Differentiating transient from persistent diabetic range hyperglycemia in a cohort of people completing tuberculosis treatment in Dhaka, Bangladesh

Background In recent non-pandemic periods, tuberculosis (TB) has been the leading killer worldwide from a single infectious disease. Patients with DM are three times more likely to develop active TB and poor treatment outcomes. Single glycemic measurements at TB diagnosis may inaccurately diagnose or mischaracterize DM severity. Data are limited regarding glycemic dynamics from TB diagnosis through treatment. Methods Prospective study of glycemia dynamics in response to TB treatment measured glycosylated haemoglobin (HbA1c) in patients presenting to TB screening centres in Bangladesh to determine the prevalence and risk factors of hyperglycemia before and at TB treatment completion. Results 429 adults with active TB disease were enrolled and divided into groups based on history of DM and initial HbA1c range: normoglycemia, prediabetes, and DM. DM was diagnosed in 37%. At treatment completion,14(6%) patients from the normoglycemia and prediabetes groups had HbA1c>6.5%, thus increasing the prevalence of DM to 39%. The number needed to screen to diagnose one new case of DM at TB diagnosis was 5.7 and 16 at treatment completion in the groups without DM. Weight gain>5% at treatment completion significantly increased the risk of hyperglycemia in the groups without DM at TB diagnosis (95% CI 1.23–26.04, p<0.05). Conclusion HbA1c testing prior to and at TB treatment completion found a high prevalence of prediabetes and DM, including a proportion found at treatment completion and commonly in people with a higher percentage of weight gain. Further longitudinal research is needed to understand the effects of TB disease and treatment on insulin resistance and DM complications.

Efficacy of Telephone Health Coaching Integration with Standard Multidisciplinary Care for Adults with Obesity Attending a Weight Management Service: A Pilot Study

Australia has one of the highest prevalences of obesity in the developed world with recognised gaps in patient access to obesity services. This non-randomised before and after study investigated the health benefits and patient acceptability of integrating the Get Healthy Service, a state-funded telephone-delivered coaching service in Australia, as an adjunct to multidisciplinary care for adults attending a public obesity service. Forty-one participants received multidisciplinary care alone while 39 participants were subsequently allocated to receive adjunctive treatment with the Get Healthy Service. Weight, body mass index, glycosylated haemoglobin, measurement of hepatic steatosis and liver enzymes were collected at baseline and 6 months. Participant evaluation was obtained post intervention. Statistically significant reductions from baseline were achieved for both control and intervention with respect to weight (−6.7 ± 2.2 kg, p = 0.01; −12.6 ± 3.2, p = 0.002), body mass index (−2.3 ± 0.8, p = 0.01; −4.8 ± 1.2 kg/m2, p = 0.002) and glycosylated haemoglobin (−0.2 ± 0.2%, p = 0.2 (NS); −0.7 ± 0.2%, p = 0.02), respectively. There were no significant differences in steatosis or liver enzymes or in outcomes between control and intervention cohorts. A high level of patient acceptability was reported. Integrating telephone-delivered coaching provided non-inferior care and high levels of patient satisfaction. Telephone coaching aligned with the principles of an obesity service should be trialled to improve patient access to obesity interventions.

The correlation between glycosylated haemoglobin levels with pure tone average values in type 2 diabetes mellitus patients

Hearing plays an important role in our daily activities, if it is impaired or lost the quality of life is affected by improper communication. The diabetes mellitus is a chronic metabolic disorder and affects all the systems in the body including auditory system. So assessment of hearing is important in diabetics to know the type, extent of hearing impairment which helps to take treatment decisions and preventive measures. Present study is focused on relationship between glycosylated haemoglobin (HbA1c) levels with pure tone average (PTA) values in type 2 diabetics. Type 2 diabetic patients with (WHI) and without (WoHI) hearing impairment, both the gender was included with age limit between 35-55 years and also ten normal subjects were included as controls. Pure tone average (PTA) is the average of hearing threshold levels at different frequencies; it gives information about an individual’s hearing level in each ear. All the data were expressed as mean ± SE. The mean were analyzed by one way ANOVA. Pearson correlation test was done to see the relationship between right and left ear PTA values in normal subjects, WoHI and WHI groups with HbA1c values. In both the groups pure tone average values are not statistically correlated with HbA1c. The left ear of both WoHI (P=0.977) and WHI (P=0.490) groups shows negative correlation with HbA1c. The HbA1c values are correlated with PTA values in all subjects. The pure tone audiometry is helpful to know the status of hearing sensitivity and type, severity of the hearing impairment in the T2DM patients in relation to HbA1c levels.

