Concordance in incidence of diabetes among persons with prediabetes detected using either oral glucose tolerance test or glycated haemoglobin

AimsTo study the concordance in the incidence of type 2 diabetes (T2DM) between cohorts with prediabetes, selected either by oral glucose tolerance test (OGTT) or glycosylated haemoglobin (HbA1c) at two years in a real world situation.MethodsTwo cohorts with impaired glucose tolerance (IGT) were selected from the non-interventional arm of the Indian diabetes prevention programmes; a group selected by using OGTT (Cohort 1, n = 498), another selected based on the HbA1c criterion (Cohort 2, n = 504). Clinical and biochemical data collected for 24 months at 6 monthly intervals were used in assessing the cumulative incidence of T2DM using the respective diagnostic criteria. Intra and inter group comparisons were analysed using appropriate statistical tests. A multiple logistic regression analysis was used to identify the variables significantly associated with the incidence of diabetes.ResultsIncidence of diabetes in both cohorts were similar at 12 and 24 months with either of the two criteria (25.3% with glucose and 27.5% with HbA1c, p = 0.41 at 24 months). The multivariate analysis confirmed the results. Only baseline waist circumference was positively associated with the incidence.ConclusionBoth OGTT and HbA1c have similar utility and validity in identifying persons with IGT. Persons identified with either of the criterion had similar incidence of T2DM among Asian Indians.     

Time spent in target range assessed by self-monitoring blood glucose associates with glycated hemoglobin in insulin treated patients with diabetes

Background and aimsSelf-monitoring blood glucose (SMBG) remains a widespread tool to monitor blood glucose. The development of diabetes management systems (DMS) allows SMBG to provide additional information as time spent in target range (TIR). This study evaluates the association between HbA1c and TIR, evaluated through DMS, over 2 months, and 2 weeks.Methods and resultsType 1 (T1D) and Type 2 (T2D) insulin-treated patients with diabetes were enrolled. We used the term PIR (Points in Range) instead of TIR, since SMBG provides point-in-time glucose values rather than a continuous trend over time. PIR was calculated in 2-month and 2-week time ranges before available HbA1c measurement.One-hundred ninety-seven patients with T1D and 36 with T2D were recruited. HbA1c and PIR were inversely associated (2 months: R -0.72, 2 weeks R -0.70; p < 0.0001) in all subjects. The relationship did not change when T1D and T2D patients were analyzed separately. For every 10% change of PIR, there was a change of HbA1c by 0.4%.ConclusionsOur study, for the first time, demonstrates a significant correlation between HbA1c and PIR calculated by DMS. DMS offers additional information useful in disease management of patients with T1D and T2D performing SMBG.     

糖化血清白蛋白检测在糖调节受损及新诊断糖尿病人群中的临床意义

目的 评估糖化血清白蛋白(GA)作为反映近期血糖总体水平的指标在糖调节受损(IGR)及新诊断糖尿病人群中的临床意义.方法 选取2007年1月至6月来本院门诊进行口服葡萄糖耐量试验的个体516名共分为3组,其中正常糖调节(NGR)组130名、IGR组154例、糖尿病组232例.测定空腹血糖(FPG)及糖负荷后0.5h血糖(0.5 h PG)、1hPG、2hPG、3hPG,同时测定HbA1c及GA等指标,对GA与各监测指标的相关性进行分析.结果 GA水平在NGR、IGR、糖尿病3组间两两比较差异均有统计学意义(P<0.01),HbA1c水平在NGR与IGR两组差异无统计学意义(P>0.05).GA与HbA1c呈显著正相关(r=0.75,P<0.01),多元逐步回归分析显示,FPG、2hPG及体重指数为GA的独立影响因素.结论 测定血糖的同时检测GA可能更有助于对糖代谢状态的评估.     

