Comparison of glycated albumin (GA) and glycated hemoglobin (HbA1c) in type 2 diabetic patients: usefulness of GA for evaluation of short-term changes in glycemic control

We studied the cross-sectional relationship between GA and HbA1c in 142 type 2 diabetic patients who had an HbA1c level < 7.5% for at least one year without fluctuation by more than 0.5%. We also followed the changes of GA and HbA1c in 18 type 2 diabetic patients for 16 weeks as they progressed from untreated severe hyperglycemia (HbA1c > or = 9.0%) to good glycemic control (HbA1c < or = 6.5%) by intensive insulin treatment. The annual mean levels of GA and HbA1c in the stably controlled patients showed a weak, but significant, correlation (r = 0.23, p<0.001) in the 142 diabetic patients. However, the GA/HbA1c ratio ranged widely from 2.0 to 4.0 showing a normal distribution (2.9 +/- 0.34, M +/- SE), although patients with conditions affecting albumin turnover or RBC lifespan were excluded from the study. The GA/HbA1c ratio was significantly higher when patients were in hyperglycemic than when glycemic control was good (3.5 +/- 0.15 vs. 2.9 +/- 0.07, M +/- SE, p<0.01). GA decreased more rapidly than HbA1c during intensive insulin therapy, but the percent reduction of HbA1c eventually corresponded with that of GA by 16 weeks after the start of treatment. These results demonstrate that, although unknown influences on GA or HbA1c may exist, GA may be a useful marker for monitoring short-term variations of glycemic control during treatment of diabetic patients.     

Glycated Albumin Predicts the Risk of Mortality in Type 2 Diabetic Patients on Hemodialysis: Evaluation of a Target Level for Improving Survival

Glycated albumin (GA) is considered a more reliable marker than glycated hemoglobin (HbA1c) for monitoring glycemic control, particularly in diabetic hemodialysis patients. We investigated the associations of GA, HbA1c, and random serum glucose levels with survival, and evaluated possible targets for improving survival in diabetic hemodialysis patients. In this prospective, longitudinal, observational study, we enrolled 90 diabetic hemodialysis patients across six dialysis centers in Japan. The median duration of follow‐up was 36.0 months (mean follow‐up, 29.8 months; range, 3–36 months). There were 11 deaths during the observation period. GA was a significant predictor for mortality (hazard ratio, 1.143 per 1% increase in GA; 95% confidence interval, 1.011–1.292; P = 0.033), whereas HbA1c and random glucose levels were not predictors for mortality. Receiver operating characteristics curve analysis showed that the cutoff value of GA for predicting the risk of mortality was 25%. In the Kaplan–Meier analysis, the cumulative survival rate was significantly greater in patients with GA ≤25% than in patients with GA >25%. GA predicted the risk of all‐cause and cardiovascular mortality in diabetic hemodialysis patients. Our results suggest that GA ≤25% is an appropriate target for improving survival in diabetic hemodialysis patients.     

预混胰岛素治疗的2型糖尿病患者转为甘精胰岛素联合口服药治疗的疗效分析

目评价甘精胰岛素联合口服降糖药物(OADs)治疗方案对使用预混胰岛素血糖控制欠佳的2型糖尿病患者的疗效及安全性.方法 预混胰岛素30/70单独或联合使用OADs血糖控制不良的2型糖尿病患者50例,随机分为治疗组(停用预混胰岛素,改为皮下注射甘精胰岛素联合OADs,n=30)和对照组(继续使用预混胰岛素早、晚餐前皮下注射...     

Clinical inertia in patients with type 2 diabetes treated with oral antidiabetic drugs: Results from a Japanese cohort study (JDDM53)

