This study examined the relationship between HbA1c levels and lower extremity complications in diabetic patients in East Harlem. It found that HbA1c levels were not strongly correlated with the number of podiatric manifestations. Specifically, HbA1c levels did not predict the number of complications after controlling for age, diabetes duration, or other factors. However, patients receiving drugs for neuropathy had significantly lower fear of falling scores than those not receiving such drugs. The study concludes that while HbA1c may not be a good predictor of foot complications, it could still provide useful clinical information for managing diabetic patients. Larger studies are needed to further explore HbA1c as a prognostic indicator.
This document summarizes a study investigating whether bariatric surgery is a more favorable treatment than conventional weight loss interventions in preventing diabetes progression in obese patients. The study used HbA1c analytical follow-up data from the Swedish Obese Subjects study to compare bariatric surgery and conventional treatment. The results showed HbA1c was a more sensitive and specific diagnostic tool than fasting blood glucose. Bariatric surgery was more effective in preventing diabetes at 2 years but the benefit lessened at 10 years compared to conventional treatment.
The document provides diagnostic criteria and guidelines for impaired glucose metabolism according to the American Diabetes Association and World Health Organization. It discusses factors that can increase risk of type 2 diabetes such as age, weight, family history, and previous gestational diabetes. Hemoglobin A1c (HbA1c) is presented as a standard for assessing glycemic control and mean blood glucose as it represents glucose levels over the previous 2-3 months. Combining fasting plasma glucose and HbA1c levels is highly predictive of impaired glucose tolerance or diabetes. Higher HbA1c levels are associated with increased cardiovascular risk independent of other risk factors.
Use of Glycated Hemoglobin (A1C) in the Diagnosis ofType 2 Diabetes Mellitus...Shahid Nawaz
The Canadian Diabetes Association reviewed the use of glycated hemoglobin (A1C) for diagnosing diabetes and recommends adding it as a diagnostic criterion. An A1C level of 6.5% or higher confirms a diagnosis of diabetes. A1C testing has advantages over glucose tests as it can be done at any time and reflects average glucose levels over several months. However, A1C levels may be affected by certain medical conditions and ethnic groups. The document provides guidelines on using A1C for diagnosis and confirms the use of traditional glucose tests remain valid options.
Glycosylated hemoglobin (HbA1c) represents the average plasma glucose over the previous 2-3 months and is measured to monitor long-term glycemic control in patients with diabetes. The document discusses the relationship between HbA1c levels and diabetes complications, factors that affect HbA1c, and recommendations for using HbA1c to diagnose diabetes. International expert committees now recommend using HbA1c ≥6.5% to diagnose diabetes due to standardization of assays and its correlation with complications.
Glycated Hemoglobin and Triglycerides in type 2 diabetes mellitusDeepak Chinagi
This study examined the relationship between glycated hemoglobin (HbA1c) levels and serum triglyceride levels in 140 patients with type 2 diabetes. The mean HbA1c was 8.5% and mean triglyceride level was 171.3 mg/dL. There was a positive correlation between HbA1c and triglyceride levels, with higher HbA1c associated with higher triglycerides. The study demonstrated that poor glycemic control, as indicated by elevated HbA1c, is associated with increased risk of cardiovascular disease possibly through effects on triglyceride levels.
ABSTRACT- Introduction: Importance of measurement of glycated hemoglobin (HbA1c) has been recommended for
the diagnosis of diabetes and pre-diabetes. However, various epidemiological studies conducted different parts of the
universe have shown significant discordance between HbA1c and glucose-based tests. Glycated hemoglobin (HbA1c) is
assumed to be the gold standard for monitoring glycemic control in patients with diabetes mellitus disorder. The Glycated
hemoglobin (HbA1c) assay provided an accurate, precise measure of chronic glycemic levels, and associates with the risk
of diabetes complications.
Materials and Methods: This is a cross sectional prospective study. A total of 868 individuals attended to the medicine
outpatient clinic at Lord Buddha Koshi Medical College, Saharsa, Bihar between Jan 2016 to Dec 2016 were selected for
the study after screening a large cohort visited OPD. The results of FPG, OGTT, and HbA1c for 868 individual were
analyzed as well as all grouped as diabetic patients, glucose intolerant (pre-diabetes) patients, and non-diabetic patients
according to new ADA criteria for the diagnosis of diabetes.
Results: Diagnostic sensitivity of all diabetic criteria were 80.33% for A1c; 75% for OGTT and only 41.87% for FPG
respectively.
Conclusion: The proposed A1c diagnostic criteria have greater diagnostic than FPG and 2-h OGTT regarding a diagnosis
of diabetes mellitus disorder.
Key-words- Glycated Hemoglobin, Fasting Plasma Glucose, Oral glucose tolerances test (OGTT), Diabetes Mellitus,
and Pre- diabetes
Rhenea lyle type ii - diabetes mellitus group presentation section 2 q. 5-8RheneaLyle
This document provides information about diagnosing and monitoring type 2 diabetes through various lab tests. It discusses key labs like fasting blood sugar (FBS), glucose tolerance tests (GTT and OGTT), HbA1c, and lipid profiles. Normal and abnormal ranges for these tests are provided. Examinations by eye doctors, dentists, and podiatrists are recommended to monitor for possible diabetes complications. Maintaining control of blood glucose levels through lifestyle changes and medications can help prevent complications like heart disease, stroke, and nerve damage.
HbA1c levels will now be reported using a new international standard (IFCC) in mmol/mol units instead of the previous DCCT-aligned percentage units. This is because the old DCCT method was found to overestimate HbA1c levels. Laboratories will report both the new IFCC value in mmol/mol and the equivalent old DCCT % value for two years during transition. After two years, only the IFCC value in mmol/mol will be reported. Guidelines and targets will also change to correspond to the new IFCC standard.
This document summarizes a study investigating whether bariatric surgery is a more favorable treatment than conventional weight loss interventions in preventing diabetes progression in obese patients. The study used HbA1c analytical follow-up data from the Swedish Obese Subjects study to compare bariatric surgery and conventional treatment. The results showed HbA1c was a more sensitive and specific diagnostic tool than fasting blood glucose. Bariatric surgery was more effective in preventing diabetes at 2 years but the benefit lessened at 10 years compared to conventional treatment.
