Role of serum β2-microglobulin, glycosylated hemoglobin, and vascular endothelial growth factor levels in diabetic nephropathy

BACKGROUND Diabetic nephropathy(DN)is a common complication of type 1 and type 2 diabetes that can lead to kidney damage and high blood pressure.Increasing evidence support the important roles of microproteins and cytokines,such asβ2-microglobulin(β2-MG),glycosylated hemoglobin(HbA1c),and vascular endothelial growth factor(VEGF),in the pathogenesis of this disease.In this study,we identified novel therapeutic options for this disease.AIM To analyze the guiding significance ofβ2-MG,HbA1c,and VEGF levels in patients with DN.METHODS A total of 107 patients with type 2 diabetes mellitus complicated with nephropathy and treated in our hospital from May 2018 to February 2021 were included in the study.Additionally,107 healthy individuals and 107 patients with simple diabetes mellitus were selected as the control groups.Changes inβ2-MG,HbA1c,and VEGF levels in the three groups as well as the different proteinuria exhibited by the three groups were examined.RESULTS Changes inβ2-MG,HbA1c,and VEGF levels in the disease,healthy,and simple diabetes groups were significantly different(P<0.05).The expression of these factors from high to low were evaluated in different groups by pairwise comparison.In the disease group,high to low changes inβ2-MG,HbA1c,and VEGF levels were noted in the massive proteinuria,microproteinuria,and normal urinary protein groups,respectively.Changes in these factors were positively correlated with disease progression.CONCLUSION The expression of serumβ2-MG,HbA1c,and VEGF was closely correlated with DN progression,and disease progression could be evaluated by these factors.

Effect of periodontal treatment on glycosylated hemoglobin levels n elderly patients with periodontal disease and type 2 diabetes

Background Periodontal disease is closely related to type 2 diabetes and is an important complication of diabetes.This study aimed to investigate the effect of periodontal treatment on levels of blood glucose （Glu） and glycosylated hemoglobin （HbA1c） among elderly patients with type 2 diabetes and periodontal disease.Methods A total of 107 elderly patients with type 2 diabetes and periodontal disease were selected and divided into two groups according to their HbA1c levels. Group A was a well-controlled diabetic group and group B was uncontrolled.Their probing depth （PD）, attachment loss （AL）, the value of Glu and HbA1c were analyzed before periodontal treatment and 4 months later.Results There was a significant difference in periodontal condition between groups A and B （P 〈0.01）. The periodontal condition for both groups was significantly （P〈0.01） improved after periodontal therapy. The effect of treatment in group A was more pronounced than group B, and the difference was significant （P 〈0.01）. After the periodontal treatment, Glu and HbA1c were reduced significantly in both groups （P 〈0.05）.Conclusions Periodontal condition is related to the control of Glu level among elderly patients with type 2 diabetes and periodontal disease. Periodontal treatment can effectively reduce the level of Glu and HbA1c as well as improve the periodontal condition in elderly type-2 diabetes patients with periodontal disease.

Switching from human insulin to biphasic insulin aspart 30 treatment gets more patients with type 2 diabetes to reach target glycosylated hemoglobin 〈7%： the results from the China cohort of the PRESENT study

Background The clinical importance of glycaemic control in patients with diabetes has been well established. This study aimed to explore twice-daily biphasic insulin aspart 30 （BIAsp 30） for insulin initiation in patients with type 2 diabetes mellitus （T2DM） who had poor glycaemic control with human insulins （His）. We use data from a Chinese cohort of the PRESENT study.Methods In the 3-month study, Chinese subjects with T2DM started insulin therapy with BIAsp 30 in routine care. Glycaemic control was measured by glycosylated hemoglobin （HbA1c）, fasting plasma glucose （FPG） and posting plasma glucose （PPG）. The safety assessment included hypoglycaemia and other adverse events.Results A total of 1989 subjects previously treated with His were switched to BIAsp 30 for 3-month treatment. Mean HbA1c, FPG and PPG were significantly improved after the therapy. The overall rate of hypoglycaemia decreased at the end of the trial except for the patients previously treated with long-acting insulin. Most of the events were minor and diurnal hypoglycaemia. Only one serious adverse drug reaction （SADR）, a local hypersensitivity, was reported. The majority of the patients （296.7%） and physicians （≥84.7%） were either satisfied or very satisfied with the treatment using BIAsp 30 compared with previous HI therapy.Conclusion The BIAsp 30 treatment improved both glycaemic control and patients＇ satisfaction without increasing hypoglycaemia in T2DM subjects inadequately controlled by Hls.

