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.

Quantification of glycated hemoglobin indicator HbA1c through near-infrared spectroscopy

A new strategy for quantitative analysis of a major clinical biochemical indicator called glycatedhemoglobin(Hb·A1c)was proposed.The technique was based on the simultaneous near-infrared(NIR)spectral determination of hemoglobin(Hb)and absolute HbAlc content(Hb·HbA1c)inhuman hemolysate samples.Wavelength selections were accomplished using the improvedmoving window partial least square(MWPLS)method for stability.Each model was establishedusing an approach based on randomness,similarity,and stability to obtain objective,stable,andpractical models.The optimal wavebands obtained using MWPLS were 958 to 1036 nm for Hband 1492 to 1858 nm for Hb·HbA1c,which were within the NIR overtone region.The validationroot mean square error and validation correlation coeficients of prediction(V-SEP,V-Rp)were 3.4g L^(-1) and 0.967 for Hb,respectively,whereas the corresponding values for Hb.HbAic were 0.63 g L^(-1) and 0.913.The corresponding V-SEP and V-Rp were 0.40% and 0.829 for the relativepercentage of HbA1c.The experimental results confirm the feasibility for the quantification of HbAlc based on simultaneous NIR spectroscopic analyses of Hb and Hb·HbA1c.

Prognostic value of glycated hemoglobin in colorectal cancer

AIM To investigate the clinical significance of routinely used glycemic parameters in a cohort of colorectal cancer(CRC) patients.METHODS Pre-treatment fasting blood glucose, insulin, Hb A1 c and homeostasis model of risk assessment(HOMA-IR) were retrospectively evaluated in a case-control study of 224 CRC and 112 control subjects matched for sex, obesity and diabetes frequency and blood lipid profile.Furthermore, the prognostic value of routinely used glycemic parameters towards progression-free(PFS) and overall survival(OS) was prospectively evaluated.RESULTS Fasting blood glucose, insulin, HOMA-IR and HbA 1c(all P < 0.0001) levels were higher in non-diabetic CRC patients compared with obesity-matched controls. All parameters were associated with increased CRC risk at ROC analysis, but no relationship with clinical-pathological variables or survival outcomes was observed for glycemia, insulinemia or HOMA-IR. Conversely, advanced CRC stage(P = 0.018) was an independent predictor of increased Hb A1 c levels, which were also higher in patients who had disease progression compared with those who did not(P = 0.05). Elevated Hb A1 c levels showed a negative prognostic value both in terms of PFS(HR = 1.24) and OS(HR = 1.36) after adjustment for major confounders, which was further confirmed in a subgroup analysis performed after exclusion of diabetic patients.CONCLUSION HbA 1c might have a negative prognostic value in CRC, thus suggesting that glycemic metabolic markers should be carefully monitored in these patients, independently of overt diabetes.

Factors Associated with Glycated Hemoglobin Levels >6.5% among Diabetic Patients Attending Kenyatta National Hospital, Kenya

Introduction: Good quality care in Type 2 diabetes mellitus (T2DM), whose prevalence is approximately 10% in Kenya, may prevent or delay diabetes complications. This study determined blood glycemic targets, defined by HbA1c levels (>6.5% [53 mmol/mol]) and associated factors among patients receiving diabetes management at Kenyatta National Hospital in Kenya. Methods: In this cross-sectional study conducted between May to September 2017, we obtained blood samples from 381 consenting T2DM patients attending KNH. The study collected data using a detailed questionnaire while taking glycemic measurements. Factors associated with poor glycemic control (HbA1c levels >6.5%) were determined using Ordinal logistic regression modeling, STATA software version 13. Results: 103 (27.1%) T2DM patients with poor glycemic control were identified. In multivariate analysis, independent risk factors associated with poor glycemic control and their 95% confidence intervals included: concurrent hypertension (aOR 1.6, [1.1, 2.4]), receiving ≥3 oral anti-diabetes medication (aOR 2.4, [1.3, 4.6]) and good adherence to medication based on self-reporting (aOR 6.2, [1.9, 41.3). Independent protective factors included self-monitoring of blood glucose levels (aOR 0.35, [0.2, 0.4]), patients aged 51 to 60 years (aOR 0.5, [0.3, 0.9]), weight between 50 and 70 kgs (aOR 0.5, [0.3, 0.9]) and receiving 1 to 2 diabetes medication (aOR 0.4, [0.3, 0.7]). Conclusion: Significantly high proportion of T2DM patients receiving treatment at KNH had poor glycemic control. Addressing comorbidities and promoting good glycemic control among long-standing T2DM patients receiving ≥3 oral anti-diabetes medication is key to delaying or preventing chronic diabetes complications. Self-monitoring of blood glucose levels needs to be encouraged as suggested by its protective effect. While differences in risk between diverse weights and ages need further studies, innovative ways of authenticating self-reports, e.g., triangulation, are required to ensure credibility. This work supports the Government of Kenya’s Vision 2030 in creating a healthy and productive population contributing to the country’s economic growth.

