Minimal mathematical model for glycation of albumin.

BACKGROUND: Glycated albumin (GA) is often described as a reflection of glucose exposure over the past 2-4 weeks. We examined the scale of the operative interval for changes in %GA from the perspective of a theoretical model for GA formation, by simulating the time course of changes in %GA after changes in glucose. METHODS: Probability of survival of albumin (A) was according to first-order elimination based on t1/2 of 17 days. Probability of formation of GA from A per unit time was proportional to glucose (G) and a glycation rate constant, k, deduced from reference values for %GA vs. G. We then simulated the kinetics of changes in %GA for conditions in which a prior steady-state (constant G) was followed by a step change in G. RESULTS: The glycation rate constant k was 9.79e-4/d/(mmol/L). We simulated changes in %GA for two scenarios involving step changes in G at time = 0: A. from 10 mmol/L to 15 mmol/L (%GA ultimately moves from 19.3% to 26.4%); B. from 15 mmol/L to 10 mmol/L (%GA ultimately moves from 26.4% to 19.3%). For both scenarios, the fractional transition of %GA between respective starting points and ultimate endpoints was after 30 days approximately 80% of the ultimate full transition. CONCLUSIONS: Model-based calculations support the description of %GA as a reflection of G over the past 4-6 weeks, longer than the period of 2-4 weeks that is commonly cited.

Oral Yeasts Carriage in Prediabetic Smokers and Nonsmokers.

BACKGROUND: Habitual smoking and prediabetes are independent risk factors for increased oral yeasts carriage (OYC); however, no studies have compared OYC amongst cigarette smokers and nonsmokers with and without prediabetes. The aim was to fill this research gap. METHODS: Ninety-two participants were included and categorised into 4 groups: group 1, prediabetic (haemoglobin A1c [HbA1c] levels, 5.7%-6.4%) cigarette smokers; group 2, cigarette smokers without prediabetes; group 3, prediabetic nonsmokers; and group 4, nonsmokers without prediabetes. Patient demographics and HbA1c levels were recorded. Data on duration of smoking habit (pack-years) and family history of smoking were collected. Information on daily toothbrushing and flossing and most recent visit to a dentist/dental hygienist was gathered. Clinical and radiographic periodontal examination was performed and unstimulated whole salivary flow rate (UWSFR) was determined. OYC was assessed using the oral rinse sampling method. Power analysis was done, and group comparisons were performed. Logistic regression analysis was performed and P values <5% reflected statistical significance. RESULTS: Respectively, 23, 24, 22, and 23 individuals with comparable mean ages were included in groups 1, 2, 3, and 4. In groups 1 and 2, participants had a smoking history of (mean ± SD) 24.7 ± 3.2 and 10.6 ± 2.5 pack-years. Plaque index, clinical attachment loss, and probing depth were higher in groups 1 (P < .05), 2 (P < .05), and 3 (P < .05) than in group 4. Number of missing teeth was significantly higher in group 1 compared with groups 2 (P < .05), 3 (P < .05), and 4 (P < .05). There was no difference in UWSFR amongst the groups. OYC was greater in group 1 than in groups 2 (P < .05), 3 (P < .05), and 4 (P < .05). OYC was greater in groups 2 (P < .05) and 3 (P < .05) than in group 4. CONCLUSIONS: In prediabetic cigarette smokers, OYC appears to be influenced by hyperglycaemia, whilst in nondiabetic smokers, the severity of periodontal inflammation appears to be the determining factor in OYC.

Impact of Point of Care Hemoglobin A1c Testing on Time to Therapeutic Intervention.

Without compromising accuracy, point of care testing (POCT) provides immediate results at the time of in person patient consultation. The purpose of this study was to evaluate time until therapeutic intervention with POCT HbA1c versus venipuncture, where venipuncture was considered standard of care.The primary outcome was time (hours) to implementation of a therapeutic intervention based on POCT HbA1c result, as compared with most recent venipuncture HbA1c before the study and its associated therapeutic intervention. A total of 94 POCT HbA1c tests were included in the primary analysis.For the POCT HbA1c, the mean time to therapeutic intervention was 1.6 ± 3.14 hours. For the previous venipuncture HbA1c, the mean time to therapeutic intervention was 1376.66 ± 3356.6 hours (P < .001). Overall, this trial showed that POCT HbA1c results in a significantly faster time to therapeutic intervention than venipuncture in a primary care clinic that serves a rural population.