The document provides diagnostic criteria and guidelines for impaired glucose metabolism according to the American Diabetes Association and World Health Organization. It discusses factors that can increase risk of type 2 diabetes such as age, weight, family history, and previous gestational diabetes. Hemoglobin A1c (HbA1c) is presented as a standard for assessing glycemic control and mean blood glucose as it represents glucose levels over the previous 2-3 months. Combining fasting plasma glucose and HbA1c levels is highly predictive of impaired glucose tolerance or diabetes. Higher HbA1c levels are associated with increased cardiovascular risk independent of other risk factors.
Use of Glycated Hemoglobin (A1C) in the Diagnosis ofType 2 Diabetes Mellitus...Shahid Nawaz
The Canadian Diabetes Association reviewed the use of glycated hemoglobin (A1C) for diagnosing diabetes and recommends adding it as a diagnostic criterion. An A1C level of 6.5% or higher confirms a diagnosis of diabetes. A1C testing has advantages over glucose tests as it can be done at any time and reflects average glucose levels over several months. However, A1C levels may be affected by certain medical conditions and ethnic groups. The document provides guidelines on using A1C for diagnosis and confirms the use of traditional glucose tests remain valid options.
Glycosylated hemoglobin (HbA1c) represents the average plasma glucose over the previous 2-3 months and is measured to monitor long-term glycemic control in patients with diabetes. The document discusses the relationship between HbA1c levels and diabetes complications, factors that affect HbA1c, and recommendations for using HbA1c to diagnose diabetes. International expert committees now recommend using HbA1c ≥6.5% to diagnose diabetes due to standardization of assays and its correlation with complications.
Glycated Hemoglobin and Triglycerides in type 2 diabetes mellitusDeepak Chinagi
This study examined the relationship between glycated hemoglobin (HbA1c) levels and serum triglyceride levels in 140 patients with type 2 diabetes. The mean HbA1c was 8.5% and mean triglyceride level was 171.3 mg/dL. There was a positive correlation between HbA1c and triglyceride levels, with higher HbA1c associated with higher triglycerides. The study demonstrated that poor glycemic control, as indicated by elevated HbA1c, is associated with increased risk of cardiovascular disease possibly through effects on triglyceride levels.
ABSTRACT- Introduction: Importance of measurement of glycated hemoglobin (HbA1c) has been recommended for
the diagnosis of diabetes and pre-diabetes. However, various epidemiological studies conducted different parts of the
universe have shown significant discordance between HbA1c and glucose-based tests. Glycated hemoglobin (HbA1c) is
assumed to be the gold standard for monitoring glycemic control in patients with diabetes mellitus disorder. The Glycated
hemoglobin (HbA1c) assay provided an accurate, precise measure of chronic glycemic levels, and associates with the risk
of diabetes complications.
Materials and Methods: This is a cross sectional prospective study. A total of 868 individuals attended to the medicine
outpatient clinic at Lord Buddha Koshi Medical College, Saharsa, Bihar between Jan 2016 to Dec 2016 were selected for
the study after screening a large cohort visited OPD. The results of FPG, OGTT, and HbA1c for 868 individual were
analyzed as well as all grouped as diabetic patients, glucose intolerant (pre-diabetes) patients, and non-diabetic patients
according to new ADA criteria for the diagnosis of diabetes.
Results: Diagnostic sensitivity of all diabetic criteria were 80.33% for A1c; 75% for OGTT and only 41.87% for FPG
respectively.
Conclusion: The proposed A1c diagnostic criteria have greater diagnostic than FPG and 2-h OGTT regarding a diagnosis
of diabetes mellitus disorder.
Key-words- Glycated Hemoglobin, Fasting Plasma Glucose, Oral glucose tolerances test (OGTT), Diabetes Mellitus,
and Pre- diabetes
Rhenea lyle type ii - diabetes mellitus group presentation section 2 q. 5-8RheneaLyle
This document provides information about diagnosing and monitoring type 2 diabetes through various lab tests. It discusses key labs like fasting blood sugar (FBS), glucose tolerance tests (GTT and OGTT), HbA1c, and lipid profiles. Normal and abnormal ranges for these tests are provided. Examinations by eye doctors, dentists, and podiatrists are recommended to monitor for possible diabetes complications. Maintaining control of blood glucose levels through lifestyle changes and medications can help prevent complications like heart disease, stroke, and nerve damage.
HbA1c levels will now be reported using a new international standard (IFCC) in mmol/mol units instead of the previous DCCT-aligned percentage units. This is because the old DCCT method was found to overestimate HbA1c levels. Laboratories will report both the new IFCC value in mmol/mol and the equivalent old DCCT % value for two years during transition. After two years, only the IFCC value in mmol/mol will be reported. Guidelines and targets will also change to correspond to the new IFCC standard.
Ueda2016 a1 c uses& limitations-fareed fawzyueda2015
Glycated hemoglobin (HbA1c or A1c) provides a measure of average blood glucose levels over the past 2-3 months and is used to diagnose and monitor diabetes. However, A1c levels can be affected by factors like anemia, kidney disease, pregnancy, blood transfusions, and hemoglobin variants. Alternative markers like fructosamine and glycated albumin may be more accurate than A1c in some conditions, but lack standardization. The document discusses the uses and limitations of A1c testing as well as conditions that can impact interpretation and alternative options for assessing glycemic control.
1) HbA1c is commonly used to assess long-term glycemic control but does not provide information about glucose variability and hypoglycemia risk.
2) Additional tests such as continuous glucose monitoring, glycated albumin, and 1,5-anhydroglucitol can help evaluate short-term control and glucose fluctuations not reflected in HbA1c.
3) Overreliance on HbA1c targets may overlook hypoglycemia risk, so a multifaceted approach considering other data is recommended for treatment decisions.
