Knowledge of HbA1c and LDL‐C treatment goals,subjective level of disease‐related information and information needs in patients with atherosclerotic cardiovascular disease

Background/HypothesisRisk factor control of diabetes mellitus (DM) and especially dyslipidemia remains unsatisfactory in patients with atherosclerotic cardiovascular disease (ASCVD). We aimed to analyze the knowledge of low‐density lipoprotein cholesterol (LDL‐C) and glycated hemoglobin (HbA1c) treatment goals, subjective level of information, and information needs in very high‐risk patients with ASCVD.MethodsASCVD patients (n = 210; 75 ± 9 years; 71.4% male; 89.5% coronary disease) with DM (96.7% type 2) completed a questionnaire assessing knowledge of HbA1c and LDL‐C treatment goals and subjective level of information and information needs on disease‐related topics of DM and ASCVD. Serum LDL‐C and HbA1c were measured.ResultsHbA1c goal (<7.0% in 60.6%) was attained more frequently than LDL‐C goal (<70 mg/dl in 39.9%; p < .01). Significantly more participants named the correct goal for HbA1c compared to LDL‐C (52.9% vs. 2.4%; p < .01). Subjective levels of information were higher and information needs were lower for DM than for ASCVD (p < .01 for all topics). No associations of knowledge of treatment goals and level of information with the attainment of treatment goals for HbA1c and LDL‐C were found. However, in multivariate regression, higher levels of education were associated with knowledge of treatment goals (HbA1c: odds ratio [OR] 1.32, 95% confidence interval [CI] 1.01–1.72, p = .04; LDL‐C: OR 2.32, 95% CI 1.07–5.03; p = .03).ConclusionIn very high‐risk patients with ASCVD, a deficit of knowledge of treatment goals to control dyslipidemia exists when compared to DM, patients felt significantly better informed for topics of DM than for ASCVD and display higher information needs for topics of ASCVD.     

2型糖尿病患者动态血糖变化与糖化血红蛋白水平的相关性分析

目的探讨2型糖尿病患者动态血糖变化与糖化血红蛋白(HbAlc)水平的相关性,为预防2型糖尿病并发症的发生提供参考。方法选取2009-05～2011-05收治的18例2型糖尿病患者,采用动态血糖监测系统(CGMS)观察2型糖尿病患者血糖变化与HbAl c的相关性。结果经Pearson分析显示,HbAlc与日内血糖水平呈正相关(P0.05),与餐后血糖波动幅度(PPGE)无明显相关性(P0.05)。结论 CGMS能详细显示日内血糖波动情况,HbAlc能反映日内整体血糖水平。     

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)     

Editorial on hemoglobin A1c, blood pressure, and lowdensity lipoprotein cholesterol goals in diabetics

The American Diabetes Association (ADA) 2013 guidelines state that a reasonable hemoglobin A1c goal for many nonpregnant adults with diabetes is less than 7.0% a hemoglobin A1c level of less than 6.5% may be considered in adults with short duration of diabetes, long life expectancy, and no significant cardiovascular disease if this can be achieved without significant hypoglycemia or other adverse effects of treatment. A hemoglobin A1c level less than 8.0% may be appropriate for patients with a history of severe hypoglycemia, limited life expectancy, advanced macrovascular and microvascular complications, extensive comorbidities, and long-standing diabetes in whom the hemoglobin A1c goal is difficult to attain despite multiple glucoselowering drugs including insulin. The ADA 2013 guidelines recommend that the systolic blood pressure in most diabetics with hypertension should be reduced to less than 140 mmHg. These guidelines also recommend use of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in the treatment of hypertension in diabetics unless they are pregnant. Diabetics at high risk for cardiovascular events should have theirserum low-density lipoprotein (LDL) cholesterol lowered to less than 70 mg/dL with statins. Lower-risk diabetics should have their serum LDL cholesterol reduced to less than 100 mg/dL. Combination therapy of a statin with either a fibrate or niacin has not been shown to provide additional cardiovascular benefit above statin therapy alone and is not recommended. Hypertriglyceridemia should be treated with dietary and lifestyle changes. Severe hypertriglyceridemia should be treated with drug therapy to reduce the risk of acute pancreatitis.     

2型糖尿病患者糖化血红蛋白水平与尿酸排泄分数的相关性研究

目的 探讨T2DM患者不同HbA1c水平与尿酸排泄分数(FEUA)的相关性. 方法 选取T2DM患者336例,根据HbA1c水平分为≤7％、7％～9％、≥9％组,比较各组身高、体重、血压、FPG及2 hPG、FIns及2 hIns、HbA1c、血脂、血尿酸(SUA)、肝肾功能指标、生化指标等. 结果 随HbA1c水平的升高,FPG、2 hPG均增高,2 hIns水平下降(P＜0.05);eGFR及FEUA升高,SUA水平下降(P均＜0.05).多元线性回归分析结果显示,FEUA与SUA、eGFR呈负相关,与HbA1c呈正相关. 结论 HbA1 c水平与FEUA相关,FEUA可能成为预测糖尿病性慢性肾脏疾病指标之一.     