Fos expression in A1/C1 neurons of rats exposed to hypoxia, hypercapnia, or hypercapnic hypoxia.

The distribution of Fos expression in catecholaminergic neurons with immunoreactivity for dopamine ß-hydroxylase (DBH) of the ventrolateral medulla was compared between rats exposed to hypoxia (10 % O2), hypercapnia (8 % CO2), and hypercapnic hypoxia (8 % CO2 and 10 % O2) for 2 h. Among the experimental groups, hypoxia-exposed rats had more Fos/DBH double-immunoreactive neurons than the control group (20 % O2) in the rostral area of the ventrolateral medulla, specifically in the range of + 150 µm to + 2,400 µm from the caudal end of the facial nerve nucleus. On the other hand, Fos/DBH double-immunoreactive neurons were scarcely observed in the ventrolateral medullary region of hypercapnia-exposed rats. The number of double-immunoreactive neurons in hypercapnic hypoxia-exposed rats was comparable to that in the control group. The present results suggest that adrenergic C1 neurons are specifically activated by hypoxia and are involved in the regulation of respiratory and circulatory functions.

The Contribution of Postprandial Glucose Levels to Hyperglycemia in Type 2 Diabetes Calculated from Continuous Glucose Monitoring Data: Real World Evidence from the DIALECT-2 Cohort.

BACKGROUND/OBJECTIVES: Traditional glycemic monitoring in type 2 diabetes is limited, whereas continuous glucose monitoring (CGM) offers better insights into glucose fluctuations. This study aimed to determine the correlations and relative contributions of fasting plasma glucose (FPG) and postprandial plasma glucose (PPG) levels to hyperglycemia. METHODS: We utilized CGM and recorded carbohydrate intake data from lifestyle diaries of 59 patients enrolled in the Diabetes and Lifestyle Cohort Twente (DIALECT-2). Correlations between FPG and the glucose management indicator (GMI), FPG and Time Above Range (TAR), PPG and GMI, and PPG and TAR were conducted. Daily and mealtime relative contributions of PPG and FPG to glycated hemoglobin (HbA1c) and GMI were determined, considering two ranges: on target (<7.0%, 53 mmol/mol) and not on target (≥7.0%, 53 mmol/mol). Correlations between mealtime PPG and carbohydrate consumption were examined. RESULTS: FPG and PPG correlated with GMI (r = 0.82 and 0.41, respectively, p < 0.05). The relative contribution of PPG in patients with HbA1c, GMI, and TAR values not on target was lower than in patients with HbA1c, GMI, and TAR values on target. When analyzing different mealtimes, patients with target GMI values had a higher PPG (73 ± 21%) than FPG after breakfast (27 ± 21%, p < 0.001). Individuals with elevated GMI levels had lower PPG after lunch (30 ± 20%), dinner (36 ± 23%), and snacks (34 ± 23%) than FPG. PPG after breakfast positively correlated (r = 0.41, p < 0.01) with breakfast carbohydrate intake. CONCLUSIONS: Both PPG and FPG contribute to hyperglycemia, with PPG playing a larger role in patients with better glycemic control, especially after breakfast. Targeting PPG may be crucial for optimizing glucose management.

Exploring the association of social connections and food security among adults with uncontrolled type 2 diabetes: a population-based study.