The Impact of Severity of Periodontal Bone Loss and the Levels of Glycated Hemoglobin (HbA1c) on the Periodontal Clinical Parameters of the 2017 World Workshop among Type 2 Diabetic Patients in Saudi Arabia

Background: Type-2 diabetic patients (uncontrolled levels of glucose blood) usually have periodontal diseases and alveolar bone loss. Objectives: The present study was designed to clarify the impact of severity of periodontal bone loss and the levels of glycated hemoglobin (HbA1c) on the periodontal clinical parameters of the 2017 World Workshop among type 2 diabetic patients in Saudi Arabia (Saudi and non-Saudi). Material and Methods: This study was done on 298 type 2 diabetic patients, selected from the internship clinics, College of Dentistry, King Khalid University, Abha, Saudi Arabia. The selection of patients was dependent on the levels of glycated hemoglobin (HbA1c), and they were categorized into controlled (<7% HbA1c) and uncontrolled type 2 diabetics (>7% HbA1c). All patients were divided according to the severity of periodontal bone loss into three groups, group I: mild periodontal bone loss, group II: moderate periodontal bone loss, and group III: severe periodontal bone loss. Clinical evaluation of periodontal diseases was carried out by clinical parameters according to the 2017 World Workshop. All data were collected and analyzed. A p-value of <0.05 was considered significant, and of <0.001 was considered highly significant. Results: The severity of periodontal bone loss were determined in controlled type 2 diabetics (<7% HbA1c) and compared to uncontrolled type 2 diabetics (>7% HbA1c). An increased percentage of patients with severe periodontal bone loss was observed in uncontrolled type 2 diabetics (>7% HbA1c) (42.9%), as compared to controlled type 2 diabetics (<7% HbA1c) (30.5%) without statistically significant (p = 0.251). An increased mean of age, clinical attachment loss (CAL), and percentage of radiographic bone loss (% RBL) were detected in controlled type 2 diabetics (<7% HbA1c), as compared to uncontrolled type 2 diabetics (>7% HbA1c). In contrast, we found an increased mean of plaque control record (PCR), gingival bleeding index (GBI), and periodontal pocket depth (PPD) in uncontrolled type 2 diabetics (>7% HbA1c) more than in controlled type 2 diabetics (<7% HbA1c) without statistically significant (p > 0.05). Moreover, the mean of age, PCR, CAL, % RBL, and PPD were more in the patients with severe periodontal bone loss, as compared to the patients with mild and moderate periodontal bone. Highly statistically significant differences were recorded (p < 0.001). Conclusion: This study demonstrates the role of uncontrolled diabetes as a risk factor for the increase in the severity of periodontal bone loss. Thus, we suggest including the glycated hemoglobin (HbA1c) levels with periodontal parameters in the evaluation of periodontal bone loss among type 2 diabetics.