Aims/IntroductionTreatment intensification is commonly delayed in people with type 2 diabetes, resulting in poor glycemic control for an unacceptable length of time and increased risk of complications.Materials and MethodsThis retrospective study investigated clinical inertia in 33,320 Japanese adults with type 2 diabetes treated with oral antidiabetic drugs (OADs) between 2009 and 2018, using data from the Computerized Diabetes Care (CoDiC^®) database.ResultsThe median time from first reported glycated hemoglobin (HbA1c) ≥7.0% (≥53 mmol/mol) to treatment intensification was considerably longer and HbA1c levels were higher the more OADs the patient was exposed to. For patients receiving three OADs, the median times from HbA1c ≥7.0% (53 mmol/mol) to intensification with OAD, glucagon‐like peptide‐1 receptor agonist or insulin were 8.1, 9.1 and 6.7 months, with a mean HbA1c level at the time of intensification of 8.4%, 8.9% and 9.3%, respectively. The cumulative incidence for time since the first reported HbA1c ≥7.0% (≥53 mmol/mol) to intensification confirmed the existence of clinical inertia, identifying patients whose treatment was not intensified despite poor glycemic control. HbA1c levels ≥7.0% (≥53 mmol/mol) after ≥6 months on one, two or three OADs were observed in 42%, 51% and 58% of patients, respectively, showing that approximately 50% of patients are above HbA1c target regardless of how many OADs they take.ConclusionsReal‐world data here show clinical inertia in Japanese adults with type 2 diabetes from early diabetes stages when they are receiving OADs, and illustrate a need for earlier, more effective OADs or injectable treatment intensification and better communication around the existence of clinical inertia.     

Assessment of microalbuminuria and glycated hemoglobin in type 2 diabetes mellitus complications

ObjectiveTo relate microalbuminuria with the degree of glycaemic control in type 2 diabetic patients and determine the prevalence of poor glycemic control amongst the normotensive diabetes mellitus (NDM) and hypertensive diabetes mellitus (HDM) with or without microalbuminuria.MethodsA total of 95 type 2 diabetes mellitus patients and 30 healthy controls were randomly selected and studied. 17 of the 95 patients were normotensive diabetic with microalbuminuria, 40 of them were HDM presenting with microalbuminuria and 38 were NDM without microalbuminuria. Their blood was obtained for fasting plasma glucose and glycated haemoglobin while their urine was obtained for albumin and creatinine estimation and the ratio was calculated.ResultsOut of the 95 diabetic patients studied, 57 (60%) of them had microalbuminuria while 38 (40%) had normoalbuminuria. The mean ages in the diabetics with microalbuminuria were higher than those without microalbuminuria (P=0.054 6). The mean glycated haemoglobin was the highest (5.95±2.06)% in NDM with microalbuminuria when compared with HDM with microalbuminuria (5.83±1.62)% and that in (5.66±2.49)% in NDM without microalbuminuria (P=0.000 9). Similarly, fasting plasma glucose was the highest (9.09±4.31) mmol/L in NDM with microalbuminuria than those without microalbuminuria (7.70±3.33) mmol/L (P=0.000 1). The prevalence of poor glycaemic control was the highest (29%) in NDM with microalbuminuria while the least (21%) in NDM without microalbuminuria.ConclusionsThe risk of microalbuminuria increases with poor glycemic control. Persistent increase in glycated haemoglobin may be an indicator of worsening albumin creatinine ratio and diabetic nephropathy. Therefore, regular screening for microalbuminuria in addition to continuous (3-monthly) glycated HbA1c estimation is advised.     

Poor Glycemic Control is a Significant Predictor of Cardiovascular Events in Chronic Hemodialysis Patients With Diabetes

We investigated the impact of glycemic control on the emergence of cardiovascular disease (CVD) in diabetic patients who were on maintenance hemodialysis in a prospective observational study. One hundred and thirty‐four diabetic hemodialysis patients (63 ± 10 years‐old, hemodialysis duration of 4.5 ± 3.9 years) at a single dialysis center were enrolled. The cohort was observed prospectively for 5 years, and the emergence of fatal and non‐fatal CVD was recorded. Patients were categorized into two groups; good (mean hemoglobin (Hb) A1C <7.0%, N = 65) and poor HbA1C (mean HbA1C ≥7.0%, N = 69). The relationship between glycemic control and CVD emergence was evaluated by Kaplan‐Meier estimation and Cox proportional hazard models. During the follow‐up period, 50 CVD events were observed. The cumulative CVD incidence in the poor HbA1C group was significantly higher than that of the good HbA1C group, as determined by Kaplan‐Meier estimation (P = 0.0250, log‐rank test). After adjustment for gender, age, duration of dialysis, and past history of CVD, a multivariate Cox proportional hazard model showed that poor HbA1C was a significant predictor of CVD events (hazards ratio [HR] 1.828 [95% CI, 1.008–3.314], P = 0.0470). When ischemic heart disease, cerebral infarction, and arteriosclerosis obliterans were determined as an endpoint, both HbA1C levels and the poor HbA1C group were significant predictors for the emergence of CVD (HR 1.269 per 1% HbA1C [95%CI, 1.022–1.574], P = 0.0307,and HR 2.816 [95% CI, 1.377–5.759], P = 0.0046, respectively). In diabetic hemodialysis patients, poor glycemic control is a significant, independent predictor of the emergence of CVD, indicating the importance of careful management of glycemic control in hemodialysis patients.     