中国成人2型糖尿病患者糖化血红蛋白控制目标及达标策略专家共识

糖化血红蛋白(HbA1C)控制目标应遵循患者为中心的个体化原则,即根据患者的年龄、病程、健康状况、药物不良反应风险等因素实施分层管理。本共识建议一般成人2型糖尿病(T2DM)患者的HbA1C控制目标为<7.0%,并对其他情况下的HbA1C目标值作出推荐。本共识建议将二甲双胍作为T2DM患者单药治疗的首选,α-糖苷酶抑制剂(AGI)或胰岛素促泌剂作为单药治疗的备选。进行联合治疗时,建议根据患者是否合并动脉粥样硬化性心血管疾病(ASCVD)、心力衰竭(HF)或慢性肾脏疾病(CKD)进行分层。如患者合并ASCVD,建议在具备条件的情况下联合有心血管获益证据的胰升糖素样肽-1受体激动剂(GLP-1RA)或钠-葡萄糖共转运蛋白2抑制剂(SGLT2i)。如患者合并CKD,建议联合用药时在条件允许的情况下首选有肾脏获益证据的SGLT2i,在患者不能使用SGLT2i时可选择有肾脏获益证据的GLP-1RA。如患者合并HF,建议在条件允许时选择SGLT2i。如患者未合并ASCVD、HF或CKD时,可根据基线HbA1C水平、低血糖风险、体重、经济状况、药物可及性等因素选择联合的药物。     

The association of glycated hemoglobin with mortality and ESKD among persons with diabetes and chronic kidney disease

Context

Diabetic kidney disease (DKD) is the leading cause of end stage kidney disease (ESKD) and is associated with a considerably shortened lifespan. While glucose-lowering therapy targeting glycated hemoglobin (HbA1c) <7% is proven to reduce the risk of developing DKD, its effects on complications of DKD are unclear.

Mismatch between ADA and AGS recommendations for glycated hemoglobin targets for older adults

In recent years, modified glycemic targets have been defined for older adults with diabetes mellitus. In a sample of elderly patients, we have identified several inconsistencies between the real life applicability of glycated hemoglobin goals recommended by the American Diabetes Association and the American Geriatrics Society.     

Online social networking services in the management of patients with diabetes mellitus: Systematic review and meta-analysis of randomised controlled trials

AimsSocial networking services (SNS) can facilitate real-time communication and feedback of blood glucose and other physiological data between patients and healthcare professionals. This systematic review and meta-analysis aims to summarise the current evidence surrounding the role of online social networking services in diabetes care.MethodsWe performed a systematic literature review of the Medline, EMBASE and PsychINFO databases of all studies reporting HbA1c (glycated haemoglobin) as a measure of glycaemic control for social networking services in diabetes care. HbA1c, clinical outcomes and the type of technology used were extracted. Study quality and publication bias were assessed.ResultsSNS interventions beneficially reduced HbA1c when compared to controls, which was confirmed by sensitivity analysis. SNS interventions also significantly improved systolic and diastolic blood pressure, triglycerides and total cholesterol. Subgroup analysis according to diabetes type demonstrated that Type 2 diabetes patients had a significantly greater reduction in HbA1c than those with Type 1 diabetes.ConclusionsOnline SNS provide a novel, feasible approach to improving glycaemic control, particularly in patients with Type 2 diabetes. Further mechanistic and cost-effectiveness studies are required to improve our understanding of SNS and its efficacy in diabetes care.     

Implications of using hemoglobin A1C for diagnosing diabetes mellitus

Until 2010, the diagnosis of diabetes mellitus was based solely on glucose concentration, but the American Diabetes Association (ADA) recommendations now include a new criterion: hemoglobin A1C ≥6.5%. Because this change may have significant implications for diabetes diagnosis, we conducted a comprehensive literature review including peer-reviewed articles not referenced in the ADA report. We conclude that A1C and plasma glucose tests are frequently discordant for diagnosing diabetes. A1C ≥6.5% identifies fewer individuals as having diabetes than glucose-based criteria. Convenience of A1C test might increase the number of patients diagnosed, but this is unproven. Diagnostic cut-points for both glucose and A1C are based on consensus judgments regarding optimal sensitivity and specificity for the complications of hyperglycemia. A1C may not accurately reflect levels of glycemia in some situations, but in comparison with glucose measurements, it has greater analytic stability and less temporal variability. When choosing a diagnostic test for diabetes, the limitations of each choice must be understood. Clinical judgment and consideration of patient preference are required to appropriately select among the diagnostic alternatives.     

