Elevated glycohemoglobin HbA1c is associated with low back pain in nonoverweight diabetics

Background Context

Low back pain (LBP) is a common complaint in clinical practice of multifactorial origin. Although obesity has been thought to contribute to LBP primarily by altering the distribution of mechanical loads on the spine, the additional contribution of obesity-related conditions such as diabetes mellitus (DM) to LBP has not been thoroughly examined.

卒中高危人群糖化血红蛋白与颈动脉粥样硬化斑块的关系研究

目的 分析卒中高危人群糖化血红蛋白与颈动脉粥样硬化斑块的关系。
方法 2018年5-6月由孝感市中心医院按整群随机抽样方法，随机抽取孝感市城乡各1个社区居民
进行筛查，通过问卷调查、体格检查、实验室检查、颈部血管超声检查筛选卒中高危人群纳入研究。
根据颈动脉超声检测结果将卒中高危人群分为非斑块组和斑块组（颈动脉）。分别采用单因素和多
因素Logistic回归，分析糖化血红蛋白与颈动脉斑块的关系，并根据年龄（60岁）、BM（I 24 kg/m2）、是
否有高血压对研究人群进行分层分析，研究不同特征的卒中高危人群中糖化血红蛋白与颈动脉斑块
的关系。
结果 最终纳入卒中高危人群629例，男性338例（53.74%），平均54.85±8.97岁，糖化血红蛋白平
均浓度为4.70%±1.02%。其中斑块组患者215例（34.18%），非斑块组患者414例（65.82%）。与非斑
块组患者相比，斑块组患者男性、卒中、TIA、高血压、超重患者比例更高，年龄更大，BMI、血压、空
腹血糖、糖化血红蛋白、TC水平更高（均P＜0.01）。校正其他危险因素后，糖化血红蛋白是颈动脉
粥样硬化斑块发生的独立影响因素（每升高1%，OR 1.16，95%CI 1.01～1.31，P =0.018）。分层分析显
示，年龄≥60岁（OR 1.48，95%CI 1.09～2.01，P =0.016）、BMI≥24 kg/m2（OR 1.97，95%CI 1.07～3.64，
P =0.030）、高血压人群（OR 1.31，95%CI 1.06～1.62，P =0.013）中糖化血红蛋白均是颈动脉斑块发生
的独立危险因素。
结论 卒中高危人群糖化血红蛋白与颈动脉斑块的发生密切相关，特别是在年龄≥6 0岁、
BMI≥24 kg/m2和高血压人群中。     

老年2型糖尿病患者轻度认知功能障碍及危险因素研究

目的探讨老年2型糖尿病(T2-DM)患者轻度认知功能障碍(MCI)的特点及相关危险因素分析。方法选取智能精神状态检查量表筛查>25分者,其中单纯T2-DM老年患者(DM组)62例,年龄、性别和教育程度相匹配的健康体检者(N组)35例。选用蒙特利尔认知评估(MoCA)量表作为认知功能的测评工具。检测入选病例的糖化血红蛋白(HbA1c)、空腹血糖(FBG)、餐后2h血糖(PBG)及血脂水平。结果 DM组与N组相比,HbA1c、FBG、PBG、三酰甘油(TG)、血清总胆固醇(TC)及低密度脂蛋白胆固醇(LDL-C)均显著升高(P<0.01或P<0.05);而高密度脂蛋白胆固醇(HDL-C)显著降低(P<0.01)。DM组的MoCA总分明显低于N组(P<0.01)。DM组MoCA评分与HbA1c、PBG、TG、年龄、受教育年限及LDL-C呈负相关(r=-0.40、-0.37、-0.34、-0.32、-0.29、-0.26,P<0.01或P<0.05)。多元逐步回归分析显示,HbA1c是影响MoCA评分的风险因素。结论老年T2-DM患者认知功能减退,血糖控制不良、血脂紊乱、年龄和受教育程度等因素与MCI相关。     

