 illustrated deposits of acid mucopolysaccharides between the collagen bundles in the reticular dermis, but the staining at pH 1.5 did not show the deposits. This case indicates that scleredema diabeticorum may be an early indicator of undiagnosed diabetes mellitus in some cases, and that impaired glucose tolerance test should be performed for individuals with scleredema even though the hemoglobin A1c level is within the normal range.

空腹血糖正常的冠心病患者糖代谢状况与血PAI-1,hsCRP,HbA1c及冠脉病变的关系

目的:调查空腹血糖正常的冠心病患者糖代谢状况,探讨冠心病合并糖耐量减低患者血浆纤溶酶原激活物抑制物1(PAI-1)、高敏C反应蛋白(hs-CRP)、糖化血红蛋白(HbA1c)水平与冠脉病变的关系。方法:对冠脉造影确诊的226例冠心病患者行口服葡萄糖耐量试验,据结果分成糖耐量正常(NGT)组,糖耐量减低(IGT)组和2型糖尿病(T2DM)组,分析糖代谢状况,测定三组的血PAI-1,hs-CRP,HbA1c水平和冠脉病变积分。结果:共发现糖代谢异常者120例(53.1%);血PAI-1,hs-CRP,HbA1c水平和冠脉病变积分在IGT和T2DM组比NGT组明显升高(P<0.05);相关分析显示,冠心病合并IGT组血PAI-1,hs-CRP,HbA1c水平和冠状动脉病变积分呈正相关,相关系数分别为r=0.6082(P<0.01)、0.4443(P<0.05)、0.6327(P<0.01)。结论:空腹血糖正常的冠心病患者糖代谢异常发生率高;冠心病合并IGT者冠脉病变严重,多支冠脉病变发生率高,病变呈弥漫性狭窄;血浆PAI-1,hs-CRP,HbA1c水平和冠状动脉病变严重程度有关。

Association Between Serum Uric Acid and Prevalence of Type 2 Diabetes Diagnosed using HbA1c Criteria Among Chinese Adults in Qingdao,China

Objective To determine whether elevated serum uric acid(UA)levels are associated with type 2 diabetes diagnosed using Hb A1 c levels among Chinese adults.Methods We conducted two population-based cross-sectional studies in Qingdao in China in 2006 and 2009.A total of 6894(39.4% men)subjects aged 35-74 years were included in the data analysis.Newly diagnosed diabetes was defined as Hb A1 c level of ≥6.5%,and prediabetes was classified as Hb A1 c level between 5.7% and 6.4% according to the International Diabetes Federation criteria.Multivariate logistic regression was employed to assess the association between UA and prevalence of type 2 diabetes defined using Glycated hemoglobin A1c(Hb A1 c levels.Results Subjects with prediabetes had higher UA levels than those with normal glucose tolerance,newly diagnosed diabetes,and known diabetes,with corresponding values of 325.1(82.5)μmol/L,310.9(84.2)μmol/L,291.3(81.7)μmol/L,305.2(83.6)μmol/L,respectively(P<0.001 for all comparisons).Binary logistic regression analysis showed that UA was a possible predictor for the prevalence of type 2 diabetes diagnosed using Hb A1 c levels,and the second quartile of UA levels had a higher odds ratio(OR:4.088;95% CI:2.900-5.765)for Hb A1 c than the other quartiles after adjusting for age,body mass index,sex,marital status,education,income,alcohol consumption,smoking,and cardiometabolic parameters.Conclusion Serum UA is significantly associated with type 2 diabetes diagnosed using Hb A1 c levels,independent of other cardiometabolic parameters.

Methods, units and quality requirements for the analysis of haemoglobin A_(1c) in diabetes mellitus