Abnormal glycosylated hemoglobin as a predictive factor for glucose metabolism disorders in antipsychotic treatment

The aim of this study was to observe the changes in glucose metabolism after antipsychotic(APS)therapy,to note the influencing factors,as well as to discuss the relationship between the occurrence of glucose metabolism disorders of APS origin and abnormal glycosylated hemoglobin(HbA1c)levels.One hundred and fifty-two patients with schizophrenia,whose fasting plasma glucose(FPG)and 2-h plasma glucose(2hPG)in the oral glucose tolerance test(2HPG)were normal,were grouped according to the HbA1c levels,one normal and the other abnormal,and were randomly enrolled into risperidone,clozapine and chlorpromazine treatment for six weeks.The FPG and 2hPG were measured at the baseline and at the end of the study.In the group with abnormal HbA1c and clozapine therapy,2HPG was higher after the study[(9.5±1.8)mmol/L]than that before the study[(7.2±1.4)mmol/L]and the difference was statistically significant(P<0.01).FPG had no statistically significant difference before and after the study in any group(P>0.05).HbA1c levels and drugs contributing to 2HPG at the end of study had statistical cross-action(P<0.01).In the abnormal HbA1c group,2HPG after the study was higher in the clozapine treatment group[(9.5±1.8)mmol/L]than in the risperidone treatment group[(7.4±1.7)mmol/L]and the chlorpromazine treatment group[(7.3±1.6)mmol/L].The differences were statistically significant(P<0.01).In the normal HbA1c group there was no statistically significant difference before and after the study in any group(P>0.05).2HPG before[(7.1±1.6)mmol/L]and after the study[(8.1±1.9)mmol/L]was higher in the abnormal HbA1c group than in the normal HbA1c group[(6.2±1.4)mmol/L vs(6.5±1.4)mmol/L]with the difference being statistically significant(P<0.01 vs P<0.001).As compared with normal HbA1c group,the relative risk(RR)of glucose metabolism disease occurrence was 4.7 in the abnormal HbA1c group with the difference being statistically significant(P<0.001).Patients with abnormal HbA1c are more likely to have a higher risk of having glucose metabolism disorders after APS treatment.

Serum tumor markers expression(CA199,CA242,and CEA)and its clinical implications in type 2 diabetes mellitus

BACKGROUND Glucose and lipid metabolic disorder in patients with type 2 diabetes mellitus(T2DM)is associated with the levels of serum tumor markers of the digestive tract,such as cancer antigen(CA)199.Therefore,tumor markers in T2DM are important.AIM To evaluate the expression of serum tumor markers[CA199,CA242,and carcinoembryonic antigen(CEA)]and the clinical implications of the expression in T2DM.METHODS For this observational study conducted at Hefei BOE Hospital,China,we enrolled 82 patients with first-onset T2DM and 51 controls between April 2019 and December 2020.Levels of fasting blood glucose(FBG),tumor markers(CA199,CEA,and CA242),glycosylated hemoglobin(HbA1c),etc.were measured and group index levels were compared.Moreover,FBG and HbA1c levels were correlated with tumor marker levels.Tumor markers were tested for diagnostic accuracy in patients with>9%HbA1c using the receiver operating curve(ROC)curve.RESULTS The T2DM group had high serum FBG,HbA1c,CA199,and CEA levels(P<0.05).A comparative analysis of the two groups based on HbA1c levels(Group A:HbA1c≤9%;Group B:HbA1c>9%)revealed significant differences in CEA and CA199 levels(P<0.05).The areas under the ROC curve for CEA and CA199 were 0.853 and 0.809,respectively.CA199,CEA,and CA242 levels positively correlated with HbA1c(r=0.308,0.426,and 0.551,respectively)and FBG levels(r=0.236,0.231,and 0.298,respectively).CONCLUSION As compared to controls,serum CEA and CA199 levels were higher in patients with T2DM.HbA1c and FBG levels correlated with CA199,CEA,and CA242 levels.Patients with poorly controlled blood sugar must be screened for tumor markers.

