Glycaemic control and sepsis risk in adults with type 1 diabetes

Aims

To study the association between glycated haemoglobin (HbA1c) and sepsis in adults with type 1 diabetes, and to explore the relationship between HbA1c and mortality among individuals who developed sepsis.

Materials and Methods

We included 33 549 adult individuals with type 1 diabetes recorded in the Swedish National Diabetes Register between January 2005 and December 2015. We used multivariable Cox regression and restricted cubic spline analyses to study the relationship between HbA1c values and sepsis occurrence and association between HbA1c and mortality among those with sepsis.

Results

In total, 713 (2.1%) individuals developed sepsis during the study period. Compared with the HbA1c reference interval of 48-52 mmol/mol (6.5-6.9%), the adjusted hazard ratio for sepsis was: 2.50 [95% confidence interval (CI) 1.18-5.29] for HbA1c <43 mmol/mol; 1.88 (95% CI 0.96-3.67) for HbA1c 43-47 mmol/mol; 1.78 (95% CI 1.09-2.89) for HbA1c 53-62 mmol/mol; 1.86 (95% CI 1.14-3.03) for HbA1c 63-72 mmol/mol; 3.15 (95% CI 1.91-5.19) for HbA1c 73-82 mmol/mol; and 4.26 (95% CI 2.53-7.16) for HbA1c >82 mmol/mol. On multivariable restricted cubic spline analysis, we found a J-shaped association between HbA1c and sepsis risk, with the lowest risk observed at HbA1c of approximately 53 mmol/mol. We found no association between HbA1c and mortality among those individuals who developed sepsis.

Conclusions

In our nationwide observational study of adult individuals with type 1 diabetes we found a J-shaped relationship between HbA1c and risk of sepsis, with the lowest risk at HbA1c levels about 53 mmol/mol (7.0%). HbA1c was not associated with mortality in individuals affected by sepsis.     

Adherence to lifestyle recommendations is associated with improved glycemic control and improved blood lipid levels in Korean adults with type 2 diabetes

We explored the association between the degree of adherence to recommendations and diabetes management in Korean adults who had type 2 diabetes for an average of 8 years. Subjects who met five or more lifestyle recommendations showed significantly lower blood lipid parameters and glycated hemoglobin than those who did not.     

Glycaemic control and body mass index in late‐adolescents and young adults with Type 1 diabetes mellitus: a population‐based study

Aims Studies of children with diabetes up to the age of 15 years report deteriorating glycaemic control in the early teenage years. The aim was to investigate glycaemia and body mass index in older teenagers and young adults. Method A Scottish, regional, population‐based, cross‐sectional study of 255 young people (117 female, 138 male) with Type 1 diabetes, aged 15–25 years (mean ±sd 19.8 ± 2.8 years, diabetes duration: 8.8 ± 5.4 years) registered on a diabetes database. Glycaemic control, body mass index (BMI) and insulin regimens were assessed in three age groups [group 1 (n = 96) 15–18 years; group 2 (n = 74) 18.1–22 years; and group 3 (n = 85) 22.1–25 years]. Results Subjects in the oldest age group had a significantly lower mean HbA_1c than those in the youngest age group (8.8 ± 1.7 vs. 9.9 ± 1.9%; P < 0.001). Mean BMI was higher in group 3 (25.2 ± 3.4 kg/m²) compared with group 1 (23.9 ± 3.1 kg/m²; P < 0.001). HbA_1c levels were higher in the younger subjects and women. Lower HbA_1c levels were associated with a higher BMI (r = ?0.324, P < 0.001) in men only. Overall, 74% took three or more injections a day, of whom 60% were on basal/bolus therapy. The proportion on basal/bolus insulin therapy increased with age and duration of diabetes. Conclusion Compared with adolescents, young adults with Type 1 diabetes have better glycaemic control and higher BMI. This was associated with lower insulin requirements.     

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.     