The formation of glycohemoglobin, especially the hemoglobin A1c(Hb_(A1c)) fraction, occurs when glucose becomes coupled with the amino acid valine in the β-chain of Hb; this reaction is dependent on the plasma concentration of glucose. Since the early 1970 s it has been known that diabetics display higher values of Hb_(A1c) because they have elevated blood glucose concentrations. Thus Hb_(A1c) has acquired a very important role in the treatment and diagnosis of diabetes mellitus. After the introduction of the first quantitative measurement of Hb_(A1c), numerous methods for glycohemoglobin have been introduced with different assay principles: From a simple minicolumn technique to the very accurate automated highpressure chromatography and lastly to many automated immunochemical or enzymatic assays. In early days, the results of the quality control reports for Hb_(A1c) varied extensively between laboratories, therefore in United States and Canada working groups(WG) of the Diabetes Controls and Complications Trial(DCCT) were set up to standardize the Hb_(A1c) assays against the DCCT/National Glycohemoglobin Standardization Program reference method based on liquid chromatography. In the 1990 s, the International Federation of Clinical Chemistry and Laboratory Medicine(IFCC) appointed a new WG to plan a reference preparation and method for the Hb_(A1c) measurement. When the reference procedureswere established, in 2004 IFCC recommended that all manufacturers for equipment used in Hb_(A1c) assays should calibrate their methods to their proposals. This led to an improvement in the coefficient of variation(CV%) associated with the assay. In this review, we describe the glycation of Hb, methods, standardization of the Hb_(A1c) assays, analytical problems, problems with the units in which Hb_(A1c) values are expressed, reference values, quality control aspects, target requirements for Hb_(A1c), and the relationship of the plasma glucose values to Hb_(A1c) concentrations. We also note that the acceptance of the mmol/mol system for Hb_(A1c) as recommended by IFCC, i.e., the new unit and reference ranges, are becoming only slowly accepted outside of Europe where it seems that expressing Hb_(A1c) values either only in per cent units or with parallel reporting of percent and mmol/mol will continue. We believe that these issues should be resolved in the future and that it would avoid confusion if mmol/mol unit for Hb_(A1c) were to gain worldwide acceptance.

联合检测血清HbAlc和Cys-C对1型糖尿病肾病早期诊断的研究

目的检测1型糖尿病肾病不同病期患者的血清中糖化血红蛋白和胱抑素-C水平,评价其组合对1型糖尿病肾病早期诊断的价值。方法选择本院确诊为1型糖尿病肾病患者和同期健康体检者,各100例,采用BECKMAN CX 4全自动生化分析仪同时检测样本血清中糖化血红蛋白和胱抑素-C的含量。结果 1型糖尿病肾病患者检测血清中糖化血红蛋白和胱抑素-C浓度水平高于对照组,P<0.05,差异具有统计学意义。1型糖尿病肾病患者不同病期的血清中糖化血红蛋白和胱抑素-C浓度水平呈递增性升高,趋势呈正相关,各期与1期比较,P<0.05,差异具有统计学意义。结论血清中糖化血红蛋白和胱抑素-C测定有助于1型糖尿病肾病早期诊断,能为临床医生提供可靠准确有价值的诊断指导依据。

Prediction of the effect on antihyperglycaemic action of sitagliptin by plasma active form glucagon-like peptide-1

AIM: To investigate whether active glucagon-like peptide-1(GLP-1) is a prediction Factor of Effect of sitagliptin on patients with type 2 diabetes mellitus(GLP-1 FEST:UMIN000010645). METHODS: Seventy-six patients with type 2 diabetes, who had insufficient glycemic control [Hemoglobin A1c(Hb A1c) ≥ 7%] in spite of treatment with metformin and/or sulfonylurea, were included in the investigation. Patients were divided into three groups by tertiles of fasting plasma active GLP-1 level, before the administration of 50 mg sitagliptin. RESULTS: At baseline, body mass index, serum UA, insulin and HOMA-IR were higher in the high active GLP-1 group than in the other two groups. The high active GLP-1 group did not show any decline of Hb A1c(7.6% ± 1.4% to 7.5% ± 1.5%), whereas the middle and low groups indicated significant decline of Hb A1c(7.4 ± 0.7 to 6.8 ± 0.6 and 7.4 ± 1.2 to 6.9 ± 1.3, respectively) during six months. Only the low and middle groups showed a significant increment of active GLP-1, C-peptide level, a decreased log and proinsulin/insulin ratio after administration. In logistic analysis, the low or middle group is a significantexplanatory variable for an Hb A1 c decrease of ≥ 0.5%, and its odds ratio is 4.5(1.40-17.6)(P = 0.01) against the high active GLP-1 group. This remains independent when adjusted for Hb A1 c level before administration, patients' medical history, medications, insulin secretion and insulin resistance.CONCLUSION: Plasma fasting active GLP-1 is an independent predictive marker for the efficacy of dipeptidyl peptidase 4 inhibitor sitagliptin.