Perform the A1C test at least two times a year in patients who are meeting treatment goals (and who have stable glycemic control). Perform the A1C test quarterly in patients whose therapy has changed or who are not meeting glycemic goals. A1C testing should be performed routinely in all patients with diabetes. The frequency of A1C testing should be dependent on the clinical situation, the treatment regimen used, and the clinician’s judgment. Some patients with stable glycemia well within target may do well with testing only twice per year. Unstable or highly intensively managed patients (e.g., pregnant type 1 diabetic women) may require testing more frequently than every 3 months.
1. HbA1c is used to measure average blood glucose levels over the previous 2-3 months and is affected by several factors beyond just glucose, such as hemoglobin variants, iron deficiency, ethnicity, and kidney disease.
2. Common hemoglobin variants like HbS, HbC, HbD and HbE can interfere with HbA1c measurement on some assays that do not account for their presence.
3. The presence of hemoglobin variants and other conditions mean that HbA1c may not always accurately reflect average glucose and additional testing is needed in some cases to properly assess diabetes and control.
[1] The document discusses various methods for monitoring blood glucose levels and glycemic control in patients with diabetes, including HbA1c, blood glucose monitoring, and glycation of hair.
[2] It compares the advantages and limitations of HbA1c testing versus blood glucose monitoring and discusses factors that can influence HbA1c levels.
[3] Correlations between HbA1c levels and average blood glucose are presented, showing HbA1c as a marker of long-term glycemic control over the preceding 120 days.
This document discusses HbA1c testing for diabetes management. It outlines that HbA1c is used to measure glycemic control, risk for complications, and quality of care. Target levels are provided for diabetics and those at risk. Analytical methods like HPLC, immunoassay, and enzymatic assays are described. Interfering factors like hemoglobin variants, jaundice, hyperlipidemia, and red blood cell disorders can impact results. Causes of abnormal high and low HbA1c values are provided along with investigation recommendations. Advantages and drawbacks of HbA1c testing are summarized.
The HbA1c test measures the amount of glycated hemoglobin in the blood over the past 2-3 months and can indicate how well diabetes has been controlled over that period. The test involves drawing blood, usually from a vein in the arm. A normal HbA1c level is below 5.7%, while for those with diabetes, maintaining a level at or below 7% is ideal. Elevated HbA1c levels mean blood glucose has been high on average and increases the risk of diabetes complications. The HbA1c test should be performed every 3-6 months to monitor diabetes management.
Diabetes mellitus is a condition where the body does not properly process glucose due to insufficient insulin production or resistance. There are two main types: type 1 diabetes results from immune destruction of insulin-producing cells and requires daily insulin injections; type 2 diabetes involves insulin resistance and reduced insulin production and can sometimes be prevented. HbA1c testing provides an indicator of average blood glucose levels over the prior 2-3 months and is the preferred method for diabetes diagnosis and monitoring, though it has some limitations. The document then describes an automated point-of-care analyzer that uses a blood sample to quickly and easily measure HbA1c levels to help manage diabetes.
The document discusses fructosamine and hemoglobin A1C (HbA1C) blood tests used to measure blood glucose levels in people with diabetes. Fructosamine measures glucose levels over the previous 2-3 weeks by detecting glucose bound to proteins like albumin. HbA1C measures levels over the past 3 months by detecting glucose bound to hemoglobin. Both tests are alternatives to daily blood glucose monitoring and provide a longer-term view of diabetes control. The document also explains what glycated proteins are and how they are formed through glycation reactions between glucose and amino groups on proteins.
The document discusses new trends in the management of diabetes in cardiac patients. It provides guidelines on glycemic targets and pharmacological therapy for type 2 diabetes. The recommended first-line treatment is metformin. Glycated hemoglobin (A1C) of less than 7% is a reasonable goal for many adults with diabetes, though some may require less or more stringent targets depending on individual factors. Combination therapy with oral medications and insulin is often needed to control blood sugar levels in type 2 diabetes.
Please correct me if anything wrong and to improve myself.
Thanks & Regards
Niranjan
9790861629
Marketing Manager - Professional Services
HITECH DIAGNOSTICS
This document discusses HbA1c, a blood test that measures average blood glucose levels over the past 3 months. It provides background on what HbA1c is, how it forms, its historical context, reference values, estimation methods, and how lowering HbA1c reduces risks of diabetes complications based on studies. It also discusses correlations between HbA1c, mean plasma glucose, advantages of HbA1c as a long-term marker of diabetes control, and limitations such as not being useful for acute decisions or situations that impact HbA1c like anemia.
This study examined whether different levels of glucose variability in patients with type 1 diabetes predict responses to continuous subcutaneous insulin infusion (CSII) therapy in terms of hypoglycemic events. The study found that:
1) Baseline low blood glucose index (LBGI), a measure of glucose variability, was the best predictor of reduced hypoglycemia on CSII therapy.
2) Patients in the highest LBGI tertile experienced a 23.3% reduction in hypoglycemic events without changes in A1C on CSII.
3) Patients in the lowest LBGI tertile had the greatest reduction in A1C on CSII of 20.99% but also experienced increased
Glycosylated Hemoglobin, also called Glycated Hemoglobin, Hemoglobin A1c, or HbA1c, refers to hemoglobin which is bound to glucose. Glycosylated Hemoglobin Test is performed to measure the percentage of glycosylated hemoglobin in blood which reflects the average blood glucose over a period of past two to three months (8 - 12 weeks).
For more information, visit
https://www.1mg.com/labs/test/glycosylated-hemoglobin-1611
A1 c versus glucose testing 19 5-2014 departement conferenceMoustafa Rezk
This document compares glucose testing and A1C testing for diagnosing diabetes. Glucose testing has limitations including lack of reproducibility between tests, requirement of fasting, and diurnal variation. A1C testing has advantages like not requiring fasting and less biological variability. However, A1C can be affected by factors like hemoglobinopathies, kidney disease, and alcohol use. Both tests are useful but understanding each test's limitations is important for accurate results. Overall A1C is convenient and detects undiagnosed diabetes but may not be suitable for all patients due to potential interferences. Standardization of A1C assays is also needed.