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.

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）.

Determination of glycated hemoglobin in patients with advanced liver disease

AIM:To evaluate the glycated hemoglobin(HbA_(1c)) determination methods and to determine fructosamine in patients with chronic hepatitis,compensated cirrhosis and in patients with chronic hepatitis treated with ribavirin. METHODS:HbA_(1c) values were determined in 15 patients with compensated liver cirrhosis and in 20 patients with chronic hepatitis using the ion-exchange high performance liquid chromatography and the immunoassay methods. Fructosamine was determined using nitroblue tetrazolium. RESULTS:Forty percent of patients with liver cirrhosis had HbA_(1c) results below the non-diabetic reference range by at least one HbA_(1c)method,while fructosamine results were either within the reference range or elevated.Twenty percent of patients with chronic hepatitis(hepatic fibrosis) had HbA_(1c)results below the non-diabetic reference range by at least one HbA_(1c)method.In patients with chronic hepatitis treated with ribavirin,50% of HbA_(1c)results were below the non-diabetic reference using at least one of the HbA_(1c)methods. CONCLUSION:Only evaluated in context with all liver function parameters as well as a red blood count including reticulocytes,HbA_(1c)results should be used in patients with advanced liver disease.HbA_(1c)and fructosamine measurements should be used with caution when evaluating long-term glucose control in patients with hepatic cirrhosis or in patients with chronic hepatitis and dbavidn treatment.

Assessment of iris volume in glaucoma patients with type 2 diabetes mellitus by AS-OCT

AIM:To examine the change of iris volume measured by CASIA2 anterior segment optical coherence tomography(ASOCT)in glaucoma patients with or without type 2 diabetes mellitus(T2DM)and explore if there is a correlation between hemoglobin A1c(HbA1c)level and iris volume.METHODS:In a cross-sectional study,72 patients(115 eyes)were divided into two groups:primary open angle glaucoma(POAG)group(55 eyes)and primary angle-closure glaucoma(PACG)group(60 eyes).Patients in each group were separately classified into patients with or without T2DM.Iris volume and glycosylated HbA1c level were measured and analyzed.RESULTS:In the PACG group,diabetic patients'iris volume was significantly lower than those of non-diabetics(P=0.02),and there was a significant correlation between iris volume and HbA1c level in the PACG group(r=-0.26,P=0.04).However,diabetic POAG patients'iris volume was noticeably higher than those of non-diabetics(P=0.01),and there was a significant correlation between HbA1c level and iris volume(r=0.32,P=0.02).CONCLUSION:Diabetes mellitus impact iris volume size,as seen by increased iris volume in the POAG group and decreased iris volume in the PACG group.In addition,iris volume is significantly correlated with HbA1c level in glaucoma patients.These findings imply that T2DM may compromise iris ultrastructure in glaucoma patients.

Association of Dietary Pattern during Pregnancy and Gestational Diabetes Mellitus： A Prospective Cohort Study in Northern China

Objective To examine the association of maternal dietary patterns during pregnancy with gestationa diabetes mellitus （GDM） in northern China. Methods The dietary intakes of pregnant women were recorded twice by 24-hour dietary recalls for three days prior to having been diagnosed with GDM, at 5-15 and 24-28 gestational weeks, respectively. GDM was diagnosed, and serum glycosylated hemoglobin （HbAlc） was measured at 24-28 weeks. Dietary patterns were assessed by factor analysis. The association of the dietary pattern with GDM and HbAlc was examined by multiple logistic models. Results Of 753 participants, 64 （8.5%） were diagnosed with GDM. Four dietary patterns were identified： Western pattern （dairy, baked/fried food and white meat）, traditional pattern （light-colored vegetables, fine grain, red meat and tubers）, mixed pattern （edible fungi, shrimp/shellfish and red meat） and prudent pattern （dark-colored vegetables and deep-sea fish）. Compared with the prudent pattern, both the Western pattern and the traditional pattern were associated with an increased risk of GDM （aOR = 4.40, 95% CI： 1.58-12.22; aOR = 4.88, 95% Ch 1.79-13.32） and a high level of HbAlc （aOR = 12.37, 95% Ch 1.47-103.91; aOR = 26.23, 95% CI： 2.54-270.74）. Compared to the lowest quartile （Q）, 0.3 of the Western pattern scores and Q3-Q4 of the traditional pattern scores were associated with a higher risk of GDM. Conclusion The consumption of the Western pattern or the traditional pattern during pregnancy may increase the risk of GDM.

