Control glucémico y estudio del metabolismo lipídico y del óseo en niños con diabetes de tipo 1 / Glycemic control and study of lipid and bone metabolism in type 1 diabetic children

Introducción. La diabetes mellitus de tipo 1 se considera una de las enfermedades crónicas más frecuentes de la infancia. Es un factor de gran riesgo de desarrollar enfermedad cardiovascular temprana y afecta también la salud ósea. Objetivo. Describir las características demográficas y los parámetros bioquímicos de una población de niños con diabetes de tipo 1, supervisados en la unidad pediátrica de diabetes de un hospital español de tercer nivel. Materiales y métodos. En este estudio retrospectivo, se determinaron los parámetros de control metabólico, lipídico y óseo en 124 niños con diabetes de tipo 1, a los que se hizo seguimiento en la Unidad Pediátrica de Diabetes del Hospital Universitario Miguel Servet de Zaragoza, desde mayo del 2020 hasta julio del 2021. Resultados. Los niños con diabetes de tipo 1 presentan peor control metabólico de la enfermedad en la pubertad, pero su control lipídico se puede considerar aceptable. Existe una correlación inversa de los marcadores de formación ósea con el tiempo de evolución de la enfermedad, así como con el control metabólico. Conclusión. Los marcadores de formación ósea se encuentran correlacionados de forma inversa con el porcentaje de hemoglobina glicosilada y con el tiempo de evolución de la diabetes. En estos pacientes, el perfil lipídico y el óseo son más favorables cuando existe un buen control metabólico de la enfermedad.

Introduction. Type 1 diabetes mellitus is considered one of the most common chronic diseases of childhood. It is a high-risk factor for developing early cardiovascular disease and it also affects bone health. Objective. To describe demographic characteristics and biochemical parameters of a population of children with type 1 diabetes, evaluated in the pediatric diabetes unit of a tertiary Spanish hospital. Materials and methods. In this retrospective study, we determined metabolic, lipid, and bone parameters in 124 children with type 1 diabetes who were monitored in the pediatric diabetes unit of the Hospital Universitario Miguel Servet in Zaragoza (Spain) from May 2020 to July 2021. Results. Children with type 1 diabetes have worse metabolic control of the disease at puberty, but their lipid control is considered acceptable. We found an inverse correlation between bone formation markers and disease duration, as well as with metabolic control. Conclusion. Bone formation markers are inversely correlated with the percentage of glycated hemoglobin and diabetes evolution time. Patients' lipid and bone profiles are more favorable when metabolic control of the disease is achieved.

Correlation between time in range and glycated hemoglobin in patients with newly-diagnosed type 2 diabetes mellitus / 中华健康管理学杂志

Objective:To explore the correlation between time in range (TIR) after short-term treatment and glycated hemoglobin after 3 months (HbA lc-3m) in patients with newly-diagnosed type 2 diabetes mellitus (T2DM). Methods:In this cross-sectional study, a total of 94 patients with newly-diagnosed T2DM who received treatment in the Department of Endocrinology of Inner Mongolia Autonomous Region People′s Hospital were enrolled from January 2018 to September 2022. The patients were followed-up for 3 months and had complete medical record. TIR was divided into three groups according to different target ranges of blood glucose (TIR1: TIR with blood glucose between 3.9 and 10.0 mmol/L, TIR2: TIR with blood glucose between 3.9 and 7.8 mmol/L, TIR3: TIR with fasting, premeal or bedtime blood glucose <6.1 mmol/L and 2 h postprandial blood glucose <8.0 mmol/L). The patients were divided into two groups based on whether their HbA 1c-3m level was less than 6.5%, and the baseline data and variations in TIR for distinct target glucose levels were compared between the two groups. Spearman′s correlation analysis and binary logistic regression analysis were used to analyze the relationship between baseline indicators, TIR after short-term treatment and HbA 1c-3m. Receiver operating characteristic curve (ROC) was drawn to evaluate the predictive ability of different TIR after short-term therapy for HbA 1c-3m. Results:There were statistically significant differences in TIR1 [81.0 (67.5, 94.6)% vs 71.4 (51.7, 85.7)%], TIR2 [57.7 (29.7, 70.8)% vs 40.9 (22.4, 52.3)%] and TIR3 [23.8 (10.2, 39.5)% vs 13.0 (4.8, 25.0)%] between patients with a HbA 1c-3m<6.5% and patients with a HbA 1c-3m≥6.5% (all P<0.05). Spearman correlation analysis showed that among all the patients with newly-diagnosed T2DM, TIR1, TIR2 and TIR3 were all negatively correlated with HbA 1c-3m [6.4 (6.1, 6.9)%] ( r=-0.322, -0.348, -0.303, respectively, all P<0.01). Logistic regression analysis showed that after adjusting for the confounding factors, TIR1 ( OR=1.021, 95% CI: 1.002-1.041; P=0.034), TIR2 ( OR=1.024, 95% CI: 1.006-1.043; P=0.011), TIR3 ( OR=1.037, 95% CI: 1.010-1.065; P=0.008) were all independently related to HbA 1c-3m. When HbA lc-3m<6.5% was taken as the target value, the area under the ROC curve: TIR1 was 0.639 (95% CI: 0.528-0.751), TIR2 was 0.671 (95% CI: 0.560-0.782), TIR3 was 0.659 (95% CI: 0.549-0.770), respectively. When HbA lc-3m<7.0% was taken as the target value, the area under the ROC curve: TIR1 was 0. 730 (95% CI: 0.619-0.841), TIR2 was 0.744 (95% CI: 0.642-0.846), TIR3 was 0.701 (95% CI: 0.588-0.814). There was no significant difference in the area among the three statistics ( P>0.05). Conclusions:For newly-diagnosed T2DM patients, TIR after short-term treatment is negatively correlated with HbA 1c after 3 months and has good predictive value for it.