Measurement of HbA1c from stored whole blood samples in the Atherosclerosis Risk in Communities study

Background: The aims of the present study were to demonstrate the reliability of HbA1c measurements during two time periods and to compare these measurements with HbA1c distribution in the general US population. Methods: HbA1c was measured in 14 069 whole blood samples in the Atherosclerosis Risk in Communities (ARIC) study using different HPLC instruments across two time periods, namely 2003–2004 and 2007–2008. At the time of measurement, samples had been in storage at ?70°C for up to 18 years. To assess differences in values, HbA1c measurements were repeated in 383 samples at both periods. Indirect comparisons were made by comparing our measurements against those from a nationally representative study. Results: The coefficients of variation for quality control samples were 1.8% (n = 89) in 2003–2004 and 1.4% (n = 259) in 2007–2008. The correlation between measurements at the two time points was high (r = 0.99), but with a slight bias: 0.29% points higher in 2007–2008 vs 2003–2004 (n = 383; P < 0.0001). The comparison yielded the following Deming regression equation: y_{(2007–2008)} = 0.073 + 1.034x_{(2003–2004)}. After alignment using this equation, the distribution of HbA1c in the ARIC study was similar to that in the national study using fresh samples. Conclusions: Measurements of HbA1c from samples stored for up to 18 years are highly reliable when using state‐of‐the‐art HPLC instruments, but with some bias introduced over time. The HbA1c data now available in the ARIC study should be invaluable for investigations into the clinical utility of HbA1c as a diagnostic test for diabetes.     

Effects of colesevelam on LDL-C, A1c and GLP-1 levels in patients with type 1 diabetes: a pilot randomized double-blind trial

Aim: Colesevelam is indicated to lower low density lipoprotein cholesterol (LDL‐C) in hyperlipidaemia and improve glycaemic control in adults with type 2 diabetes. This short‐term pilot study evaluates its effects in type 1 diabetes. Methods: This double‐blind, randomized, investigator‐initiated, single‐centred, 12‐week pilot study evaluated 40 adults (age = 36.4 ± 9.4 years) with type 1 diabetes (duration = 20.4 ± 8.5 years) and hyperlipidaemia. It was powered to show a treatment difference of >10% LDL‐C reduction. Subjects received 3.75 g/day colesevelam (n = 20) or placebo (n = 20) for 12 weeks. LDL‐C and haemoglobin A1c (A1c) levels were assessed at screening (week 2), baseline (week 0) and every 4 weeks throughout the treatment duration. Glucagon‐like peptide‐1 (GLP‐1) and glucose‐dependent insulinotropic peptide (GIP) levels were measured during 4‐h meal (Boost Plus^®, Nestle HealthCare Nutrition Inc., Florham Park, New Jersey, USA) challenge tests (MCT) at baseline and 12 weeks. Results: Colesevelam treatment resulted in a significant reduction in LDL‐C values at 4 weeks [?12.1% (95% CI: ?20.1 to ?4.1), p = 0.004] which was sustained for the study duration (p = 0.005 at 12 weeks). The treatment group also showed a significant change in A1c from baseline at week 4; however, this was not significant for the study duration. There was a significant median increase in GLP‐1 levels during the first 2 h of the baseline MCT in the treated group but no difference at 12 weeks. Conclusions: During this short‐term pilot study, colesevelam treatment effectively lowered LDL‐C in patients with type 1 diabetes. Improvements in A1c seen at week 4 were not sustained. Effects on glycaemic control in subjects with type 1 diabetes may be related to a postprandial rise in GLP‐1 levels and require further clinical study.     

The relation between HbA1c and hypoglycemia revisited; a secondary analysis from an intervention trial in patients with type 1 diabetes and impaired awareness of hypoglycemia

Aims

We aimed to re-assess the previously shown but recently disputed association between HbA1c and severe hypoglycemia.

老年2型糖尿病患者HbA1c与CYFRA21-1、CA199水平的相关性分析

目的 探讨老年2型糖尿病(T2DM)患者HbA1c和CYFRA21-1、CA199水平的相关性.方法 选取60例老年T2DM患者和60例中年T2DM患者,所有患者治疗时间处于2018年1月—2019年1月,根据患者患者糖化血红蛋白(HbAlc)水平,以7.0％为标准界限,HbAlc<7.0％的为血糖良好组,HbAlc>...     

大连地区门诊2型糖尿病患者糖化血红蛋白达标率及口服降糖药物治疗现状的3年调查分析

目的 评估2009～2011年大连地区门诊T2DM患者HbA1c达标情况及口服降糖药物治疗现状. 方法 收集2009年1171例、2010年1196例和2011年1245例T2DM患者临床数据.以HbA1 c＜7.0％为控制达标. 结果 2009、2010及2011年平均HbA1c水平为(8.8±2.1)％、(8.5±1.9)％及(8.8±2.3)％,达标率为20.6％、21.3％及21.6％;口服降糖药物使用比例依次为二甲双胍(M)、α糖苷酶抑制剂(A)、磺脲类(S)、格列奈类(G)及增敏剂类(T);常用的双药组合依次是M+A、S+M及S+A;单药、双药、三药及以上治疗方案HbA1c达标率为43.4％、27.0％及11.5％. 结论 大连地区门诊T2DM患者中仅有不到1/4的患者实现血糖控制达标.口服降糖药物中M和A最常用,双药联合是最主要的治疗方案,单药HbA1c达标率最高.