BACKGROUND: Primary health care professionals are held accountable for various quality measures in the treatment of patients with chronic diseases such as diabetes. Uncontrolled type 2 diabetes (T2D) remains a considerable health problem; thus, further studying patients with this condition is important for delivering effective interventions. Social determinants of health (SDoH) have been shown to affect various aspects of diabetes care in different subpopulations. We studied the association of SDoH with uncontrolled T2D in a population of adult primary care patients. METHODS: We retrospectively searched our electronic health record for adult patients (≥18 years) with a diagnosis of T2D and a hemoglobin A1c (HbA1c) level of 8% or higher. Patients were empaneled to 2 primary care clinic sites between January 1, 2021, and January 31, 2022. Patients were grouped by HbA1c level to stratify patients according to the extent of uncontrolled T2D. Patient characteristics were compared among groups. Unadjusted and adjusted multinomial logistic regression analysis was used to estimate the odds of various SDoH factors among patient groups with different levels of uncontrolled T2D. RESULTS: The study cohort included 1,596 patients. Most patients were White (79%), and the median age was 58.8 years. The median HbA1c level was 8.9%, and approximately 68% of patients were obese (body mass index [BMI] ≥30). When the study population was grouped by HbA1c level (8% to < 9% [n = 806], ≥9% to < 12% [n = 684], and ≥12% [n = 106]), significant differences among groups were observed in age group (P < .001), marital status (P < .001), race (P < .001), ethnicity (P = .001), and BMI category (P = .01). In groups with higher HbA1c levels, we noticed a higher percentage of patients who were aged 51 to 65 years or single. Among patients with uncontrolled HbA1c levels, more patients were obese than overweight. Patients in the intermediate HbA1c group had increased odds of food insecurity and some decreased social connections, even after adjusting for age, sex, race, ethnicity, and marital status. CONCLUSIONS: Among patients with uncontrolled T2D, higher HbA1c levels were associated with decreased social connections and increased food insecurity. Our findings provide insight into the role of these SDoH in managing T2D and have important implications for primary care practice.

Associations between glycated haemoglobin and multi-modal imaging markers of early cardiac aging.

BACKGROUND: Glycated haemoglobin (HbA1c) is a well-established biomarker for diabetes diagnosis and management and is linked to risk of cardiovascular death. However, among adults without cardiovascular disease (CVD) and diabetes, the value of HbA1c in predicting distinct signatures of myocardial ageing has not been explored. METHODS: Subjects, from among older adults without CVD, underwent comprehensive cardiovascular and metabolic assessment. Transthoracic echocardiography measured left ventricular structure and function. Longitudinal left atrial (LA) strain comprising reservoir strain (Ɛs), conduit strain (Ɛe) and booster strain (Ɛa) and their corresponding peak strain rates (SRs, SRe, SRa) were measured using cardiac magnetic resonance (CMR). Blood sampling for biomarkers and cardiovascular examinations were performed. RESULTS: 247 subjects (mean age 71 years, 44.1% female, mean HbA1c 6.0%) were included. HbA1c was significantly associated with E/A ratio (p < 0.0001), conduit strain (Ɛe) (p < 0.0001), conduit strain rate SRe (p < 0.0001), and conduit strain rate to booster strain rate SRe:SRa ratio (p < 0.0001). Multivariate models adjusting for clinical variables such as body mass index, blood pressure, heart rate, diabetes mellitus, smoking, and associated cardiac parameters, demonstrated a persistent independent association. Each unit increase in HbA1c was associated with lower E/A ratio, lower Ɛe, higher SRe and lower SRe:SRa ratio. These associations remained significant after diabetic subjects were excluded. CONCLUSION: Distinct associations were found between HbA1c and myocardial functions of interest in the ageing heart. HbA1c may be useful biomarker for stratifying risks associated with myocardial ageing, independent of diabetes status. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02791139.

MiR-375: it could be a general biomarker of metabolic changes and inflammation in type 1 diabetes patients and their siblings.

PURPOSE: Type 1 diabetes (T1D) is a chronic autoimmune illness that results in loss of pancreatic beta cells and insulin insufficiency. MicroRNAs (miRNAs) are linked to immune system functions contributing to the pathophysiology of T1D, miRNA-375 is significantly expressed in the human pancreas and its circulatory levels might correspond to beta cell alterations. Pancreatic islet cell antibodies (ICA) and Glutamic acid decarboxylase antibodies (GADA) have roles in autoimmune pathogenesis and are predictive markers of T1D. The aim of this work was to detect serum level changes of miRNA-375, ICA, and GADA in T1D patients, and their siblings compared to healthy controls and correlate them with T1D biochemical parameters. METHODS: The study included 66 T1D patients (32 males and 34 females; age range 3-18 years), 22 patients' siblings (13 males and 9 females; age range 4-17 years), and 23 healthy controls (7 males and 16 females; age range 4-17 years). MiRNA-375 levels were measured using quantitative reverse transcription polymerase chain reaction (RT-qPCR), while ICA and GADA levels were measured using enzyme-linked immunosorbent assay (ELISA). Data analysis was done utilizing SPSS-17 software. RESULTS: MiR-375 levels were downregulated in T1D patients and further decreased in their siblings when compared to healthy controls. Furthermore, miR-375 exhibited inverse correlations with HbA1c levels but no correlations with Total Insulin Dose, disease duration, or autoantibodies (GADA & ICA). CONCLUSION: Our study indicates that miR-375 is significantly downregulated in children with T1D and their siblings, suggesting its potential role as a biomarker for beta-cell function and glycemic control.