This study evaluated metabolic syndrome (MetS) as a predictor of diabetes compared to other markers like hemoglobin A1c (HbA1c) in a Japanese population. HbA1c was found to be a much better predictor of diabetes than MetS or fasting plasma glucose, with an AUC of 0.89. MetS had an AUC of only 0.63 and was a poorer predictor than measures like BMI or liver enzymes. The odds ratio of diabetes was highest for HbA1c ≥6.0% at 33.5, compared to 5.39 for MetS. The authors concluded that MetS is not a good predictor of diabetes compared to simple measures like HbA1c in Japanese individuals
An HbA1c test is used to check diabetes or pre-diabetes conditions in patients. Pre-diabetes condition shows an increased blood sugar level that means a person is at risk for getting diabetes. In case a person already has diabetes, an HbA1c test can help the doctor to monitor their condition and blood sugar levels.
This document provides standards of care for diabetes management as established by the American Diabetes Association (ADA). It discusses the classification and diagnosis of diabetes, including the criteria for diagnosing diabetes based on A1C, fasting plasma glucose, and oral glucose tolerance tests. It also defines categories of increased risk for diabetes, also known as prediabetes. The standards are intended to provide guidance to clinicians and others on the components of diabetes care and treatment goals.
This study analyzed prescription claims data from 238,402 patients with type 2 diabetes to identify predictors of changes in adherence to oral antidiabetes medications between years. The study found that about one third of patients changed adherence status from one year to the next, with about 22% becoming nonadherent after being adherent previously. For those who became nonadherent, the strongest predictors were the number of 90-day prescriptions filled, diabetes medication burden, longest gap in filling prescriptions, number of antidiabetes drug classes used, and copay for last drug. For those who became adherent after being nonadherent, the top predictors were medication burden, prescription gaps, fluctuating adherence, 90-day prescript
The document discusses various interventions to improve quality of care for patients with diabetes. It describes goals for metabolic control to reduce complications, benchmarking and recognition programs, and the economic impacts of improved diabetes management. It also discusses a model for promoting intensive insulin therapy at the primary care level using basal-bolus insulin regimens along with patient education.
Ueda2016 a1 c uses& limitations-fareed fawzyueda2015
Glycated hemoglobin (HbA1c or A1c) provides a measure of average blood glucose levels over the past 2-3 months and is used to diagnose and monitor diabetes. However, A1c levels can be affected by factors like anemia, kidney disease, pregnancy, blood transfusions, and hemoglobin variants. Alternative markers like fructosamine and glycated albumin may be more accurate than A1c in some conditions, but lack standardization. The document discusses the uses and limitations of A1c testing as well as conditions that can impact interpretation and alternative options for assessing glycemic control.
1) HbA1c is commonly used to assess long-term glycemic control but does not provide information about glucose variability and hypoglycemia risk.
2) Additional tests such as continuous glucose monitoring, glycated albumin, and 1,5-anhydroglucitol can help evaluate short-term control and glucose fluctuations not reflected in HbA1c.
3) Overreliance on HbA1c targets may overlook hypoglycemia risk, so a multifaceted approach considering other data is recommended for treatment decisions.
Perform the A1C test at least two times a year in patients who are meeting treatment goals (and who have stable glycemic control). Perform the A1C test quarterly in patients whose therapy has changed or who are not meeting glycemic goals. A1C testing should be performed routinely in all patients with diabetes. The frequency of A1C testing should be dependent on the clinical situation, the treatment regimen used, and the clinician’s judgment. Some patients with stable glycemia well within target may do well with testing only twice per year. Unstable or highly intensively managed patients (e.g., pregnant type 1 diabetic women) may require testing more frequently than every 3 months.
1. HbA1c is used to measure average blood glucose levels over the previous 2-3 months and is affected by several factors beyond just glucose, such as hemoglobin variants, iron deficiency, ethnicity, and kidney disease.
2. Common hemoglobin variants like HbS, HbC, HbD and HbE can interfere with HbA1c measurement on some assays that do not account for their presence.
3. The presence of hemoglobin variants and other conditions mean that HbA1c may not always accurately reflect average glucose and additional testing is needed in some cases to properly assess diabetes and control.
[1] The document discusses various methods for monitoring blood glucose levels and glycemic control in patients with diabetes, including HbA1c, blood glucose monitoring, and glycation of hair.
[2] It compares the advantages and limitations of HbA1c testing versus blood glucose monitoring and discusses factors that can influence HbA1c levels.
[3] Correlations between HbA1c levels and average blood glucose are presented, showing HbA1c as a marker of long-term glycemic control over the preceding 120 days.
This document discusses HbA1c testing for diabetes management. It outlines that HbA1c is used to measure glycemic control, risk for complications, and quality of care. Target levels are provided for diabetics and those at risk. Analytical methods like HPLC, immunoassay, and enzymatic assays are described. Interfering factors like hemoglobin variants, jaundice, hyperlipidemia, and red blood cell disorders can impact results. Causes of abnormal high and low HbA1c values are provided along with investigation recommendations. Advantages and drawbacks of HbA1c testing are summarized.
The HbA1c test measures the amount of glycated hemoglobin in the blood over the past 2-3 months and can indicate how well diabetes has been controlled over that period. The test involves drawing blood, usually from a vein in the arm. A normal HbA1c level is below 5.7%, while for those with diabetes, maintaining a level at or below 7% is ideal. Elevated HbA1c levels mean blood glucose has been high on average and increases the risk of diabetes complications. The HbA1c test should be performed every 3-6 months to monitor diabetes management.
Diabetes mellitus is a condition where the body does not properly process glucose due to insufficient insulin production or resistance. There are two main types: type 1 diabetes results from immune destruction of insulin-producing cells and requires daily insulin injections; type 2 diabetes involves insulin resistance and reduced insulin production and can sometimes be prevented. HbA1c testing provides an indicator of average blood glucose levels over the prior 2-3 months and is the preferred method for diabetes diagnosis and monitoring, though it has some limitations. The document then describes an automated point-of-care analyzer that uses a blood sample to quickly and easily measure HbA1c levels to help manage diabetes.