Correlation between glycated hemoglobin index and insulin antibody positive in type 2 diabetes mellitus patients with poor oral hypoglycemic control / 中国糖尿病杂志

Objective To analyze the correlation between glycated hemoglobin index(HGI)and insulin antibody(IAA)positivity in type 2 diabetes mellitus(T2DM)patients with poorly controlled oral hypoglycemic agents.Methods A total of 260 T2DM patients with poor control of oral hypoglycemic agents and receiving insulin treatment in the Department of Endocrinology of Orthopedics and Diabetes Hospital of Haikou City from January 2020 to December 2021 were selected and divided into IAA positive group(n=75)and IAA negative group(n=185).Clinical data and biochemical indicators of the two groups were compared and analyzed the correlation between IAA positivity and other indicators.Results IAA positive group had a higher proportion of patients with insulin high dosage,insulin treatment time>2 years,and higher FIns,FPG,SUA and HGI than IAA negative group(P<0.05 or P<0.01),HbA1c≥9%lower than IAA negative group(P<0.01).Spearman correlation analysis showed that IAA positive was positively correlated with HGI(P<0.01),and negatively correlated with SUA and HDL-C(P<0.01).Logistic regression analysis showed that insulin treatment time,FIns,FPG,SUA,HbA1c and HGI were the influencing factors for IAA positive in T2DM patients.Receiver operating characteristic curve analysis showed that the area under the ROC curve for predicting IAA positive by HGI was 0.854,the optimal critical value for HGI was 0.4%,with the sensitivity 83.2%and the specificity 79.3%.Conclusion In T2DM patients with poorly controlled oral hypoglycemic drugs,high HGI has predictive value for IAA positivity.

Use of probiotics and similar in pediatric patients with Type 1 Diabetes Mellitus: a systematic review / Uso de probióticos e similares em pacientes pediátricos com Diabetes Mellitus tipo 1: uma revisão sistemática

ABSTRACT Objective: To perform a systematic review of randomized controlled trials, evaluating the effect of probiotics, prebiotics or symbiotics supplementation on glycemic and inflammatory control in children with Type 1 Diabetes Mellitus (T1DM). Data source: The Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed), Clinical Trials, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) and Scientific Electronic Library Online (SciELO) databases were searched. Randomized clinical trials of pediatric patients with DM1 using probiotics, prebiotics or symbiotics were included, regardless of year or language of publication. Studies that did not evaluate glycated hemoglobin (HbA1c) were excluded. Metabolic results (HbA1c, total insulin dose and C-peptide) and inflammatory control [interleukin-10 (IL-10), tumor necrosis factor-alpha (TNF-α) and interferon-gamma (IFN-γ)] during probiotic supplementation or similar, related to modification of the intestinal microbiota, were analyzed. PROSPERO ID: CRD42022384485. Data synthesis: Five studies were selected for a systematic review. Regarding metabolic markers, only one of the articles that analyzed HbA1c showed a significant decrease (p=0.03) in the intervention group. One study identified a reduction in the total dose of insulin and increased C-peptide levels. Regarding the evaluation of inflammatory parameters (IL-10, TNF-α, INF-γ), there were no statistical relevant modifications. Conclusions: Current data from the literature were not conclusive in identifying an improvement in glycemic control and did not observe changes in inflammatory parameters with the use of probiotics, prebiotics or symbiotics in pediatric patients with T1DM.

RESUMO Objetivo: Realizar uma revisão sistemática de ensaios clínicos randomizados controlados avaliando o efeito da suplementação de probióticos, prebióticos ou simbióticos no controle glicêmico e inflamatório em crianças com diabetes mellitus tipo 1 (DM1). Fontes de dados: As bases Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed), Clinical Trials, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Scientific Electronic Library Online (SciELO) foram pesquisadas. Foram incluídos ensaios clínicos randomizados de pacientes pediátricos com DM1 em uso de probióticos, prebióticos ou simbióticos, independentemente de ano ou idioma de publicação. Foram excluídos os trabalhos que não avaliaram hemoglobina glicada (HbA1c). Os resultados metabólicos (HbA1c, dose de insulina total e peptídeo C) e o controle inflamatório [interleucina-10 — IL-10), fator de necrose tumoral-alfa (TNF-α) e interferon-gama (IFN-γ)] durante a suplementação de probióticos ou similares, relacionados à modificação da microbiota intestinal, foram analisados. ID PROSPERO: CRD42022384485. Síntese dos dados: Cinco estudos foram selecionados para revisão sistemática. Com relação aos marcadores metabólicos, apenas um dos artigos que analisaram a HbA1c apresentou diminuição significativa (p=0,03) no grupo intervenção. Um estudo identificou redução da dose total de insulina e aumento dos níveis de peptídeo C. Quanto à avaliação dos parâmetros inflamatórios (IL-10, TNF-α, INF-γ), não houve modificações de relevância estatística. Conclusões: Os dados atuais da literatura não foram conclusivos em identificar melhora no controle glicêmico e não observaram mudanças nos parâmetros inflamatórios com o uso de probióticos, prebióticos ou simbióticos em pacientes pediátricos com DM1.

