Evaluation of Central Corneal Epithelial Thickness With Anterior Segment OCT in Patients With Type 2 Diabetes Mellitus

Aim: The aim of this study was to evaluate the central corneal thickness (CCT) and central corneal epithelial thickness (CCET) in patients with Type 2 diabetes mellitus (DM), and the effect of the duration of diabetes, the degree of diabetic retinopathy (DR), and HbA1c level. Method: CCT and CCET values ​​of 72 patients diagnosed with type 2 DM and 72 healthy individuals were measured by anterior segment optical coherence tomography (AS-OCT). The eye tear function was evaluated with the Tear Break-up Time test (TBUT) and the Schirmer test. From the results of fundus examination, the diabetic patients were grouped as those without DR, with non-proliferative DR, and with proliferative DR. The disease duration and the HbA1c levels were recorded. Results: In the diabetic patients, the mean CCT was determined to be thicker (p=0.025), the CCET was thinner (p=0.003), and the TBUT and Schirmer values were lower (p<0.001, p<0.001, respectively). The duration of diabetes and the HbA1c level were not found to have any statistically significant effect on these parameters (p>0.05). The presence of retinopathy had no significant effect on CCT, TBUT and Schirmer values. The CCET was determined to be thinner in patients with retinopathy (p<0.001). Conclusion: As the corneal epithelial thickness is reduced in patients with advanced diabetic retinopathy, corneal epithelial pathologies can be seen more often. Therefore, early and effective treatment can be started taking into consideration the complications which may develop associated with the corneal epithelium following surgical procedures, especially those applied to the cornea.

Effect of the interaction between physical activity and estimated macronutrient intake on HbA1c: population-based cross-sectional and longitudinal studies

IntroductionHealthy diet and physical activity (PA) are essential for preventing type 2 diabetes, particularly, a combination of diet and PA. However, reports on interaction between PA and diet, especially from large epidemiological studies, are limited. We investigated the effect of interaction between PA and macronutrient intake on hemoglobin A1c (HbA1c) levels in the general population.Research design and methodsWe conducted a cross-sectional study of 55 469 men and women without diabetes who participated in the baseline survey of the Japan Multi-Institutional Collaborative Cohort Study. A self-administered questionnaire ascertained PA and macronutrient intake (carbohydrate, fat, and protein). Multiple linear regression analyses were performed to adjust for confounding variables and examine the interactions. In addition, we conducted a longitudinal study during a 5-year period within a subcohort (n=6881) with accelerometer-assessed PA data.ResultsOverall, PA had a weak inverse association (β=−0.00033, p=0.049) and carbohydrate intake had a strong positive association (β=0.00393, p<0.001) with HbA1c. We observed a tendency of interactions between PA and carbohydrate or fat intake, but not protein intake, on HbA1c levels after adjusting for age, sex, study area, total energy intake, alcohol consumption, smoking, and medication for hypertension or hypercholesterolemia (Pinteraction=0.054, 0.006, and 0.156, respectively). The inverse associations between PA and HbA1c level were more evident in participants with high-carbohydrate (or low-fat) intake than in participants with low-carbohydrate (or high-fat) intake. Although further adjustment for body mass index slightly attenuated the above interactions (Pinteraction=0.098 for carbohydrate and 0.068 for fat), the associations between PA and HbA1c level in stratified analyses remained unchanged. Similar associations and interactions were reproduced in the longitudinal study.ConclusionsThe present results suggest that the effect of PA on HbA1c levels is modified by intake of macronutrient composition.

