RESUMO
Background: Glycemic imbalance has long been recognized as a major vascular risk factor, and in the can be considered an authentic vascular condition that accelerates the development of chronic complications and major cardiovascular events in diabetics. Aim: The main aim of this study is to determine the correlation between the deferential glycemic profile parameters in order to assess the linkage of these parameters with cardiovascular risk score and chronic complications. Method: During this Covid pandemic, a cross-sectional descriptive and analytical study was included 384 Algerian diabetic patients (189 men, 205 women) with a 9-month follow-up. The diagnostic criteria for diabetes have been defined according to FID and WHO guidelines. Fasting blood sugar levels, GPP and HbA1c, prevalence of chronic complications and cardiovascular risk score were evaluated. Multifactor statistical analysis was performed by Software R studio (Package for Social science software), significance was set at p < 0,05. Results: The mean ± SD age of the patients was 61.28 ± 10.04 with mean fasting blood sugar (61.28 ± 10.04), PPG (3.59 ± 1.02) and HbA1c (8.67 ± 1.64%). PPG and FPG are positively and significantly correlated with HbA1c (regression curves;Figure 1) with a stronger correlation between FPG and HbA1c (r = 0.698). A significant association between Hb1Ac and cardiovascular risk score was noted in patients at very high risk and those at high risk (p-value <10-3). This clinical adherence was the object of studying the multifactorial relationship between Hb1Ac, dyslipidemia and BMI, the correlation of which was significantly positive with r = 0.852. In view of these results and the emergence of significant links, the correlational study by the application of the Pearson test between the variabilities studied, the risk score and the chronic complications shows that there is a very strong association between PPG, Hb1Ac, cardiovascular risk score and macroangiopathy complication. Likewise, the correlation was also positive but moderately significant between FPG, Hb1Ac, and microangiopathy complications. (Correlation matrix in Figure 2). Discussion: The HbA1c is the essential tool for monitoring diabetic patients, its level reflecting glycemic equilibration. It is widely accepted that the glycemic balance of diabetic patients is a complex “alchemy” involving both changes in fasting blood sugar and changes in postprandial blood glucose. The study demonstrated the link between these three parameters and determined its relationship to chronic complications. In this way, glycemic balancing reduces the micro-vascular complications of diabetic patients.
RESUMO
Background: Diabetes is one of the main non-communicable diseases with alarming prevalence in the world, including in Algeria. Diabetes is characterized by chronic hyperglycemia accompanied by a metabolic disorder of carbohydrates, lipids and proteins. A level of glycated hemoglobin (HbA1c) ≥ 6.5% was included as a diagnostic criterion for diabetes. The altered lipid profile is commonly present in type 2 diabetes. Patients with type 2 diabetes (T2DM) have an increased prevalence of dyslipidemia, which contributes to their high risk of cardiovascular disease (CVD). Aim: This study is an attempt to determine the correlation between the serum lipid profile and blood glucose and to assess the importance of HbA1c as an indicator of dyslipidemia. Method: This descriptive and analytical cross-sectional study was carried out during this Covid pandemic, at the level of the diabetic house and the Khemis Meliana hospital (North Algerian) over a period of 9 months. A total of 384 patients with T2DM aged 30 to 89 years were selected for this purpose. Dyslipidemia was defined according to the guidelines of the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III). Diabetes has been defined according to the criteria of the American Diabetes Association. The levels of fasting blood sugar, total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglycerides (TG) and glycated hemoglobin (HbA1c) were evaluated. Statistical analysis was performed by R studio software (Package for Social science software). The significance test was calculated by the unpaired Student “t” test. Correlation studies (Pearson correlation) have been performed between glycated hemoglobin (HbA1c) and lipid ratios and individual lipid indices. Significance was set at p <0.05. Results: The mean age ± standard deviation of the patients was 61.28 ± 10.04 years with a mean duration of diabetes was 14.32 ± 6.24 years. Significant positive correlations were observed between HbA1c and serum total cholesterol (p-value <10-6), triglyceride (p-value <10-3) and LDL-C (p-value = 0.002). In contrast, the correlation between HbA1c and HDL-C was negative and insignificant. Thus, the association between HbA1c and the atherogenicity index, especially the LDL-C / HDL-C ratio has been well established. Discussion: The study concluded that the HbA1c value correlated well with the lipid profile of diabetic patients. Thus, HbA1c can also be used as a predictor of dyslipidemia and therefore early diagnosis of dyslipidemia can be used as a preventive measure for the development of CVD in patients with T2DM.
RESUMO
Background: Diabetes mellitus is one of the main non-communicable diseases in the world, including in Algeria. Its progressive chronicity, the development of which is strongly associated with the level of HbA1c, glycemic control, lifestyle and therefore with the behavior of the person in his environment. These are precisely the targets of therapeutic patient education (TPE), which is considered the cornerstone of the management of diabetes and its complications. Aim: The objective of this study is to assess the impact of therapeutic education on the benefit of HbA1c and glycemic control. On the other hand, to teach patients to solve their health problems. Method: This descriptive and analytical cross-sectional study was carried out during this crazy period of Covid, at the level of the Khemis Miliana Region (North of Algeria), the aim of which was to study the clinical, biological and evolutionary epidemiological profile of heart disease. Among 384 patients with T2DM aged 30–89 years selected for this purpose, 26.04% patients benefited from education sessions versus 73.86% patients were not observed. Therapeutic education has been defined according to the WHO approach and the CBDCE guidelines. Diabetes was defined according to the criteria of the American Diabetes Association and the assessment of the treatment adherence score was carried out according to the GERARD and Morisky protocol. Multifactor statistical analysis was performed using R studio software, significance was set at p < 0.05. Results: The mean age ± SD of the educated patients was 52.18 ± 3.52, with the sex ratio (0.53 in favor of women). 26% of our participants followed a strict diet by measuring the amount of their food consumed, and 85% of them had false beliefs about nutrition. Blood glucose was monitored regularly in 75% of our patients, but home self-monitoring was only found in 13 cases. The application of the Pearson test between the glycemic control of observant patients and the benefit of HbA1c was statistically significant (p = 0.007). This significance was confirmed by the expected reduction of 1% HbA1c in over 75% of patients expected to sensitize. In addition, regular glycemic monitoring was remarkable in educated patients following their sensitization by admitting that the relationship between these two parameters was statistically significant (p = 0.003). On the hygiene-dietetic scale, the change in nutritional habits following awareness shows that a very powerful association was found between education and compliance with hygiene-dietetic measures with a p-value equal to 0.0001. Furthermore, the assessment of a significant association between education and complications was not statistically noticed (χ2 = 3.659;p = 0.056). This may be due to several factors such as the age of the participant as well as the duration of the diabetes. [Formula presented] [Formula presented] Discussion: The study concluded that the benefits of diabetes self-management education immediately improve during follow-up the HbA1c levels, confirmed by the significant decrease in the percentage of HbA1c of diabetic patients involved in education programs self-management.