The impact of glycosylated hemoglobin and 75-g oral glucose tolerance test glucose levels on birthweight percentile

SUMMARY OBJECTIVE: Our research objective was to validate and contribute further evidence to the studies regarding large for gestational age and birthweight percentile by examining oral glucose tolerance test and glycosylated hemoglobin levels in both healthy women and those with gestational diabetes mellitus. METHODS: This retrospective cohort study was conducted at a tertiary care hospital involving 106 women who delivered at gestational week 36 or later between February 2022 and February 2023. Maternal, obstetric, and neonatal data were collected from the participant's medical records. Large for gestational age and non-large for gestational age groups were compared. Correlation analysis was used to determine associations among oral glucose tolerance test, glycosylated hemoglobin levels, and the birthweight percentile. RESULTS: Mothers of neonates in the large for gestational age category had higher body mass indexes before pregnancy (p=0.002) and delivery (p=0.003), as well as a higher incidence of gestational diabetes mellitus (p=0.027). Mothers of male large for gestational age infants had higher fasting plasma glucose and glycosylated hemoglobin levels compared to male non-large for gestational age infants (p=0.007 and p=0.004, respectively). There was a weak positive correlation between fasting plasma glucose levels and birthweight percentile in the overall group (r=0.342, p<0.006). Further analysis by gender showed a weak positive correlation between birthweight percentile and fasting plasma glucose and glycosylated hemoglobin values in male newborns (r=0.393, p=0.004 and r=0.373, p=0.006, respectively). CONCLUSION: Our study has established a clear association between the birthweight percentile in male infants and the levels of glycosylated hemoglobin and fasting plasma glucose measured during oral glucose tolerance test. It is imperative to devise potential strategies aimed at achieving optimal glycosylated hemoglobin and fasting plasma glucose parameters to effectively reduce the frequency of large for gestational age in male infants.

Outcomes of Transcatheter Aortic Valve Implantation in Patients with and without Diabetes Mellitus

ABSTRACT Introduction: Diabetes mellitus (DM) in patients undergoing cardiac transcatheter or surgical interventions usually is correlated with poor outcomes. Transcatheter aortic valve implantation (TAVI) has been developed as a therapy choice for inoperable, high-, or intermediate-risk surgical patients with severe aortic stenosis (AS). Objective: To evaluate the impact of DM and hemoglobin A1c (HbA1c) on outcomes and survival after TAVI. Methods: Five hundred and fifty-two symptomatic severe AS patients who underwent TAVI, of whom 164 (29.7%) had DM, were included in this retrospective study. Follow-up was performed after 30 days, six months, and annually. Results: The device success and risks of procedural-related complications were similar between patients with and without DM, except for acute kidney injury, which was more frequent in the DM group (2.4% vs. 0%, P=0.021). In-hospital and first-year mortality were similar between the groups (4.9% vs. 3.6%, P=0.490 and 15.0% vs. 11.2%, P=0.282, respectively). There was a statistical difference between HbA1c ≥ 6.5 and HbA1c ≤ 6.49 groups in total mortality (34.4% vs. 15.8%, P<0.001, respectively). The only independent predictors were Society of Thoracic Surgeons score (hazard ratio [HR] 1.28, 95% confidence interval [CI] 1.09-1.51; P=0.003) and HbA1c level ≥ 6.5 (HR 10.78, 95% CI 2.58-21.50; P=0.003) in multivariable logistic regression analysis. Conclusion: In this study, we conclude that DM was not correlated with an increased mortality risk or complication rates after TAVI. Also, it was shown that mortality was higher in patients with HbA1c ≥ 6.5, and it was an independent predictor for long-term mortality.

Use of FGF21 analogs for the treatment of metabolic disorders: a systematic review and meta-analysis

ABSTRACT FGF21 is a hormone produced primarily by the liver with several metabolic functions, such as induction of heat production, control of glucose homeostasis, and regulation of blood lipid levels. Due to these actions, several laboratories have developed FGF21 analogs to treat patients with metabolic disorders such as obesity and diabetes. Here, we performed a systematic review and meta-analysis of randomized controlled trials that used FGF21 analogs and analyzed metabolic outcomes. Our search yielded 236 articles, and we included eight randomized clinical trials in the meta-analysis. The use of FGF21 analogs exhibited no effect on fasting blood glucose, glycated hemoglobin, HOMA index, blood free fatty acids or systolic blood pressure. However, the treatment significantly reduced fasting insulinemia, body weight and total cholesterolemia. None of the included studies were at high risk of bias. The quality of the evidence ranged from moderate to very low, especially due to imprecision and indirection issues. These results indicate that FGF21 analogs can potentially treat metabolic syndrome. However, more clinical trials are needed to increase the quality of evidence and confirm the effects seen thus far.

Impact of sustained virologic response on glucose parameters among patients with chronic hepatitis C treated with direct-acting antivirals

ABSTRACT Objective: The aim of this study was to evaluate the glycated hemoglobin (HbA1c) levels before and after sustained virologic response (SVR) and investigate the baseline characteristics associated with improved glycemic control in patients with chronic hepatitis C (CHC) achieving SVR after direct-acting antivirals (DAA) therapy. Materials and methods: Consecutive adult patients with CHC who achieved SVR after DAA treatment between January 2016 and December 2017 at Hospital de Clínicas de Porto Alegre (RS, Brazil) were prospectively included. Levels of HbA1c were measured up to 24 weeks before DAA therapy and 12 weeks after SVR. Exclusion criteria were decompensated cirrhosis, HIV and/or hepatitis B virus, liver disease of other etiologies, and/or modification of prediabetes/type 2 diabetes mellitus (PDM/T2DM) management. The primary outcome was a comparison of HbA1c levels before and after SVR. Secondary outcomes were the baseline variables associated with improved glycemic control. Results: The study included 207 patients with a mean age of 60.6±10.7 years, of whom 51.7% were women, 56% had cirrhosis, 37.7% had HCV genotype 3, and 54.5% had baseline T2DM or PDM. The median HbA1c level reduced significantly after SVR (5.5%, interquartile range [IQR] 4.9%-6.3%) compared with baseline (5.7%, IQR 5.3­%-6.7%; p = 0.01). The baseline characteristics associated with improved HbA1c after SVR were cirrhosis, genotype 3, and age ≤ 60 years. Conclusion: Among patients with CHC, SVR after DAA was associated with HbA1c reduction, particularly in those with cirrhosis, genotype 3, and age ≤ 60 years.