Comparison of the glycemic control of the normo- and hypertensive Chinese patients with type 2 diabetes in a general outpatient clinic in Hong Kong

ObjectivesTo describe and compare glycemic control between normo- and hypertensive type 2 diabetic Chinese patients in outpatient setting.MethodsThis retrospective cross-sectional study was performed by retrieving the records of 548 Chinese type 2 diabetic patients. HbA1c ≦ 6.5% was regarded as glycemic good control. Linear and logistic regressions were used to compare mean HbA1c levels and the proportions with good glycemic control between hypertensive and normotensive patients while controlling for confounders.ResultsThe means HbA1c for all diabetic, hypertensive and normotensive patients were 7.70, 7.55 and 8.01, respectively. The normotensive group had a significant higher HbA1c (p = 0.004). Significantly higher HbA1c was associated with lower age (CI of β: ?0.024 to ?0.001, p = 0.039), female gender (CI of β: 0.039–0.552, p = 0.024) and medication use (CI of β: 0.577–1.250, p < 0.001).The proportions with good glycemic control for the all diabetic, hypertensive, normotensive subjects were 0.235, 0.249 and 0.207, respectively. No significant difference was shown for the two groups’proportions (p = 0.283). Lower proportions of good control were shown in females (CI of OR: 0.398–0.905, p = 0.015) and those on medication (CI of OR: 0.211–0.543, p < 0.001) by stepwise logistic regression.ConclusionThe hypertensive diabetic patients had better glycemic control than the normotensives.     

Impact of Medication Adherence and Glycemic Control on the Risk of Micro- and Macrovascular Diseases in Patients with Diabetes

PurposeOur purpose in the research was to clarify the impact of medication adherence to oral hypoglycemic agents during a 1-year period and subsequent glycemic control on the risk of micro- and macrovascular diseases.MethodsExamined was a nationwide claims database on 13,256 individuals with diabetic eye disease without requiring prior treatment, 7,862 without prior initiation of dialysis, 15,556 without prior coronary artery disease, 16,243 without prior cerebrovascular disease, and 19,386 without prior heart failure from 2008 to 2016 in Japan. Medication adherence was evaluated by the proportion of days covered. Patients were considered to have poor adherence if the proportion of days covered was <80%. Multivariate Cox regression model identified risks of micro- and macrovascular diseases.ResultsIn each group, mean age was 53 to 54 years, HbA1c was 7.1% to 7.2%, and median follow-up period was 4.6 to 5.1 years, and the percentage of poor adherence was approximately 30%. During the study period, 532 treatment-requiring diabetic eye disease, 75 dialysis, 389 coronary artery disease, 316 cerebrovascular disease, and 144 heart failure events occurred. Multivariate Cox regression model revealed that the hazard ratio (95% confidence interval) of dialysis in the poor adherence group was 2.04 (1.27-3.30) compared with the good adherence group. The hazard ratios in the poor adherence/poor glycemic control group were 3.34 (2.63-4.24) for treatment-requiring diabetic eye disease, 4.23 (2.17-8.26) for dialysis, 1.69 (1.23-2.31) for coronary artery disease, and 2.08 (1.25-3.48) for heart failure compared with the good adherence/good glycemic control group.ConclusionsPoor medication adherence was an independent risk factor for the initiation of dialysis, suggesting that clinicians must pay close attention to these patients.     

Comparison of annual variability in HbA1c and glycated albumin in patients with type 1 vs. type 2 diabetes mellitus

ObjectiveIt has been suggested that plasma glucose (PG) levels per se and long-term variations in PG levels are associated with diabetic vascular complications. Glycated albumin (GA) reflects shorter-term glycemic control, as well as postprandial PG levels, as compared to HbA1c. In this study, we hypothesized that GA more strongly reflects long-term variations in PG levels than HbA1c, and compared the variability of HbA1c and that of GA in patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM).MethodsThis study included 8 T1DM patients and 48 T2DM patients. Over a 1-year period, HbA1c and GA were measured every month and the mean values and coefficients of variation (CV) for each patient were calculated.ResultsIn both T1DM and T2DM patients, the CV of GA was significantly higher than the CV of HbA1c. Both the CV of HbA1c and the CV of GA were significantly higher in the T1DM patients than in the T2DM patients.ConclusionThe annual variability in GA was greater than that in HbA1c. In addition, the annual variability in HbA1c and that in GA in the T1DM patients were greater than in the T2DM patients. Our findings suggest that GA more accurately reflects long-term variations in PG levels than HbA1c.     