2型糖尿病患者空腹血糖与糖化血红蛋白的关系

目的 探讨2型糖尿病（2-DM）患者空腹血糖（FBG）与糖化血红蛋白（HbA1c）相关性。方法分别以己糖激酶法、硼酸亲和层析法检测160例2-DM患者的FBG和HbA1c;再将4个水平分组的FBG和HbA1c进行相关分析。并以30例非糖尿病患者作对照。结果2-DM患者的HbA1c明显高于对照组（J〈0．01）各组FBG和HbA1c的相关系数r分别为：0．336（P〉0．10）,0．312（P〉0．10）。0．349（P〈0．01）,0．404（P〈0．01）。结论对于经治疗的2-DM患者,当其FBG〈7．0mmol/L时．FBG和HbA1c无直线相关关系;当FBG≥7．0mmol／L时则存在直线相关关系,但相关程度比较低。     

Production and characterization of monoclonal antibodies against non-A1c glycated hemoglobin

Hybridomas secreting monoclonal antibodies specific for hemoglobin nonenzymatically glycated in the non-A_1c position were produced by fusion of SP 2/0 myeloma cells with spleen cells from BALB/c mice immunized with nonenzymatically glycated hemoglobin prepared from human erythrocytes. Wells containing hydridomas secreting antibodies against glycohemoglobin were identified by binding, in an enzyme-linked immunosorbent assay, to purified glycated hemoglobin. The colony designated E85, which secreted antibodies discriminating between glycated versus unglycated hemoglobin, was cloned at least four times by limiting dilution and used for further study, performed with purified monoclonal antibody. Specificity of E85 was demonstrated by immunoblotting and by ELISA, wherein the monoclonal antibody reacted with glycated hemoglobin but not with hemoglobin A_1c or with unglycated hemoglobin. Immunoblotting of human plasma with E85 on nitrocellulose yielded no reactive proteins, indicating site specificity for glycated epitopes residing in hemoglobin but not in other nonenzymatically glycated proteins present in plasma. E85 differs from other antibodies raised against glycated hemoglobin and other glycated proteins, which recognize hemoglobin glycated at the N terminal valine of the β chain (HbA_1c) or which recognize glycated residues only after reductive conversion to glucitollysine and which do not discriminate between different glycated proteins. Thus, this report describes the establishment of the first hybridoma secreting monoclonal antibody raised against a physiologic (unreduced) form of non-A_1c glycohemoglobin, and for the glycated epitope when it resides in glycohemoglobin but not in other proteins or in hemoglobin A_1c.     

Methods,units and quality requirements for the analysis of haemoglobin A1c in diabetes mellitus

The formation of glycohemoglobin, especially the hemoglobin A_1c (HbA_1c) fraction, occurs when glucose becomes coupled with the amino acid valine in the β-chain of Hb; this reaction is dependent on the plasma concentration of glucose. Since the early 1970s it has been known that diabetics display higher values OF HbA_1C because they have elevated blood glucose concentrations. Thus HbA_1c has acquired a very important role in the treatment and diagnosis of diabetes mellitus. After the introduction of the first quantitative measurement OF HbA_1C, numerous methods for glycohemoglobin have been introduced with different assay principles: From a simple mini-column technique to the very accurate automated high-pressure chromatography and lastly to many automated immunochemical or enzymatic assays. In early days, the results of the quality control reports for HbA_1c varied extensively between laboratories, therefore in United States and Canada working groups (WG) of the Diabetes Controls and Complications Trial (DCCT) were set up to standardize the HbA_1c assays against the DCCT/National Glycohemoglobin Standardization Program reference method based on liquid chromatography. In the 1990s, the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) appointed a new WG to plan a reference preparation and method for the HBA_1c measurement. When the reference procedures were established, in 2004 IFCC recommended that all manufacturers for equipment used in HbA_1c assays should calibrate their methods to their proposals. This led to an improvement in the coefficient of variation (CV%) associated with the assay. In this review, we describe the glycation of Hb, methods, standardization of the HbA_1c assays, analytical problems, problems with the units in which HbA_1c values are expressed, reference values, quality control aspects, target requirements for HbA_1c, and the relationship of the plasma glucose values to HbA_1c concentrations. We also note that the acceptance of the mmol/mol system for HbA_1c as recommended by IFCC, i.e., the new unit and reference ranges, are becoming only slowly accepted outside of Europe where it seems that expressing HbA_1c values either only in per cent units or with parallel reporting of percent and mmol/mol will continue. We believe that these issues should be resolved in the future and that it would avoid confusion if mmol/mol unit for HbA_1c were to gain worldwide acceptance.     

