hba1c measurement
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2022 ◽  
Author(s):  
Saskia P Hagenaars ◽  
Alexandra C Gillett ◽  
Francesco Casanova ◽  
Katherine G Young ◽  
Harry D Green ◽  
...  

Aims The aim of this study was to evaluate longitudinal associations between the mean and variability of HbA1c levels in individuals with type 2 diabetes (T2D) and major depressive disorder (MDD). Methods Individuals with T2D from the UK Biobank with linked primary care records were analysed. An HbA1c measurement within +/- 6-months of T2D diagnosis was taken as baseline, with subsequent HbA1c measurements used as the outcome in generalised least squares regression to evaluate longitudinal associations with a three-level MDD diagnosis variable (MDD controls, pre-T2D MDD cases and post-T2D MDD cases). Results Using 7,968 T2D individuals, we show that MDD has utility in explaining mean HbA1c levels (p=6.53E-08). This is attributable to MDD diagnosis interacting with baseline T2D medication (p=3.36E-04) and baseline HbA1c (p=2.66E-05), but not with time- when all else is equal, the temporal trend in expected HbA1c did not differ by MDD diagnosis. However, joint consideration with baseline T2D medication showed that each additional medication prescribed was associated with a +4 mmol/mol (2.5%) increase in expected HbA1c across follow up for post-T2D MDD cases, relative to pre-T2D MDD cases and MDD controls. Furthermore, variability in HbA1c increased across time for post-T2D MDD cases but decreased for MDD controls and pre-T2D MDD cases. Conclusions These findings suggest closer monitoring of individuals with both T2D and MDD is essential to improve their diabetic control, particularly for those who develop MDD after T2D diagnosis.


2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Wenhui Zhang ◽  
Yu Liu ◽  
Baosheng Sun ◽  
Yanjun Shen ◽  
Ming Li ◽  
...  

AbstractFlash glucose monitoring (FGM) was introduced in China in 2016, and it might improve HbA1c measurements and reduce glycaemic variability during T1DM therapy. A total of 146 patients were recruited from October 2018 to September 2019 in Liaocheng. The patients were randomly divided into the FGM group or self-monitoring blood glucose (SMBG) group. Both groups wore the FGM device for multiple 2-week periods, beginning with the 1st, 24th, and 48th weeks for gathering data, while blood samples were also collected for HbA1c measurement. Dietary guidance and insulin dose adjustments were provided to the FGM group patients according to their Ambulatory Glucose Profile (AGP) and to the SMBG group patients according to their SMBG measurements taken 3–4 times daily. All of the participants underwent SMBG measurements on the days when not wearing the FGM device. At the final visit, HbA1c, time in range (TIR), duration of hypoglycaemia and the number of diabetic ketoacidosis (DKA) events were taken as the main endpoints. There were no significant difference in the baseline characteristics of the two groups. At 24 weeks, the HbA1c level of the FGM group was 8.16 ± 1.03%, which was much lower than that of the SMBG group (8.68 ± 1.01%) (p = 0.003). The interquartile range (IQR), mean blood glucose (MBG), and the duration of hypoglycaemia in the FGM group also showed significant declines, compared with the SMBG group (p < 0.05), while the TIR increased in the FGM group [(49.39 ± 17.54)% vs (42.44 ± 15.49)%] (p = 0.012). At 48 weeks, the differences were more pronounced (p < 0.01). There were no observed changes in the number of episodes of DKA by the end of the study [(0.25 ± 0.50) vs (0.28 ± 0.51), p = 0.75]. Intermittent use of FGM by T1DM patients can improve their HbA1c and glycaemic control without increasing the hypoglycaemic exposure in insulin-treated individuals with type 1 diabetes in an developing country.


2021 ◽  
Author(s):  
Sam Kafai Yahyavi ◽  
Ole Snorgaard ◽  
Filip Krag Knop ◽  
Morten Schou ◽  
Christina Lee ◽  
...  