Effectiveness of short message service intervention to improve glycated hemoglobin control and medication adherence in type-2 diabetes: A meta-analysis of prospective studies

BackgroundDistance education or reminder by texting short message may improve HbA1c level and medication adherence to type-2 diabetes.MethodsElectronic databases (PubMed, EBSCO, Elsevier, Springer, Wiley, and Cochrane) were searched systematically for published studies up to Mar 2019. SMD and 95% confidence interval (CI) were used to evaluate the intervention effect on HbA1c level and medication adherence. The heterogeneity of the study was estimated with the I2 statistic. The publication bias was described by Beggs’ test, Egger’s test and plot.ResultsTen studies with 380 interventions and 275 controls were included in this meta-analysis. The Hba1c overall SMD was −0.49%, 95% CI −0.75 to 0.22%, and the overall SMD was 0.96%, 95% CI 0.45–1.47 for medication adherence. The I² and P were 64.90%, 0.002 and 56.40%, 0.10 respectively for Hba1c level and medication adherence.ConclusionSMS intervention was effective for HbA1c level and medication adherence according to this study for T2DM over first 6 months.     

不同糖代谢状态人群糖化血清白蛋白与HbA1c的相关性分析

目的 探讨糖化血清白蛋白(GA)与HbA1c的关系,并初步建立不同HbA1c水平其相对应的GA值.方法 选取2006年10月至2009年4月来上海交通大学附属第六人民医院门诊进行口服葡萄糖耐量试验(OGTT)的受试者2 532名,其中正常糖调节组898例、糖调节受损组695例、新诊断2型糖尿病患者组939例.采用液态酶法测定GA水平,高压液相法测定HbA1c水平,分析GA与HbA1c之间的关系.结果 (1)2532例研究对象,HbA1c水平为(6.3±1.1)%,GA水平为(17.9±4.5)%,GA/HbA1c为2.85±0.51.(2)HbA1c、GA及空腹血糖、糖负荷后各时点血糖均显著正相关(r为0.567～0.776,P均<0.01).(3)GA与HbA1c呈显著正相关(r=0.701,P<0.01),其回归方程为GA=2.871×HbA1c-0.112,即HbA1c每升高1%,GA相应升高2.87%.HbA1c为6.5%时,对应的GA值为18.5%;以GA≤18.5%来预测HbA1c≤6.5%,其敏感性、特异性、阳性预测值、阴性预测值、准确度分别为82.32%、72.49%、86.48%、65.73%、79.19%.而当HbA1c为7.0%时,GA对应值为20.0%;当HbA1c7.5%时,GA对应值为21.4%.结论 初步建立了各Hbh1c水平其相应的GA值,为GA的临床应用提供了依据.     

2型糖尿病患者糖化血红蛋白衰减动力学研究

目的 研究T2DM患者胰岛素强化治疗后HbA1c衰减动力学. 方法 选取胰岛素强化治疗后血糖达标并可持续控制血糖患者41例,随访3个月血糖和HbA1c水平,建立HbA1c衰减动力学模型. 结果 血糖达标后,HbA1c于1周后开始下降,其后下降基本呈线性,衷减速率0.071（0.062,0.077）％/d,半衰期39.4（31.7,44.6）d,衰减方程y=-0.0706×（x-7）＋治疗前HbA1c. 结论 T2DM患者经胰岛素强化治疗达标后,根据HbA1c衰减方程计算结果,与相应时间点HbA1c检测值比较,可初步判断HbA1c是否能达标,并指导治疗措施调整.     

Discordance between fasting glucose-based and hemoglobin A1c-based diagnosis of diabetes mellitus in Koreans

We analyzed data of 35,624 non-diabetic Koreans using fasting plasma glucose (FPG) criteria and HbA1c criteria in screening for diabetes. Among the 1,491 subjects newly diagnosed with diabetes, 473 (31.6%) met the FPG criteria only (≥7.0 mmol/l), 350 (23.5%) met HbA1c criteria only (≥6.5%), and 668 (44.9%) met both criteria. The DM-by-HbA1c group had significantly older age, higher proportion of women, and lower hemoglobin concentration. The DM-by-FPG group had higher systolic and diastolic blood pressure, fasting serum insulin, and HOMA-IR. Further studies are needed to determine which of these criteria is superior in predicting the risks of long-term vascular complications of diabetes.     

