Influence of albumin leakage on glycated albumin in patients with type 2 diabetes undergoing hemodialysis.

Glycated albumin (GA) is recommended as a better glycemic indicator than HbA1c in patients undergoing hemodialysis, because the red blood cell lifespan is generally faster than that in normal subjects. However, GA can be also affected by protein loss in urine and hemodialysis fluid. Therefore, in this study, we investigated the effect of albumin leakage induced by hemodialysis on GA. Nine patients undergoing hemodialysis with a large or small amount of albumin leakage were observed for 9 months in a crossover manner. As a result, it was shown that albumin leakage could affect GA, but the effect was practically small considering the prescription of diabetic drugs. The correlations between HbA1c and blood glucose levels and between GA and blood glucose levels were similar in our study. In conclusion, GA was a reliable indicator, even with the change of hemodialysis modality. The influence of albumin leakage induced by hemodialysis on GA was negligible practically. We should recognize that the preferable glycemic indicator in patients undergoing hemodialysis depends on the hemoglobin and albumin metabolism of each patient.

Factors associated with diabetes control : results of a 2-year cohort study of outpatients with type 2 diabetes.

Type 2 diabetes is a typical lifestyle disease. We aimed to identify the factors affecting glycemic control in 64 outpatients with type 2 diabetes over a 2-year period. We defined poor glycemic control using a change in glycosylated hemoglobin (?HbA1c) of ??0.5% over 2 years and/or HbA1c ??7.5% at the end of the study period. We used a questionnaire to collect information on oral health behavior and lifestyle, including eating and smoking habits, and analyzed the relationships between indices of diabetes control and responses to the questionnaire. The mean (SD) HbA1c of the participants was 6.87% (0.77%) at a baseline, and 6.93% (0.69%) after 2 years. Twenty-three participants (36.0%) had poor glycemic control. ?HbA1c and the change in body mass index (?BMI) correlated (Spearman's rank correlation, r?=?0.350, p?

Association between diabetes-related clinical indicators and oral health behavior among patients with type 2 diabetes.

Objective : The aim of this study was to evaluate the association between diabetes-related indicators and oral health behavior among patients with type 2 diabetes. Methods : Seventy-four outpatients were included. We administered a questionnaire and divided the patients into two groups according to oral health behavior and eating habits. We then compared diabetes-related clinical records between the groups and performed logistic regression analysis. Results : Participants who brushed their teeth before bedtime every night had lower BMIs than those who did not. Participants who reported eating slowly and chewing well every day had significantly lower HbA1c than their counterparts. Participants who reported gum bleeding had significantly higher LDL-cholesterol than their counterparts. Binominal logistic regression analysis revealed that BMI < 25 was associated with not brushing teeth before bedtime every night, HbA1c < 7.5 with not eating slowly or chewing well every day, and LDL-cholesterol < 120 with gum bleeding (odds ratio : 0.140, 95% confidence interval : 0.036-0.540 ; OR : 0.085, 95% CI : 0.010-0.736, OR : 0.275, 95% CI : 0.077-0.979, respectively). Conclusions : Our findings suggest that toothbrushing before bedtime every night is associated with reduced risk of obesity and that eating slowly and chewing well are advantageous for glycemic control in patients with type 2 diabetes.J. Med. Invest. 68 : 140-147, February, 2021.

Hereditary spherocytosis diagnosed with extremely low glycated hemoglobin compared to plasma glucose levels.

Glycated hemoglobin (HbA1c) is an important indicator of glycemic control in patients with diabetes. High-performance liquid chromatography (HPLC) is the most commonly used method for measuring HbA1c levels; as HPLC measures all hemoglobin types, the values can be influenced by hemoglobin variants. Moreover, as HPLC-HbA1c levels are low in some diseases, including hemolytic anemia, it may be difficult to differentiate hemoglobin variants from these diseases based on HPLC-HbA1c levels alone. Similar HbA1c values using both HPLC and immunoassays (IAs) are noted for these diseases, while discrepancies are noted in the case of hemoglobin variants. Herein, we describe our process of differential diagnosis for hereditary spherocytosis, the most common inherited hemolytic anemia, in a 56-year-old man presenting with a low HPLC-HbA1c level compared to the glucose concentration, concomitant with anemia, jaundice, hyperbilirubinemia, cholelithiasis, and splenomegaly. There was a discrepancy between HbA1c levels measured with HPLC and IAs and glycated albumin levels. The possibility of hemoglobin variants was unlikely, based on the chromatography and isoelectric focusing results. The haptoglobin levels and reticulocyte counts were low and high, respectively. The direct and indirect Coomb's tests were negative. The presence of spherocytes on blood smears and flow cytometric analysis of the eosin-5-maleimide binding test supported a diagnosis of hereditary spherocytosis. We recommend that when a discrepancy between HPLC-HbA1c levels and glucose concentrations is noted, clinicians should consider hemolysis or hemoglobin variants as the diagnosis. It should be considered that a discrepancy between HbA1c levels measured with HPLC and IAs does not specifically exclude hemolysis.

Cognitive dysfunction during hypoglycemia in an elderly subject without diabetes.

