Within-subject variation of HbA1c: A systematic review and meta-analysis.

BACKGROUND: Glycosylated haemoglobin (HbA1c) measurement is used to diagnose and to guide treatment of diabetes mellitus. Within-subject variability in measured HbA1c affects its clinical utility and interpretation, but no comprehensive systematic review has described within-subject variability. METHODS: A systematic review and meta-analysis was performed of within-subject variability of HbA1c. Multiple databases were searched from inception to November 2022 for follow-up studies of any design in adults or children, with repeated measures of HbA1c or glycosylated haemoglobin. Title and abstract screening was performed in duplicate, full text screening and data extraction by one reviewer and verified by a second. Risk of bias of included papers was assessed using a modified consensus-based standards for the selection of health measurement Instruments (COSMIN) tool. Intraclass correlation coefficient (ICC) results were pooled with a meta-analysis and coefficient of variation (CV) results were described by median and range. RESULTS: Of 2675 studies identified, 111 met the inclusion criteria. Twenty-five studies reported variability data in healthy patients, 19 in patients with type 1 diabetes and 59 in patients with type 2 diabetes. Median within-subject coefficient of variation (CV) was 0.070 (IQR 0.034 to .09). For healthy subjects the median CV for HbA1c % was 0.017 (IQR 0.013 to 0.022), for patients with type 1 diabetes 0.084 (IQR 0.067 to 0.89) and for type 2 diabetes 0.083 (IQR 0.06 to 0.10). CV increased with mean population HbA1c. LIMITATIONS: Assessment of variability was not the main aim of many of the included studies and some relevant papers may have been missed. Many included papers had few participants or few repeated measurements. CONCLUSIONS: Within-subject variability of HbA1c is higher for patients with than without diabetes and increases with mean population HbA1c. This may confound observed relationships between HbA1c variability and health outcomes. Because of its importance in clinical decision-making there is a need for better estimates and understanding of factors associated with of HbA1c variability.

Miniature Schnauzers under primary veterinary care in the UK in 2013: demography, mortality and disorders.

BACKGROUND: Individual dog breeds are often reported as predisposed to specific breed-related disorders but reliable epidemiological data on disease prevalence are sparse. The Miniature Schnauzer in the UK is a popular small breed dog that is often considered as relatively healthy and long-lived, but is this really true? This study aimed to use data from the VetCompass™ Programme at the Royal Veterinary College to characterise the demography, mortality and common disorders of the general population of Miniature Schnauzers under veterinary care in the UK. RESULTS: The study population of 455,557 dogs from 304 clinics in the VetCompass™ database under veterinary care during 2013 included 3857 Miniature Schnauzers (0.85%). For dogs with data available, 1771 (56.9%) were neutered and 1893 (49.2%) were females. Mean adult bodyweight overall was 9.9 kg (SD 2.2 kg) and median longevity was 11.6 years (IQR 9.3-13.1, range 0.5-17.0). The most prevalent fine-level precision disorders recorded were periodontal disease (n = 343, prevalence 17.4, 95% CI: 15.7-19.1), obesity/overweight (164, 8.3, 95% CI: 7.1-9.6), anal sac impaction (114, 5.8, 95% CI: 4.8-6.9), vomiting (100, 5.1, 95% CI% 4.1-6.1) and otitis externa (99, 5.0, 95% CI% 4.1-6.1). The most prevalent grouped-level precision disorders were dental (n = 378, prevalence: 19.2, 95% CI: 17.5-21.0), enteropathy (270, 13.7, 95% CI: 12.2-15.3), cutaneous (250, 12.7, 95% CI: 11.2-14.2) and aural (197, 10.0, 95% CI: 8.7-11.4). CONCLUSIONS: This study provides generalisable evidence on the demography, longevity and most prevalent disorders in the Miniature Schnauzer breed in the UK. Awareness of common diseases and breed predispositions can support evidence-based policies to improve breed health, guide veterinary surgeons when producing differential diagnosis lists, and assist owners when purchasing or caring for their pets.

Control of spatial orienting: context-specific proportion cued effects in an exogenous spatial cueing task.

Cognitive control refers to the ability to adjust strategy use based on the demands of a current context or task. Recent research using attentional filtering tasks has shown that cognitive control can adapt rapidly and automatically in accord with learning that is specific to particular tasks, items, and contexts (Crump, Gong, & Milliken, 2006; Fernandez-Duque & Knight, 2008; Jacoby, Lindsay, & Hessels, 2003). However, the role of context-specific control has not been investigated in detail in spatial orienting tasks. In a series of three experiments, the proportion of validly cued trials in an exogenous spatial cueing task was manipulated for one context but not for another context, with the two contexts intermixed randomly across trials. The results revealed that spatial/temporal contextual cues in conjunction, but not individually, produced context-specific control over spatial orienting.