Objective: To assess the risk of major adverse cardiovascular events (MACE), all-cause mortality, and initiation of medical treatment in subjects with prediabetes according to first-time measured HbA1c. <p>Research design and methods: Through registry databases, we identified 326,305 Danish patients with a first HbA1c between 40-51 mmol/mol (5.8-6.8%) from 2011 to 2017. After exclusion of patients with prior disease, 84,678 patients were followed 12 months after first HbA1c measurement. Cox regression models were used to estimate hazard ratios (HRs) of MACE and standardized absolute risks. Cumulative incidences were used to analyse initiation of glucose-lowering, anti-hypertensive, cholesterol-lowering and anti-thrombotic medication.</p> <p>Results: The 12-months risk of MACE and all-cause mortality increased gradually with increasing HbA1c until 47 mmol/mol (6.5%). Compared to HbA1c of 40-41 mmol/mol (5.8-5.9%), subjects with HbA1c of 46-47 mmol/mol (6.4-6.5%) had a 0.79% (95% CI 0.33-1.24) higher standardized absolute risk and a HR of 2.21 (95% CI 1.67-2.92) of MACE. Patients with a HbA1c of 48-49 mmol/mol (6.5-6.6%) had a -0.09% (95% CI -0.35-0.52) lower absolute risk and a HR of 1.33 (95% CI 0.87-2.05) of MACE. Initiation of medication was significantly lower among patients with HbA1c of 46-47 mmol/mol (6.4-6.5%) compared to patients with HbA1c of 48-49 mmol/mol (6.5-6.6%).</p> Conclusion: In the D<a>anish population screened for diabetes with HbA1c, the highest risk of MACE and all-cause mortality was found in subjects with HbA1c just below the diagnostic threshold for diabetes. Our results highlight the need for increased focus on the treatment of cardiovascular risk-factors in subjects with prediabetes.</a>


2021 ◽  
Author(s):  
Sam Kafai Yahyavi ◽  
Ole Snorgaard ◽  
Filip Krag Knop ◽  
Morten Schou ◽  
Christina Lee ◽  
...  

Objective: To assess the risk of major adverse cardiovascular events (MACE), all-cause mortality, and initiation of medical treatment in subjects with prediabetes according to first-time measured HbA1c. <p>Research design and methods: Through registry databases, we identified 326,305 Danish patients with a first HbA1c between 40-51 mmol/mol (5.8-6.8%) from 2011 to 2017. After exclusion of patients with prior disease, 84,678 patients were followed 12 months after first HbA1c measurement. Cox regression models were used to estimate hazard ratios (HRs) of MACE and standardized absolute risks. Cumulative incidences were used to analyse initiation of glucose-lowering, anti-hypertensive, cholesterol-lowering and anti-thrombotic medication.</p> <p>Results: The 12-months risk of MACE and all-cause mortality increased gradually with increasing HbA1c until 47 mmol/mol (6.5%). Compared to HbA1c of 40-41 mmol/mol (5.8-5.9%), subjects with HbA1c of 46-47 mmol/mol (6.4-6.5%) had a 0.79% (95% CI 0.33-1.24) higher standardized absolute risk and a HR of 2.21 (95% CI 1.67-2.92) of MACE. Patients with a HbA1c of 48-49 mmol/mol (6.5-6.6%) had a -0.09% (95% CI -0.35-0.52) lower absolute risk and a HR of 1.33 (95% CI 0.87-2.05) of MACE. Initiation of medication was significantly lower among patients with HbA1c of 46-47 mmol/mol (6.4-6.5%) compared to patients with HbA1c of 48-49 mmol/mol (6.5-6.6%).</p> Conclusion: In the D<a>anish population screened for diabetes with HbA1c, the highest risk of MACE and all-cause mortality was found in subjects with HbA1c just below the diagnostic threshold for diabetes. Our results highlight the need for increased focus on the treatment of cardiovascular risk-factors in subjects with prediabetes.</a>