Persistently High Glycated Hemoglobin in a Subgroup of Type 2 Diabetic Patients Who Failed Usual Oral Antihyperglycemics and Insulin in Côte d’Ivoire

Background: Type II diabetes mellitus is associated with multiple metabolic derangements which can cause secondary pathophysiological changes in multiple organ systems. This in turn can impose a heavy burden of morbidity and mortality from micro‑ and macro‑vascular complications. This study aimed to describe the metabolic and therapeutic profile of a subgroup of type 2 diabetic patients who have treatment failure with oral anti-hyperglycemic agents with persistent hyperglycemia despite insulin treatment. Methods: 60 type 2 diabetic patients in treatment failure with oral antidiabetics and under insulin treatment, aged 35 to 70 years, were recruited at the Diabetes Clinic of the University Teaching Hospital of Treichville in Abidjan, Côte d’Ivoire. Blood samples were collected in tubes containing Ethylenediaminetetraacetic Acid (EDTA) to determine glycated hemoglobin (HbA1c). Results: The average age of the population was 54 ± 9.38 years with a sex ratio (M/F) of 0.3, an average BMI of 30.25 ± 5 kg/m2, and an average HbA1c of 10.1% ± 1.6% for an average diabetes duration of 11.8 ± 5.8 years. The average insulin dose was 74.556 ± 16.21 UI/day, and the average duration of insulin treatment was 5.4 ± 3.1 years. The average HbA1c value was 10.1% ± 1.87% in men against 10.03% ± 1.53% in women with no significant difference (p = 0.1). The mean HbA1c values according to patient weight were 10.08% ± 2.05% for normal weight, 9.55% ± 2.26% for overweight, and 10.57% for obese, with no significant difference between the three groups of patients (p = 0.1). Conclusion: This study showed a persistence increase in glycated hemoglobin regardless of the treatment regimen, duration, and dose of insulin treatment in the subpopulation of type 2 diabetic patients.

Glycated albumin may be a choice, but not an alternative marker of glycated hemoglobin for glycemic control assessment in diabetic patients undergoing maintenance hemodialysis

Background It has been suggested that glycated hemoglobin （HbAlc） underestimate the actual glycemic control levels in maintenance hemodialysis （MHD） patients, because of anemia and the using of erythropoietin （EPO）; it was recommended that glycated albumin （GA） should be an alternative marker. Therefore, the assessment performances of glycemic control were compared between GA and HbAlc in this research by referring to mean plasma glucose （MPG） in diabetes mellitus （DM） patients undergoing MHD or not. Methods MPG was calculated according to the data registered at enrollment and follow-up 2 months later and corresponding HbAlc, albumin （ALB）, GA, etc. were measured in 280 cases. A case-control study for comparing GA and HbAlc was done among the groups of MHD patients with DM （n=88） and without DM （NDM; n=90）, and non-MHD ones with DM （n=102） using MPG for an actual glycemic control standard. Results In these 3 groups, only for DM patients＇ （whether undergoing MHD or not）, GA and HbAlc correlated with MPG significantly （P 〈0.01）. Through linear regression analysis, it could be found that the regression curves of GA almost coincided in MHD and non-MHD patients with DM, because the intercepts （2.418 vs. 2.329） and slopes （0.053 vs. 0.057） were very close to each other. On the contrary, regression curves of HbAlc did not coincide in the two groups, because variance of the slopes （0.036 vs. 0.052） were relatively large. Through comparing receiver operating characteristic （ROC） areas under the curve （AUC）, it could be understood that the assessment performances of GA and HbAlc in MHD patients were lower than those in non-MHD ones, and assessment performance of HbAlc in MHD patients was better than GA （P 〈0.05）. In addition, the effects of Hb and EPO dose on HbAlc, or that of ALB on GA were unobvious in our study. Conclusions Actual glycemic control level in MHD patients with DM may be underestimated by HbAlc, and it could be avoided by GA; however, glycemic evaluating performance of HbAlc may be still better than that of GA. Therefore, HbAlc should not be replaced completely although GA can be used as a choice to monitor glycemic level.