Diabetes tipo II. A terapia periodontal não cirúrgica pode favorecer o controle glicêmico do paciente? / Type II Diabetes. Does nonsurgical periodontal therapy improve glycemic control in patientes? / Diabetes tipo II. ¿Puede la terapia periodontal no quirúrgica mejorar el control glicémico del paciente?

Introdução:A doença periodontal corresponde àcondição que acomete os tecidos de proteção e/ou suporte do dente através de uma inflamação crônica causadapor patógenos.Estacondição pode ser modificada ou associada às doenças sistêmicas, como por exemplo, o diabetes mellitus tipo II (DM2).Objetivo:Avaliar quais os efeitos da terapia periodontal não cirúrgica sobre o controle glicêmico de pacientes diagnosticados com DM2.Metodologia:Revisão integrativa elaborada a partir de pesquisas clínicas randomizadas indexadas nas bases de dados Pubmed, Embase, Cochrane, Web of Science e BVS, na qual foram utilizados os descritores "periodontal diseases treatment", "glycemic control" e "metabolic control".Resultados:Dos trabalhos avaliados, seis foram selecionados para compor a revisão, tendo em vista os critérios de inclusão e exclusão estabelecidos. Logo, é notório que a terapia periodontal básica indica melhora no controle glicêmico dos pacientes com DM2, de acordo comanálise da HbA1c e PCR,portanto, com base nos resultados dessa pesquisa, o tratamento periodontal não cirúrgico parece contribuir para o controle metabólico. Apesar disso, alguns estudos se opõem aoresultadodo controle glicêmicodesses pacientes, reforçando a existência de variáveis que interferem nos resultados da pesquisa, como os níveis de hemoglobina, estágio da doença periodontal, amostra, dietae atividade física dos pacientes.Conclusões:O resultado deverá ser avaliado com maior cautela, tendo em vista as possibilidades de variáveis presentes nesse tipo de pesquisa. Por fim, ensaios controlados devem ser realizados para alcançar um maior esclarecimento a respeito dos efeitos da terapia periodontal não cirúrgica no controle glicêmico de pacientes com DM2 (AU).

Introduction:Periodontal disease is a condition in which protective or supportive tissues of the tooth are affected by chronic inflammation caused by pathogens. This condition may be modified or associated with systemic diseases such as type 2 diabetes mellitus (T2DM).Objective:To evaluate the effects of nonsurgical periodontal therapy on glycemic control in patients diagnosed with T2DM. Methodology:An integrative review was performed using randomized clinical trials indexed in PubMed, Embase, Cochrane, Web of Science, and BVS databases. The descriptors "periodontal disease treatment," "glycemic control," and "metabolic control" were used. Results:From the reviewed studies, six were selected for the review considering the established inclusion and exclusion criteria.Basic periodontal therapy improves glycemic control in patients with T2DM, as evidenced by analysis of glycated hemoglobin (HbA1c) and polymerase chain reaction (PCR). Therefore, based on the results of this research, nonsurgical periodontal treatment contributes to metabolic control. However, some studies contradict the effect of glycemic control in these patients, reinforcing the presence of variables that interfere with research results, such as hemoglobin levels, stage of periodontal disease, sample, dietand physical activity of patients. Conclusions:The results should be evaluated with more caution considering the potential variables present in this type of research. Finally, controlled trials should be conducted to understand better the effects of nonsurgical periodontal therapy on glycemic control in patients with T2DM (AU).

Introducción: La enfermedad periodontal es una condición en la cual los tejidos protectores o de soportedel diente se ven afectados por una inflamación crónica causada por patógenos. Esta condición puede modificarse o asociarse a enfermedades sistémicas como la diabetes mellitus tipo 2 (DM2). Objetivo: Evaluar los efectos de la terapia periodontal no quirúrgica en el control glucémico en pacientes diagnosticados con DM2. Metodología: Se realizó una revisión integradora utilizando ensayos clínicos aleatorizados indexados en las bases de datos de PubMed, Embase, Cochrane, Web of Science y BVS. Se utilizaron los descriptores "tratamiento de enfermedades periodontales", "control glucémico" y "control metabólico". Resultados: De los estudios revisados, se seleccionaron seis para la revisión, considerando los criterios de inclusión y exclusión establecidos. La terapia periodontal básica mejora el control glucémico en pacientes con DM2, como se evidencia en el análisis de la hemoglobina glicosilada (HbA1c) y la reacción en cadena de la polimerasa (PCR). Por lo tanto, basándose en los resultados de esta investigación, el tratamiento periodontal no quirúrgico contribuye al control metabólico. Sin embargo, algunos estudios contradicen el efecto del control glucémico en estos pacientes, lo que refuerza la presencia de variables que interfieren en los resultados de la investigación, como los niveles de hemoglobina, el estadio de la enfermedad periodontal, la muestra, la dieta y la actividad física de los pacientes. Conclusiones: Los resultados deben evaluarse con mayor precaución, considerando las posibles variables presentes en este tipo de investigación. Por último, se deben realizar ensayos controlados para comprender mejor los efectos de la terapia periodontal no quirúrgica en el control glucémico en pacientes con DM2 (AU).

