The association of glycemic level and prevalence of tuberculosis: a meta-analysis

Background Diabetes is a well-known risk factor for tuberculosis and poorly glycemic control may increase the risk of tuberculosis. We performed a meta-analysis to explore the association of glycemic control in diabetic patients and their tuberculosis prevalence. Methods We included observational studies that investigated the prevalence of tuberculosis associated with glycemic control. The markers of glycated hemoglobin A1c (HbA1c) and fasting plasma glucose were used to evaluate the exposure of interest in the study. We searched related articles in PubMed, EMBASE and Web of Science through 14 December 2019. The Newcastle-Ottawa scale was used to assess the risk of bias of included studies. Results Seventeen studies (four cohort studies, five case-control studies and eight cross-sectional studies) were included, involving 1,027,074 participants. The meta-analysis found the pooled odds ratio of prevalent tuberculosis increased a 2.05-fold (95%CI: 1.65, 2.55) for the patients with HbA1c ≥7.0% compared to those with HbA1c concentration < 7.0%. Furthermore, we found the mean of HbA1c was higher in the diabetes mellitus with tuberculosis group than the diabetes-only group (P = 0.002). In the sensitivity analysis, the finding remains consistent. Conclusion Our study provides the evidence that poorly controlled diabetes in diabetics may be associated with increased prevalence of tuberculosis. More efforts should focus on screening tuberculosis in uncontrolled diabetes.

Relationship between hyperglycemia, insulin resistance and serum apoptosis marker m30- antigen in patients with type 2 diabetes mellitus

Objective: The amount of evidence suggests that the apoptosis marker M30-antigen (an antibody that recognizes the cytokeratin-18 fragment) has an association with hyperglycemia. Material and Methods: In this study, serum M30 levels of 145 patients diagnosed with prediabetes (n = 28) and type 2 diabetes, which was divided into four groups according to their HbA1c levels, were measured. The health control group (n = 24) was composed of healthy individuals. Serum concentrations of M30 antigen were measured using an enzyme-linked immunosorbent assay system and expressed as mean ± SD. HbA1c concentration was determined by boronate affinity technology according to NGSP standards. Results: M30 levels were comparable in the healthy control group (64,39±3,9 U/L) and prediabetes group (82,07±13,7). Type 2 diabetes Groups A, B, C, and D had levels of 109,38±16 U/L, 117,46±14,3 U/L, 173,69±48,1 U/L, and 163,40±37,3 U/L, respectively. The analysis of the data has shown that serum levels of M30 in the control and prediabetes groups were significantly lower than Type 2 diabetes Groups C and D (p=0.043). When all groups were taken into consideration, a significant relationship was found between HbA1c and serum M30 levels (r=0.231, p=0.002). Conclusion: Apparently, the increase in glycemia is followed by a rise in the serum levels of the, suggesting that apoptosis occurs as a secondary effect immediately after hyperglycemia.

Glycated Hemoglobin (HbA1c) Concentrations Among Children and Adolescents With Diabetes in Middle- and Low-Income Countries, 2010–2019: A Retrospective Chart Review and Systematic Review of Literature