The document discusses fructosamine and hemoglobin A1C (HbA1C) blood tests used to measure blood glucose levels in people with diabetes. Fructosamine measures glucose levels over the previous 2-3 weeks by detecting glucose bound to proteins like albumin. HbA1C measures levels over the past 3 months by detecting glucose bound to hemoglobin. Both tests are alternatives to daily blood glucose monitoring and provide a longer-term view of diabetes control. The document also explains what glycated proteins are and how they are formed through glycation reactions between glucose and amino groups on proteins.
The document discusses new trends in the management of diabetes in cardiac patients. It provides guidelines on glycemic targets and pharmacological therapy for type 2 diabetes. The recommended first-line treatment is metformin. Glycated hemoglobin (A1C) of less than 7% is a reasonable goal for many adults with diabetes, though some may require less or more stringent targets depending on individual factors. Combination therapy with oral medications and insulin is often needed to control blood sugar levels in type 2 diabetes.
Please correct me if anything wrong and to improve myself.
Thanks & Regards
Niranjan
9790861629
Marketing Manager - Professional Services
HITECH DIAGNOSTICS
This document discusses HbA1c, a blood test that measures average blood glucose levels over the past 3 months. It provides background on what HbA1c is, how it forms, its historical context, reference values, estimation methods, and how lowering HbA1c reduces risks of diabetes complications based on studies. It also discusses correlations between HbA1c, mean plasma glucose, advantages of HbA1c as a long-term marker of diabetes control, and limitations such as not being useful for acute decisions or situations that impact HbA1c like anemia.
This study examined whether different levels of glucose variability in patients with type 1 diabetes predict responses to continuous subcutaneous insulin infusion (CSII) therapy in terms of hypoglycemic events. The study found that:
1) Baseline low blood glucose index (LBGI), a measure of glucose variability, was the best predictor of reduced hypoglycemia on CSII therapy.
2) Patients in the highest LBGI tertile experienced a 23.3% reduction in hypoglycemic events without changes in A1C on CSII.
3) Patients in the lowest LBGI tertile had the greatest reduction in A1C on CSII of 20.99% but also experienced increased
Glycosylated Hemoglobin, also called Glycated Hemoglobin, Hemoglobin A1c, or HbA1c, refers to hemoglobin which is bound to glucose. Glycosylated Hemoglobin Test is performed to measure the percentage of glycosylated hemoglobin in blood which reflects the average blood glucose over a period of past two to three months (8 - 12 weeks).
For more information, visit
https://www.1mg.com/labs/test/glycosylated-hemoglobin-1611
A1 c versus glucose testing 19 5-2014 departement conferenceMoustafa Rezk
This document compares glucose testing and A1C testing for diagnosing diabetes. Glucose testing has limitations including lack of reproducibility between tests, requirement of fasting, and diurnal variation. A1C testing has advantages like not requiring fasting and less biological variability. However, A1C can be affected by factors like hemoglobinopathies, kidney disease, and alcohol use. Both tests are useful but understanding each test's limitations is important for accurate results. Overall A1C is convenient and detects undiagnosed diabetes but may not be suitable for all patients due to potential interferences. Standardization of A1C assays is also needed.
This study evaluated metabolic syndrome (MetS) as a predictor of diabetes compared to other markers like hemoglobin A1c (HbA1c) in a Japanese population. HbA1c was found to be a much better predictor of diabetes than MetS or fasting plasma glucose, with an AUC of 0.89. MetS had an AUC of only 0.63 and was a poorer predictor than measures like BMI or liver enzymes. The odds ratio of diabetes was highest for HbA1c ≥6.0% at 33.5, compared to 5.39 for MetS. The authors concluded that MetS is not a good predictor of diabetes compared to simple measures like HbA1c in Japanese individuals
An HbA1c test is used to check diabetes or pre-diabetes conditions in patients. Pre-diabetes condition shows an increased blood sugar level that means a person is at risk for getting diabetes. In case a person already has diabetes, an HbA1c test can help the doctor to monitor their condition and blood sugar levels.
This document provides standards of care for diabetes management as established by the American Diabetes Association (ADA). It discusses the classification and diagnosis of diabetes, including the criteria for diagnosing diabetes based on A1C, fasting plasma glucose, and oral glucose tolerance tests. It also defines categories of increased risk for diabetes, also known as prediabetes. The standards are intended to provide guidance to clinicians and others on the components of diabetes care and treatment goals.
This study analyzed prescription claims data from 238,402 patients with type 2 diabetes to identify predictors of changes in adherence to oral antidiabetes medications between years. The study found that about one third of patients changed adherence status from one year to the next, with about 22% becoming nonadherent after being adherent previously. For those who became nonadherent, the strongest predictors were the number of 90-day prescriptions filled, diabetes medication burden, longest gap in filling prescriptions, number of antidiabetes drug classes used, and copay for last drug. For those who became adherent after being nonadherent, the top predictors were medication burden, prescription gaps, fluctuating adherence, 90-day prescript
The document discusses various interventions to improve quality of care for patients with diabetes. It describes goals for metabolic control to reduce complications, benchmarking and recognition programs, and the economic impacts of improved diabetes management. It also discusses a model for promoting intensive insulin therapy at the primary care level using basal-bolus insulin regimens along with patient education.
Diabetic is a well known public health problem of today. There are many risk factors of it, which can be identified in pre-diabetic state. So the present study was conducted with the aim to know the status of anthropometric and haematological parameters in pre-diabetic states. For this hospital based study pre-diabetic subjects were identified from first degree relatives of type 2 DM Patients, enrolled in diabetic research centre P.B.M. hospital Bikaner. Relevant investigations were done. Data thus collected on semi-structured questionnaire and analysed using content analysis. Data analysis revealed that although mean Body Mass Index (BMI) was within normal range but Waist circumference (WC), West Hip (W/H) Ratio, Systolic blood pressure were higher than the normal range accepted for that parameter. But mean value of all the studied haematological parameter were within the normal range accepted for that parameter. So it can be conclude that anthropology of an individual may be associated with the pre-diabetic state. Hypertension was found in 25.35% of pre-diabetics. Further researches are necessary to find out this possible association of anthropologic parameter and pre-diabetic state.