Correlación entre tiempo en rango y hemoglobina glicosilada en personas con diabetes mellitus: revisión sistemática / Correlation between time on target and glycated hemoglobin in people with diabetes mellitus: systematic review / Correlação entre tempo no alvo e hemoglobina glicada de pessoas com diabetes mellitus: revisão sistemática

Objetivo: analizar la correlación entre el tiempo en rango y la hemoglobina glicosilada de personas que viven con diabetes mellitus y realizan la monitorización continua de la glucemia o el automonitoreo de la glucemia capilar Método: revisión sistemática de etiología y riesgo basada en las directrices del JBI e informada según los Preferred Reporting Items for Systematic Reviews and Meta-Analyses, abarcando seis bases de datos y la literatura gris. La muestra incluyó 16 estudios y la calidad metodológica fue evaluada utilizando las herramientas del JBI. Protocolo registrado en Open Science Framework, disponible en https://doi.org/10.17605/OSF.IO/NKMZB. Resultados: tiempo en rango (70-180 mg/dl) mostró una correlación negativa con la hemoglobina glicosilada, mientras que el tiempo por encima del rango (>180 mg/dl) mostró una correlación positiva. Los coeficientes de correlación variaron entre -0,310 y -0,869 para el tiempo en rango, y entre 0,66 y 0,934 para el tiempo por encima del rango. Un estudio se realizó en una población que hacía el automonitoreo. Conclusión: hay una correlación estadísticamente significativa entre el tiempo en rango y el tiempo por encima del rango con la hemoglobina glicosilada. Cuanto mayor sea la proporción en el rango glucémico adecuado, más cerca o por debajo del 7% estará la hemoglobina glicosilada. Se necesitan más estudios que evalúen esta métrica con datos del automonitoreo de la glucemia.

Objective: to analyze the correlation between time on target and glycated hemoglobin in people living with diabetes mellitus and carrying out continuous blood glucose monitoring or self-monitoring of capillary blood glucose. Method: systematic review of etiology and risk based on JBI guidelines and reported according to Preferred Reporting Items for Systematic Reviews and Meta- Analyses, covering six databases and grey literature. The sample included 16 studies and methodological quality was assessed using JBI tools. Protocol registered in the Open Science Framework, available at https://doi.org/10.17605/OSF.IO/NKMZB. Results: time on target (70-180 mg/dl) showed a negative correlation with glycated hemoglobin, while time above target (>180 mg/dl) showed a positive correlation. Correlation coefficients ranged between -0.310 and -0.869 for time on target, and between 0.66 and 0.934 for time above target. A study was carried out on a population that performed self-monitoring. Conclusion: there is a statistically significant correlation between time on target and time above target with glycated hemoglobin. The higher the proportion in the adequate glycemic range, the closer to or less than 7% the glycated hemoglobin will be. More studies are needed to evaluate this metric with data from self-monitoring of blood glucose.

Objetivo: analisar a correlação entre o tempo no alvo e a hemoglobina glicada de pessoas que vivem com diabetes mellitus e realizam a monitorização contínua da glicemia ou a automonitorização da glicemia capilar. Método: revisão sistemática de etiologia e de risco pautada nas diretrizes do JBI e reportada conforme Preferred Reporting Items for Systematic Reviews and Meta-Analyses, abrangendo seis bases de dados e a literatura cinzenta. A amostra incluiu 16 estudos e a qualidade metodológica foi avaliada utilizando as ferramentas do JBI. Registrado protocolo no Open Science Framework, disponível em https://doi.org/10.17605/OSF.IO/NKMZB. Resultados: tempo no alvo (70-180 mg/dl) apresentou correlação negativa com a hemoglobina glicada, enquanto o tempo acima do alvo (>180 mg/dl) mostrou correlação positiva. Os coeficientes de correlação variaram entre -0,310 e -0,869 para o tempo no alvo, e entre 0,66 e 0,934 para o tempo acima do alvo. Um estudo foi efetuado com população que realizava a automonitorização. Conclusão: há correlação estatisticamente significativa entre o tempo no alvo e o tempo acima do alvo com a hemoglobina glicada. Quanto maior a proporção na faixa glicêmica adequada, mais próxima ou inferior a 7% estará a hemoglobina glicada. São necessários mais estudos que avaliem essa métrica com dados da automonitorização da glicemia.

Evaluación de aspectos clínicos relacionados con la amputación de miembros inferiores en personas que viven con diabetes mellitus tipo 2 en México / Evaluation of clinical aspects related to lower limb amputation among individuals living with type 2 diabetes mellitus in Mexico

RESUMEN Introducción: La diabetes continúa siendo una de las principales causas de discapacidad y muerte en la población mundial. Alrededor del 25% de las personas con diabetes desarrollarán una úlcera en alguno de sus miembros pélvicos inferiores. Objetivo: El presente estudio evalúa los aspectos clínicos relacionados con la amputación del miembro inferior pélvico en una cohorte de pacientes con diabetes mellitus. Métodos: Estudio retrospectivo, transversal, realizado en colaboración entre el Instituto Mexicano del Seguro Social y la Facultad de Farmacia de la Universidad Autónoma del Estado de Morelos, implicó una revisión de expedientes de pacientes con diabetes mellitus tipo 2 en el Hospital General Regional "Ignacio García Téllez". Se seleccionaron 100 expedientes clínicos y Electrónicos basados en criterios de inclusión, que incluían edad mayor de 18 años, afiliación en el sitio del estudio, evolución de la diabetes de al menos 10 años, tratamiento farmacológico para la diabetes y diagnóstico de pie diabético con curación completa o amputación como resultado. Los análisis estadísticos se realizaron mediante STATA y se obtuvo aprobación ética. Resultados: Los pacientes con un control glucémico óptimo cuantificando sus niveles de glucosa en ayunas (<130 mg/dl) así como sus valores de hemoglobina glicosilada (< 7%) tuvieron una menor frecuencia de amputaciones (p˂0,001; Chi2) en comparación con aquellos pacientes sin un control glucémico adecuado. Conclusión: Se encontró que ser hombre, valores de hemoglobina glucosilada superiores al 7% y valores promedio de glucosa en ayunas superiores a 130 mg/L aumentan la probabilidad de presentar una amputación de extremidad inferior.