ObjectivesTo explore the glycemic control [represented by glycated hemoglobin (HbA1c) concentrations] in children with diabetes mellitus (DM) in east China and middle- and low-income countries, from 2010 to 2019.MethodsRetrospective data of children with DM from two hospital-based health records were reviewed. Data on HbA1c concentrations, hospitalization due to diabetic ketoacidosis, and patient demographics were collected and analyzed. A systematic review was subsequently performed to analyze publications that report HbA1c concentrations in patients aged &lt;18 years. Patients’ characteristics extracted from each publication were used to generate simulated individual data for pooled analysis. HbA1c estimates were derived from steady-state iterations.ResultsData of 843 diabetic children (aged 11.2 ± 3.9 years) with 2,658 HbA1c measures were retrieved from the two hospitals during the period 2010–2020. The duration of diabetes in the patients was 4.4 ± 2.8 years, and their HbA1c was 8.1 ± 2.2%. Patients who were internal migrants had significantly higher HbA1c concentration than resident patients (8.4 vs. 7.9%). The literature review yielded 1,164 publications, and the majority (74.1%) of patient data were published in high-income countries. The patient data extracted from these publications generated 486,416 HbA1c concentration estimates between 2005 and 2019. The average HbA1c concentration during the 15 years was 9.07 ± 2.15%. The mean HbA1c concentrations among children were 8.23, 8.73, 9.20, and 10.11% in high-income country (HIC), upper-middle income country (UMIC), lower-middle income country (LMIC), and low-income country (LIC) respectively. The mean rate of optimized glycemic control (HbA1c &lt;7.5%) among children was 32.4, 27.5, 21.7, and 12.7% in HIC, UMIC, LMIC, and LIC, respectively.ConclusionsThe current study indicated that there is substantial room for improvement in glycemic control in children with DM worldwide, especially in middle- and low-income countries.

Development of the optimal procedure for increasing HbA1c concentration in control materials for external quality assessment

Background: The research aimed to increase certain HbA1c concentrations at medical decision levels for external quality control samples from healthy donor blood. Methods: The in vitro study was performed from October 2019 to January 2021 at Quality Control Center for Medical Laboratory at University of Medicine and Pharmacy at Ho Chi Minh City. The study observed on the conditions including the optimal buffer solutions (BAGPM, BPS, Ringer, Saline), temperature (2ºC - 8ºC, 22ºC - 24ºC, 37ºC), and glucose concentration (100 mM, 305 mM, 500 mM) affecting the HbA1c concentration in vitro to make the external quality control samples fell in normal, prediabetes, and diabetes range. At every condition, the HbA1c concentration was measured by Tina Quant method to look for the optimal procedure to increase HbA1c concentration required of the external quality control protocol. Results: The highest HbA1c concentration (11.57±0.2%) was found in BAGPM solution with 100 mM glucose after 15 days with the baseline HbA1c 5.43±0.13%; the HbA1c level increase dramatically at 37ºC in BAGPM 500 mM glucose solution in fifteen days (40.03±1.05%). Conclusions: The appropriate conditions were identified to prepare HbA1c standards for prediabetic and diabetic levels. The standards for HbA1c concentrations were recommended to prepare by incubating RBCs from non-diabetic donor blood in BAGPM solution containing glucose at 37ºC for 24 hours. Glucose concentrations should be 100 mM and 500 mM, respectively, for prediabetic level (HbA1c ~ 6.0 ± 0.12%) and diabetic level (HbA1c ~ 9.6 ± 0.17%).

Possible dulaglutide-associated cholecystitis with safe continuation post cholecystectomy

Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Possible dulaglutide-induced cholecystitis, with successful resumption of dulaglutide after cholecystectomy, is discussed. Summary A 72-year-old White man was started on dulaglutide for outpatient management of type 2 diabetes, in addition to his existing antihyperglycemic regimen of metformin, glipizide, pioglitazone, and insulin glargine. His glycated hemoglobin (HbA1c) concentration improved from 8.2% to 7.2% with the addition of dulaglutide. Furthermore, the use of dulaglutide did not lead to weight loss. After 16 months of treatment with dulaglutide, he presented to the emergency room with nausea, loss of appetite, and progressive sharp, nonradiating right upper quadrant pain. Based on symptom presentation, laboratory workup, and computed tomography scan results, acute cholecystitis was diagnosed. He underwent a cholecystectomy to remove what was found to be a gangrenous gallbladder. Per documented surgical dictation from the cholecystectomy, the gallbladder was removed, but portions of the biliary tree were left intact. The patient was continued on dulaglutide postoperatively without recurrence of bile stones, biliary tree disease, or abdominal symptoms at 8 months after initial cholecystitis incident. Conclusion A male patient with possible dulaglutide-induced cholecystitis was successfully continued on dulaglutide therapy post cholecystectomy without recurrent complications within the biliary tract.