Intensive versus conventional glycemic control: What is best for patients with type 2 diabetes?

BackgroundRecently a hot debate was raised to answer if intensive glycemic control aimed to reduce HbA1c to less than 6.5% is better than conventional therapy in terms of future outcomes. A lot of studies were conducted to explore that but few mega trials were conducted.ObjectiveTo evaluate the effect and safety of both intensive and conventional insulin therapy in patients with type 2 diabetes.MethodologyTraditional systematic review was conducted; criteria for studies selection were formatted. Studies selected were criticized.ResultsThree mega trials (3) randomized 23,182 participants with type 2 diabetes (11,591 to intensive glycemic control and 11,591 to conventional glycemic control) were included. Only diabetic nephropathy was noted to be delayed in onset or progression by intensive insulin therapy.ConclusionThere are no benefits from intensive glycemic therapy (target HbA1c < 6.4%) versus conventional glycemic therapy (target HbA1c > 6.4%) except for decrease the rate of new onset or progression of nephropathy.     

The effect of glycemic control on salivary lipid peroxidation in type II diabetic patients

Background and objectiveHyperglycemia and some disturbance in antioxidant system lead to free radicals production and oxidative stress. Assessment of some products of oxidative stress could be effective in evaluation of diabetic control. This study aimed at evaluation of glycemic control on salivary lipid peroxidation in diabetic patients.MethodsThis case control study has been done on 44 diabetic (type II) and 44 healthy subjects. Un-stimulated saliva was collected and correlation between malondialdehid (MDA) as an end -product of lipid peroxidation and HbA1c was assessed.ResultsMDA and HbA1c of diabetic patients were significantly higher than control group. There was a indirect correlation between MDA and glycemic control level.ConclusionEvaluation of salivary MDA levels could be useful in prediction of glycemic control.     

2型糖尿病患者治疗过程中的临床惰性及其影响因素:一项多中心观察性研究结果

目的了解通过生活方式干预和口服药物治疗的2型糖尿病(T2DM)患者治疗过程中的临床惰性并分析其影响因素。方法2015年3至5月对"中国城市三级甲等医院T2DM费用调查研究"中基线糖化血红蛋白(HbA1c)≥7.0%的患者进行随访,6个月后了解患者药物治疗情况,如6个月后治疗方案未做升级,即未增加≥1种的口服降糖药物、未起始胰岛素或未起始胰高糖素样肽-1(GLP-1)受体激动剂即被视为临床惰性。采用logistic回归模型进行多变量分析以识别临床惰性的独立预测因素。结果共纳入T2DM患者178例,其中男101例(56.7%),女77例(43.3%),年龄(58±11)岁,糖尿病病程(7±7)年,HbA1c(8.6±1.6)%。T2DM患者总体临床惰性发生率为52.2%(93/178),增加口服降糖药物种类、起始胰岛素或者起始GLP-1受体激动剂的比例分别为30.9%(55/178)、16.3%(29/178)和0.6%(1/178)。临床惰性的影响因素包括HbA1c7.5%~8.9%(OR=3.437,95%CI:1.421~8.309)和HbA1c≥9.0%(OR=9.738,95%CI:3.634~26.901)、糖尿病视网膜病变(OR=2.732,95%CI:1.004~7.431)、使用两种以上口服药物(OR=2.651,95%CI:1.248~5.635)以及糖尿病病程(OR=1.064,95%CI:1.005~1.126)。结论超过半数血糖控制不达标的T2DM患者治疗过程中存在临床惰性。病程长、血糖控制差、使用两种以上口服药物以及合并糖尿病视网膜病变的患者更容易出现临床惰性。     

Relationship between glycemic control and chronic obstructive pulmonary disease in patients with type 2 diabetes: A nested case-control study