C15 ada standards of medical care in diabetes 2012Diabetes for all
This document provides standards of care for diabetes management and treatment. It discusses that diabetes requires ongoing medical care and patient self-management to prevent complications. The standards are intended to guide clinicians and other stakeholders in evaluating quality of care and setting treatment goals, while allowing for flexibility based on individual patient factors. Diagnosis of diabetes can be made based on hemoglobin A1c, fasting plasma glucose, or oral glucose tolerance test results.
This document provides guidelines for managing post-meal glucose levels in diabetes. It summarizes the methodology used to develop the guidelines, which included reviewing evidence and reaching consensus among an international panel of experts. The guidelines are an update from 2007 and aim to help lower risks of diabetes complications by achieving optimal post-meal glucose control.
C14 idf guideline for management of postmeal glucose in diabetes 2011Diabetes for all
This document provides guidelines for managing post-meal glucose levels in people with diabetes. It finds that post-meal hyperglycemia is independently associated with several harmful health outcomes. While there is no direct evidence that controlling post-meal glucose improves clinical outcomes, targeting both post-meal and fasting glucose is important for achieving optimal glycemic control. A variety of dietary and pharmacological therapies can effectively lower post-meal plasma glucose. The guideline recommends a post-meal glucose target of 9.0 mmol/l or 160 mg/dl as measured 1-2 hours after a meal through self-monitoring of blood glucose.
Background: One of the commonest complications of poorly controlled Type 2 diabetes mellitus (T2DM) is Diabetic nephropathy (DN), which occurs in 30-40% of DM cases. It is important to identify the high-risk group who are likely to develop DN with the modifiable and non-modifiable risk factors. This study had the objectives to estimate and correlate the levels of the urine albumin creatinine ratio (UACR) with age, anthropometric measures, glycaemic control markers, lipids, and renal function. To estimate each variable as independent and multivariate risk factors.
Materials and Methods: It was an observational and cross-sectional study conducted in a tertiary care center in Eastern India. Totally, 221 consecutive ambulatory T2DM subjects were recruited after obtaining their written consent.
Results: The diabetics were classified as having diabetic nephropathy by the urine albumin creatinine ratio (ACR) of >30 mg/gm. 53.4% of our study group had DN. There was a significant risk associated with PPBS with p=0.043 (<0.05), serum creatinine with p=0.032 (<0.05), and urine albumin with p=0.0001 (<0.001). In the multivariate regression analysis of all these variables, there was a highly significant likelihood ratio for predicting DN with p=0.0001 (<0.001) with a predictive value of 74.5% in females and 75% in males.
Conclusion: The additive factors contributed by the risk factors in the prediction of DN will benefit the DM in the prevention of DN.
Keywords: diabetic nephropathy, risk factors, diabetic kidney disease, Asian Indian
This study evaluated platelet parameters in 100 subjects with type 2 diabetes and 100 non-diabetic controls. Mean platelet volume (MPV) and platelet distribution width (PDW) were significantly higher in diabetic subjects compared to controls. Among diabetics, those with HbA1c >7% had significantly higher MPV and PDW than those with HbA1c ≤7%, indicating poorer glycemic control is associated with increased platelet activity. MPV was also higher in diabetics with disease duration >10 years compared to those with duration ≤10 years, suggesting longer diabetes duration impacts platelet function. The study concludes that MPV can serve as a prognostic marker for cardiovascular risk in diabetes.
The document provides guidelines for standards of medical care in diabetes. It discusses that diabetes is a complex chronic illness requiring ongoing patient self-management and education to prevent complications. The guidelines are intended to provide clinicians and others with components of diabetes care and treatment goals. Key recommendations include screening, diagnostic, and treatment actions known to positively impact health outcomes for patients with diabetes.
The Effect of Demographic Data and Hemoglobin A 1c on Treatment Outcomes in P...asclepiuspdfs
Objective: Diabetes mellitus, the most common cause of non-traumatic foot amputations, is a life-threatening condition due to its high mortality and morbidity. In our study, we retrospectively evaluated our patients with diabetic foot syndrome in our clinic. Materials and Methods: The demographic data, duration of diabetes, Wagner classification, haemoglobin A 1c (HbA1c) levels, white blood cell, C-reactive protein sedimentation levels, hospital stay, and treatment results were evaluated retrospectively in 14 patients with diabetic foot between January 2017 and December 2018. Results: The mean age of the patients was 62.43 ± 7.7 years. Of the 14 patients, 3 were females and 11 were males. All 14 patients were type 2 diabetes mellitus. When diabetic foot Wagner classification was performed, 6 patients were evaluated as Wagner 2, five patients were Wagner 3, and three patients were evaluated as Wagner 4. Nine patients had complete amputation and 3 had vascular surgery. Conclusion: Although the level of HbA1c is below the target level, the risk of diabetic foot is increased when there is no adequate diabetes mellitus foot training. Inadequate diabetic patient education and hospitalization of patients after infection progress the amputation rate.
Prevalence of Chronic Kidney disease in Patients with Metabolic Syndrome in S...asclepiuspdfs
Background and Objective: Chronic kidney disease (CKD) which is an increasingly important clinical and public health issue is associated with cardiovascular disease. Epidemiologic studies have also linked metabolic syndrome (MetS) with an increased risk of incident CKD. Therefore, the present study was designed retrospectively to find the prevalence and potential risk factors of CKD in patients with MetS in Saudi Arabia.
The document provides guidelines for standards of medical care for diabetes. It discusses that diabetes is a complex chronic illness requiring ongoing management. It recommends screening asymptomatic adults who are overweight or at risk for diabetes, using A1C, FPG, or OGTT tests. It defines prediabetes categories and the criteria for diagnosing diabetes based on lab test results.
The document provides guidelines for standards of medical care in diabetes. It discusses that diabetes is a complex chronic illness requiring ongoing patient self-management and education to prevent complications. The guidelines are intended to provide clinicians and others with components of diabetes care and treatment goals. Key recommendations include screening, diagnostic, and treatment actions known to positively impact health outcomes for patients with diabetes.