Visit-to-visit glycated hemoglobin A1c variability in adults with type 2 diabetes: a systematic review and meta-analysis

Background:Current practice uses the latest measure of glycated hemoglobin(HbAlc)to facilitate clinical decision-making.Studies have demonstrated that HbAlc variability links the risk of death and complications of diabetes.However,the role of HbAlc variability is unclear in clinical practice.This systematic review summarized the evidence of visit-to-visit HbAlc variability regarding different metrics in micro-and macro-vascular complications and death in people with type 2 diabetes.Methods:We searched PubMed,EMBASE(via OVID),and Cochrane Central Register(CENTRAL,via OVID)for studies investigating the association between HbAlc variability and adverse outcomes in patients with type 2 diabetes and performed random-effects meta-analysis stratified by HbAlc variability metrics in terms of standard deviation(SD),coefficient of variation(CV),and HbAlc variability score(HVS).Results:In people with type 2 diabetes,the highest quantile of all three HbAlc variability metrics(HbAlc-standard deviation[HbAlc-SD],HbAlc-coefficient of variance[HbAlc-CV],and HVS)is associated with increased risks of all-cause mortality,cardiovascular events,progression to chronic kidney disease,amputation,and peripheral neuropathy.For example,the hazard ratio of HbAlc-SD on all-cause mortality was 1.89 with 95%confidence interval(95%CI)1.46–2.45(HbAlc-CV 1.47,95%CI 1.26-1.72;HVS 1.67,95%CI 1.34–2.09).Conclusions:High HbAlc variability leads to micro-and macro-vascular complications of type 2 diabetes and related death.People with type 2 diabetes and high HbAlc variability need additional attention and care for the potential adverse outcomes.

Glycated hemoglobinis associated with mid-term mortality in non-ST segment elevation acute coronary syndrome undergoing percutaneous coronary intervention

Background Whether glycated hemoglobin(HbA1c)implicates as a prognosis predictor in patients with coronary artery diseaseremains controversial. We investigated whether HbA1 c is an independent predictor of mid-term mortality in non-ST segment elevation acute coronary syndrome(NSTEACS)patients undergoing percutaneous coronary intervention(PCI). Methods In a single-center study,1075 patients undergoing PCI were included. HbA1 c was measured at admission,along with other standard laboratory values. The outcome was all-cause mortality during a 1.48-year median follow-up period. Results Kaplan-Meier curve showed that HbA1c≥6.5% was associated with all-cause mortality. According to multivariate analysis(after adjusting for potential confounding factors),HbA1c≥6.5% predicted mid-term mortality(hazard ratio:2.02;95% CI:1.03-3.98;P=0.041). The other risk factors for mortality were hemoglobin,low-density lipoprotein cholesterol,and triglyceride. Conclusions InNSTEACS patients undergoing PCI,HbA1c≥6.5% is associated with mid-term mortality.

Increased level of glycated hemoglobin portends high risk of coronary artery stenosis

Background Increased level of glycated hemoglobin （HbAlc） is associated with higher incidence of coronary artery disease （CAD） in the diabetics. However, the relationship between HbAlc and the risk of coronary artery stenosis in the non-diabetics is controversial. Methods A retrospective research was conducted on 338 enrolled participants who have undergone 2 times of coronary angiographic examination within the past year. Clinical and laboratory variables at the initial and the second time of admission were collected. According to the initial median HbAlc level, all participants were divided into two groups named lower and higher groups. The relationship between HbAlc level and the risk of coronary artery stenosis over time was evaluated. Results The initial values of HbAlc in lower and upper groups were 5.78 ± 0.35% and 6.21 ± 0.32% （P 〈 0.05）. As compared to the lower group, the percentages of male and smoking participants, and the serum level of CRP were significantly higher in the higher group （P 〈 0.05）. Other traditional risk factors were comparable between the two groups. There were 54.2% and 55.2% participants with single vessel stenosis, and 45.8% and 44.8% with multiple vessel stenoses, respectively in the two groups without significant difference. The second time of admission, were 308.5 ± 25.4 days （lower group） and 300.7 ± 30.1 days （higher group） from the initial admission. Although no significant changes of HbAlc level were observed when compared to initial, HbAlc level in the higher group was still significantly higher in comparison to the lower group （6.24 ±0.39% vs. 5.80 ± 0.36%, P = 0.008）. The percentage of new coronary artery stenosis （≥ 50% stenosis） was higher in the higher group than that in the lower group （41.7% vs. 32.3%, P 〈 0.001）. Multivariate regression analyses suggested that HbAlc remained independent factor associated with coronary artery stenoses after extensive adjustment for risk factors. Conclusion In the nondiabetics, increased baseline HbAlc level portends the risk of coronary atherosclerotic plaque progression over time.

