Abstract P161: Relationship Between Clinical Availability of Hemoglobin A1c and Glucose Therapy Intensification in Patients With Diabetes Hospitalized for Acute Myocardial Infarction

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Joshua M Stolker ◽  
John A Spertus ◽  
Darren K McGuire ◽  
Silvio E Inzucchi ◽  
Saif S Rathore ◽  
...  
Keyword(s):  
Regression Models ◽  
Hemoglobin A1c ◽  
Clinical Care ◽  
Insulin Dose ◽  
Daily Insulin Dose ◽  
Patients With Diabetes ◽  
Acute Mi ◽  
Glucose Therapy ◽  
Multivariable Adjustment

BACKGROUND Hemoglobin A 1c (A1C) assessment is recommended for hospitalized patients (pts) with diabetes (DM). Whether in-hospital A1C levels are associated with glucose therapy intensification (GTI) after MI is unknown. METHODS TRIUMPH is a multicenter MI registry which enrolled 1343 pts with established DM between 2005-08. Of 1149 pts with DM and measured A1C, 886 (77%) were assessed as part of clinical care, and an additional 263 (23%) had A1C assessed in the research core laboratory (results unavailable to clinicians). GTI was defined as new or increased doses of antihyperglycemic agents, or increased daily insulin dose by ≥20% at discharge. Pts were divided into those with vs. without clinically available A1C and stratified by A1C subgroup (<7, 7-9, >9). Poisson regression models evaluated if clinically available A1C was independently associated with GTI. RESULTS Overall, 420 of 1149 pts (36%) with measured A1C had levels <7, 423 (37%) were between 7-9, and 306 (27%) were >9. GTI was prescribed in 367 pts (32%). Clinically available A1C was associated with more frequent GTI in pts with suboptimal (A1C 7-9) and poor (A1C >9) glycemic control, but not in those with adequate control (A1C <7; Figure ). After multivariable adjustment (including blood glucose), clinically available A1C was an independent predictor of GTI (RR 1.27, 95% CI 1.08-1.51). CONCLUSION Nearly two-thirds of pts with DM have suboptimal or poor long-term glucose control at the time of acute MI, and fewer than 50% of these pts are prescribed GTI at hospital discharge. Availability of A1C levels to clinicians may facilitate intensification of glucose therapy after MI in pts with inadequate long-term DM control.

scholarly journals ABCD position statement on risk stratification of adult patients with diabetes during COVID-19 pandemic

2021 ◽  
Author(s):  
Dinesh Nagi ◽  
Emma Wilmot ◽  
Karissa Owen ◽  
Dipesh Patel ◽  
Lesley Mills ◽  
...  
Keyword(s):  
Diabetes Care ◽  
Clinical Care ◽  
Position Statement ◽  
Specialist Care ◽  
Long Term Conditions ◽  
Use Of Technology ◽  
Patients With Diabetes ◽  
Long Term Impact ◽  
The Uk

At the time of submission of this manuscript, the COVID-19 pandemic had cost nearly 60,000 lives in the UK. This number currently stands at over 120,000 deaths. A high proportion (one third) of these lived with diabetes. The huge acute and emergency medicine effort to support people with COVID-19 has had a major knock-on impact on the delivery of routine clinical care, especially for long-term conditions like diabetes.Challenges to the delivery of diabetes services during this period include a reduction in medical and nursing staff, limitations placed by social distancing on physical clinical space, and balancing virtual vs face-to-face care. There is a need to re-group and re-organise how we deliver routine out-patient adult diabetes services during the ongoing COVID-19 pandemic. We offer some suggestions for how patients can be stratified into red (urgent), amber (priority) and green (routine) follow up with suggestions of how often people should be seen. We also offer recommendation on how we can identify those at highest risk and try and minimise the long- term impact of COVID on diabetes careDuring the COVID pandemic we have seen things happen in days that previously took years. The restart of diabetes services has triggered a more widespread use of virtual consultations and data management systems, but also offers an opportunity for more joined-up and cohesive working between primary and specialist care. While we do our best to keep our patients and colleagues safe, this pandemic is already proving to be a catalyst for change, accelerating the appropriate use of technology in diabetes care and implementing innovative solutions. To achieve this aspiration, further work – currently led by the Association of British Clinical Diabetologists in collaboration with Diabetes UK and the Primary Care Diabetes Society – to make recommendations on future proofing diabetes care in UK is in progress.