Association between total functional tooth unit score and hemoglobin A1c levels in Japanese community-dwelling individuals: the Nagasaki Islands study.

BACKGROUND: It is widely recognized that periodontal disease is associated with diabetes mellitus. Periodontal disease is accompanied by inflammation of the periodontal tissue, impaired masticatory function, and the presence of periodontopathic bacteria, all of which may affect glycemic control. However, the exact relationship between these factors and glycemic control has not yet been established. In this study, we aimed to investigate the relationship between periodontal disease-related factors and glycemic control in Japanese community-dwelling individuals. METHODS: We conducted a cross-sectional study involving 671 participants aged 29-92 (65.3 ± 12.1) years, using data from the Nagasaki Islands Study. Participants underwent routine medical examinations, including body mass index (BMI) and hemoglobin A1c (HbA1c) levels. Information on the participants' demographics (age and sex) and whether they were on diabetes medications, had an exercise habit, consumed alcohol, engaged in late-night eating, had regular dental checkups, and smoked was obtained using a self-administered questionnaire. Dental examinations were performed to examine dentition status, probing pocket depth, clinical attachment level (CAL), and bleeding on probing. Functional tooth units (FTUs), defined as pairs of occluding posterior teeth, were used as an indicator of occlusal support area. Saliva samples were collected and levels of two species of periodontopathic bacteria (Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans) were determined using real-time polymerase chain reaction. We analyzed the association between HbA1c levels and variables related to periodontal status, masticatory function, and salivary levels of periodontopathic bacteria. RESULTS: Bivariate analysis showed that HbA1c levels were significantly associated with age, sex, exercise habit, BMI, diabetes medications, CAL, salivary P. gingivalis level, number of teeth, and three FTU subcategories. In the multiple regression analysis, age, BMI, diabetes medications, and total FTU score (i.e., including natural teeth, implant-supported artificial teeth, fixed prostheses, and removable dentures) remained associated with HbA1c levels (B = 0.23, 0.14, 0.52, and - 0.12; p < 0.001, p < 0.001, p < 0.001, and p = 0.008, respectively). CONCLUSIONS: In this community-based cross-sectional study, total FTU was significantly associated with HbA1c levels, independent of other risk factors. This suggests that reconstructed occlusal support areas, including dentures, are associated with glycemic control in the older population.

Combined Diabetes Education/Skills Training and Social Needs Resolution Intervention for Older African Americans with Poorly Controlled Type 2 Diabetes (DM Social Needs): Study Protocol for a Randomized Controlled Trial.

BACKGROUND: Approximately 11.3% of the US population has diabetes. The burden of diabetes is higher in older adults and African Americans (AAs), such that 40% of adults aged 50 years and older have diabetes; African Americans are 60% more likely to be diagnosed with diabetes compared to non-Hispanic Whites (NHWs). Structural racism has resulted in fewer economic and educational opportunities for AAs, higher social risks, and unmet basic needs, which result in financial instability, housing instability, food insecurity, and a lack of transportation compared to NHWs. The presence of these unmet basic needs is a driver of poor adherence to diabetes self-management in older AAs. AIM: To test the preliminary efficacy of a nurse case-manager, telephone-delivered intervention that provides foundational diabetes self-management education and skills training, while also addressing and resolving the unmet social needs of older AAs with poorly controlled type 2 diabetes mellitus (T2DM). The primary hypothesis is that older AAs with T2DM randomized to the DM Social Needs intervention will have significantly lower hemoglobin A1C (HbA1C), blood pressure, and LDL levels compared to the usual care arm at 6 months post randomization. METHODS: This is a three-year prospective, randomized clinical trial that will enroll 100 AAs aged 50 and older with type 2 diabetes (T2DM) and HbA1C ≥ 8% into one of the following two groups: (1) a nurse case-manager, telephone-delivered intervention that provides foundational diabetes self-management education and skills training, but also addresses and resolves unmet social needs; or (2) an enhanced usual care group that will receive mailed diabetes education materials. Participants will be followed for 6 months to determine the effect of the intervention on HbA1C, blood pressure, and low-density lipoprotein (LDL) cholesterol levels. RESULTS: Baseline characteristics will be presented by study group, and within- and between-group changes in primary outcomes from baseline to 6 months will be reported. CONCLUSION: The results from this study will provide insights into the efficacy of a combined diabetes education and skills training and social needs resolution intervention for older African Americans with poorly controlled type 2 diabetes and will inform strategies to improve diabetes outcomes for this vulnerable population.