Relationship between hemoglobin glycation index and risk of hypoglycemia in type 2 diabetes with time-in-range in target

BACKGROUND In patients with type 2 diabetes mellitus(T2DM),the risk of hypoglycemia also occurs in at a time-in-range(TIR)of>70%.The hemoglobin glycation index(HGI)is considered the best single factor for predicting hypoglycemia,and offers new perspectives for the individualized treatment of patients with well-controlled blood glucose levels that are easily ignored in clinical settings.All participants underwent a 7-days continuous glucose monitoring(CGM)using a retrospective CGM system.We obtained glycemic variability indices using the CGM system.We defined HGI as laboratory hemoglobin A1c minus the glucose management indicator.Patients were categorized into low HGI(HGI<0.5)and high HGI groups(HGI≥0.5)according to HGI median(0.5).Logistic regression and receiver operating characteristic curve analyses were used to determine the risk factors for hypoglycemia.RESULTS We included 129 subjects with T2DM(54.84±12.56 years,46%male)in the study.Median TIR score was 90%.The high HGI group exhibited lower TIR and greater time below range with higher hemoglobin A1c than the low HGI group;this suggests more glycemic excursions and an increased incidence of hypoglycemia in the high HGI group.Multivariate analyses revealed that mean blood glucose,standard deviation of blood glucose and HGI were independent risk factors for hypoglycemia.Receiver operating characteristic curve analysis indicated that the HGI was the best predictor of hypoglycemia.In addition,the optimal cut-off points for HGI,mean blood glucose,and standard deviation of blood glucose in predicting hypoglycemia were 0.5%,7.2 mmol/L and 1.4 mmol/L respectively.CONCLUSION High HGI was significantly associated with greater glycemic excursions and increased hypoglycemia in patients with TIR>70%.Our findings indicate that HGI is a reliable predictor of hypoglycemia in this population.

Association of the glycemic background patterns and the diabetes management efficacy in poorly controlled type 2 diabetes

BACKGROUND Inadequate glycemic control in patients with type 2 diabetes(T2DM)is a major public health problem and a significant risk factor for the progression of diabetic complications.AIM To evaluate the effects of intensive and supportive glycemic management strategies over a 12-month period in individuals with T2DM with glycated hemoglobin(HbA1c)≥10%and varying backgrounds of glycemic control.METHODS This prospective observational study investigated glycemic control in patients with poorly controlled T2DM over 12 months.Participants were categorized into four groups based on prior glycemic history:Newly diagnosed,previously well controlled with recent worsening,previously off-target but now worsening,and HbA1c consistently above 10%.HbA1c levels were monitored quarterly,and patients received medical,educational,and dietary support as needed.The analysis focused on the success rates of good glycemic control and the associated factors within each group.RESULTS The study showed significant improvements in HbA1c levels in all participants.The most significant improvement was observed in individuals newly diagnosed with diabetes:65%achieved an HbA1c target of≤7%.The results varied between participants with different glycemic control histories,followed by decreasing success rates:39%in participants with previously good glycemic control,21%in participants whose glycemic control had deteriorated compared to before,and only 10%in participants with persistently poor control,with mean HbA1c levels of 6.3%,7.7%,8.2%,and 9.7%,respectively.After one year,65.2%of the“newly diagnosed patients”,39.3%in the“previously controlled group”,21.9%in the“previously off-target but now worsened'”group and 10%in the“poorly controlled from the start”group had achieved HbA1c levels of 7 and below.CONCLUSION In poorly controlled diabetes,the rate at which treatment goals are achieved is associated with the glycemic background characteristics,emphasizing the need for tailored strategies.Therefore,different and comprehensive treatment approaches are needed for patients with persistent uncontrolled diabetes.