Plasma endothelin-1 and total insulin exposure in diabetes mellitus

1999 ◽  
Vol 97 (2) ◽  
pp. 149-156 ◽  
Author(s):  
Flemming WOLLESEN ◽  
Lars BERGLUND ◽  
Christian BERNE
Keyword(s):  
Type Ii Diabetes ◽  
Type I Diabetes ◽  
Insulin Dose ◽  
Albumin Excretion Rate ◽  
Wall Structure ◽  
Type I ◽  
Type Ii ◽  
C Peptide ◽  
Patients With Diabetes

Insulin stimulates endothelin-1 (ET-1) expression in a dose-response relationship, and ET-1 effects on vascular wall structure are similar to the long-term complications of diabetes. We therefore determined whether the plasma ET-1 concentration in patients with diabetes is associated with their total insulin exposure to see if plasma ET-1 might be a link between insulin exposure and long-term complications of diabetes. We studied 69 patients with Type I and 40 patients with Type II diabetes mellitus in equally tight glycaemic control for 2 years in a cross-sectional design. We measured basal and glucagon-stimulated plasma C-peptide, abdominal sagittal diameter, skinfold thickness, glomerular filtration rate, albumin excretion rate and standard clinical characteristics. Mean HbA1c was 6.4% in Type I and 6.3% in Type II diabetes. Patients with an albumin excretion rate > 300 μg/min were excluded. Adjusted mean plasma ET-1 was 4.11 (S.E.M. 0.39) pg/ml in 21 normal subjects, 3.47 (0.19) pg/ml in Type I diabetes and 4.84 (0.26) pg/ml in Type II diabetes (P = 0.0001). In all patients with measurable plasma C-peptide, plasma ET-1 was associated with basal plasma C-peptide (r = 0.5018, P < 0.0001), with stimulated plasma C-peptide (r = 0.5379, P < 0.0001), and with total daily insulin dose (r = 0.2219, P = 0.00851). Abdominal obesity, metabolic abnormalities, blood pressure and glomerular filtration rate were not associated with plasma ET-1, when corrected for C-peptide and daily insulin dose. Our study shows that the plasma concentration of ET-1 is closely associated with insulin secretion and insulin dose in patients with diabetes. Plasma ET-1 is higher in Type II diabetes than in Type I diabetes. Increased insulin exposure in patients with diabetes may have long-term effects on vascular wall structure through its stimulation of ET-1 expression.

scholarly journals The impact of curative treatment on hyperglycemia in patients with Cushing syndrome

2021 ◽  
Author(s):  
Justine Herndon ◽  
Ravinder Jeet Kaur ◽  
Mark Romportl ◽  
Emily Smith ◽  
Amy Koenigs ◽  
...  
Keyword(s):  
Hemoglobin A1c ◽  
Cushing Syndrome ◽  
Insulin Dose ◽  
Close Monitoring ◽  
Oral Medications ◽  
Daily Insulin Dose ◽  
Appropriate Therapy ◽  
Therapy Modification ◽  
The Impact

Abstract Context Hyperglycemia is a common complication of Cushing syndrome (CS). Objective We aimed to determine the impact of curative procedure on hyperglycemia and its management in patients with CS. Design Retrospective longitudinal cohort study, 2000-2019. Setting Referral center. Patients Adults with endogenous CS and hyperglycemia. Main outcome measure Hemoglobin A1c (HbA1c), intensity of hyperglycemia therapy, improvement of hyperglycemia. Results In 174 patients with CS (pituitary in 106, ectopic in 25, adrenal in 43), baseline median HbA1c was 6.9% (range 4.9-13.1), with 41 (24%) patients not on any therapy for hyperglycemia, 93 (52%) on oral medications, and 64 (37%) on insulin (median daily units of 58, range 10-360). Following CS remission, at the end of follow up (median 10.5 months), 37 (21%) patients demonstrated resolution of hyperglycemia, 82 (47%) demonstrated improvement, and 55 (32%) had no change or worsening in hyperglycemia. At the end of follow up, HbA1c decreased by 0.84% (p &lt; 0.0001) and daily insulin dose decreased by a mean of 30 units, p &lt; 0.0001. Biochemical hypercortisolism severity score (severe vs moderate/mild: Odds ratio (OR) of 2.4 (95%CI of 1.1-4.9)), and CS subtype (nonadrenal vs adrenal: OR of 2.9 (95%CI 1.3-6.4)), but not type of hyperglycemia (diabetes vs prediabetes: OR of 2.1 (0.9-4.9)) were associated with hyperglycemia improvement at the end of follow up. Conclusion Two thirds of patients with CS and hyperglycemia demonstrate resolution or improvement of hyperglycemia after a curative procedure. Close monitoring during CS recovery is needed to assure appropriate therapy modification.

