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.

The importance of HbA1C test in prediabetes with special reference to Purvarupavastha of Prameha-A literary review

Diabetes mellitus is a metabolic disorder causing hyperglycaemia with defect in metabolism of carbohydrates, fats, and proteins due to defect in insulin secretion, or its utilization or both. Prediabetes is a condition in which the blood glucose levels do not meet the criteria for diabetes or too high to be considered normal (ADA). It is an early stage of DM. So it is important to diagnose Diabetes Mellitus type 2 in the previous stage that is prediabetes. It is already in practice to diagnose it with laboratory blood tests. But additionally, we can also take help of Prameha purvarupas as premonitory symptoms in patients prediabetes. HbA1C is a useful parameter to diagnose prediabetes. There is mild or no symptoms mentioned for prediabetes. Purvarupas of Prameha mentioned in Ayurvedic samhitas can be useful to know early stage of Diabetes mellitus type 2, clinically. The purpose of this article is to highlight the importance of Purvarupa of Prameha to diagnose prediabetes. So, the need of hour is to focus on screening and diagnosing pre-Diabetes earlier, by spreading knowledge and awareness among society which will play a key role to reduce the conversion of pre-diabetes to diabetes mellitus.

IQVision: An Image-Based Evaluation Tool for Quantitative Lateral Flow Immunoassay Kits

The development of quantitative lateral flow immunoassay test strips involves a lot of research from kit manufacturers’ standpoint. Kit providers need to evaluate multiple parameters, including the location of test regions, sample flow speed, required sample volumes, reaction stability time, etc. A practical visualization tool assisting manufacturers in this process is very much required for the design of more sensitive and reliable quantitative LFIA test strips. In this paper, we present an image-based quantitative evaluation tool determining the practical functionality of fluorescence-labelled LFIA test cartridges. Image processing-based algorithms developed and presented in this paper provide a practical analysis of sample flow rates, reaction stability times of samples under test, and detect any abnormalities in test strips. Evaluation of the algorithm is done with Glycated Hemoglobin (HbA1C) and Vitamin D test cartridges. Practical sample flow progress for HbA1C test cartridges is demonstrated. The reaction stability time of HbA1C test samples is measured to be 12 min, while that of Vitamin D test samples is 24 min. Experimental evaluation of the abnormality detection algorithm is carried out, and sample flow abnormalities are detected with 100% accuracy while membrane irregularities are detected with 96% accuracy.

Cost-effectiveness analysis for HbA1c test intervals to screen patients with type 2 diabetes based on risk stratification

Background The best HbA1c test interval strategy for detecting new type 2 diabetes mellitus (T2DM) cases in healthy individuals should be determined with consideration of HbA1c test characteristics, risk stratification towards T2DM and cost effectiveness. Methods State transition models were constructed to investigate the optimal screening interval for new cases of T2DM among each age- and BMI-stratified health individuals. Age was stratified into 30–44-, 45–59-, and 60–74-year-old age groups, and BMI was also stratified into underweight, normal, overweight and obesity. In each model, different HbA1c test intervals were evaluated with respect to the incremental cost-effectiveness ratio (ICER) and costs per quality-adjusted life year (QALY). Annual intervals (Japanese current strategy), every 3 years (recommendations in US and UK) and intervals which are tailored to each risk stratification group were compared. All model parameters, including costs for screening and treatment, rates for complications and mortality and utilities, were taken from published studies. The willingness-to-pay threshold in the cost-effectiveness analysis was set to US $50,000/QALY. Results The HbA1c test interval for detecting T2DM in healthy individuals varies by age and BMI. Three-year intervals were the most cost effective in obesity at all ages—30-44: $15,034/QALY, 45–59: $11,849/QALY, 60–74: $8685/QALY—compared with the other two interval strategies. The three-year interval was also the most cost effective in the 60–74-year-old age groups—underweight: $11,377/QALY, normal: $18,123/QALY, overweight: $12,537/QALY—and in the overweight 45–59-year-old group; $18,918/QALY. In other groups, the screening interval for detecting T2DM was found to be longer than 3 years, as previously reported. Annual screenings were dominated in many groups with low BMI and in younger age groups. Based on the probability distribution of the ICER, results were consistent among any groups. Conclusions The three-year screening interval was optimal among elderly at all ages, the obesity at all ages and the overweight in 45–59-year-old group. For those sin the low-BMI and younger age groups, the optimal HbA1c test interval could be longer than 3 years. Annual screening to detect T2DM was not cost effective and should not be applied in any population.