RAMAN SPECTROSCOPY OF HUMAN HEMOGLOBIN FOR DIABETES DETECTION

Glycat ed hemoglobin(HbAlc)has been increasingly accepted as the gold standard for diabetesmonit oring.In this study,Raman spect roso was tentatively emplo yed for human hemoglobin(b)bioc hemical analysis aimed at de veloping a a simple blood test for diabetes monitoring.Ramanspectroscopy measurementsperformed oWereglobimples of patients(n=39)withconfirmed diabetes and healthyvolulhetentatiassignments of the measuredRaman bands were perfortwogegroups.Meanwhile,principal componentaminant analysis(LDA)wereemployed to develop effective weell1ormal controls andpatients with diabetes.Asat wo groups demonstrated twodistinct clust ers with a sensitivity and specificity d 73%,respectively.Then the effectiveness of the diagnostic algorithm based onechnique was confirmed by receiveroperating characteristic(ROC)curve.The area under the ROC curve was 0.92,indicating a good diagnostic result.In summary,our preliminary results demonstrate that proposing Raman spectroscopy can provide a significant potential for the noninvasive detection of diabetes.

Corneal subepithelial nerve fibers in type 2 diabetes:potential biomarker of diabetic neuropathy

AIM:To observe the changes in corneal subepithelial nerve fibers(CNFs)and Langerhans cells(LCs)in patients with type 2 diabetes using corneal laser confocal microscopy(CLCM).METHODS:A total of 60 patients(64 eyes),including 40 patients with type 2 diabetes(DM group)and 20 subjects without diabetes(control group)were included with CLCM.Neuron J plugin of Image J software were used for quantitative analysis of CNF length(CNFL),CNF density(CNFD),corneal nerve branch fiber density(CNBD),main branch length density,branch length density,corneal nerve fiber tortuosity(NT)score,and LCs density.An independent samples t-test to analyze the variability between the two groups was performed,and Pearson correlation analysis was used to analyze the relationships between CNF and multiple biochemical indicators in the DM group.The predictive power of CNF for type 2 diabetes was assessed using the receiver operating characteristic(ROC)curve.RESULTS:There were significant differences in the CNFL,CNFD,and main branch length density between two groups.The results of Pearson correlation analysis showed a significant negative correlation between CNFD and the duration of diabetes as well as triglyceride levels and total cholesterol,and a significant positive correlation between CNFD and serum albumin.In addition,the NT score showed a positive correlation and urea nitrogen,similar to the positive correlation observed between LC density and glycosylated hemoglobin(HbA1c)levels.CNFD showed the highest area under the curve(AUC of ROC)value,followed by main branch length density and CNFL.The AUC of the ROC curve under the logistic regression model also demonstrated good predictive values.The cut-off values of CNFD,CNFL,and main branch length density for diabetes showed 31.25,18.85,and 12.56,respectively.CONCLUSION:In patients with type 2 diabetes,there is a notable reduction in both CNFL and CNFD.These measurements can be influenced by various blood biochemical factors.However,the compromised nerve fibers can serve as valuable indicators for predicting the onset of type 2 diabetes and also as biomarkers for detecting diabetic neuropathy and its related complications.

Utilising continuous glucose monitoring for glycemic control in diabetic kidney disease

In this editorial,we comment on the article by Zhang et al.Chronic kidney disease(CKD)presents a significant challenge in managing glycemic control,especially in diabetic patients with diabetic kidney disease undergoing dialysis or kidney transplantation.Conventional markers like glycated haemoglobin(HbA1c)may not accurately reflect glycemic fluctuations in these populations due to factors such as anaemia and kidney dysfunction.This comprehensive review discusses the limitations of HbA1c and explores alternative methods,such as continuous glucose monitoring(CGM)in CKD patients.CGM emerges as a promising technology offering real-time or retrospective glucose concentration measure-ments and overcoming the limitations of HbA1c.Key studies demonstrate the utility of CGM in different CKD settings,including hemodialysis and peritoneal dialysis patients,as well as kidney transplant recipients.Despite challenges like sensor accuracy fluctuation,CGM proves valuable in monitoring glycemic trends and mitigating the risk of hypo-and hyperglycemia,to which CKD patients are prone.The review also addresses the limitations of CGM in CKD patients,emphasizing the need for further research to optimize its utilization in clinical practice.Altogether,this review advocates for integrating CGM into managing glycemia in CKD patients,highlighting its superiority over traditional markers and urging clinicians to consider CGM a valuable tool in their armamentarium.