ABSTRACT Introduction: Diabetes continues to be a leading cause of disability and death in the world's population. About 25% of people with diabetes will develop an ulcer in one of their lower pelvic limbs. Objective: The present study evaluates the clinical aspects related to lower pelvic limb amputation in a cohort of patients with diabetes mellitus. Lazarte Echegaray Hospital during the period 2017-2020. Methods: Retrospective, cross-sectional study, conducted in collaboration between the Mexican Institute of Social Security and the School of Pharmacy of the Autonomous University of Morelos State, involved a review of records of patients with type 2 diabetes mellitus at the Regional General Hospital "Ignacio García Téllez". One hundred clinical and electronic records were selected based on inclusion criteria, which included age over 18 years, affiliation at the study site, diabetes evolution of at least 10 years, pharmacological treatment for diabetes and diagnosis of diabetic foot with complete healing or amputation as an outcome. Statistical analyses were performed using STATA and ethical approval was obtained. Results: Patients with optimal glycemic control by quantifying their fasting glucose levels (<130 mg/dl) as well as their glycated hemoglobin values (< 7%) had a lower frequency of amputations (p˂0.001; Chi2) compared to those patients without adequate glycemic control. Conclusion: Being male, glycosylated hemoglobin values greater than 7% and mean fasting glucose values greater than 130 mg/L were found to increase the likelihood of having a lower extremity amputation.

Third trimester HbA1c as a prognostic indicator in the prediction of large-for-gestational age babies in South Indian women with gestational diabetes mellitus: A cross-sectional study

Background: The prevalence of hyperglycemia first detected during pregnancy is showing an escalating increase in recent years contributed by the increasing obesity prevalence, advanced maternal age at delivery, and the universal screening protocol during the first antenatal visit. There exists a very little data on the role of HbA1c in pregnancy and the results remain inconsistent. There is a need to define diagnostic criteria to predict the adverse perinatal outcomes in gestational diabetes mellitus (GDM). Aims and Objectives: This study was aimed to assess the role of HbA1c as a prognostic indicator of third trimester mean blood glucose in GDM pregnancies and in predicting the birth of large for gestational age (LGA) babies. Materials and Methods: 200 pregnant women with GDM and 200 pregnant women without GDM and their neonates participated in this analytical cross-sectional study. Maternal age, height, weight, BMI, and neonatal birth weight were recorded. Third trimester maternal HbA1c level was analyzed by high-performance liquid chromatography. The association between HbA1c and LGA births was analyzed. Results: The mean HbA1c levels and percentage of LGA births were high in GDM group. Multiple logistic regression analysis showed association between high HbA1c values and LGA births in GDM. A Receiver operating characteristic curve was drawn to derive the optimal cut-off value, sensitivity, and specificity of HbA1c in predicting birth of LGA neonates in GDM. Conclusion: This study shows that high third trimester HbA1c levels in GDM increase the risk of LGA births. Further studies are needed to define standard cut-off values of glycated Hb in each trimester of pregnancy.

Carbohydrate counting as a strategy to optimize glycemic control in type 1 diabetes mellitus

ABSTRACT Objective: The objective of this study was to verify the impact of carbohydrate counting (CC) on glycemic control and body weight variation (primary and secondary outcomes, respectively) between consultations in patients with diabetes mellitus (T1D) followed at a tertiary hospital in southern Brazil in a public health system environment. We also sought to investigate CC adherence. Materials and methods: This retrospective cohort study included 232 patients with T1D who underwent nutritional monitoring at a referral hospital for diabetes care between 2014 and 2018. To assess primary and secondary outcomes, data from 229 patients, 49 of whom underwent CC during this period and 180 individuals who used fixed doses of insulin, were analyzed. The impact of CC on glycemic control was assessed with the mean glycated hemoglobin (HbA1c) level at all consultations during the follow-up period. Results: In the model adjusted for the most confounders (except pregnancy), the mean HbA1c was better in the CC group (8.66 ± 0.4% vs. 9.36 ± 0.39%; p = 0.016), and body weight variation was lower (0.13 ± 0.28 kg vs. 0.53 ± 0.24 kg; p = 0.024). Adherence to CC was reported in 69.2% of consultations. Conclusion: CC optimized the glycemic control of individuals with T1D, resulting in less weight variation than in the fixed insulin dose group, which indicates that CC is an important care strategy for these patients.

Flash glucose monitoring system in patients with type 1 diabetes in healthcare center in Brazil: real world data from a short-term prospective study

ABSTRACT Objectives: To evaluate the alternate use of flash glucose monitoring (FGM) with self-monitoring blood glucose (SMBG), in patients with type 1 diabetes (T1D). Materials and methods: Two weeks of open FGM (P2), both preceded (P1) and followed by 2 weeks (P3) of SMBG with a blinded FGM system. Mean absolute relative difference (MARD) was calculated by (-FGMi − SMBGi-) / SMBGi, where it was a paired data sample. Results: In total, 34 patients were evaluated. Time in range (TIR) did not change between P1 and P2. In 12 patients (35.3%), TIR increased from 40% at P1 to 52% at P2 (p = 0.002) and in 22 (64.7%), TIR decreased or did not change. FGM use resulted in decreased % time spent in hypoglycemia (<70 mg/dL) (6.5% vs. 5.0%; p = 0.005), increased % time spent in hyperglycemia (>180 mg/dL) (44.5% to 51%; p = 0.046) with no significant change in % TIR. The proportion of patients who reached sensor-estimated glycated hemoglobin (eA1c) < 7% decreased from 23.5% at P1 to 12.9% at P2, p = 0.028. For the whole sample, the MARD between the two methods was 15.5% (95% CI 14.5-16.6%). For normal glucose range, hyperglycemic levels and hypoglycemic levels MARD were 16.0% (95% CI 15.0-17.0%), 13.3% (95% CI 11.5-15.2%) and 23.4% [95% CI 20.5-26.3%)], respectively. Conclusion: FGM after usual SMBG decreased the % time spent in hypoglycemia concomitant with an undesired increase in % time spent in hyperglycemia. Lower accuracy of FGM regarding hypoglycemia levels could result in overcorrection of hypoglycemia.