Is pulmonary vascular remodeling an intermediate link between hyperglycemia and adverse outcomes in patients with idiopathic pulmonary arterial hypertension? Insights from a multi-center cohort study.

BACKGROUND: Hyperglycemia upon admission is associated with poor prognosis of many cardiovascular diseases. However, the relationship of stress hyperglycemia ratio (SHR), admission blood glucose (ABG), and hemoglobin A1c (HbA1c) with pulmonary hypertension has not been reported. This study aimed to explore the association of hyperglycemia indices with disease severity and long-term adverse outcomes in patients with idiopathic pulmonary arterial hypertension (IPAH). METHODS: This multi-center cohort study included 625 consecutive patients diagnosed with or treated for IPAH between January 2015 and June 2023. SHR was calculated using the followings: ABG (mmol/L)/(1.59 × HbA1c [%] - 2.59). The primary endpoint was defined as clinical worsening events. Multivariable Cox regression and restricted cubic spline analyses were employed to evaluate the association of SHR, ABG, and HbA1c with endpoint events. The mediating effect of pulmonary hemodynamics was evaluated to investigate the potential mechanism between hyperglycemia and clinical outcomes. RESULTS: During a mean follow-up period of 3.8 years, 219 (35.0%) patients experienced all-cause death or clinical worsening events. Hyperglycemia indices correlated with well-validated variables that reflected the severity of IPAH, such as the World Health Organization functional class, 6-min walk distance, and N-terminal pro-brain natriuretic peptide levels. Multivariable Cox regression analyses indicated that SHR (hazard ratio [HR] 1.328, 95% confidence intervals [CI]: 1.185, 1.489 per 0.1-unit increment, P < 0.001) and ABG (HR 1.317, 95% CI: 1.134, 1.529 per 1.0-unit increment, P < 0.001) were independent predictors of primary endpoint events. Mediation analysis indicated that pulmonary vascular resistance mediated 5.65% and 14.62% of the associations between SHR and ABG and clinical worsening events, respectively. The addition of SHR significantly improved reclassification, discrimination ability, and model fit beyond the clinical risk prediction model. CONCLUSIONS: SHR is positively associated with clinical worsening in patients with IPAH. The association appeared to be partially mediated through the pathway of pulmonary vascular remodeling, indicating that SHR may serve as a valuable indicator for providing additional risk information.

Effects of Daily Almond Consumption on Glycemia in Adults with Elevated Risk for Diabetes: A Randomized Controlled Trial.

The purpose of this study was to examine the potential for sustained almond consumption to reduce HbA1c concentrations among individuals with elevated values. A 16-week randomized, parallel-arm, controlled trial was conducted. Eighty-one adults with elevated HbA1c concentrations (>5.7%) were randomly assigned to incorporate 2 oz of raw almonds (A: n=39) or energy-matched snacks (C: n=42) into their daily diets. Body weight, body composition, plasma lipids, HbA1c, plasma vitamin E, glycemia (by meal tolerance test and continuous glucose monitoring), dietary intake, and hedonic responses to test foods were measured at stipulated time points. Participants consuming almonds ingested 253 kcal/d more than participants in the control group (P=0.02), but this did not result in a significant difference in body weight. No statistically significant differences were observed in HbA1c concentrations, blood chemistries, body composition, or glycemia over time or between groups. However, Healthy Eating Index scores improved within the almond group as compared to the control group (P<0.001). Additionally, the hedonic rating of almonds within the almond group did not decline as markedly as the control group's reduced liking of the pretzel snack. Alpha-tocopherol increased significantly, and gamma tocopherol tended to decrease in the almond group, indicating compliance with the dietary intervention. Overall, daily ingestion of 2oz of raw almonds in a self-selected diet for 16 weeks did not alter short-term or longer-term glycemia or HbA1c concentrations in adults with elevated HbA1c concentrations, but they were well-tolerated hedonically and improved diet quality without promoting weight gain.