Impairment of gastrointestinal quality of life in severely obese patients

AIM: To investigate the common gastro-intestinal symptoms and quality of life in severely obese subjects.

Prognostic Significance of HbA1c Level in Asian Patients with Prediabetes and Coronary Artery Disease

Background:Measuring glycosylated hemoglobin(HbA1c)is a simple way to assess patients with prediabetes or diabetes mellitus.It has been shown that HbA1c level predicts prognosis in patients with coronary artery disease(CAD)and the incidence of diabetes mellitus.However,the prognostic significance of HbA1c level in Asian patients with prediabetes and CAD is not yet clear.Our study aimed to determine the relationship between HbA1c level and major adverse cardiovascular events(MACE)in patients with prediabetes and CAD.Methods:We enrolled 1367 patients with prediabetes and CAD in the final analysis,and grouped them according to the HbA1c level.Primary end points included nonfatal myocardial infarction,hospitalization for unstable angina,and ischemia-driven revascularization.Cox proportional-hazards regression analysis was used to determine the relation-ship between HbA1c level and MACE after our accounting for confounding factors.Results:A total of 1367 patients(age 58.8±10.3 years;71.6%men)were included.During 43 months of follow-up,197 patients experienced at least one primary end point event.Multivariate Cox proportional-hazards regression analy-sis showed in comparison of HbA1c levels that the hazard ratio for primary end points was 4.110,with a 95%confidence interval of 2.097-6.011(P<0.001).Conclusions:HbA1c level positively correlated with MACE,demonstrating it is a valuable indicator for indepen-dently predicting MACE in Asian patients with prediabetes and CAD.

Efficacy and safety of saxagliptin in patients with type 2 diabetes mellitus:a meta-analysis of randomized controlled trials

As a new oral hypoglycemic agent, saxagliptin belongs to the class of dipeptidyl peptidase-4 （DPP-4） inhibitors. However, it remains inconclusive whether saxagliptin is associated with increased risk of adverse events （AE） and efficacy as add-on treatment. Therefore, we performed an up-to-date meta-analysis to compare the efficacy and safety of saxagliptin with placebo and other oral hypoglycemic agents in adult patients with type 2 diabetes mellitus （T2DM）. Randomized clinical trials （RCTs） comparing saxagliptin with comparators were retrieved by selecting articles from Pubmed, Embase, Cochrane Library and Clinical Trials Registry Platform up to Oct. 2013. Weighted mean difference （WMD） was used to analyze the effect of hypoglycemic agents on HbAlc, weight and fasting plasma glucose （FPG）. While the patients who achieved HbAlc〈7.0% and had AE were analyzed as relative risks （RR）. A total of 18 articles from 16 RCTs and one clinic trial from the WHO International Clinical Trials Registry Platform met the included criterion. Clinically significant decrease from baseline HbAlc compared with placebo was certified for 2.5 mg/day saxagliptin （WMD = -0.45%, 95% CI, -0.48% to -0.42%） and 5 mg/d saxagliptin （WMD = -0.52%, 95% CI, -0.60% to -0.44%）. Saxagliptin as add-on therapy was superior to thiazolidinediones, up-titrated glyburide, up-titrated metformin or metformin monotherapy in achieving HbA1c〈7.0%. Treatment with saxagliptin had negligible effect on weight, and it was considered weight neutral. Saxagliptin treatment did not increase the risk of hypoglycemia （RR = 1.28, 95% CI 0.72 to 2.27, P = 0.40） and serious adverse experiences （RR = 1.25, 95% CI 0.94 to 1.66, P = 0.13）. No statistically significant differences were observed between saxagliptin and comparators in terms of the risk of infections. The present study showed that saxagliptin was effective in improving glycaemic control in T2DM with a low risk of hypoglycaemia and incidence of infections in either monotherapy or add-on treatment. This founding should be further certified by large-sample size and good-designed RCT.