Inverse relationship between glomerular hyperfiltration and C-peptide level in Type 1 diabetes

Background: Increased glomerular filtration rate (GFR) commonly develops in early diabetes and is closely correlated with the development of diabetic nephropathy. Objective: The aim was to study the relationship between GFR, C-peptide level and other parameters at diagnosis of Type 1 diabetes. Methods: We determined GFR, Cpeptide level, glycated hemoglobin (HbA1c), body mass index (BMI) SDS and loss of weight at diagnosis of Type 1 diabetes in 495 children (231 females). Linear and multiple regression analysis was used to test for the associations between GFR and other parameters. Results: In the 495 patients, GFR median (interquartile range) was increased vs normal values (p = 0.0001). GFR was significantly negatively correlated with age (p < 0.001) and C-peptide level (p = 0.001), and positively correlated with weight loss (p = 0.02). The multiple regression analysis showed that age (p = 0.001) and C-peptide level (p = 0.05) were independently and negatively related to GFR. Conclusions: This study shows that, at onset of Type 1 diabetes, higher the GFR, younger the age and lower the C-peptide level are. The role of this hyperfiltration in the development of later nephropathy and the putative preventive effect of C-peptide administration need to be evaluated.

The Influence of Initial Management and Family Stress on Metabolic Control in Children with Type 1 Diabetes

The aim was to assess whether temporal changes in the initial management for children diagnosed with type 1 diabetes over a ten year period affected metabolic control two years after diagnosis. A further aim was to investigate if social factors, registered at diagnosis, had an impact on metabolic control two years after diagnosis. During the years 1997-2006, 247 children and adolescents were diagnosed with type 1 diabetes at a University Hospital in Sweden. The analysed data included HbA1c, pH at diagnosis, initial intravenous insulin infusion and length of hospital stay at diag?nosis, subcutaneous insulin type, number of diabetes check-up visits, emergency visits, re-admissions and social factors. Length of hospital stay decreased significantly over the ten year period. Neither hospital stay nor differences in insulin treatment was significantly correlated with children’s metabolic control over time. Length of hospital stay was not re?lated with families’ social stress situation. However, girls in families with more family stress at the time of diagnosis had higher HbA1c during follow-up than girls with less family stress or boys. Factors of importance for the child’s long-term metabolic control need to be further investigated so the initial management can be tailored to each individual family’s needs. This would imply an effective utilization of both families’ and health care resources.

16例暴发性1型糖尿病患者临床特点分析

目的分析16例暴发性1型糖尿病(FT1DM)患者的临床资料,提高临床医师对FT1DM的认识。方法选取2008年1月—2015年5月海南省人民医院收治住院的FT1DM患者16例。记录患者发病时临床症状;抽取肘静脉血,检测血糖、糖化血红蛋白(HbA1c)、D-3羟丁酸、总二氧化碳(CO_2)、血肌酐(Scr)、肌酸激酶(CK)、血淀粉酶、血常规、胰岛相关自身抗体〔谷氨酸脱羧酶抗体(GADAb)、胰岛细胞抗体(ICA)、胰岛素自身抗体(IAA)〕水平。患者在酮症或酮症酸中毒纠正后1~3 d,检测空腹C肽(FCP)和餐后2 h C肽(PCP)水平。对患者进行长期随访。结果 2008年1月—2015年5月,16例FT1DM患者占同期所有住院糖尿病患者(22 999例)的0.70‰,占住院1型糖尿病患者(457例)的3.5%。16例患者起病急骤,病程为12 h^6 d。临床症状上,15例患者出现恶心、呕吐,8例出现腹痛,6例伴上呼吸道感染,6例出现意识障碍,5例出现多饮、多尿,5例伴发热;血糖水平均明显升高(17.0~46.1 mmol/L);Hb A1c接近正常(5.6%~8.2%);FCP水平降低(<0.003~0.090 nmol/L);PCP水平降低(<0.003~0.160 nmol/L);动脉血pH值降低(6.92~7.30);血清D-3羟丁酸水平升高(5.18~9.69mmol/L);总CO2降低(1.0~20.0 mmol/L);12例Scr水平升高(94~275μmol/L);7例CK水平升高(263~5 373U/L);9例血淀粉酶水平升高(110~436 U/L);14例白细胞计数(WBC)升高〔(13.3~31.9)×10~9/L〕;胰岛β细胞功能几乎衰竭,迅速发展为糖尿病酮症酸中毒。入院后患者经积极补液扩容、小剂量胰岛素静脉滴注、纠正电解质紊乱抢救后,病情均好转。在酮症酸中毒纠正后继续胰岛素泵或基础+餐时胰岛素强化治疗,出院后沿用住院期间胰岛素强化治疗方案至今。8例患者门诊随访3~34个月,复查FCP、PCP仍接近于入院时水平。结论 FT1DM患者占同期所有住院糖尿病患者的0.70‰,占住院1型糖尿病患者的3.5%。FT1DM起病急骤、代谢紊乱严重,常合并多系统损害,部分患者以消化道或上呼吸道症状起病。患者胰岛β细胞功能呈完全且不可逆损害,预后差,需终身胰岛素替代治疗,应引起重视。