2021 ◽  
Vol 104 (7) ◽  
pp. 1117-1123

Objective: To evaluate the risk factors and prevalence of diabetic retinopathy (DR) in both medical and socioeconomic aspects and find prevalence of thalassemia which associated hemoglobin A1c (HbA1c) measurement in diabetes mellitus (DM) patients at six primary care units (PCU) of Naresuan University Hospital (NUH). Materials and Methods: A cross-sectional survey of DM patients participated in annual proactive DR screening program at six PCU of NUH between December 2016 and March 2017 was conducted. Medical data were retrieved from medical records at PCU. Patients were also interviewed to gather socioeconomic information. Fundus examination was done by indirect ophthalmoscope. Three milliliters of blood was collected from each patient on the same day for Hb analysis. Results: Four hundred and eighty-eight DM patients participated in the present study. Mean age, duration of DM, fasting blood sugar (FBS) level, and HbA1c level were 61.2±9.8 years, 8 years (4 to 12), 124 mg/dL (108 to 151.5), and 7.1% (6.5 to 8.1), respectively. Prevalence of overall DR was 2.9% (14 patients) and proliferative DR was 0.2% (1 patient). Risk factors of DR were HbA1c at 7% or more [adjusted OR 4.7 (95% CI 1.4 to 13.5) and p=0.011] and emotional stress [adjusted OR 3.3 (95% CI 1.1 to 9.8) and p=0.033). Thalassemia screening found 116 patients had abnormal hemoglobin. Ninety-three patients were HbE trait, eight were HbE, ten were alpha-thalassemia trait, two were beta-thalassemia trait, one was HbH, one was alpha- and beta-thalassemia trait (α/β), and one was alpha-thalassemia trait and HbE trait (α/E), and all of them were thalassemia minor or intermedia. Only four patients from HbE trait group had DR. The mean HbA1c in all groups of patients with either normal or abnormal hemoglobin were not statistically significant different. Conclusion: The present study showed that HbA1c and emotional stress might have played an important role in association with DR development. Thalassemia minor and intermedia seemed not to associate with HbA1c measurement. Keywords: Diabetic retinopathy; Thalassemia; Primary care unit; Naresuan university; Risk factors


2021 ◽  
Vol 9 (2) ◽  
pp. 43
Author(s):  
Manthana Mitchai ◽  
Nattakarn Suwansaksri ◽  
Suphakdee Seanseeha ◽  
Jindamanee Saenboonsiri ◽  
Putthichai Kraitree ◽  
...  

Background and Objectives: Hemoglobin A1c (HbA1c) is widely used for the monitoring and management of diabetes mellitus. The aim of this study is to investigate the influence of hemoglobin (Hb) variants on the measurement of HbA1c. Materials and Methods: HbA1c levels of 845 blood samples obtained from diabetic patients with various hemoglobin types were measured using a turbidimetric inhibition immunoassay and capillary electrophoresis. Results: Of 845 patients with diabetes, 65.7% (555/845) have the normal hemoglobin type (A2A) and 34.3% (290/845) have various abnormal hemoglobin types, including heterozygous HbE 30.2% (255/845), homozygous HbE 1.9 % (16/845), Hb Constant Spring (CS) trait 1.4% (12/845), CSEA Bart’s 0.2% (2/845), and beta-thalassemia trait 0.6% (5/845). In most of the patients with diabetes, HbA1c levels determined by two different methods, inhibition immunoassay and capillary electrophoresis, gave strong positive correlation (R = 0.901, P < 0.001), except for those with homozygous HbE (N = 16) and CSEA Bart’s (N = 2). In all 18 patients with homozygous HbE and CSEA Bart’s, the HbA1c was undetectable by capillary electrophoresis, meaning that their estimated average glucose was undeterminable, although their HbA1c levels could be measured using an inhibition immunoassay. The discrepancy of HbA1c results obtained from two different methods is noted in patients without HbA. Conclusions: We have demonstrated the erroneous nature of HbA1c measurement in patients with hemoglobin variants, especially in those without HbA expression. Therefore, in the population with a high prevalence of hemoglobinopathies, hemoglobin typing should be considered as basic information prior to HbA1c measurement.


2021 ◽  
pp. 193229682110231
Author(s):  
Alexandra D. Monzon ◽  
Susana R. Patton ◽  
Mark Clements

Background: Previous studies utilizing glucose data from continuous glucose monitors (CGM) to estimate the Glucose Management Indicator (GMI) have not included young children or determined appropriate GMI formulas for young children with type 1 diabetes (T1D). Methods: We extracted CGM data for 215 children with T1D (0-6 years) from a repository. We defined sampling periods ranging from the 3-27 days prior to an HbA1c measurement and compared a previously established GMI formula to a young child-specific GMI equation based on the sample’s CGM data. We examined associations between HbA1c, GMI values, and other CGM metrics for each sampling period. Results: The young child-specific GMI formula and the published GMI formula did not evidence significant differences when using 21-27 days of CGM data. The young child-specific GMI formula demonstrated higher correlations to laboratory HbA1c when using 18 or fewer days of CGM data. Overall, the GMI estimate and HbA1c values demonstrate a strong relationship in young children with T1D. Conclusions: Future research studies may consider utilizing the young child-specific GMI formula if the data collection period for CGM values is under 18 days. Further, researchers and clinicians may consider changing the default number of days of data used to calculate glycemic metrics in order to maximize validity of CGM-derived metrics.