scholarly journals Severe hyperglycemia and insulin resistance in patients with SARS-CoV-2 infection: a report of two cases

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Alison H. Affinati ◽  
Amisha Wallia ◽  
Roma Y. Gianchandani
Keyword(s):  
Insulin Resistance ◽  
Type 2 Diabetes ◽  
African American Women ◽  
Insulin Dose ◽  
Clinical Feature ◽  
Severe Insulin Resistance ◽  
Daily Insulin Dose ◽  
Medication Side ◽  
Patients With Diabetes

Abstract Background Severe insulin resistance is an uncommon finding in patients with type 2 diabetes but is often associated with difficult to managing blood glucose. While severe insulin resistance is most frequently seen in the setting of medication side effects or rare genetic conditions, this report of two cases highlights the presence of severe insulin resistance in the setting of severe COVID-19 and explores how this may contribute to the poor prognosis of patients with diabetes who become infected with SARS-CoV-2. Case presentation Here we present the cases of two African-American women with pre-existing type 2 diabetes who developed severe COVID-19 requiring mechanical ventilation and concurrent severe insulin resistance with total daily insulin dose requirements of greater than 5 unit/kg. Both patients received aggressive insulin infusion and subcutaneous insulin therapy to obtain adequate glucose management. As their COVID-19 clinical course improved, their severe insulin resistance improved as well. Conclusions The association between critical illness and hyperglycemia is well documented in the literature, however severe insulin resistance is not commonly identified and may represent a unique clinical feature of the interaction between SARS-CoV-2 infection and type 2 diabetes.

scholarly journals The role of proper insulin injection technique training FOR achieving of good glycaemic control

2018 ◽  
Vol 21 (5) ◽  
pp. 419-424
Author(s):  
Inna V. Misnikova ◽  
Valeriya A. Gubkina ◽  
Alexander V. Dreval
Keyword(s):  
Glycemic Control ◽  
Insulin Dose ◽  
Insulin Injection ◽  
Injection Technique ◽  
Good Glycemic Control ◽  
Daily Insulin ◽  
Daily Insulin Dose ◽  
Good Glycaemic Control ◽  
Patients With Diabetes ◽  
The Uk

Inappropriate injection technique leads to incorrect insulin dosing, increased pain and impaired glucose control in patients with diabetes. This review examines in detail the results of two clinical studies, the Glycemic Impact of Insulin Injection Technique (GIIIT) and the UK Lipo Study (UKLS) that examined the effect of teaching patients proper injection techniques to achieve good glycemic control. The GIIIT study included patients with type 1 and type 2 diabetes (1870 years) who were on a regimen of multiple daily insulin injections. They were categorised into three groups: those that received structured injection technique training using 4-mm injection needles (TN), those that received injection technique training (T) and control (C). The UKLS study included 75 patients who received structured training to reduce the risk of developing lipohypertrophy. Initially, deviations from proper insulin injection technique were observed in a majority of patients in both the studies. In the GIIIT study, 6 months after training under TN and T conditions, HbA1c decreased by 1%, with no observable changes under the C condition. The daily insulin dose was increased by 6 IU in all conditions. Overall, the use of 4-mm short needles reduced post-injective pain in all patients. In the UKLS study, for 6 months, the variability of glycemia and frequency of unexplained hypoglycaemia decreased as the daily dose of insulin decreased by an average 6 IU; in addition, HbA1c level decreased from 8.6% to 8.2%. Six months after the training, both studies noted a decrease in or disappearance of lipohypertrophy in the patients. These results indicate that proper injection technique training improves glycemic control in patients with diabetes.

scholarly journals Is Diabetic Ketoacidosis A Good Predictor Of 5-Year Metabolic Control in Children with Newly Diagnosed Type 1 Diabetes?

2021 ◽  
Author(s):  
Emilia Kowalczyk ◽  
Aneta Stypułkowska ◽  
Barbara Majewska ◽  
Małgorzata Domaradzka ◽  
Aleksandra Hoffmann ◽  
...  
Keyword(s):  
Metabolic Control ◽  
Insulin Dose ◽  
Diabetes Diagnosis ◽  
Newly Diagnosed ◽  
Daily Insulin Dose ◽  
Early Implementation ◽  
Modern Technologies