The document provides guidelines for standards of medical care in diabetes. It discusses that diabetes is a complex chronic illness requiring ongoing patient self-management and education to prevent complications. The guidelines are intended to provide clinicians and others with components of diabetes care and treatment goals. Key recommendations include screening, diagnostic, and treatment actions known to positively impact health outcomes for patients with diabetes.
The document provides guidelines for standards of medical care in diabetes. It discusses that diabetes is a complex chronic illness requiring ongoing patient self-management and education to prevent complications. The guidelines are intended to provide clinicians and others with components of diabetes care and treatment goals. Key recommendations include screening, diagnostic, and treatment actions known to positively impact health outcomes for patients with diabetes.
Trategies for preventing type 2 diabetes an update for cliniciansRodrigo Diaz
The document discusses strategies for preventing type 2 diabetes. It provides background on the rising prevalence of diabetes and obesity globally. Individuals with prediabetes, defined as impaired fasting glucose or impaired glucose tolerance, are at high risk of progressing to type 2 diabetes. Lifestyle interventions targeting diet and exercise changes are the main strategy recommended for preventing or delaying the onset of type 2 diabetes in prediabetic individuals.
Management of Hyperglycemia in Type 2 Diabetes, 2015: A Patient- Centered App...Mgfamiliar Net
Update to a Position Statement of the American Diabetes Association and the European Association for the Study of Diabetes
Diabetes Care 2015;38:140–149 | DOI: 10.2337/dc14-2441
Recent studies have highlighted the growing global burden of type 2 diabetes, with over 600 million people projected to have the disease by 2045. In particular, Egypt will face explosive growth in cases. While control of blood sugar levels is important for reducing complications, most patients do not achieve treatment goals. Intensifying treatment in a timely manner when blood sugar is poorly controlled can reduce cardiovascular risks. Inertia on the part of both physicians and healthcare systems often limits timely treatment changes needed to improve outcomes for patients with type 2 diabetes.
SIN SARGATA (ISS), PIED DIABÉTIQUE, GOOD, 17 A.pdfSargata SIN
The study retrospectively analyzed 180 cases of diabetic foot treated at a Cambodian hospital between 2011-2015. Most patients were older farmers over 60 years old. The majority (70%) underwent debridement, while amputation was required for 31%. High blood pressure was present in 46% of patients and end-stage renal failure in 6.1%. The study found diabetic foot complications occurred in both younger and older diabetic patients and were related not only to glycemic control and diabetes duration, but also patient knowledge.
This document presents standards of care for diabetes published by the American Diabetes Association. It discusses that diabetes requires ongoing medical care and patient self-management to prevent complications. The standards provide clinicians and others components of diabetes care, treatment goals, and ways to evaluate quality of care, while allowing for customization based on individual patient factors. The recommendations are based on evidence from screening, diagnostic and therapeutic interventions shown to positively impact patient health outcomes and be cost-effective.
1. Diabetic Lower ExtremityComplications, Fear of Falling and Associated HbA1c Levels:
A Cross-Sectional Study of the East HarlemPopulation
Garry Shtofmakher1, Roger Kilfoil1, Adam Rozenstrauch1, Meenakshi Das Lala5, Matthew Weintraub2, Michael Rothstein, MSN3, Anthony Iorio, DPM,MPH4
New York College of Podiatric Medicine (NYCPM)
1
4thYear Student at NYCPM Class of 2015, 2
2nd Year Student at NYCPM Class of 2017, 3
Clinical Instructor at NYCPM, 4
Associate Professor and Chair, Department of Community Health and Medicine; AssistantDean for Continuing Medical Education,5
Weill Cornell Medical College
BACKGROUND
● Hemoglobin A1c (HbA1c) levels used to measure patients’ blood
glucose levels over 120 days
● Although more costly to quantify than fasting blood glucose
levels, HbA1c might be a more reliable diagnostic and prognostic
indicator for specific podiatric comorbidities
● One of the main risk factors for the development of diabetic foot
ulcers was HbA1C >9% (1)
● Data suggest that the early detection of diabetic foot
complications could reduce the prevalence of ulceration (2)
● Therefore, glucose control is important for the prevention of
diabetic complications
● Preventative measures are key during discussions of the
financial implications of diabetic feet in a hospital setting
● Ulcers account for 1 in 5 diabetes-related hospital visits (3)
● The rate of readmission (for any reason in the same calendar
year) in patients with diabetic foot ulcers was 33.4% in 2008 (4)
● It is estimated that diabetic care accounts for ~25% of hospital
costs
● The pathogenesis and the podiatric implications of diabetes
mellitus are poorly understood (5)
● A better understanding of the co-morbidities and financial
burdens of this global illness, particularly within the podiatric
community, could improve care in the diabetic population and
potentially reduce healthcare spending
● The primary aim of this study was to correlate HbA1c levels with
the podiatric manifestations most commonly encountered in the
clinical setting
● This study was the first to survey HbA1c levels in the East
Harlem population presenting to the Foot Clinics of New York
(FCNY) and correlating the resulting data with various podiatric
manifestations
● These analyses will determine if HbA1c is a positive predictor of
the lower extremity complications commonly manifested in
diabetes
● A secondary objective was to investigate if the progression of
diabetes-related complications had any affect on the fear of
falling
Figure 1. The diabetic pedal manifestations in the study subjects.
Figure 2. The research protocol algorithm.
Figure 3. The relationship between mean HbA1c levels and the
total number of podiatric manifestations. There was a statistically
significant difference in HgA1C ( HbA1c ) levels between groups
(P = 0.027).
Figure 4. The correlation HbA1C levels and the total number of
podiatric manifestations.
Table 1. Demographic characteristics of the study subjects.
MATERIALS AND METHODS
● This study was reviewed and approved by New York College of
Podiatric Medicine IRB
● Prospective subjects were recruited if they reported an
International Classification of Diseases (ICD) code consistent
with diabetes using electronic medical records
● Subjects were enrolled if they expressed a desire to participate,
conformed with the inclusion and exclusion criteria, and provided
informed consent
● Asummary of the study protocol is shown in Figure 2.
● The lower extremities of all subjects were examined using a
comprehensive checklist based on the common symptoms
● HbA1c levels were then measured using a HbA1c measuring
device.
