Drugs affecting HbA1c levels

Glycated hemoglobin (HbA1c) is an important indicator of glycemic control in diabetes mellitus, based on which important diagnostic and therapeutic decisions are routinely made. However, there are several situations in which the level of HbA1c may not faithfully reflect the glycemic control in a given patient. Important among these is the use of certain non-diabetic medications, which can affect the HbA1c levels in different ways. This review focuses on the non-diabetic medications which can inappropriately raise or lower the HbA1c levels, and the postulated mechanisms for the same.     

Prevalence of Diabetes in Asian Indians Based on Glycated Hemoglobin and Fasting and 2-H Post-Load (75-g) Plasma Glucose (CURES-120)

Abstract Objective: With the introduction of glycated hemoglobin (A1c) as a method of screening for diabetes, it is essential to study how use of A1c would affect the prevalence of diabetes in different ethnic groups. We compared the prevalence of diabetes by fasting (FPG) and 2-h post-load (75-g) plasma glucose (2-h PG) and A1c criteria in an Asian Indian population. Research Design and Methods: Subjects (n=2,188) without known diabetes were drawn from the Chennai Urban Rural Epidemiological Study, a population-based study in Chennai, South India. FPG, 2-h PG, and A1c estimations were carried out. Prevalence rates of diabetes were compared using as cut points FPG ≥7?mmol/L (126?mg/dL), 2-hr PG ≥11.1?mmol/L (200?mg/dL), or A1c ≥6.5% criteria. Results: Prevalence of diabetes was 6.1% (n=134) using the FPG criterion, 10.1% (n=221) by the 2-h PG criterion, and 12.8% (n=281) by the A1c criterion. Thus the prevalence of diabetes by the A1c criterion was 110% and 27% higher than the FPG and 2-hr PG criteria, respectively. Only 121 of these subjects were identified by all three criteria. Subjects diagnosed by the A1c criteria had the lowest FPG, 2-h PG, A1c, and serum triglyceride levels. Conclusions: In Asian Indians, use of A1c criteria would result in markedly higher prevalence rates of diabetes. It also identifies a different set of individuals with milder glucose intolerance and lower serum triglyceride levels.     

PCR-based assay using occult blood detection cards for detection of diarrheagenic Escherichia coli in specimens from U.S. travelers to Mexico with acute diarrhea

Large field studies of travelers' diarrhea for multiple destinations are limited by the need to perform stool cultures on site in a timely manner. A method for the collection, transport, and storage of fecal specimens that does not require immediate processing and refrigeration and that is stable for months would be advantageous. This study was designed to determine if enterotoxigenic Escherichia coli (ETEC) and enteroaggregative E. coli (EAEC) DNA could be identified from cards that were processed for the evaluation of fecal occult blood. U.S. students traveling to Mexico during 2005 to 2007 were monitored for the occurrence of diarrheal illness. When ill, students provided a stool specimen for culture and occult blood by the standard methods. Cards then were stored at room temperature prior to DNA extraction. Fecal PCR was performed to identify ETEC and EAEC in DNA extracted from stools and from occult blood cards. Significantly more EAEC cases were identified by PCR that was performed on DNA that was extracted from cards (49%) or from frozen feces (40%) than from culture methods that used HEp-2 adherence assays (13%) (P < 0.001). Similarly, more ETEC cases were detected from card DNA (38%) than from fecal DNA (30%) or by culture that was followed by hybridization (10%) (P < 0.001). The sensitivity and specificity of the card test were 75 and 62%, respectively, compared to those for EAEC by culture and were 50 and 63%, respectively, compared to those for ETEC. DNA extracted from fecal cards that was used for the detection of occult blood is of use in identifying diarrheagenic E. coli.     

Reactivation of hepatitis B after liver transplantation: Current knowledge,molecular mechanisms and implications in management

Chronic hepatitis B(CHB) is a major global health problem affecting an estimated 350 million people with more than 786000 individuals dying annually due to complications, such as cirrhosis, liver failure and hepatocellular carcinoma(HCC). Liver transplantation(LT) is considered gold standard for treatment of hepatitis B virus(HBV)-related liver failure and HCC. However, post-transplant viral reactivation can be detrimental to allograft function, leading to poor survival. Prophylaxis with high-dose hepatitis B immunoglobulin(HBIG) and anti-viral drugs have achieved remarkable progress in LT by suppressingviral replication and improving long-term survival. The combination of lamivudine(LAM) plus HBIG has been for many years the most widely used. However, life-long HBIG use is both cumbersome and costly, whereas long-term use of LAM results in resistant virus. Recently, in an effort to develop HBIG-free protocols, high potency nucleos(t)ide analogues, such as Entecavir or Tenofovir, have been tried either as monotherapy or in combination with low-dose HBIG with excellent results. Current focus is on novel antiviral targets, especially for covalently closed circular DNA(ccc DNA), in an effort to eradicate HBV infection instead of viral suppression. However, there are several other molecular mechanisms through which HBV may reactivate and need equal attention. The purpose of this review is to address post-LT HBV reactivation, its risk factors, underlying molecular mechanisms, and recent advancements and future of anti-viral therapy.