Obesity,but not metabolic syndrome,as a risk factor for late-onset asthma in Japanese women

Background

Several cross-sectional studies have suggested an association between obesity and asthma. However, few studies have investigated this relationship longitudinally, especially in middle-aged subjects. Although metabolic syndrome is a well-known risk factor for many non-communicable diseases, its contribution to asthma remains controversial.

Six-month efficacy of benfluorex vs. placebo or metformin in diet-failed type 2 diabetic patients

Six-month efficacy of benfluorex (Mediator) (150–450 mg/day) was assessed in a double-blind multicenter study vs. placebo or metformin hydrochloride (850–2550 mg/day). After a 2-month run-in period of strict dieting, 722 type 2 diabetic patients were randomized (1:2:2) to receive placebo (n=144), benfluorex (n=294) or metformin (n=284). After a 5-week dose-finding phase, the efficacy of benfluorex was compared with that of placebo (test for difference, main analysis) and metformin (non-inferiority test, secondary analysis) during a 6-month fixed-dose treatment. At entry after strict dieting, there was no difference between groups for HbA_1C (placebo, 7.4%±1.5%; benfluorex, 7.7%±1.6%; metformin, 7.8%±1.6%) and fasting plasma glucose (FPG; placebo, 9.7±2.3 mmol/l; benfluorex, 10.0±2.0 mmol/l; metformin, 10.2±2.5 mmol/l). At the end of the dose-finding phase, mean doses were 2.71 tablets/day for placebo group, 2.65 tablets/day for benfluorex (397.5 mg/day) and 2.50 tablets/day for metformin (2125 mg/day). At the end of treatment, HbA_1C level decreased by 0.60% (p<0.001) in benfluorex patients while it increased by 0.50% (p<0.001) with placebo (intent-to-treat analysis). The mean endpoint difference was −0.86% (SE, 0.17%; p<0.001). Mean endpoint difference in HbA_1C between benfluorex and metformin was 0.28% (SE, 0.12%) [90% CI, 0.07 to 0.48] (non-inferiority test, p=0.037). Treatment with benfluorex was well tolerated; 39% of these patients reported one or more emergent adverse events (compared to 38% on placebo and 43% on metformin) and only two patients suffered a treatment-related, serious adverse event. This study demonstrates that benfluorex: (1) significantly reduces HbA1C and fasting plasma glucose when compared to placebo; (2) has a good safety profile; and (3) has relatively lower potency compared to metformin, although the non-inferiority test (equivalence limit for HbA_1C of 0.5%) was significant. Received: 30 January 2002 / Accepted in revised form: 15 October 2002 Note Portions of these data were presented at the 37^th Annual Meeting of the European Association for the Study of Diabetes. Correspondence to S. Del Prato     

Evaluation of the analytic performances of the new HPLC system HLC-723 G7 for the measurement of hemoglobin A1c

OBJECTIVES: The analytical performance of a new automated HPLC system, for the determination of HbA1C in blood (Tosoh HLC-723 G7), was studied. DESIGN AND METHODS: The study design included the evaluation of imprecision, linearity, interference and carryover. Comparison study was performed by comparing HbA1C results with those obtained from an established method (Bio-Rad Variant II). RESULTS: Total imprecision was less than 1.34% and the results were linear up to 17.2% HbA1C. The method showed a wide analytical range, and no carryover between specimens. Comparison study yielded, r=0.989, Sy.x=0.255, regression equation (y=0.9895x-0.35); Bland-Altman plot showed a mean bias=- 0.43% HbA1C with confidence limits ranging from -0.48% to -0.38% HbA1C. The presence of abnormal hemoglobin was clearly revealed, and no interference from labile HbA1C was apparent. CONCLUSION: The HLC-723 G7 instrument seems to be a reliable system for routine assay of HbA1C.     

毛细管电泳法检测糖尿病大鼠糖化血红蛋白及其对治疗效果的评价

应用毛细管电泳法快速检测糖尿病大鼠糖化血红蛋白,以探讨HbA1c在糖尿病大鼠治疗中的变化。结果表明,毛细管电泳法能快速、有效分离糖化血红蛋白与非糖化血红蛋白,未治疗糖尿病组的HbA1c显著高于正常对照组、氨基胍治疗组、磷酸川芎嗪治疗组及联合治疗组（P＜0.01）,而各治疗组间虽有差别但并无统计学意义（P＞0.05）。提示应用本法检测HbA1c可用于糖尿病大鼠药物治疗效果的监测。