● Data were analyzed statistically using SPSS Version 20 (IBM,
Armonk, NY)
● Multiple statistical models were used, including
● One-wayANOVA
● Correlations and regression analysis
● The primary outcomes were HbA1c levels and the duration of
diabetes
● The secondary outcome was Modified Falls Efficacy Scale
(MFES) score, which was used to measure the risk of falling
● P < 0.05 was considered to indicate statistical significance
RESULTS
Demographics of the Study Population
● Atotal of 38 patients were enrolled at Foot Center of New York
● The mean number of podiatric manifestations was 4.43 (SD =
62.35)
● The mean HbA1C level was 8.23% (SD = 1.94)
● Most subjects were male andAfricanAmerican
● The mean MFES score was 8.19 (SD = 2.5)
Relationships Among Variables
● Several predictors of podiatric manifestations were examined,
including
● Mean MFES score
● Age
● Concurrent treatments for neuropathy
● HbA1C levels
● Correlational analyses revealed that the total number of podiatric
manifestations was:
● Not related to concurrent treatments for neuropathy (r= −0.135, P
= 0.420)
● Not related to MFES score (r = −0.161, P = 0.321)
● Age was also not a significant predictor of podiatric
manifestations (r = −0.137; P = 0.399)
● Regression analyses revealed that the duration of diabetes did
not predict podiatric manifestations (B = −0.019, beta = 0.075;
SE = 0.04;, P = 0.669)
● Regression results also indicated that mean MFES score did not
predict HbA1c levels (B = 0.048; beta = 0.063; SE = 0.125; P =
0.706).
The Ability of HbA1C to Predict Podiatric Manifestations
was no
podiatric
● Simple correlational analyses revealed that there
correlation between HbA1C and the number of
manifestations (r = 0.24; P > 0.05; Figure 4)
● Several follow-up regression analyses were performed to assess
the ability of HbA1c to predict podiatric manifestations when
controlling for individual parameters such age and duration of
diabetes
● HbA1C did not predict number of podiatric manifestations after
controlling for controlling for
● Age and diabetes duration (B = 0.140; beta = 0.124; SE = 0.245;
P = 0.572)
● Age alone (P = 0.290)
● Diabetes duration alone (P = 0.255).
The Effect of Neuropathy Drugs on Mean MFES Score
● Independent t-tests indicated that a subject’s mean MFES score
was influenced by concurrent neuropathy drugs
● Participants receiving neuropathy drugs (M = 6.1) exhibiting a
significantly lower MFES score than did participants not receiving
neuropathy drugs (M = 9.085; t = −3.663; P < 0.001).
The Effect of Neuropathy Drugs on HbA1C Levels
● Finally, data were analyzed to determine whether concurrent
neuropathy drugs could predict a participant’s Hb1AC level
● The results of t-tests indicated that the HbA1c levels of participants
receiving neuropathy drugs (M = 7.566) did not significantly differ
from those not taking neuropathy drugs (M = 8.511), although there
was a trend (t = −1.284; P = 0.208)
CONCLUSIONS
● The podiatric manifestations of patients with diabetes in East
Harlem are wide-ranging
● The two most common findings were nail and skin disorders, which
are both considered to be precursors of infections and amputations
● These are not to be overlooked given their high financial and
quality-of-life implications on individuals with diabetes, particularly
elderly and immunocompromised patients
● The effects of neuropathic drugs were assessed regarding the fear
of falling
● MFES score is a strong indicator of falling in neuropathic diabetics
● Since healthcare in the USA is shifting toward preventative
medicine, finding more cost-effective ways to deliver care for
diabetic patients is crucial
● Predictive tools could help reduce the economic burden of diabetes
● This study assessed the ability of HbA1c to predict the total number
of podiatric manifestations in diabetic patients
● Surprisingly, HbA1C was not a good predictor of the number of
podiatric manifestations
● The weak correlation between HbA1c levels and the total number of
podiatric manifestations might be due to the small sample size
● Nevertheless, these findings do not rule out the potential value of
HbA1C as a predictor of lower extremity complications
● The ANOVA results revealed that between groups of total number
of podiatric manifestations there was a robust effect seen by the
HbA1c number (P = 0.02)
● Future studies should examine the potential of HbA1C for
predicting lower extremity complications
● Although HbA1C levels might be a weak prognostic indicator for
predicting diabetic lower extremity complications, they might be
useful in other clinical situations
REFERENCES
1. Lavery LA, Armstrong DG, Vela SA, Quebedeaux TL, Fleischli JG. Practical criteria for
screening patients at high risk for diabetic foot ulceration. Arch Intern Med. 1998 Jan
26;158(2):157-62.
2. Lipsky BA, Berendt AR, Deery HG, Embil JM, Joseph WS, Karchmer AW, et al. Diagnosis
and treatment of diabetic foot infections. Clin Infect Dis. 2004 Oct 1;39(7):885-910.
3. Bild DE, Selby JV, Sinnock P, Browner WS, Braveman P, Showstack JA. Lower-extremity
amputation in people with diabetes. epidemiology and prevention. Diabetes Care. 1989
Jan;12(1):24-31.
4. Margolis DJ, Malay DS, Hoffstad OJ, Leonard CE, MaCurdy T, Tan Y, et al. Economic
Burden of Diabetic Foot Ulcers and Amputations: Data Points #3. In: Data Points Publication
Series. Rockville (MD): ; 2011.
5. Litzelman DK, Marriott DJ, Vinicor F. Independent physiological predictors of foot lesions in
patients with NIDDM. Diabetes Care. 1997 Aug;20(8):1273-8.
SPECIAL THANKS
A special thanks to the New York College of Podiatric Medicine for helping us fund our trip to the
30th Annual Clinical Conference on Diabetes. A special thanks to Dr. Eileen Chusid, PhD,
Dr. James Ford, PhD, Dr. Khurram H. Khan, DPM, and Mr. Paul Tremblay, MLIS, MA for
providing their expertise, and guidance in the preparation of this poster. A special thanks to
members of the NYCPM Class of 2015 for their assistance with patient recruitment.