Interaction of sleep quality and sleep duration on glycemic control in patients with type 2 diabetes mellitus

Background Copious evidence from epidemiological and laboratory studies has revealed that sleep status is associated with glucose intolerance, insulin resistance, thus increasing the risk of developing type 2 diabetes. The aim of this study was to reveal the interaction of sleep quality and sleep quantity on glycemic control in patients with type 2 diabetes mellitus. Methods From May 2013 to May 2014, a total of 551 type 2 diabetes patients in Tianjin Metabolic Diseases Hospital were enrolled. Blood samples were taken to measure glycosylated hemoglobin （HbAlc）, and all the patients completed the Chinese version of the Pittsburgh Sleep Quality Index （PSQI） questionnaire to evaluate their sleep status. ＂Good sleep quality＂ was defined as PQSI 〈5, ＂average sleep quality＂ was defined as PQSI 6-8, and ＂poor sleep quality＂ was defined as PQSI 〉8. Poor glycemic control was defined as HbAlc 〉7%. Sleep quantity was categorized as 〈6, 6-8, and 〉8 hours/ night. Short sleep time was defined as sleep duration 〈6 hours/night. Results In the poor glycemic control group, the rate of patients who had insufficient sleep was much higher than that in the other group （X2=11.16, P=0.037）. The rate of poor sleep quality in poor glycemic control group was much greater than that in the average control group （X2=9.79, P=-0.007）. After adjusted by gender, age, body mass index, and disease duration, the adjusted PSQI score＇s OR was 1.048 （95% CI 1.007-1.092, P=0.023） for HbAlc level. The sleep duration＇s OR was 0.464 （95% CI 0.236-0.912, P=0.026） for HbAlc level. One-way analysis of variance showed that the poor sleep quality group had the highest homeostasis model assessment-insulin resistance （P 〈0.01）. Conclusions Inadequate sleep, in both quality and quantity, should be regarded as a plausible risk factor for glycemic control in type 2 diabetes. Poor sleep might bring much more serious insulin resistance and could be the reason for bad glycemic control. A good night＇s sleep should be seen as a critical health component tool in the prevention and treatment of type 2 diabetes. It is important for clinicians to target the root causes of short sleep duration and/or poor sleep quality.

Effect of Health Education Based on Integrative Therapy of Chinese and Western Medicine for Adult Patients with Type 2 Diabetes Mellitus： A Randomized Controlled Study

Objective： To investigate the effects of health education based on integrative therapy of Chinese and Western medicine for type 2 diabetes mellitus（T2DM） from the aspects of knowledge, attitude and practice（KAP）, health-related quality of life（HRQo L）, body mass index（BMI） and glucose control. Methods： Patients were individually randomized into intervention group（receiving integrative education, n=120） and control group（receiving usual education, n=120）. The primary outcome was the changes in glycosylated hemoglobin A1c（HbA1c） levels after 3, 6, 9 and 12 months from baseline. Hierarchical linear models（HLMs） were used to assess within-group changes in outcomes over time and between-group differences in patterns of change. Secondary outcomes were KAP scores, HRQo L scores and BMI after 6 and 12 months, paired-sample t test was used to assess within-group changes in outcomes in 6 and 12 months, independent-sample t test was used to assess between-group differences in patterns of change. Results： HbA1c decreased statistically from baseline to 3 months, from 3 to 6 months, from 6 to 9 months and from 9 to 12 months in the intervention group（all P〈0.01）; and decreased significantly from baseline to 3 months, and from 3 to 6 months in the control group（P〈0.01）. There were significant between-group differences from baseline to 3 months（P=0.044）, from 6 to 9 months（P〈0.01） and from 9 to 12 months（P〈0.01）. Significant improvements in the intervention group along with significant between-group differences were found in KAP and HRQo L scores respectively（all P〈0.05）. The number in the intervention group of normal weight increased from 56 at baseline to 81（6 months）, 94（12 months）, the number in the control group were 63（baseline）, 69（6 months）, 70（12 months）, the χ~2 of hierarchical analysis of BMI were 6.93（P=0.075）, 10.31（P=0.016）, 15.53（P〈0.01）, respectively. Conclusion： Health education based on integrative therapy of Chinese and Western medicine is beneficial to the control of T2DM and should be recommended for T2DM.