血管黏附蛋白-1在糖尿病肾病患者体内水平变化及意义

目的观察2型糖尿病(T2DM)患者血管黏附蛋白-1(VAP-1)、超敏C反应蛋白(hs-CRP)水平变化,探讨其与糖尿病肾病(DN)发病关系。方法采用酶联免疫吸附法(ELISA)检测DN组患者(40例)、T2DM组患者(39例)血清VAP-1、hs-CRP、生化法检测血糖(Glu)、高效液相比色法检测糖化血红蛋白(GHbA-1)水平并与健康对照组(46例)比较。结果 VAP-1、hs-CRP、Glu、GHbA-1组间差异均有统计学意义(P<0.05),DN组VAP-1、hs-CRP水平高于T2DM组及健康对照组,且T2DM组hs-CRP水平高于健康对照组。T2DM组内VAP-1与hs-CRP、Glu水平呈正相关(r=0.568、0.755;P<0.05、0.01);hs-CRP与Glu、GHbA-1水平呈正相关(r=0.886、0.475;P<0.01、0.05)。Glu与GHbA1呈正相关(r=0.471;P<0.05)。DN组内VAP-1与hs-CRP、GHbA-1、Glu水平呈正相关(r=0.521、0.830、0.454;P<0.05、0.01、0.05),hs-CRP与Glu呈正相关(r=0.690;P<0.01)。结论 T2DM患者Glu及GHbA-1水平变化对VAP-1、hs-CRP升高存在影响,高VAP-1可致微血管病发生并影响患者肾功能,VAP-1拮抗治疗是预防糖尿病并发症的重要方面。

儿童1型糖尿病血清T细胞亚群与胰岛功能的相关性

目的分析1型糖尿病初发患儿外周血T细胞亚群(CD4^+、CD8^+、CD4^+/CD8^+)变化特点;探讨1型糖尿病初发患儿外周血T细胞亚群与胰岛功能的关系。方法选择2010-05~2013-12山西省儿童医院确诊的T1DM初发患儿43例,25例健康体检儿童为对照组。采用流式细胞技术测定血清CD4^+、CD8^+、CD4^+/CD8^+T细胞亚群,并对两组结果进行比较。对T1DM初发患儿T细胞亚群与糖化血红蛋白、C肽(C-P)水平进行相关性分析。结果 T1DM组患儿外周血CD4^+T细胞、CD4^+/CD8^+T细胞明显高于对照组(P<0.05),CD8^+T细胞明显低于对照组,差异有统计学意义(P<0.05)。T1DM患儿外周血CD4^+T细胞与Hb A1c呈正相关(r=0.261,P<0.05),与C-P呈负相关(r=-0.270,P<0.05);CD8^+T细胞与Hb A1c无明显相关性(r=-0.156,P>0.05),与C-P水平呈正相关(r=0.162,P<0.05);CD4^+/CD8^+T细胞与Hb A1c无明显相关性(r=0.200,P>0.05),与C-P水平呈负相关(r=-0.243,P<0.05)。结论 T1DM的发病过程存在T淋巴细胞亚群失衡,CD4^+T细胞异常激活、CD8^+T细胞缺陷和CD4^+/CD8^+T细胞比值增高。CD4^+及CD4^+/CD8^+T细胞与C肽呈负相关,CD8^+T细胞与C肽呈正相关。