Diagnostic value of fasting capillary glucose,fructosamine and glycosylated haemoglobin in detecting diabetes and other glucose tolerance abnormalities compared to oral glucose tolerance test

New diagnostic criteria for diabetes mellitus recommend lowering of the fasting plasma glucose to 7.0 mmol/l. In contrast to recommendations of the American Diabetes Association (AA). WHO recommends using the oral glucose tolerance test (OGTT) in clinical practice. In this study, based on OGTT results and WHO 1998 criteria, we determined if measuring fasting capillary glycaemia (FCG) along with fructosamine and/or glycosylated haemoglobin allows the detection of glucose tolerance abnormalities better than FCG alone. OGTT was performed in 538 patients. Serum fructosamine was determined in 480 of the patients, and glycosylated haemoglobin in 234 of the patients. According to WHO 1998 criteria, the patients were divided into groups due to glucose tolerance abnormalities. Fructosamine correlated stronger with 2-h post-load glucose concentrations than with FCG. HbA1c correlated stronger with FCG than with 2-h post-load glucose. Combined use of fructosamine and FCG predicted 2-h post-load glucose better than combined use of FCG and HbA1c. Receiver operating characteristic curve analyses showed that FCG was the best criterion in discriminating diabetes. Combined use of FCG and fructosamine slightly improved the ability to discriminate glucose tolerance abnormalities from normal glucose tolerance. FCG is the most effective predictor of 2-h post-load glucose and the best criterion for discriminating diabetes and other glucose tolerance abnormalities from normal glucose tolerance. Fructosamine is a potentially useful post-load glycaemia index. OGTT is irreplaceable in identification of patients with high post-load glycaemia. Received: 14 March 2001 / Accepted in revised form: 19 December 2001     

Factors associated with clinic non-attendance in adults with Type 1 diabetes mellitus

In order to examine the causes of non-attendance in a diabetic clinic, a 1-year retrospective casenote review of 259 diabetic patients with no evidence of major complications was undertaken. Frequency of clinic attendance, clinic non-attendance, and glycaemic control (HbA_1c) were recorded. In a sub-sample of 82 patients, more detailed demographic data was obtained via questionnaire. During the previous year 39 % of patients had failed to attend the clinic on at least one occasion and 10 % were recurrent non-attenders. Non-attenders had a significantly higher mean HbA_1c compared with those who did attend (8.1 ± 2.2 vs 7.6 ± 1.6 %; p = 0.03). They were also significantly younger (mean age 27 ± 7 vs 29 ± 9 yrs; p = 0.02) and had a significantly shorter duration of diabetes (12 ± 8 vs 15 ± 10 yrs; p = 0.02). Attendance did not differ according to gender or age of onset of diabetes. Sub-sample analysis showed that smokers, those with children at home, and single parents were all more likely to default from their appointments. Non-attendance is a significant problem at our diabetic clinic, however, by addressing the reasons why patients fail to attend clinic we hope to develop strategies to encourage regular attendance. This may be translated into improved glycaemic control and ultimately reduce the risk of late diabetic complications. © 1998 John Wiley & Sons, Ltd.     

Effectiveness of a colour coded HbA1c graphical record in improving diabetes control in people with type 2 diabetes: a randomized control trial

We conducted a six-month randomized-controlled-trial to evaluate the effectiveness of a colour-coded HbA1c-graphical record in improving HbA1c level among type 2 diabetes patients. There was an improvement in the mean HbA1c knowledge score but the usage of the colour-coded HbA1c-graphical record did not produce reduction in the HbA1c level.     

HbA1C和空腹血糖在糖尿病筛查中的应用价值

目的探索HbA1c及FPG筛查糖尿病（DM）的应用价值。方法南京地区参加体检的未诊断糖尿病1330例,测定FPG和HbA1c,予标准化早餐后测定餐后2小时血糖（2hPG）,用受试者工作特征曲线（ROC）评价FPG和HbA1C筛查糖尿病的效果。结果按1999年WHO的糖尿病诊断标准,本研究人群DM患病率为6．8％。采用ROC曲线判断,与DM状态相关的FPG临界点为6．1mmol／L,敏感性和特异性分别为81．3％和96．3％;HbA1c临界点为6．1％,敏感性和特异性分别为83,5％和88．8％。当采用FPG≥6．1mmol／L或HhA1c≥6．1％作为标准时,敏感性达到92．3％,同时有较好的特异性81．2％。结论单独使用FPG较HbA1c在筛查DM中具有稍高的价值,为了最大限度的筛查DM患者,建议对6．1mmol／L≤FPG≤7．0mmol／L或HbA1c≥6．1％的患者行OGTT以明确有无糖尿病。     