Reference Interval of Hemoglobin A1c and Influence of Hematological Parameters on Its Serum Concentration in Dogs

HbA1c could be an alternative to fructosamine as a marker for glucose levels over a longer period. In this study, we calculated a reference interval for HbA1c in dogs and investigated the correlation of HbA1c with hemoglobin and different hematological parameters. In total, 110 blood samples from dogs were investigated. Significant negative correlations were found between HbA1c and erythrocyte count, hemoglobin concentration, as well as hematocrit. There was a tendency in the red cell distribution width. No significant correlation was found in the reticulocyte number and the erythrocyte indices. In conclusion, there is an association of different blood parameters with the HbA1c concentration, which have to be considered for the interpretation of HbA1c.

THE CONCENTRATION OF ANTI THYROGLOBULIN (TGAB) AND ANTI THYROID PEROXIDASE (TPOAB) AUTOANTIBODY IN NON-OBESE DIABETIC PATIENTS

Introduction: Autoimmune diseases are usually systemic. The autoimmune polyendocrine syndrome was defined as a failure of various endocrine glands caused by an autoimmune mechanism. Autoimmune diabetes (type 1 and LADA) is not exceptional, the long-lasting positivity of anti-GAD may increase the risk of developing thyroid autoimmune diseases. Aims: (1) To determine the concentration and the positivity rate of Thyroglobulin autoantibody (TgAb) and TPO autoantibody (TPOAb) on non-obese diabetic patients. (2) To examine the relationship between thyroglobulin autoantibody (TgAb) and TPO autoantibody (TPOAb) to the negative and positive anti GAD autoantibody status and some other factors. Subjects and methods: 85 serum samples of non-obese diabetic patients (BMI < 23) were used to measure the anti GAD autoantibody, anti Tg and anti TPO autoantibody by enzyme-linked immunoassay and electrochemiluminescence immunoassay, at the Hue university hospital. Results: The mean concentration of the TgAb and TPOAb were 1118.35 ± 1583.45 IU/ml and 85.85 ± 42.22 IU/ml, respectively. The positivity rate of the TgAb was 9.4% and the positive rate of the TPOAb was là 14.1%. There was a statistically significant difference in the positivity of the TPO antibody with the presence or absence of the GAD antibody, between the mean concentration of TPO antibody and diabetes detection time and HbA1C concentration between anti-Tg (+), anti-TPO (+) groups and anti-Tg (-), anti-TPO (-) groups. Conclusions: There was a correlation between anti-TPO positivity with non-obese diabetes patients with positive anti-GAD, between diabetes detection time with anti-TPO concentration. In patients with anti-Tg (+), anti-TPO (+), the HbA1C concentration was found higher than those with anti-Tg(-), anti-TPO(-). Keywords: diabetes, non-obese, GAD autoantibody, Tg autoantibody, TPO autoantibody.

Improving efficiency through workflow optimization in a pharmacist-run diabetes clinic

Purpose To evaluate the impact of hiring nonclinical support staff on pharmacist productivity and diabetes control outcomes in internal medicine clinics of an integrated healthcare system. Methods A retrospective, longitudinal cohort study was conducted. Patients were included if they were contacted by telephone for a diabetes consultation with a clinical pharmacist from July 1, 2015, through June 30, 2017. Nonclinical support staff were hired in July 2016 to schedule patient appointments with the clinical pharmacists. The primary outcome was the average rate of completed telephone encounters per month before and after hiring of nonclinical support staff. The secondary outcome was the mean change in glycated hemoglobin (HbA1c) level in patients who had a laboratory assay completed within 90 days of clinical pharmacist outreach. The tertiary outcome was the call completion rate for scheduled appointments vs unscheduled calls. Results In total, 6,709 patients were included; their average age was 55 years. After the intervention, the mean (SD) rate of completed telephone encounters increased from 61% (3.8%) to 77% (3.5%) (P &lt; 0.001). Small improvements were noted in glycemic control, as measured by the mean (SD) percentage of patients with an HbA1c concentration of &lt;8%, which increased from 31% (5.2%) to 42% (3.0%) (P &lt; 0.001), and the mean (SD) change in average HbA1c concentration, which increased from 8.9% (0.2%) to 8.5% (0.1%) (P &lt; 0.001). Throughout the study, scheduled calls were more likely to be completed than unscheduled calls (mean [SD] completion rate, 66% [9.0%] vs 74% [6.0%]; P &lt; 0.001). Conclusion Hiring nonclinical support staff led to greater efficiency among the clinical pharmacist team, yielding a higher volume of telephone interactions, a modest overall decrease in HbA1c values, and an increased likelihood of reaching patients by phone.