Does poor early metabolic control predict subsequent poor control in young children with type 1 diabetes: an exploratory study

Background: We sought to determine whether poor metabolic control during the early stages of Type 1 diabetes mellitus predicts control during subsequent years. We hypothesized that poor control in the first year after diagnosis would predict poor control in the following year, and that poor control in the second year after diagnosis would predict poor metabolic control in subsequent years. Methods: We conducted a retrospective review of a cohort of urban children treated for diabetes at our institution who were diagnosed between 1992 and 2005. We calculated odds ratios to determine whether control in Year 1 or in Year 2 predicted control in Years 3–6. Cox regression analyses were used to determine whether poor early control predicted progression to subsequent poor control. Results: Metabolic control in the first year after diagnosis was not a good predictor of future control. However, poor metabolic control in the second year after diagnosis was highly predictive of poor control in subsequent years and predicted faster progression to poor control. Conclusion: The findings suggest that poor metabolic control in Year 2 may be a predictor of subsequent poor metabolic control. Targeting prevention interventions to reduce non‐adherence and to enhance metabolic control to families that show poor metabolic control in Year 2 may prove to be an optimum investment in terms of improved medical outcomes and enhanced quality of life.     

Relationship of alcohol use and facial flushing to blood pressure and HbA1c among Cambodian populations with dysglycemia in the U.S. and in Cambodia

Background and aimsFacial flushing after drinking alcohol, common among Asians, is a phenotype for genes involved in alcohol metabolism.MethodsWe investigated cross-sectional associations between flushing, alcohol use, blood pressure (BP) and HbA1c among (n = 287) Cambodians with dysglycemia in Cambodia and in the U.S. Participants were categorized as Abstainers, Flushers who drink, or Non-flushers who drink.ResultsFlushers and Non-flushers had similar alcohol use. Flushers had higher BP than Non-flushers and Abstainers, even after controlling for confounders. Findings were similar across countries. Drinkers had higher HbA1c than Abstainers.ConclusionsFuture research should examine whether reducing alcohol improves cardiometabolic outcomes.     

Plasma relaxin concentration is related to beta-cell function and insulin sensitivity in women with type 2 diabetes mellitus

The aim of the study was to assess whether HbA_1c levels reflected mean blood glucose (MBG) levels in Type 2 diabetes. Despite the good correlation between HbA_1c and MBG, one-third of the patients had consistently higher HbA_1c or lower HbA_1c levels than that expected under the hypothesis that HbA_1c is solely determined by MBG, suggesting the existence of different haemoglobin glycation phenotypes. The use of HbA_1c alone for glycemic control monitoring in these patients could be insufficient to clearly trace their risk of complications.     

2型糖尿病患者的血糖控制和医疗费用的多因素分析

目的　了解中国大城市 2型糖尿病 (T2DM )患者的血糖 (PG)和糖化血红蛋白 (HbA1c)及其控制情况 ,以及影响患者医疗费用的因素。　方法　对国内 11个大城市的T2DM患者抽样调查 ,收集其疾病控制和治疗费用数据 ,以及相关的影响因素。调查的 1111例T2DM患者中 ,门诊 6 5 8例 ,住院 4 5 3例 ,采用描述统计的方法分析患者的HbA1c和PG控制情况 ,用多因素模型分析医疗费用的主要影响因素。　结果　 6 8%患者的空腹血糖 (FPG)没有得到很好控制 ( >7.0mmol/L) ,4 2 %的HbA1c控制效果不佳 ( >7.5 % )。门诊医疗费用的多因素分析中医院级别 (P <0 .0 0 1)、并发症 (P<0 .0 0 1)和末次空腹静脉血糖控制水平 (P <0 .0 5 )是影响患者就诊费用的主要因素。住院医疗费用多因素分析结果显示 ,住院天数 (P <0 .0 0 1)、医院级别、并发症 (P <0 .0 0 1)、家庭人均收入是影响患者住院费用的主要因素。　结论　中国大城市中 5 0 %左右T2DM患者按照 ( 2 0 0 2年的治疗情况 )PG和HbA1c控制效果不佳 ,并发症和PG控制效果不好是T2DM患者医疗费增多的显著因素     