Diabetes distress,the mediator of the poor glycemic control and depression:A meta-analysis

BACKGROUND Diabetes-related distress(DRD)is a common psychological disorder specifically associated with diabetes,its cross-talk with depression,and glycated hemoglobin(HbA1c)was discussed controversially.Interventions addressing DRD were shown to improve HbA1c.However,the primary concern is to investigate the association of DRD with glycemic control.No meta-analyses have compared the effects of depression and diabetes distress on HbA1c.AIM To assess the relationship between DRD,depression,and glycemic control.METHODS We systematically searched PubMed MEDLINE,Google Scholar,and Cochrane Library from inception up to May 2024.The keywords diabetes distress,depression,psychopathology,glycemic control,HbA1c,glycated hemoglobin,fasting,and postprandial blood glucose were used.A datasheet was used to extract the author’s name year and country of publication,diabetes distress,depression,and HbA1c among patients with DRD,depression,and control subjects.RESULTS Out of the 2046 studies retrieved,55 full texts were screened and 22 studies were included in the final meta-analysis.Diabetes distress was associated with poor glycemic control,odd ratio=0.42,95%confidence interval(CI):0.17-0.67,and P value<0.001,and odd ratio=0.52,95%CI:0.38-0.72,and P value<0.001 respectively.No significant difference was observed between depression and DRD regarding the impact on HbA1c,odd ratio=0.13,95%CI:0.15-0.41,P value=0.37,I2 for heterogeneity=76%.However,when heterogeneity was eliminated,diabetes distress influenced the HbA1c more compared to depression,odd ratio=0.29,95%CI:0.17-0.41,and P value<0.001.CONCLUSION DRD negatively influenced the HbA1c and glycemic control more than depression.Further studies using more specific measures(ecological momentary assessment)to assess DRD are recommended.

Management of diabolical diabetes mellitus and periodontitis nexus: Are we doing enough?

Periodontitis is the commonest oral disease affecting population worldwide. This disease is notorious for the devastation of tooth supporting structures, ensuing in the loss of dentition. The etiology for this disease is bacterial biofilm, which accumulates on the teeth as dental plaque. In addition to the biofilm microorganisms, other factors such as environmental, systemic and genetic are also responsible in progression of periodontitis. Diabetes mellitus (DM) is metabolic disorder which has an impact on the global health. DM plays a crucial role in the pathogenesis of periodontitis. Periodontitis is declared as the &#x0201c;sixth&#x0201d; major complication of DM. Evidence based literature has depicted an enhanced incidence and severity of periodontitis in subjects with DM. A &#x0201c;two way&#x0201d; relationship has been purported between periodontitis and DM. Mutual management of both conditions is necessary. Periodontal therapy (PT) may assist to diminish the progression of DM and improve glycemic control. Various advanced technological facilities may be utilized for the purpose of patient education and disease management. The present paper clarifies the etio-pathogenesis of periodontitis, establishing it as a complication of DM and elaborating the various mechanisms involved in the pathogenesis. The role of PT in amelioration of DM and application of digital communication will be discussed. Overall, it is judicious to create an increased patient cognizance of the periodontitis-DM relationship. Conjunctive efforts must be undertaken by the medical and oral health care professionals for the management of periodontitis affected DM patients.

Attainment of multifactorial treatment targets among the elderly in a lipid clinic