The aim of the present study was to examine whether an elderly subject without diabetes experiences hypoglycemia during his daily life or after an oral glucose tolerance test (OGTT), and investigate whether hypoglycemic episodes affect cognitive function. The 85-year-old healthy subject, who is a sports enthusiast, showed lower than normal (< 80 mg/dl) blood glucose levels on two occasions over 6 days in the early morning. The subject also experienced hypoglycemic episodes and blood glucose levels of 65 and 74 mg/dl, respectively, during the 6-h OGTT given after a 13-h fast. Cognitive function, as assessed using a numeracy test and a driving simulator test, deteriorated during the hypoglycemic episodes but recovered 0.5 h after ingestion of a confectionary product (two pieces of Dorayaki containing 247 kcal and 51.5 g of carbohydrate each). Cognitive dysfunction caused by mild hypoglycemia can be involved in a part of traffic accidents in elderly drivers.

[Contribution of the Department of Laboratory Medicine for the Protection and the Treatment of Diabetes Mellitus in Tokushima Prefecture].

Diabetes mortality rates of Tokushima prefecture have been worst one in Japan for 12 years. We started up the organization named "Tokushima Medical Doctors Association against Diabetes" for the disease prevention and the improvement of the treatments in Tokushima prefecture. More than 240 medical doctors in Tokushima prefecture joined the association. The activities of the association are ( 1) training of medical doctors, (2) education for co-medical staffs, (3) education and enlightenment for patients and the public, (4) cooperation with Tokushima prefectural medical association and the communities. For the purpose of education for the co-medical staffs, we organized the association of Certified Diabetes Educator of Japan in Tokushima and support the association as the secretariat office. We also work as Tokushima branch office of Japan Association for Diabetes and Education and Care. The prevention of disease and the improvement of medical activity level are one of the big roles those the university hospital is responsible, because the university hospital is anticipated to work as a medical leader in the community. As the University hospital can take care of all medical staffs, so it is thought to be important to contribute the local medical treatment level different with the medical association and prefecture secretariat. The promotion conference for Diabetes mellitus was established last year. The relation among the associations we take care, the local medical association, and the prefecture secretariat are getting better. We hope that our cooperative activities will contribute to reducing morbidity and mortality from diabetes in Tokushima prefecture.

Glycated albumin (GA) is more advantageous than hemoglobin A1c for evaluating the efficacy of sitagliptin in achieving glycemic control in patients with type 2 diabetes.

OBJECTIVE: The aim of this study was to compare the utility of hemoglobin A1c (HbA1c) and glycated albumin (GA) for evaluating the efficacy of the dipeptidyl peptidase-4 (DPP-4) inhibitor, sitagliptin, in patients with type 2 diabetes. METHODS: Sitagliptin (50 mg) was administered orally once daily in 67 outpatients with type 2 diabetes. Drug effectiveness was deemed present if the HbA1c or GA level decreased by 5% at week 4 and week 12 relative to the baseline value. RESULTS: The mean HbA1c level decreased from 8.1 ± 1.0% at baseline to 7.8 ± 0.9% at week 4 and 7.2 ± 0.8% at week 12. The mean GA level decreased from 25.0 ± 4.5% at baseline to 22.2 ± 3.8% at week 4 and 20.8 ± 3.5% at week 12. At week 4 and week 12, the drug was effective in 37.8% and 71.6% of the patients, respectively, when assessed based on changes in HbA1c, and in 83.6% and 97.0% of the patients, respectively, when assessed based on changes in GA. CONCLUSION: GA is superior to HbA1c for evaluating the efficacy of sitagliptin treatment in patients with type 2 diabetes.

Lower value of glycated haemoglobin relative to glycaemic control in diabetic patients with end-stage renal disease not on haemodialysis.

BACKGROUND: Glycated haemoglobin (HbA1c) concentration is lower relative to glyacemic control in diabetic patients on haemodialysis. However, it is unknown as to whether this is also true for diabetic patients with end-stage renal disease but not on haemodialysis. METHODS: Correlations between HbA1c or glycated albumin (GA) and estimated glomerular filtration rate (eGFR) (determined by serum creatinine concentration, sex and age) were investigated in 86 diabetic patients with renal dysfunction not on dialysis. The mean values of HbA1c and of red blood cell (RBC) lifespan were compared among four groups of patients: Group 1 (n = 30, eGFR ≥ 60 mL/min/1.73 m(2)), Group 2 (n = 30, eGFR < 60 mL/min/1.73 m(2) but ≥30 mL/min/1.73 m(2)), Group 3 (n = 13, eGFR < 30 mL/min/1.73 m(2) but ≥15 mL/min/1.73 m(2)) and Group 4 (n = 13, eGFR < 15 mL/min/1.73 m(2) without haemodialysis). RBC lifespan was determined in each subject from the difference between alveolar carbon monoxide (CO) concentration and atmospheric CO concentration. RESULTS: HbA1c was significantly correlated with eGFR (r = 0.37, P = 0.0004), but GA was not. The HbA1c values in Group 3 (6.8 ± 0.6%) and Group 4 (6.3 ± 0.5%) were significantly lower than that in Group 1 (7.4 ± 0.8%), but there was no difference between Group 2 (7.2 ± 0.7%) and Group 1. There was a significant correlation between RBC lifespan and eGFR, and the mean RBC lifespan in Group 3 (96 ± 35 d) and Group 4 (94 ± 30 d) were significantly shorter than that in Group 1 (127 ± 30 d). CONCLUSIONS: Diabetic patients with stage 4 or 5 chronic kidney disease not on haemodialysis had significantly lower values of HbA1c and shorter RBC lifespan compared with diabetic patients without renal dysfunction.