Impact of iron deficiency anemia on HbA1c level in non-diabetic children

Background and objective: HbA1c has been endorsed by the American Diabetes Association and World Health Organization to diagnose and monitor diabetes mellitus. Its value is directly proportional to the blood glucose level. However, besides the blood glucose level, other factors like iron deficiency anemia can affect HbA1c level. We conducted this study to reveal the impact of iron deficiency anemia on HbA1c level and to assess whether HbA1c result changes after the correction of iron deficiency anemia. Methods: Twenty five non-diabetic children who were confirmed to have iron deficiency anemia were enrolled. HbA1c, hemoglobin, serum iron, and ferritin were measured and compared at baseline and post-correction of iron deficiency anemia with a three-month age-appropriate dose of iron therapy. The baseline results were compared with 25 age- and sex-matched normal controls. Results: Children with iron deficiency anemia had significantly higher HbA1c level (6.144±0.6312, P <0.001) than the control group (5.032±0.5558, P <0.001). After three months of treatment of iron deficiency anemia, HbA1c significantly dropped (from 6.144±0.6312, P <0.001 to 5.604±0.51, P <0.001). Conclusion: This study concluded that HbA1c is inversely proportional to iron deficiency anemia in non-diabetic children, and treatment of iron deficiency anemia led to a drop in HbA1c level. Due to this false elevation of HbA1c by iron deficiency anemia, iron deficiency anemia should be considered and excluded before making the diagnosis or deciding on any therapeutic change in diabetic children. Keywords: Iron deficiency anemia; HbA1c; Non-diabetic children.

Effect of vitamin D supplementation on HbA1c level in a cohort of type 1 diabetic patients

Background and objective: Glycemic control is essential to halt the progression of diabetic complications. Some studies previously showed the effect of vitamin D on pancreatic β-cell function and insulin secretion. This study aimed to assess the effect of vitamin D supplementation on HbA1c in patients with type 1 diabetes and vitamin D deficiency. Methods: This prospective quasi-experimental study was conducted in Erbil city from 1st September to 1st December 2019. In this study, 76 patients attending Layla Qasim diabetic center were tested. Only 50 patients were recruited that had vitamin D deficiency (25OHD: <20) and were aged less than 18 years. They received vitamin D supplementation for 12 weeks. HbA1c and vitamin D level was measured before and after supplementation. Results: Before vitamin D supplementation, the mean level of serum 25(OH)D among females (8.67 ± 2.56) was lower than males (14.31 ± 3.19). However, no association was found between the initial HbA1c level and gender. HbA1c level (mean = 8.24 ± 0.49) improved significantly after vitamin D supplementation to the level of 7.93 ± 0.67 (P = 0.032). There was a significant difference between groups of glycosylated hemoglobin levels of (first tertile<7.5%, second tertile 7.6%-9.9%, third tertile ≥10%) after 12 weeks of supplementation with vitamin D (P <0.001). Conclusion: Vitamin D supplementation in type 1 diabetic patients with vitamin D deficiency lead to significant improvement in HbA1c level. Keywords: Diabetes; Deficiency; Vitamin D.

HbA1c levels with albuminuria in diabetes mellitus patients

Introduction: The number of people with diabetes mellitus (DM) worldwide with kidney complications has increased. Glycemic control by assessing HbA1c levels is one factor that influences the occurrence of kidney damage in DM patients. This study aims to determine the relationship between HbA1c levels and the incidence of albuminuria in DM patients. Methods: This study was a cross-sectional analytic observational study with consecutive sampling techniques in DM patients who did not have urinary tract infections and had no history of other kidney diseases, which were then measured for HbA1c levels and protein in the urine. Results: A total of 20 patients (62.5 %) were female, and 12 patients (37.5 %) were male. The average age of the patients was 59.81±4.89 years, and the average length of suffering from DM was 6.21±2.27 years. The average HbA1c level was 8.63±2.15, with an HbA1c level >7 found in 21 patients (65.7 %). In this study, there were 21 patients (65.7 %) with uncontrolled HbA1c levels. In this study, the prevalence of negative albuminuria was 56.2 %, while the prevalence of positive albuminuria was 43.8 %. There was a significant relationship between uncontrolled HbA1c levels and the incidence of albuminuria in DM patients (p=0.03). Conclusion: Uncontrolled HbA1c levels were associated with the incidence of albuminuria in DM patients.