Evaluation of an Ion-Exchange HPLC Device for HbA1c Measurement

Background The ADAMS™ HA-8180V is the 8th generation of a fully automated ion-exchange HPLC system from ARKRAY, and the first to be released onto the US market. We evaluated the HA-8180V, for routine hemoglobin A1c measurement in comparison with the Roche Cobas c501, the Tosoh G8 analyzer for normal hemoglobin, and with the Trinity analyzer for hemoglobin variants. Methods The analytical performance (linearity, precision, carryover, and sample stability) was assessed based on the Clinical and Laboratory Standards Institute (CLSI) and manufacturer guidelines. A comparison of the HA-8180V against two major analytical methods was performed for 100 whole blood samples. HA-8180V variant mode was also compared against the Trinity ultra2 A1c analyzer for 50 samples containing hemoglobin variants (HbC 14, HbS 14, HbD 12, and HbE 10). Results The within-run and total CVs were &lt;0.01 and 0.75% at low HbA1c concentration and 0.46 and 0.63% at high HbA1c concentration, respectively. Linearity was shown in the concentration range 3.4–18.1% HbA1c, carryover was 0.00%, and stability values were excellent. Method comparison demonstrated a high concordance between methods. Conclusion The eighth generation ADAMS HA-8180V A1c analyzer demonstrated high analytical performance adequate for routine clinical use.

Hypomagnesaemia and its determinants in a contemporary primary care cohort of persons with type 2 diabetes

Aims Among persons with type 2 diabetes mellitus (T2DM) hypomagnesaemia has been reported in 14–48% of patients. This may be of significance given the emerging associations of hypomagnesaemia with glucometabolic disturbances and possibly even complications. We assessed the prevalence of hypomagnesaemia and its determinants, in a well-defined cohort of persons with T2DM treated in primary care. Methods Observational cohort study among persons with T2DM treated in primary care in the Northeast of the Netherlands. Magnesium was measured using a colorimetric endpoint assay (Roche). Hypomagnesaemia was defined as a serum magnesium level <0.70 mmol/L. Pearson correlations were performed to correlate variables with serum magnesium. Next, a stepwise backward regression model was made. Results Data of 929 persons (55% male) with a mean age of 65 (± 10) years, diabetes duration 6.5 [3.0–10.1] years, and HbA1c concentration 6.7 (± 0.7)% (50 (± 9) mmol/mol) were analysed. Serum magnesium was 0.79 (± 0.08) mmol/L. The percentage of persons with magnesium deficiency was 9.6%. Age, diabetes duration, BMI, HbA1c, use of metformin, sulfonylurea derivatives, and DPP4 inhibitors were negatively associated with magnesium concentrations. In contrast, LDL cholesterol and serum creatinine were positively associated serum magnesium. Conclusions Hypomagnesaemia was present in 9.6% of T2DM patients treated in primary care. This percentage is remarkably lower than reported previously, possibly due to the unselected nature of our population. Concerning T2DM-related factors, only BMI, HbA1c and the use of metformin, sulfonylurea derivatives and DPP4 inhibitors correlated negatively with magnesium concentrations.