2021 ◽  
Vol 66 ◽  
Author(s):  
Yael Rachamin ◽  
Oliver Senn ◽  
Sven Streit ◽  
Julie Dubois ◽  
Michael J. Deml ◽  
...  

Objectives: We aimed to explore the impact of the Swiss shutdown in spring 2020 on the intensity of health services use in general practice.Methods: Based on an electronic medical records database, we built one patient cohort each for January-June 2019 (control, 173,523 patients) and 2020 (179,086 patients). We used linear regression to model weekly consultation counts and blood pressure (BP) and glycated hemoglobin (HbA1c) measurement counts per 100 patients and predicted non-shutdown values. Analyses were repeated for selected at-risk groups and different age groups.Results: During the shutdown, weekly consultation counts were lower than predicted by −17.2% (total population), −16.5% (patients with hypertension), −17.5% (diabetes), −17.6% (cardiovascular disease), −15.7% (patients aged &lt;60 years), −20.4% (60–80 years), and −14.5% (&gt;80 years). Weekly BP counts were reduced by −35.3% (total population) and −35.0% (hypertension), and HbA1c counts by −33.2% (total population) and −29.8% (diabetes). p-values &lt;0.001 for all reported estimates.Conclusion: Our results document consequential decreases in consultation counts and chronic disease monitoring during the shutdown. It is crucial that health systems remain able to meet non-COVID-19-related health care needs.


2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A465-A466
Author(s):  
Noura Semreen ◽  
Gene Otuonye ◽  
Angelica Medina Pena ◽  
Natasha Rastogi

Abstract Glycated hemoglobin (HbA1c) is an invaluable tool in diabetes mellitus (DM) management. Conventionally obtained via venous blood sampling, point-of-care (POCT) capillary HbA1c measurement offers an opportunity for immediate treatment modification, reduced cost & increased patient satisfaction. While previous studies using the POCT HbA1c test A1cNow+ have shown accuracy within a 0.5% range from the gold standard venous HbA1c, we noted discrepancy in our community health clinic & sought to evaluate the accuracy of POCT HbA1c levels compared to venous HbA1c levels to guide our clinical decision-making. In this 2-part study, we compared POCT HbA1c levels measured via a single use A1CNow+ HbA1c monitoring device & venous HbA1c samples measured by a standardized lab. Part1: after retrospective chart review, we identified 262 patients with prediabetes, Type1 or Type2 DM based on ADA guidelines who attended our clinic from January 2019-June 2019 & received POCT HbA1c with A1cNow+ testing during their visit. Of those cases, 47 patients also had a venous HbA1c at a standardized laboratory within 1 month of having their POCT HbA1c performed in our clinic. Part2: We noted variability in the temperature storage of A1CNow+ test strips. Storage was standardized to room temperature as per device instructions in June 2019. We subsequently reviewed charts from June 2019-December 2019 & identified 118 patients who had both POCT HbA1c & venous HbA1c measurement within a 1 month period. Patients was categorized into subgroups per ACP guidelines for DM control: prediabetic (HbA1c 5.7–6.4%), controlled DM (HbA1c 6.5 to 8.0%) & uncontrolled DM (HbA1c &gt;8.0%). The average difference between POCT & venous HbA1c tests was calculated & analyzed for statistical significance using paired t test analysis. Part1: For patients in prediabetic, controlled & uncontrolled DM subgroups, the mean difference between A1cNow+ & standardized venous HbA1c testing was 0.68% (p= 0.004), 1.15% (p= &lt;0.0001) and 1.36% (p= 0.0003) respectively. Part2: After standardization of test strip storage, the mean difference between A1cNow+ & venous HbA1c testing for prediabetic, controlled & uncontrolled DM patients was 0.33% (p= 0.002), 0.41% (p= 0.011) and 1.26% (p= &lt;0.0001) respectively. POCT HbA1c provides a unique opportunity to immediately address glycemic control. Its advantages are especially apparent in a patient population with limited resources & poor follow up, as in our clinic. Although standardizing test storage improved overall concordance between A1cNow+ HbA1c testing & venous HbA1c, there was still a statistically significant larger mean difference in uncontrolled DM patients. In prediabetic & controlled DM patients, however, POCT HbA1c was accurate within previously published reports of a 0.5% range when compared to venous HbA1c. An algorithm has since been developed to guide our clinical decision making with these findings.


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