Evaluation of Clinical, Demographic, and Biochemical Profiles of Trinidadian Patients Undergoing Coronary Angiography

Background: Trinidad and Tobago ranks number 45 in the world for total deaths due to coronary heart disease. Predictive tests for coronary angiographic results set the basis for earlier monitoring of the disease before additional complications become obvious. Aims and Methods?This study aimed to evaluate the anthropometric and biochemical parameters of 124 patients with suspected coronary artery disease (CAD) in Trinidad and how these parameters correlate to the findings at angiography. Results?The biochemical parameters showed statistically significant correlations with CAD severity by Spearman's rank-order correlation. Two clinical parameters showed significant associations with CAD severity—ethnicity (?2 (4)?=?12.925, p?=?0.012) and presence of type 2 diabetes at baseline (?2 (4)?=?21.483, p?<?0.001). Conclusion?Biochemical parameters such as fasting blood sugar, N-terminal pro B-type natriuretic peptide, creatinine, and hemoglobin A1c were well correlated and well associated with the severity of CAD after diagnosis by the process of coronary angiography. Hence, these factors can be taken into consideration to predict the severity of CAD.

Hypovitaminosis D causes suboptimal glycemic control in type 2 diabetic patients

Background: Vitamin D deficiency and associated complications are widely prevalent in the Indian subcontinent. Hypovitaminosis D is known to play deleterious effects on cardiovascular and skeletal functions in human beings. Yet, its effect on carbohydrate metabolism and diabetes mellitus (DM) is less known. Aim and Objectives: In the current case– control study, our primary aim is to find out the potential effect of hypovitaminosis D on glycemic control in type 2 DM (T2DM) patients. Materials and Methods: The study population comprised 250 T2DM patients recruited primarily from Madhya Pradesh, India. The case group of 125 T2DM patients with hypovitaminosis D was compared with a control group of 125 T2DM patients with sufficient vitamin D. We mainly investigated the effect of hypovitaminosis D (both deficiency and insufficiency) on glycemic control in T2DM patients. Results: We observed that both fasting and 2-h postprandial blood glucose were found to be elevated significantly in T2DM patients with hypovitaminosis D (P < 0.01). The glycated hemoglobin level was also elevated (P < 0.01) in the case group suggesting impaired glycemic control for a chronic period. An inverse association is found between glycemic status and serum vitamin D (OH)D3 levels. Conclusions: Our results show the significance of maintaining sufficient plasma vitamin D levels, along with hypoglycemic medication in T2DM patients to improve their glycemic control and avoid diabetic comorbidities.

Correlation of glycated hemoglobin and diastolic dysfunction in type 2 diabetes mellitus patients in a tertiary care centre

Background: There is a substantial increase in the coincidence of diabetes mellitus and cardiomyopathy. The cardiomyopathy may occur in patients who have no evidence of large vessel disease or abnormalities. The early and commonest hemodynamic derangement of diabetic cardiomyopathy is left ventricular diastolic dysfunction. So, the present study was undertaken to assess the prevalence of diastolic dysfunction in patients with type 2 diabetes and to assess the correlation of diastolic dysfunction and HbA1c% levels. Materials and methods: A total of 100 diabetic patients with minimum 5 years duration of diabetes were selected from Malla Reddy Hospital, Suraram from August 2020 to June 2022. Patients with minimum history of 5 years of type 2 diabetes were scrutinized for Doppler echo cardiography and HbA1c levels. Results: Diastolic dysfunction of left ventricle was observed in 58 patients out of 100, of which 54 (93.1%) patients had HbA1c% of > 6.4. 2 (3.4%) patients belong to HbA1c% group of 5.7-6.4. and 2(3.4%) patients belong to HbA1c% of < 5. Conclusion: Our findings indicate that myocardial damage in patients with diabetes affects diastolic function before systolic function. Diabetic cardiomyopathy is characterized by an early diastolic dysfunction and a later systolic dysfunction. Impaired diastolic function was not affected by sex or type of diabetes. Even young patients with diabetics with normal systolic ventricular function have diastolic dysfunction, which serves as a marker of a diabetic cardiomyopathy. Diastolic seems not to correlate with disease duration. HbA1c% can be a very good indicator of long term prognosis. Strong corelation exists between diastolic dysfunction and HbA1c.

Correlación entre la glucosa salival con la glucosa de ayuno, la Hemoglobina glicada y el Péptido-C en personas con diabetes mellitus tipo 2

Objetivo : Determinar la correlación entre la glucosa salival con la glucosa en ayunas, HbA1c y el péptido C en personas con Diabetes Mellitus tipo 2 (DM2). Materiales y métodos : Estudio transversal llevado a cabo en el Centro de Investigación en Diabetes, Obesidad y Nutrición (CIDON) en Lima, Perú durante el año 2021. Se categorizó en buen control metabólico (HbA1c<7 %) y mal control metabólico (HbA1c≥7 %). Se midió la glucosa basal, HbA1c y el péptido C en sangre. La glucosa salival se midió con el método glucosa oxidasa. La correlación de Spearman fue usada para determinar la asociación entre la glucosa salival con la glucosa en ayunas, HbA1c y el péptido- C. Resultados : Participaron un total de 142 personas con DM2. La concentración de glucosa salival fue significativamente más elevada en DM2 con mal control metabólico (p<0.01). Se observó una correlación positiva débil significativa entre la glucosa salival y la glucosa basal (r=0.23, p=0.04) y HbA1c (r=0.26, p=0.02) en DM2 con mal control metabólico y una correlación negativa insignificante (r=-0.08; p=0.47) con el péptido C. Conclusiones : La glucosa salival presenta una asociación significativa y positiva con la glucosa en sangre y la HbA1c, pero no con el péptido C en personas con DM2 con mal control metabólico. Sin embargo, hay muchos factores que deben ser considerados y analizados más a fondo para determinar su posible uso.