AimsTo evaluate the relationship between glycemic control and plasma glycated hemoglobin (HbA1c) levels in patients with type 2 diabetes mellitus (T2D) and the risk of chronic obstructive pulmonary disease (COPD).MethodsWe conducted a population-based, retrospective, nested, case-control study involving 124,876 patients with DM2 from the Canary Islands, Spain. From the cohort, we selected all COPD cases and, for each case, five control subjects who were COPD free. We analyzed the association between glycemic control, HbA1c level and incident COPD.ResultsA total of 1320 incidence cases of COPD (1.06%) were identified and matched individually with 6600 controls according to age and sex. After multivariate adjustment, the COPD risk increased among patients with poor glycemic control compared to patients with good glycemic control [HbA1c levels <7% (53 mmol/mol)] (OR 1.18; 95% CI: 1.03–1.36). In comparison with patients exhibiting HbA1c levels <7% (53 mmol/mol), the risk of COPD was higher among people with HbA1c levels of 7–8% (53–64 mmol/mol) (OR 1.24; 95% CI: 1.05–1.47) and 8–9% (64–75 mmol/mol) (OR 1.31; 95% CI: 1.04–1.66).ConclusionsPoor glycemic control reveals a weak association with increased risk of COPD in T2D patients.     

Glycemic control and safety in Chinese patients with type 2 diabetes mellitus who switched from premixed insulin to insulin glargine plus oral antidiabetics: a large,prospective, observational study

In some circumstances, the premixed insulin should be switched to alternative therapy. The effectiveness and the safety of switching from premixed insulin to insulin glargine plus oral antidiabetic drugs (OADs) in Chinese patients with type 2 diabetes mellitus (T2DM) have not been clarified and, hence, will be assessed in this study. Chinese patients with T2DM (2013 men and women aged 18–75 years) who had received premixed insulin ± OADs for ≥3 months with glycated hemoglobin (HbA1c) ≤ 10% were enrolled in a prospective, observational study conducted at 53 hospitals across China. At baseline and at the discretion of the physician, patients switched from premixed insulin to insulin glargine plus OADs. Changes in HbA1c, fasting plasma glucose (FPG), 2‐hour postprandial glucose (PPG), treatment satisfaction, and the incidence of hypoglycemia were assessed for 16 weeks. In total, 1850 patients completed the study. Mean HbA1c level for the group decreased significantly (from 7.8% ± 1.2% at week 1 to 7.0% ± 1.0% at week 16; P  < .0001), and 55.2% of patients achieved HbA1c < 7% at week 16. Mean FPG and 2‐hour PPG decreased significantly (−1.4 ± 2.2 and −2.1 ± 3.9 mmol/L, respectively; both P  < .0001), whereas patient satisfaction improved significantly. Adverse events were reported in 18.7% of patients. Chinese patients with T2DM who switched from premixed insulin to insulin glargine plus OADs achieved significantly improved glycemic control and treatment satisfaction with a low incidence of hypoglycemia. Patients who are most likely to achieve the HbA1c target less than 7% are younger, have shorter disease duration, and have lower baseline HbA1c and FPG levels.     

Pregnancy outcome and glycemic control in women with type 1 diabetes: A retrospective comparison between CSII and MDI treatment

AimPresent study was aimed to evaluate glycemic control and maternal–fetal outcome in pregnant type 1 diabetic patient treated with continuous subcutaneous insulin infusion (CSII) or multiple daily injections of insulin (MDI).Patients and methodsA retrospective observational study included thirty-four pregnant type 1 diabetic patients. Patients were divided into two group, CSII treated group (n = 14) and MDI treated group (n = 20). The HbA1c level and maternal–fetal outcome were evaluated in both the treatment group. Outcome parameters such as glycemic control (HbA1c), hypoglycemic events, time and mode of delivery and labor results (abortion, premature labor, perinatal mortality, neonatal weight, Apgar score, neonatal hypoglycaemia, presence of congenital abnormalities) were analyzed.ResultsPregnancy outcome and glycemic control in pregnant type 1 diabetic patients treated with CSII and MDI were evaluated and compared. Two groups were compared for their epidemiological parameters, although patients on CSII treatment had longer duration of diabetes compared to MDI treated group. Reduction in HbA1c level was higher in CSII treated patients at first (CSII: 0.9% vs MDI: 0.46%), second (CSII: 1.58% vs MDI: 0.78%) and third trimester (CSII: 1.74% vs MDI: 1.09%) of pregnancy compared to MDI treated patients. Duration of pregnancy and new born baby weight were founded similar in both group. Moreover, the rate of abortion, preterm labor, cesarean section and hypoglycemia in new born were founded less in CSII treated group compared to MDI treated group and Apgar score was significantly (p < 0.05) higher in CSII treated group compared to MDI treated group.ConclusionResults of present study revealed that the CSII gives better glycemic control and pregnancy outcome in pregnant type 1 diabetic patients compared to MDI treatment. CSII also decreases the daily insulin requirement compared MDI.     