Periodontal disease and type 1 diabetes mellitus: Associations with glycemic control and complications: An Indian perspective

AimTo evaluate the frequency of periodontal disease in a group of patients with type 1 diabetes mellitus and its relationship with diabetic metabolic control, duration and complications.Materials and methodsA comparison was made of periodontal parameters (plaque index, bleeding index, pocket depth and attachment loss) in a group of diabetic patients versus a group of non-diabetics (n = 20). Statistical analysis was performed to evaluate the relationship between periodontal parameters and degree of metabolic control, the duration of the disease and the appearance of complications.ResultsDiabetics had greater bleeding index (p < 0.001), probing pocket depth (p < 0.001) and clinical attachment level (p = 0.001). Patients diagnosed for diabetes for shorter duration of time (4–7 years) showed bleeding index-disease severity correlation to be 1.760 ± 0.434.ConclusionPatients with type 1 diabetes have increased periodontal disease susceptibility. Periodontal inflammation is greatly increased in subjects with longer disease course, poor metabolic control and diabetic complications.     

Dimethylarginines in patients with type 2 diabetes mellitus: relation with the glycaemic control

We tested the relationship between plasma levels of dimethylarginines (ADMA and SDMA) and glycaemic control in 43 type 2 diabetic patients. Type 2 diabetics with poor glycaemic control (HbA1c > 6.5) had significantly lower SDMA and higher ADMA concentrations than those with well-controlled glycaemia (HbA1c < 6.5).     

Blood pressure disturbances and endothelial dysfunction markers in children and adolescents with type 1 diabetes

Objective: Being the earliest step on the way to atherosclerosis, endothelial dysfunction is particularly escalated in diabetes. This study aimed at assessing endothelial dysfunction and blood pressure disturbances in young patients with type 1 diabetes mellitus (T1DM) and defining their interrelations. Methods: The study group comprised 52 children and adolescents aged 14.07 ± 3.03 years, with T1DM duration 5.13 ± 2.18 years. 20 healthy controls with similar age and sex distribution were included. Chosen serum biochemical markers of endothelial damage: intercellular adhesion molecule-1 (sICAM-1), vascular cell adhesion molecule-1 (sVCAM-1), sE-selectin, tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) as well as ambulatory blood pressure monitoring (ABPM) were performed in all subjects. Results: Patients with T1DM displayed significantly higher concentrations of chosen markers of endothelial dysfunction compared to controls (sVCAM-1 (ng/ml): 951.56 ± 330.68 vs. 710.35 ± 162.12, TNF-α (pg/ml): 16.63 ± 8.32 vs. 9.41 ± 4.23, IL-6 (pg/ml): 3.38 ± 1.31 vs. 2.45 ± 0.81; p < 0.05). Within the study group subjects with an abnormal ABPM reading had significantly higher concentrations of sE-selectin compared with subjects with normal ABPM (in ng/ml: 45.71 ± 15.63 vs. 32.42 ± 11.95; p < 0.01). The study revealed a significant positive correlation between sE-selectin and systolic as well as diastolic pressure loads during the day period (respectively: r = 0.46, r = 0.60; p < 0.01). Conclusions: Endothelium dysfunction may be present early in the course of T1DM in children and adolescents. It seems to be related with blood pressure disturbances which highlights the need to intensify treatment in this group of patients.     

Fluctuations in HbA1c are associated with a higher incidence of cardiovascular disease in Japanese patients with type 2 diabetes