Short time effect of Covid 19 pandemic on HbA1c and acute metabolic complications in children with type 1 diabetes

Background COVID19 pandemic is currently affecting every aspect of daily life of communitiesy throughout the world. We aimed to check how this situation affects the metabolic control of children with type 1 diabetes. Methods We analyzed all patients with type 1 diabetes a HbA1c test after at least two months ensuing the start of the epidemic in Turkey. We compared the results with the most recent HbA1c test in the hospitals automation system before the epidemic. In addition, diabetic ketoacidosis (DKA) and severe hypoglycemia rates were compared. Results Among the eligible 219 cases 77.6% had decreased HbA1c levels according to their former result. Mean drop was about 9.71% compared to the former test in the whole group. Age, sex and time interval between two tests were not found to affect this tendency. Diabetic ketoacidosis rate was the same as before the pandemic, whereas severe hypoglycemia rates increased. Conclusions Despite the potential of the pandemic to affect routine care of chronic diseases in a negative way the short term metabolic control of type 1 children with type 1 diabetes improved. Telemedicine support by the diabetes team and increased care in the family environment might be possible explanations.

Impact of Work and Recreational Physical Activity on Prediabetes Condition among U.S. Adults: NHANES 2015–2016

More minutes of physical activity (PA) accumulated during a day are associated with a lower risk of diabetes mellitus type 2. However, it is less known if distinct dimensions of PA can produce a different protective effect in the prevention of prediabetes. The aim of this study was to analyze the impact of work and recreational PA on prediabetes among U.S. adults during the period 2015–2016 using the National Health and Nutrition Examination Survey (NHANES) database. Individuals (n = 4481) with hemoglobin A1c (HbA1c) test values of 5.7% to 6.4% were included. A logistic regression multivariate-adjusted analysis was conducted to estimate the association between the odds ratios (ORs) and 95% confidence intervals (CIs) of prediabetes, with work and recreational PA. The prevalence of prediabetes among U.S. adults was lower in physically active individuals both at work (~24%) and recreational (~21%) physical activities compared to individuals who were not physically active (27 to 30%). Individuals lacking practice of recreational PA had a high risk of prediabetes (OR = 1.26, 95% CI: 1.080 to 1.466). PA may be a protective factor for prediabetes conditions depending on gender, age, ethnic group, waist circumference, and thyroid disease.

Cost-effectiveness analysis for HbA1c test intervals to screen patients with type 2 diabetes based on risk stratification.

Background: To determine the best HbA1c test interval strategy for detecting new type 2 diabetes mellitus (T2DM) cases in a healthy population, HbA1c test characteristics, risk stratification towards T2DM and cost effectiveness were considered.Methods: State transition models were built to study the optimal screening interval for new cases of T2DM among each age- and BMI-stratified health population. Age was stratified into 30-44-, 45-59-, and 60-74-year-old age groups, and BMI was also stratified into underweight (<18.5 kg/m2), normal (18.5-25 kg/m2), overweight (25-30 kg/m2) and obesity (≥30 kg/m2). In each model, different HbA1c test intervals were compared to evaluate costs per quality-adjusted life year (QALY) and the incremental cost-effectiveness ratio (ICER). We compared intervals annually (current Japanese strategy), every three years (US and UK recommendations) and tailored to each risk stratification group, based on our previous work. All model parameters, including screening and treatment costs, complications and mortality rates and utilities, were applied from published studies. The willingness-to-pay threshold in the cost-effectiveness analysis was set to US $50,000/QALY.Results: The HbA1c test interval for detecting T2DM in a healthy population varies by age and BMI. Three-year intervals were the most cost effective in obesity at all ages—30-44: $15,034/QALY, 45-59: $11,849/QALY, 60-74: $8,685/QALY—compared with the other two interval strategies. The three-year interval was also the most cost effective in the 60-74-year-old age groups—underweight: $11,377/QALY, normal: $18,123/QALY, overweight: $12,537/QALY—and in the overweight 45-59-year-old group; $18,918/QALY. In other groups, the screening interval for detecting T2DM was found to be longer than three years, as previously reported. Annual screenings were dominated in many groups with low BMI and in younger age groups. Based on the probability distribution of the ICER, QALY does not show much difference among any groups.Conclusions: Annual screening to detect T2DM was not cost effective and should not apply to any population. The three-year screening interval was optimal among all elderly populations, the obesity at all ages and the overweight 45-59-year-old group. For the low BMI and younger age groups, the optimal HbA1c test interval can be longer than three years.