Abstract Purpose: The study aimed to evaluate whether the presence of DKA at diabetes diagnosis was associated with poorer metabolic control during a 5-year follow-up.Methods: The study included children treated due to newly diagnosed T1D complicated with DKA between 2010-2014 with a complete 5-year follow-up. In every case we performed individual matching for age, gender and BMI with a person without DKA (nDKA) on recognition. We collected data regarding treatment modality, HbA1C, total daily insulin dose, basal insulin and BMI-SDS.Results: 85 children at the median age of 7.93 years had DKA at diabetes diagnosis. The median pH was 7.19.Continuous subcutaneous insulin infusion (CSII) was used in 87% of participants in each group. No differences in HbA1C level (7,3%vs7,2%;p=.413) were noted after 5 years of disease duration. The severity of ketoacidosis exerted no significant effect on HbA1C. The method of insulin delivery at baseline was significantly associated with HbA1C levels after 5 years of observation, βCSII=-1.46,95%CI[-2.01 to -0.92],p<.001.Conclusions: The presence of DKA at diabetes diagnosis is not associated with deteriorated long-term metabolic control in children using modern technologies. The early implementation of CSII into diabetes treatment may change the effect of DKA and lead to a long-term HbA1C improvement.

scholarly journals Changes over Time in Hemoglobin A1C (HbA1C) Levels Predict Long-Term Survival Following Acute Myocardial Infarction among Patients with Diabetes Mellitus

2021 ◽  
Vol 10 (15) ◽  
pp. 3232
Author(s):  
Ygal Plakht ◽  
Harel Gilutz ◽  
Arthur Shiyovich
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hemoglobin A1c ◽  
Prognostic Significance ◽  
Diabetic Patients ◽  
Term Survival ◽  
Patients With Diabetes ◽  
One Year ◽  
Hba1c Levels

Frequent fluctuations of hemoglobin A1c (HbA1C) values predict patient outcomes. However, data regarding prognoses depending on the long-term changes in HbA1C among patients after acute myocardial infarction (AMI) are scarce. We evaluated the prognostic significance of HbA1C levels and changes among diabetic patients (n = 4066) after non-fatal AMI. All the results of HbA1C tests up to the 10-year follow-up were obtained. The changes (∆) of HbA1C were calculated in each patient. The time intervals of ∆HbA1C values were classified as rapid (<one year) and slow (≥one year) changes. The outcome was all-cause mortality. The highest mortality rates of 53.8% and 35.5% were found in the HbA1C < 5.5–7% and ∆HbA1C = −2.5–(−2%) categories. A U-shaped association was observed between HbA1C and mortality: adjOR = 1.887 and adjOR = 1.302 for HbA1C < 5.5% and ≥8.0%, respectively, as compared with 5.5–6.5% (p < 0.001). Additionally, ∆HbA1C was associated with the outcome (U-shaped): adjOR = 2.376 and adjOR = 1.340 for the groups of <−2.5% and ≥2.5% ∆HbA1C, respectively, as compared to minimal ∆HbA1C (±0.5%) (p < 0.001). A rapid increase in HbA1C (but not decrease) was associated with a greater risk of mortality. HbA1C values and their changes are significant prognostic markers for long-term mortality among AMI-DM patients. ∆HbA1C and its timing, in addition to absolute HbA1C values, should be monitored.

scholarly journals Challenges in Hemoglobin A1C Measurement in 183 Patients with Diabetes having Hemoglobin Variants and Chemically Modified Derivatives

2021 ◽  
Vol 2 (4) ◽  
pp. 7
Author(s):  
Dilshad Ahmed Khan ◽  
Sumbal Nida
Keyword(s):  
Hemoglobin A1c ◽  
Clinical Chemistry ◽  
Glycosylated Hemoglobin ◽  
Diabetic Patients ◽  
Chemically Modified ◽  
Patients With Diabetes ◽  
Hemoglobin Variants ◽  
Selection Of

Diabetes is considered as one of the most common metabolic disorder. It has challenged in terms of diagnosis,monitoring and management in the patients with type-2 diabetes. Glycosylated Hemoglobin (HbA1c) hasrecently been validated for the diagnosis diabetes in non-fasting condition, long term blood glycose monitoringand also predicting its complications in the patients. National Glycohemoglobin Standardization Program andInternational Federation of Clinical chemistry have been collaborating for the harmonization of HbA1cmethods and directing the laboratories to maintain strict quality goals. However, standardization of variousHbA1c methods being used worldwide still needs consideration especially in diabetic patients havinghemoglobin variants. The main objectives are to review HbA1c methods and address challenges in itsmeasurement methodology for the patients with diabetes mellitus having hemoglobin variants or chemicallymodified derivatives. Thus, to provide guidance to the clinical pathologist for selection of appropriate methodfor their laboratories.

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