Glycated hemoglobin A1C level and the risk of diabetic retinopathy in Africa: A systematic review and meta-analysis

Background and aimsDiabetic retinopathy is a frequent cause of acquired blindness worldwide. Various studies have reported the effects of glycemic control on the risk of diabetic retinopathy, but the results remain inconclusive. Therefore, this meta-analysis was performed to determine the association between glycated hemoglobin A1C levels and diabetic retinopathy in Africa.MethodsA systematic search was performed using the PubMed, African Journals Online, Google Scholar, Scopus, and Wiley Online Library from inception to June 11, 2020, for observational studies addressing the association of hemoglobin A1c levels with diabetic retinopathy. The I² statistic was used to check heterogeneity across the included studies. A random-effects model was applied to estimate the pooled effect size (OR) and respective 95% confidence interval across studies. A funnel plot and Egger’s regression test were used to determine the presence of publication bias. Sensitivity analysis was used to determine the effect of a single study on the overall estimation. All statistical analyses were performed using STATA™ Version 14 software.ResultA total of 23 articles with 18,099 study participants were included in this meta-analysis. In the present review, when HbA1c was analyzed as a categorical variable, poor glycemic control (HbA1c >7%) was associated with an increased risk of diabetic retinopathy when compared with good glycemic control (OR = 1.25; 95% CI; 1.14, 1.38). Similarly, when HbA1c was analyzed as a continuous variable, a higher HbA1c was associated with an increased risk of diabetic retinopathy (MD: 0.42, 95% CI; 0.11, 0.98).ConclusionOur meta-analysis indicated evidence for poor glycemic control as an independent risk factor for the development of diabetic retinopathy in patients with diabetes mellitus. Therefore, the authors suggest that clinicians should advise their patients with diabetes to maintain their HbA1c levels within the normal range.     

Predictor variables and an equation for estimating HbA1c attainable by initiation of basal supported oral therapy†

Aims/Introduction: A method of estimating HbA1c attained after initiation of basal supported oral therapy (BOT) has not been reported previously. The aim of the present study was to determine which characteristics of patients could influence the effectiveness of BOT introduction, and to obtain an equation to estimate HbA1c after BOT initiation. Materials and Methods: Sixty consecutive insulin‐naive type 2 diabetic patients with poor glycemic control (HbA1c ≥7.5%) started once‐daily injections of insulin glargine. Simple correlations were calculated between parameters such as HbA1c at baseline, HbA1c at week 24, reduction rate of HbA1c over 24 weeks (calculated as: [HbA1c level at baseline – HbA1c level at week 24]/HbA1c level at baseline), duration of diabetes, and the number of classes of coadministered oral antidiabetic drugs. Using multiple linear regression models, the independent effects of these parameters on HbA1c at week 24 were evaluated separately. Results: Multiple linear regression analysis revealed that duration of diabetes (β = 0.561; P < 0.001) and HbA1c at baseline (β = 0.284; P = 0.006) were significant predictors of HbA1c at week 24. The best fitting multiple regression equation was: HbA1c at week 24 = 0.078 × duration of diabetes + 0.218 × HbA1c at baseline + 4.628 (r² = 0.437). Conclusions: The equation based on the multiple linear regression models indicates necessary conditions for type 2 diabetic patients to achieve target HbA1c. The present findings emphasize the principle that early initiation of BOT in type 2 diabetes effectively achieves good glycemic control. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2011.00164.x, 2011)     

Impaired intestinal barrier function in type 2 diabetic patients measured by serum LPS,Zonulin, and IFABP