Effects of collaborative learning-based food literacy program on healthy eating behavior and hemoglobin A1c among older adults with uncontrolled type 2 diabetes: A randomized controlled trial study in Thailand.

Background: Uncontrolled type 2 diabetes mellitus (T2DM) is a prevalent issue among older adults. Healthy eating behavior (HEB) is a significant factor contributing to blood sugar control. It is a complex behavior that requires knowledge, attitudes, and skills in food literacy, which can be achieved through collaborative learning by nurses. Although collaborative learning has successfully improved food literacy and HEB among adults and older adults in general, its effectiveness has not been investigated among older adults with uncontrolled T2DM. Objective: This randomized controlled trial aimed to examine the effects of the Collaborative Learning-Based Food Literacy Enhancement Program (CLFLEP) on HEB and hemoglobin A1c (HbA1c) levels among older adults with uncontrolled T2DM. Methods: Participants were 80 older adults with uncontrolled T2DM attending primary care units (PCUs) or sub-district health promotion hospitals in northern Thailand. They were randomly assigned to either the experimental group (n = 40) or the control group (n = 40). The experimental group received the CLFLEP to enhance four domains of food literacy through five major elements of collaborative learning, while the control group received standard care. Data were collected between January and June 2023 using the Demographic Data Form, the Eating Behavior Questionnaire, the HbA1c test, and the Short Food Literacy Questionnaire. Data analysis involved descriptive statistics for demographic characteristics and independent t-test and paired sample t-test for HEB and HbA1c based on intention-to-treat (ITT) and per-protocol (PP) analyses. Results: The experimental group had a higher HEB score than the control group (p <0.001 for ITT and PP) and higher than their scores before program participation (p <0.001 for ITT and PP). The effect size (Cohen's d) was 1.46. The experimental group also had a lower HbA1c level than the control group (p = 0.002 for ITT and PP) and lower than their levels before program participation (p = 0.005 for ITT and 0.001 for PP). The effect size (Cohen's d) was 0.70. Conclusion: The CLFLEP was effective in promoting food literacy, HEB, and blood sugar control. Nurses can be trained to use this program to provide collaborative health education for older adults with uncontrolled T2DM. Nursing administrators can use these findings to develop organizational policies that enhance nurses' competencies as educators skilled in collaborative learning. Trial Registry Number: TCTR20221222005 [Thai Clinical Trials Registry].

Glycemic indicators and mental health symptoms: results from the greater Beirut area cardiovascular cohort.

Introduction: Depression and anxiety present high and complex comorbidity with diabetes. One proposed explanation is that glycemic dysregulations and diabetes-related processes can influence mental health risk. We examined the associations of concurrent and prior glycemic indicators (Hemoglobin A1c (HbA1c) and fasting blood glucose (FBG) levels) with depression and anxiety symptoms in a community-based sample of middle-aged Lebanese adults. Methods: Data come from the Greater Beirut Area Cardiovascular Cohort (GBACC), with baseline and 5-year assessments of sociodemographic, lifestyle, and biological factors (n=198). Depression (Patient Health Questionnaire-9) and anxiety (General Anxiety Disorder-7) symptoms were assessed at follow-up. We investigated associations between glycemic indicators and continuous mental health scores using first linear and then piecewise regression models. Results: Adjusted piecewise regression models showed different associations with mental outcomes across glycemic indicators in the diabetic/clinical compared to the non-diabetic range: Among participants with <126 mg/dl baseline FBG, higher FBG levels in this range were significantly associated with lower depressive (beta=-0.12, 95%CI= [-0.207, -0.032]) and anxiety symptoms (beta=-0.099, 95%CI= [-0.186, -0.012]). In contrast, among participants with baseline FBG levels ≥126 mg/dl, higher FBG levels were significantly associated with higher anxiety symptoms (beta=0.055; 95%CI= 0.008, 0.102). Higher baseline FBG levels in the ≥126 mg/dl range showed a not statistically significant trend for higher depressive symptoms. Although not significant, baseline HbA1c levels showed similar patterns with negative associations with mental health symptoms in the <6.5% range. Discussion: Results show that FBG levels were associated with poorer mental health symptoms only in the clinical/diabetic range, and not in the normal range. Associations were observed with baseline glycemic indicators, highlighting potentially early and prolonged associations with mental health. Findings highlight the importance of clinical changes in glycemic indicators for mental health and motivate further research into the transition toward adverse associations between diabetes and mental health.