Objetivo : To determine the correlation between salivary glucose levels with fasting blood glucose, HbA1c, and C-peptide in patients with type 2 diabetes mellitus (T2DM). Materials and methods : This is a cross-sectional study performed at the Centro de Investigación en Diabetes, Obesidad y Nutrición (CIDON) in Lima, Peru, during 2021. Patients were categorized as those with good metabolic control (HbA1c<7 %), and poor metabolic control (HbA1c≥7 %). Baseline fasting blood glucose, as well as blood HbA1c and C-peptide values were measured. Salivary glucose was measured using the glucose oxidase method. Spearman's correlation was used for determining an association between salivary glucose levels and fasting blood glucose, HbA1c, and C-peptide. Results : One-hundred and forty-two subjects with T2DM participated in the study. Salivary glucose was significantly higher in T2DM subjects with poor metabolic control (p<0.01). A weak positive correlation between salivary glucose and fasting blood glucose (r= 0.23, p= 0.04) and HbA1c (r= 0.26, p= 0.02) was observed in subjects with T2DM and poor metabolic control, and also a non-significant negative correlation (r=-0.08; p= 0.47) with C-peptide. Conclusions : Salivary glucose levels show significant and positive association with fasting blood glucose and HbA1c, but not with C-peptide in persons with T2DM and poor metabolic control. However, there are many factors that should be considered and analyzed in detail aiming to determine its potential use.

Logro de control metabólico temprano en adultos con diabetes mellitus tipo 2 en Perú

Objetivo: Estimar la proporción de sujetos con diabetes mellitus tipo 2 (DMT2) que alcanzan la meta terapéutica para HbA1C un año después del diagnóstico (control metabólico temprano). Métodos: Revisión retrospectiva de historias clínicas de adultos atendidos en 16 centros médicos distribuidos en nueve ciudades peruanas. Se incluyeron pacientes que recibieron un diagnóstico inicial de DMT2 y tuvieron al menos un año de seguimiento. Se consideraron las metas metabólicas definidas en los estándares ADA 2018. Resultados: Se incluyeron 457 sujetos (53,03% mujeres). Cuando fueron diagnosticados, la edad media fue de 55,75 años (DE ± 12,92), la media de HbA1C fue de 9,10% (DE ± 2,28). Hubo diagnóstico concomitante de hipertensión arterial o de dislipidemia en 27,13% y 52,40%, respectivamente. Al año de seguimiento, 57,76% de los sujetos alcanzó la meta de HbA1C ( 40 mg / dL), 24,31% para HDL-c en mujeres (>50 mg/dL), 48,24% para triglicéridos (<150 mg/dL), y 89,23% para presión arterial (<140/90 mmHg). Conclusiones: En este estudio en condiciones de la vida real, en adultos con DMT2 con un año de seguimiento, el logro de la meta de HbA1C (<7%) se alcanzó en el 58% de los pacientes. Si bien estos resultados son compatibles con los reportados en otros estudios de la región, se evidencia la oportunidad de mejorar el logro temprano de metas con el objetivo de optimizar los resultados a largo plazo.

Aim: To estimate the proportion of subjects with type 2 diabetes mellitus (T2DM) who attain therapeutic goal for HbA1C one year after diagnosis (early metabolic control). Methods: Retrospective review of medical records of adults cared for at 16 centers in nine Peruvian cities. Patients who received an initial diagnosis of T2DM and had at least one year of follow up were included. Metabolic goals were as defined by ADA 2018 standards. Results: 457 subjects were included (53,03% female). At diagnosis, mean age was 55,75 years (SD ± 12.92), mean HbA1C was 9,10% (SD ± 2,28). Concomitant hypertension or dyslipidemia were present in 27,13% and 52,40%, respectively. At one year follow up, 57,76% of subjects attained the goal for HbA1C ( 40 mg/dL), 24,31% for HDL-c in women (>50 mg/dL), 48,24% for triglycerides (<150 mg/dL), and 89,23% for blood pressure (<140/90 mmHg). Conclusions: In this real-life study of adults with T2DM with one year of follow up, metabolic control for HbA1C (<7%) was attained in 58% of subjects. While the results are compatible with those reported in other studies in the region, there is opportunity to further improve early treatment goal attainment to optimize long-term outcomes.

The effects of occupational noise exposure on glycated hemoglobin and prediabetes / 中国职业医学

Objective To investigate the relationship between occupational noise exposure and glycated hemoglobin (HbA1c) levels, as well as prediabetes diagnosed by HbA1c. Methods A total of 1 181 workers from a cigarette factory were selected as the research subjects using a judgment sampling method. Workers were divided into control, low-level noise exposure and high-level noise exposure groups, consisting of 236, 359, and 586 individuals, respectively. The blood sample was collected for HbA1c test and occupation noise exposure intensity in workplace was detected by an area-sampling method. Results There were no statistical significant differences in HbA1c levels and prediabetes prevalence among the three groups of workers (all P>0.05). After adjusting for potential confounding factors such as years of service, gender, smoking, pack-years of smoking, alcohol consumption, and body mass index, multiple linear regression analysis showed that the high-level noise exposure group had higher HbA1c level than the control group (P<0.05). Multivariable logistic regression analysis results showed that the high-level noise exposure group had higher risk of prediabetes compared with the control group (P<0.05). Conclusion Occupational noise exposure could be a risk factor for the increased HbA1c levels and prediabetes incidence among the occupational population. More attention should be paid to the effects of occupational noise exposure on the HbA1c level in occupational health surveillance.