IntroductionThe epithelial tight junctions of intestine were impaired in murine model of type 2 diabetes mellitus (T2DM). The aim of this work was to investigate the alteration of intestinal barrier in T2DM patients.Methods90 patients with T2DM and 28 healthy controls were recruited. Serum lipopolysaccharide (LPS), Zonulin, and intestinal fatty acid binding protein (IFABP) were measured by ELISA, based on which a derived permeability risk score (PRS) was calculated. Subgroup analyses were conducted based on the glycemic control (HbA1c < 7%, or HbA1c ≥ 7%), the amount of chronic diabetic complications, and the use of aspirin at the time.ResultsSerum LPS, Zonulin, and IFABP, and PRS of T2DM group were significantly higher than those of the control group (p < 0.05 for all). Serum LPS and PRS was higher in T2DM patients with poor glycemic control (both p < 0.05). Patients with more chronic complications of diabetes had higher serum LPS and IFABP, and PRS (all p < 0.05). No differences were found in these serum markers between T2DM patients being treated with aspirin or not.ConclusionsIntestinal barrier function was impaired in T2DM patients. Poor glycemic control and more chronic complications of diabetes were associated with worse intestinal barrier function. Treatment with aspirin did not aggravate the impairment of intestinal barrier in T2DM patients.     

Predictors of type 2 diabetes relapse after Roux-en-Y Gastric Bypass: A ten-year follow-up study

Aims: To assess the impact of bariatric surgery on remission and relapse of type 2 diabetes mellitus (T2DM) at 10 years of follow-up and analyze predictive factors.Materials and Methods: Eighty-eight obese subjects undergoing Roux-en-Y gastric bypass (RYGB) and 25 subjects assigned to medical therapy (MT) were evaluated every year for 10 years. T2DM remission was defined by the American Diabetes Association criteria.Results: Body mass index (BMI), fasting glucose, and haemoglobin A1c (HbA1c) improved more markedly in RYGB than MT patients throughout the 10-year period. Post-surgery remission rates were 74% and 53% at 1 and 10 years, respectively, while remission did not occur in MT patients. One-year post-surgery, BMI decreased more in subjects with remission than in those without, but no further decrease was observed thereafter. By partial-least-squares analysis, T2DM duration, baseline HbA1c, and ensuing insulin therapy were the strongest predictors of remission. Remission was achieved at one year in 91% of patients with T2DM duration < 4 years, and 79% of them remained in remission at 10 years. On the contrary only 42% of patients with T2DM duration ≥ 4 years achieved remission, which was maintained only in 6% at the end of 10 years. By survival analysis, patients with T2DM duration < 4 years had higher remission rates than those with duration ≥ 4 years (hazards ratio (HR) 3.1 [95%CI 1.8–5.7]). Relapse did not occur before two years post-surgery and was much less frequent in patients with < 4- vs ≥ 4-year duration (HR 11.8 [4.9–29.4]).Conclusions: Short T2DM duration and good glycemic control before RYGB surgery were the best requisites for a long-lasting T2DM remission, whereas weight loss had no impact on the long-term relapse of T2DM.     

More patients reach glycaemic control with a fixed‐ratio combination of insulin glargine and lixisenatide (iGlarLixi) than with basal insulin at 12 weeks of treatment: A post hoc time‐to‐control analysis of LixiLan‐O and LixiLan‐L

The present post hoc analysis of two 30‐week clinical trials compared efficacy and hypoglycaemia outcomes at early study visits with iGlarLixi (insulin glargine U100 [iGlar] and lixisenatide) vs iGlar alone in patients with type 2 diabetes (T2D) uncontrolled on oral antidiabetic drugs (OADs; LixiLan‐O trial) or basal insulin (LixiLan‐L trial). Time to control, defined as days to achieve glycated haemoglobin (HbA1c) <53 mmol/mol (<7%) or fasting plasma glucose (FPG) ≤7.2 mmol/L, was estimated using the Kaplan–Meier method. In the LixiLan‐O and LixiLan‐L trials, 60% and 46% of patients, respectively, reached HbA1c <53 mmol/mol (<7%) with iGlarLixi at 12 weeks, vs 45% and 24%, respectively, with iGlar. In the LixiLan‐O trial, the median time to target HbA1c was approximately half with iGlarLixi vs iGlar (85.0 vs 166.0 days; P < .0001). In the LixiLan‐L trial, the median time to target HbA1c was 153.0 days with iGlarLixi, while target HbA1c was never reached by 50% of patients with iGlar (P < .0001). Time‐to‐target FPG and hypoglycaemia outcomes were similar between treatments. In T2D uncontrolled on OADs or basal insulin, iGlarLixi resulted in glycaemic control in more patients than did iGlar at early treatment time points.