PP439 Data Driven Subgroups Of Patients With Type 1 Diabetes Based On Health Technology For Insulin Delivery

IntroductionPatients with type 1 diabetes (T1D) require the administration of insulin to maintain glycemic control. Currently, two modes of subcutaneous insulin delivery have gained wider acceptance: multiple daily injections (MDI) and continuous subcutaneous insulin infusion (CSII). Randomized controlled trials have shown that CSII is associated with a slightly lower glycated hemoglobin (HbA1c) level when compared with MDI.The case study on diabetes by the H2020 Next Generation Health Technology Assessment project aims to link evidence from randomized controlled trials to real-world data to estimate the impact of health technology on specific subgroups of patients, as a first step in building prediction models to personalize treatment strategies. This work aims to assess whether patients with T1D can be stratified according to the use of health technology for insulin delivery and associated glycemic control from real-world data.MethodsWe used a longitudinal prospective data repository of T1D patients from 83 clinics in the United States (T1D exchange). A data-driven two-step clustering analysis was done on adult individuals (n = 8,034) with more than five years of disease duration. Clusters were based on body mass index (BMI), sex, age at diagnosis, diabetes duration, HbA1c level, and insulin delivery method. The optimal number of clusters was estimated based on silhouette width.ResultsWe identified the following four clusters of T1D patients characterized by differences in gender and insulin delivery method: men and women with insulin injections or pens and men and women with CSII. Individuals that used CSII had lower HbA1c levels, a higher BMI, and longer diabetes duration than those using Injections or pens.ConclusionsThis preliminary work identified subgroups of T1D patients linked to insulin delivery methods. Future research includes the study of complications associated with different clusters and additional data sources. While the data were sourced from the T1D Exchange, the analyses, content, and conclusions presented have not been reviewed or approved by the T1D Exchange.

P-P29 The glycated haemoglobin (HbA1c) test is not a predictor of pancreatectomy specific complications or survival

Background The glycated haemoglobin (HbA1c) test is a venous blood test used as a diagnostic test for diabetes mellitus and to monitor glucose control in patients known to have diabetes. The test has been recommended by National Institute for Health Care Excellence (NICE) clinical guidelines in the pre-operative setting since 2016. The purpose of testing is to reduce perioperative morbidity and mortality by optimising management of blood glucose levels in the perioperative period. The aim of this study was to assess the prognostic value of HbA1c in pancreatic cancer patients treated with pancreaticoduodenectomy. Methods This is a retrospective analysis of a prospectively managed database of pancreatic resections at a single institution from January 2016 to December 2020. Included patients had confirmed pancreatic adenocarcinoma and underwent a pancreaticoduodenectomy with preoperative measurement of their HbA1c. Patients who were already prescribed insulin were excluded. Demographic data, survival, operative and perioperative details were collected. Included patient records were assessed for the incidence of postoperative complications in accordance with International Study Group of Pancreatic Surgery guidelines for pancreatic fistula, delayed gastric emptying and post pancreatectomy haemorrhage. An HbA1c greater than 41 was deemed elevated. Results There were 145 patients who met the inclusion criteria. The HbA1c level was normal in 101/145 (70%) and elevated in 44/45 (30%). The postoperative pancreatic fistula rate was 18% in the patients with a normal HbA1c and 23% in those with elevated HbA1c (p = 0.499). The rate of delayed gastric emptying was 21 and 23% in the patients with normal and elevated HbA1c respectively. There were five relaparotomies overall, one of these patients had an elevated preoperative HbA1c. There were no perioperative deaths. Overall survival was 31months (95%CI 27-35) with a normal preoperative HbAlc and 32months (95%CI 27-38) if elevated. Conclusions There is little doubt that the preoperative HbA1c is helpful in the package of preoperative assessment tests to optimise patients for surgery. However, the preoperative HbA1c level in patients planned for pancreaticoduodenectomy is not predictive of pancreaticoduodenectomy specific complications such as postoperative pancreatic fistula, delayed gastric emptying, relaparotomy or mortality. In addition, long-term overall survival is not influenced by an elevated preoperative HbAlc.