711 Effect of Roux-En-Y Gastric Bypass on HbA1c As Well As Number of Medications in Diabetic Patients

Aim Roux en Y gastric bypass (RYGB) is known to ameliorate Type 2 Diabetes Mellitus (T2DM) in morbidly obese patients. We aimed to determine both the reduction in the glycosylated haemoglobin (HbA1c) and the number of anti-diabetic medications (including insulin) in diabetic patients undergoing RYGB over a five-year period. Method We reviewed data of diabetic patients (n = 530) who underwent RYGB from January 2012 – December 2017, including those with a minimum of a 2-year post-operative follow up (n = 47). Preoperatively, BMI, HbA1c and the number of anti-diabetic medications and the duration of T2DM since diagnosis were recorded. These measurements were repeated at the end of the two year follow up. Results At the time of enrolment in the bariatric programme, the median BMI was 42.5 (range, 31.7-61.5) kg/m2, mean duration of T2DM was 58 months and median HbA1c was 59 (37-118) mmol/mol. The mean number of anti-diabetic medications taken, including insulin, was 2. At the end of 2-year follow-up, the median BMI was 32 (range, 24-41) kg/m2 and HbA1c was 41(range, 33-91) mmol/mol. 15 patients (31.9%) still required anti-diabetic medication, 12 of whom had a diagnosis of T2DM for 3 years or more at time of enrolment. Conclusions RYGB is strongly associated with a resolution of T2DM in morbidly obese patients. In those who were not resolved, the number of anti-diabetic medications taken and HbA1c were reduced. The impact of the surgery is dependent on the duration of T2DM since diagnosis preoperatively.

Improving diabetic patients’ outcomes in family medicine in the United Arab Emirates

We evaluated a diabetic mini-clinic by assessing adherence to American Diabetes Association guidelines and changes in glycosylated haemoglobin levels. Of 1063 patients, 721 were multiple attenders. Single and multiple attenders showed no significant differences in age, sex, time since diagnosis or body mass index. Female and male multiple attenders showed significant declines in glycosylated haemoglobin levels over the first 12 and 18 months respectively. After 2 years, these levels were similar to those at entry to the clinic. The clinic’s compliance with standard measurement guidelines was high. The diabetic mini-clinic model, which is effective in industrialized countries, was equally effective in this setting.

A Study on Glycosylated Haemoglobin Values at 6 - 12 Weeks of Pregnancy as an Early Predictor of Gestational Diabetes Mellitus

BACKGROUND Gestational diabetes mellitus (GDM) is a major health problem arising due to insulin resistance in pregnant women. It is associated with multiple maternal complications which may cause end organ failure, complicated labour and delivery and thereby increasing the maternal morbidity and mortality. The foetus is also at risk for problems beginning from in utero and extending into the neonatal period and adult life. We wanted to correlate first trimester HbA1c values with the subsequent development of gestational diabetes mellitus and identify if glycosylated haemoglobin can be used as an adjunct with other screening methods. METHODS It is a prospective cohort study. This study was conducted from August 2015 to August 2017. All women of gestational age 6 to 12 weeks who came to Sri Ramachandra University outpatient department were taken for this study. Informed consent was obtained and a detailed history taking was done as per proforma. Along with routine antenatal investigations, Glycosylated haemoglobin (HbA1c) was also done. Oral Glucose Tolerance Test was to be performed at 24 - 28 weeks as per the World Health Organisation –with 75gm criteria and the results were tabulated and analysed to know the significance of Glycosylated haemoglobin (HbA1c) in the outcome of gestational diabetes mellitus. Further a fasting and postprandial blood sugar was done in the 3rd trimester for all patients as a secondary screening tool for gestational diabetes mellitus. Secondary outcomes of obstetric and neonatal complications were also studied. RESULTS In the present study a total of 323 patients were screened for HbA1c during the first trimester and followed till delivery. Only 21.9 % developed gestational diabetes mellitus. Elevated Glycosylated haemoglobin (HbA1c) value of 5.7 - 6.4 % was seen in 5.9 %. CONCLUSIONS Most of the patients with elevated Glycosylated Haemoglobin in the first trimester had high chance of developing gestational diabetes mellitus. Glycosylated haemoglobin is indeed a simple way of screening, but its solitary use remains controversial and hence could possibly be tried as an adjunct with other screening methods. KEY WORDS Glycosylated Haemoglobin, Gestational Diabetes Mellitus, Glycaemic Control, Maternal and Foetal Morbidity and Mortality