A nomogram for predicting survival based on hemoglobin A1c and circulating tumor cells in advanced gastric cancer patients receiving immunotherapy.

BACKGROUND: Our study aimed to investigate the correlation between hemoglobin A1c (HbA1c), circulating tumor cells (CTCs) and prognosis in advanced gastric cancer (GC) patients who received immunotherapy and explore the potential prognostic predictors to develop a nomogram. METHODS: We retrospectively enrolled 259 patients with advanced GC treated at Beijing Friendship Hospital between September 2014 and March 2024. Patients were divided into the immunochemotherapy cohort (ICT) and the chemotherapy (CT) cohort. Survival rate was calculated by Kaplan-Meier survival curve, and the differences were evaluated by log-rank test. The univariate and multivariate Cox proportional hazards regression model was used to identify factors independently associated with survival. A nomogram was developed to estimate 6-, 12-, and 18-month progression-free survival (PFS) probability based on the ICT cohort. RESULTS: Patients achieved higher PFS in the ICT cohort than the CT cohort. We focused on the ICT cohort and constructed a nomogram based on the multivariate analysis, including five variables: age, PD-L1 expression, HbA1c, CTCs and CEA*. The concordance index value was 0.82 in the training cohort and 0.75 in the validation cohort. Furthermore, we proved the nomogram was clinically useful and performed better than PD-L1 expression staging system. Notably, we found high HbA1c level but not diabetes mellitus significantly affected the efficacy of ICT. CONCLUSION: ICT showed better PFS than CT. In addition, HbA1c and CTCs were novel biomarkers to predict PFS in patients treated with ICT. The nomogram could predict PFS of advanced GC patients receiving ICT with increased accuracy and favorable clinical utility.

Performance evaluation of the glycated hemoglobin A1c analyzer for point-of-care testing compared with laboratory-based devices: a multicenter validation study.

In this dual-center study, we assessed the BioHermes A1C EXP M13 system for point-of-care (POC) HbA1c testing against two NGSP-certified HPLC instruments, the Bio-Rad D100 and Tosoh G8. Analyzing 605 samples, we evaluated the A1C EXP's reproducibility, sensitivity, specificity and impact of anemia on HbA1c measurements. The device showed excellent reproducibility with CVs under 2.4% and high sensitivity and specificity for diabetes diagnosis-98.1% and 96.8% against D100, and 97.1% and 96.7% against G8. Passing-Bablok regression confirmed a close correlation between A1C EXP and the HPLC instruments, with equations y = 0.10625 + 0.9688x (D100) and y = 0.0000 + 0.1000x (G8), and Bland-Altman plots indicated mean relative differences of -1.4% (D100) and -0.4% (G8). However, in anemic samples, A1C EXP showed a negative bias compared to HPLC devices, suggesting that anemia may affect the accuracy of HbA1c results. The study indicates that A1C EXP is a reliable POC alternative to laboratory assays, albeit with considerations for anemic patients.

The association of the basal TIMI flow, post-PCI TIMI flow and thrombus grade with HbA1c levels in non-diabetic patients with acute ST segment elevation myocardial infarction undergoing primary PCI.