Aims/Introduction: To reveal whether visit‐to‐visit variability in HbA1c is associated with higher risk of cardiovascular disease (CVD) in patients with type 2 diabetes. Materials and Methods: The study was conducted on 689 Japanese patients with type 2 diabetes [295 women, 394 men; mean (±standard deviations (SD)) age 65 ± 11 years]. Variability in HbA1c was evaluated as the intrapersonal SD of serial measurements of HbA1c during the follow‐up period for at least 12 months. Patients were divided into quartiles according to the SD of HbA1c, and the primary endpoint was defined as incident CVD. Cox’s proportional hazards model was used to calculate hazard ratios (HR) and 95% confidence intervals (CI). Results: During a median follow‐up period of 3.3 years (range 1.0–6.3 years), 26 ± 14 measurements of HbA1c were obtained per patient and 61 episodes of incident CVD were recorded. The 5‐year cumulative incidence of CVD in patients across the first, second, third, and fourth quartiles of SD in HbA1c was 4.9, 8.7, 17.1, and 26.2%, respectively (P < 0.001, log‐rank test). Multivariate Cox regression analysis revealed that the incidence of CVD was significantly higher in patients in the fourth quartile of SD in HbA1c compared with those in the first quartile (HR 3.38; 95% CI 1.07–10.63; P = 0.039), independent of mean HbA1c and other traditional cardiovascular risk factors. Conclusions: Variability of HbA1c may be a potent predictor of incident CVD in Japanese patients with type 2 diabetes. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2011.00155.x, 2011)     

Long-term body weight trajectories and metabolic control in type 1 diabetes patients on insulin pump or multiple daily injections: A 10-year retrospective controlled study

Background and aimsOverweight/obesity is a clinical concern also in patients with Type 1 diabetes (T1DM). These patients' body weight may vary depending on whether treatment consists in continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI), as these treatments lead to different blood glucose control, insulin doses, and eating behaviors. We compared long-term body weight trajectories in persons with diabetes on CSII or MDI regimens.Methods and resultsAnnual changes in body weight, HbA1c, and daily insulin doses over 6–10 years were retrospectively analyzed in T1DM adult patients on CSII (n = 90) or MDI (n = 90), strictly matched for sex, age, BMI, and diabetes duration. Mean follow-up was 9.1 ± 1.4 years. Body weight increased linearly (∼0.5 kg per year) throughout the observation period (p = 0.001, repeated measures ANOVA) with no significant difference between the CSII and MDI cohorts (p = 0.74), in either normal-weight or overweight/obese patients. HbA1c over follow-up was lower with CSII than with MDI (p = 0.037), maintaining the initial reduction after starting pump therapy. Insulin doses over follow-up were stably lower than baseline (∼20%) with CSII, while linearly increasing (∼20% from baseline to the end of observation) with MDI (p = 0.002). Mean annual weight changes correlated directly with total insulin dose changes (r = 0.191; p = 0.011) and baseline HbA1c level (r = 0.267; p = 0.001), and inversely with HbA1c changes (−0.173; p = 0.021) and baseline age (r = −0.254; p = 0.001).ConclusionT1DM patients on CSII or MDI showed comparable body weight gain over a 10-year follow-up, despite improved glycemic control and decreased insulin doses with CSII.     

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.     

The clinical outcomes of patients with diabetes and hypertension in a peri-urban area,Johannesburg, South Africa

AimTo describe the clinical outcomes of patients with type 2 diabetes (DM2) and hypertension (HT) who received treatment and care at a specialized primary healthcare facility.MethodsA cross-sectional study was conducted and data retrieved from 349 patient’s records. The clinical outcomes were linked to individual risk factors and demographic profiles. Patients with HT who had at least four blood pressure (BP) measurements and patients with DM2 who had at least two HbA1c measurements in a 12-month period were included.ResultsMore females had controlled HT than males. There was no sex difference observed for the control of DM2. Patients with HT visited the clinic for a median period of 96 days (IQR 35–257). Among 59.1% (n = 159) patients who achieved at least one controlled BP measurement, 64.2% (n = 102) had a controlled BP at the last visit. Patients with DM2 visited the clinic for a median period of 851 days (IQR 449.5–1254). From a total of 34 patients (43.5%) who achieved at least one controlled HbA1c measurement, 55.9% (n = 19) had a controlled HbA1c at the last visit.ConclusionDespite the difference in patient profiles, more than half of the patients who received specialised DM2 and HT care managed to achieve BP and HbA1c control.