Objective To examine target attainment of lipid-lowering, antihypenensive and antidiabetic treatment in the elderly in a specialist set- ting of a University Hospital in Greece. Methods This was a retrospective study including consecutive subjects 〉 65 years old （n = 465） with a follow-up 〉 3 years. Low-density lipoprotein cholesterol （LDL-C）, blood pressure （BP） and glycated hemoglobin （HbAlc） goal achievement were recorded according to European Society of Cardiology/European Atherosclerosis Society （ESC/EAS）, European Society of Hypertension （ESH）/ESC and European Association for the Study of Diabetes （EASD） guidelines. Results The LDL-C targets were attained by 27~,4, 48% and 62% of very high, high and moderate risk patients, respectively. Those receiving statin ＋ ezetimibe achieved higher rates of LDL-C goal achievement compared with those receiving statin monotherapy （48% vs. 33%, P 〈 0.05）. Of the diabetic sub- jects, 71% had BP 〈 140/85 mmHg, while 78% of those without diabetes had BP 〈 140/90 mmHg. A higher proportion of the non-diabetic individuals （86%） had BP 〈 150/90 mmHg. Also, a higher proportion of those with diabetes had HbAlc 〈 8% rather than 〈 7% （88% and 47%, respectively）. Of note, almost one out of three non-diabetic individuals and one out of ten diabetic individuals had achieved all three treatment targets. Conclusions Even in a specialist setting of a University Hospital, a high proportion of the elderly remain at suboptimal LDL-C, BP and HbAlc levels. The use of drug combinations could improve multifactorial treatment target attainment, while less strict tar- gets could be more easily achieved in this population.

Twenty-four-hour movement guidelines during middle adolescence and their association with glucose outcomes and type 2 diabetes mellitus in adulthood

Purpose:The aim of the present study was to determine the association between adherence to the 24-h movement guidelines during middle adolescence and glucose outcomes(glycated hemoglobin and fasting glucose)and type 2 diabetes mellitus(T2DM)in adulthood,14 and 22 years later.Methods:We analyzed data from apparently healthy adolescents aged 12-18 years who participated in WavesⅠandⅡ(1994-1996,n=14,738),WaveⅣ(2008-2009,n=8913),and Wave V(2016-2018,n=3457)of the National Longitudinal Study of Adolescent to Adult Health(Add Health)in the United States.Physical activity,screen time,and sleep duration were measured using questionnaires,and the 24-h guidelines were defined as:5 or more times moderate-to-vigorous physical activity per week,≤2 h per day of screen time,and 9-11 h of sleep for 12-13 years and 8-10 h for 14-17 years.Capillary and venous whole blood was collected and analyzed to determine glycated hemoglobin and fasting glucose for WavesⅣandⅤ,respectively.Results:Only 2.1%of the adolescents met all the 3 guidelines,and 37.8%met none of them.In both wavesⅣandⅤ,adolescents who met physical activity and screen time guidelines had lower odds of T2DM in adulthood than those who did not meet any of these guidelines(WaveⅣ;prevalence ratio(PR)=0.57,95%confidence interval(95%CI):0.21-0.89;Wave V:PR=0.43,95%CI:0.32-0.74).Only for Wave V did adolescents who met all 3 guidelines have lower odds of T2DM at follow-up compared with those who did not meet any of these guidelines(PR=0.47,95%CI:0.24-0.91).Also,for each increase in meeting one of the 24-h recommendations,the odds of T2DM decreased by 18%(PR=0.82,95%CI:0.61-0.99)and 15%(PR=0.85,95%CI:0.65-0.98)in adulthood for WavesⅣandⅤ,respectively.Conclusion:Promoting all 24-h movement guidelines in adolescence,especially physical activity and screen time,is important for lowering the potential risk of T2DM in adulthood.

Maintaining the metabolic homeostasis of Helicobacter pylori through chronic hyperglycemia in diabetes mellitus:A hypothesis

Helicobacter pylori(H.pylori)infection occurs in almost half of the world's population,most of whom are merely carriers of this microorganism.H.pylori is shown to be detected more frequently in patients with diabetes mellitus(DM)than in the general population,which is accompanied by a significantly increased risk of developing H.pylori-associated diseases.In addition,eradication therapy shows a low efficiency for H.pylori infection in patients with DM.There is a relationship between the level of chronic hyperglycemia and a higher detection rate of H.pylori as well as a lower efficiency of eradication therapy in patients with DM.The exact mechanisms of these phenomena are unknown.The authors make a hypothesis that explains the relationship between chronic hyperglycemia and the increased detection rate of H.pylori,as well as the mechanisms contributing to the improved survival of this bacterium in patients with DM during eradication therapy.