OBJECTIVES: The acute phase of ST-segment elevation myocardial infarction (STEMI), as determined by TIMI angiographic criteria, is influenced by various factors that impact the patient's clinical outcome. However, the modifiable risk factors of impaired TIMI flow (TIMI<3) and its effective treatment are not fully understood. Hyperglycemia may induce a pro thrombotic state and thus affect TIMI flow before or after PCI. This study investigates the correlation between hemoglobin A1c levels, TIMI flow grade, and thrombus grade in infarct-related arteries, assessing its predictive value in non-diabetic patients with STEMI. METHODS: The 265 patients selected based on the hemoglobin A1c level lower than 6.5 % and were divided into three groups based on HbA1c level. Comparison between three groups in terms of risk factors, troponin level, blood glucose level, lipid profile, kidney function, number of involved vessels, type of MI, left ventricular ejection fraction, TIMI flow before and after primary angioplasty, thrombus burden, complications and hospital mortality was made. RESULTS: With the increase in HbA1c level, the prevalence of TIMI 3 flow after primary PCI decreased. The prevalence of TIMI flow 2-3 before angioplasty also decreased with the increase in HbA1c level. Increased hemoglobin A1c was also significantly related to large thrombus burden (p=0.021). Morover, hemoglobin A1c remained an independent predictor of post-PCI TIMI flow and thrombus burden. CONCLUSIONS: Elevated hemoglobin A1c is a predictor of TIMI flow less than 3 after primary PCI and high thrombus burden, in STEMI patients without a history of diabetes mellitus.

Techniques for Implementing Continuous Glucose Monitoring in Primary Care: Key CGM Updates and Highlights from the ADA 2024 Conference [Podcast].

This podcast discusses innovations, advancements, and discoveries in continuous glucose monitoring that were presented at the American Diabetes Association 84th Scientific Sessions held in Orlando, Florida, June 2024. Specifically, the author will discuss sessions focused on (1) Equity and access to new technologies; (2) The role of the interdisciplinary team in technology onboarding in primary care; (3) New technologies for glucose monitoring and sensing; (4) New technologies for continuous glucose monitoring (CGM); and (5) CGM implementation in primary care.

Does Non-surgical Periodontal Therapy With Adjunct Antimicrobial Photodynamic Therapy Help Reduce Periodontal Inflammation and Haemoglobin A1c Levels in Patients With Type-2 Diabetes Mellitus? A Systematic Review and Meta-analysis.

PURPOSE: The aim of the present systematic review and meta-analysis was to assess the efficacy of non-surgical periodontal therapy (NSPT) with adjunct photodynamic therapy (aPDT) in reducing periodontal inflammation and haemoglobin A1c (HbA1c) levels in patients with diabetes mellitus (DM). MATERIALS AND METHODS: The focused question was 'Does NSPT with adjunct aPDT help reduce periodontal inflammation and HbA1c levels in patients with DM?' The PICO (patient/population, intervention, comparison and outcomes) was formatted as follows: Patients (P): Participants diagnosed with DM; Intervention (I): NSPT with adjunct PDT for the treatment of periodontitis; Control (C): NSPT alone or NSPT with adjunct systemic antibiotic therapy; and Outcome (O): Changes in HbA1c levels. The inclusion criteria comprised RCTs specifically evaluating the impact of NSPT on HbA1c levels in diabetic patients, with a specific focus on interventions involving NSPT with and without adjunct aPDT. The literature search was performed in accordance with the Preferred reporting items for systematic reviews and meta-analysis. Indexed databases were searched without time and language restrictions using various keywords. Forest plots were created to illustrate the effects of the different studies and the global estimation. RESULTS: Five RCTs were included and processed for data extraction. The number of participants ranged from 12 to 45 patients with medically diagnosed type-2 DM. In all RCTs, aPDT was done using a diode laser with wavelengths ranging between 660 and 810 nm. Three and two RCTs had moderate and high RoB, respectively. In two RCTs, NSPT with adjunct aPDT reported no improvement in clinical periodontal parameters. Two studies reported that NSPT with adjunct aPDT significantly reduces periodontal probing depth compared to NSPT alone. Four of the five RCTs reported that NSPT+PDT does not influence HbA1c levels. CONCLUSIONS: NSPT with or without adjunct aPDT does not affect HbA1c levels in patients with type-2 DM.