Effectiveness of intervention program on the change of glycaemic control in diabetes with depression patients: A meta-analysis of randomized controlled studies

AimThe glycaemic control of diabetes with depression was inconsistent from randomized controlled studies. This meta-analysis aimed to explore the effectiveness of intervention methods in diabetes with depression.MethodsThis study systematically searched electronic databases (PubMed, EBSCO, Elsevier, Springer, Wiley, and Cochrane) for studies published up to August 17, 2020. Standardized mean difference (SMD) and 95%CI were used to evaluate the effectiveness of interventions on HbA1c. Heterogeneity was estimated using the I² statistic. Begg’s test was used to assess the possible publication bias among studies.ResultsTwelve studies of 2444 cases were included in this study. The overall SMD is ?0.22 and 95%CI ?0.33 to ?0.10 in 0–6 months of intervention group. The I² and P were 18.4% and 0.26. There are no publication bias tested (z = 0.37, P = 0.72).ConclusionCognitive behavioral therapy and mindful self-compassion might be effective method to improve glycaemic control of diabetes with depression in 0–6 months.     

糖化血红蛋白和空腹血糖用于早期筛查糖尿病的意义

探讨HbA1C和空腹血糖(FPG)在社区人群糖尿病筛查中的应用价值.对上海市杨浦区2个街道社区流行病学调查中的1 794名居民行口服葡萄糖耐量试验(OGTT),并检测HbA1C,根据世界卫生组织1999年糖尿病诊断标准,筛查出正常糖耐量(NGT)、空腹血糖受损(IFG)、糖耐量受损(IGT)、IFG合并IGT和糖尿病分别为1 411、111、73、33和166例.采用受试者工作特征(ROC)曲线判断,与诊断糖尿病相关的FPG最佳切点为6.15 mmol/L,敏感性和特异性分别为89.0%和92.8%,曲线下面积为0.959;与诊断糖尿病相关的HbA1C最佳切点为6.5%,敏感性和特异性分别为71.1%和80.2%,曲线下面积为0.822;以FPG≥6.1 mmol/L且HbA1C≥6.5%筛查糖尿病,其敏感性和特异性分别为66.9%和97.0%;以FPG≥16.1mmol/L或HbA1C≥6.5%筛查糖尿病,其敏感性和特异性分别为96.3%和76.7%.研究结果提示空腹血糖和HbA1C在社区糖尿病的筛查诊断中均有很好的价值,联合应用可提高诊断率.

Abstract：

The validity of HbA1C and fasting plasma glucose(FPG)for screening of diabetes in community population was investigated.A total of 1 794 subjects from two sub-districts of Yangpu District,Shanghai,underwent a 75 goral glucose tolerance test(OGTT)and HbA1C determination.Based on 1999 World Health Organization criteria,there were 1 411 subjects with normal glucose tolerance(NGT),111 impaired fasting glucose(IFG),73 impaired glucose tolerance(IGT),33 IFG+IGT,and 166 diabetes.According to the receiver operating characteristic curve,the optimal cut-point of FPG for diagnosing diabetes was 6.15 mmol/L with sensitivity of 89.0%,specificity of 92.8%,and area under the curve of 0.959.The cut-point of HbA1C for diagnosing diabetes was 6.5% with a sensitivity and specificity of 71.1% and 80.2%.The area under the curve was 0.822.The screening model using FPG ≥6.1mmol/L and HbA1C≥6.5% had sensitivity of 66.9% and specificity of 97.0%.When the model was FPG ≥6.1 mmol/L or HbA1C ≥6.5%,the sensitivity and specificity was 96.3% and 76.7% respectively.The results suggest that both FPG and HbA1C have good value for screening diabetes in community,and FPG combined with HbA1C may further promote diagnostic efficacy.