Periodontitis is the commonest oral disease affecting population worldwide. This disease is notorious for the devastation of tooth supporting structures, ensuing in the loss of dentition. The etiology for this disease...Periodontitis is the commonest oral disease affecting population worldwide. This disease is notorious for the devastation of tooth supporting structures, ensuing in the loss of dentition. The etiology for this disease is bacterial biofilm, which accumulates on the teeth as dental plaque. In addition to the biofilm microorganisms, other factors such as environmental, systemic and genetic are also responsible in progression of periodontitis. Diabetes mellitus (DM) is metabolic disorder which has an impact on the global health. DM plays a crucial role in the pathogenesis of periodontitis. Periodontitis is declared as the “sixth” major complication of DM. Evidence based literature has depicted an enhanced incidence and severity of periodontitis in subjects with DM. A “two way” relationship has been purported between periodontitis and DM. Mutual management of both conditions is necessary. Periodontal therapy (PT) may assist to diminish the progression of DM and improve glycemic control. Various advanced technological facilities may be utilized for the purpose of patient education and disease management. The present paper clarifies the etio-pathogenesis of periodontitis, establishing it as a complication of DM and elaborating the various mechanisms involved in the pathogenesis. The role of PT in amelioration of DM and application of digital communication will be discussed. Overall, it is judicious to create an increased patient cognizance of the periodontitis-DM relationship. Conjunctive efforts must be undertaken by the medical and oral health care professionals for the management of periodontitis affected DM patients.展开更多
Nonalcoholic fatty liver disease(NAFLD) is one of themajor causes of chronic liver injury. NAFLD includes a wide range of clinical conditions from simple steatosis to nonalcoholic steatohepatitis(NASH), advanced fibro...Nonalcoholic fatty liver disease(NAFLD) is one of themajor causes of chronic liver injury. NAFLD includes a wide range of clinical conditions from simple steatosis to nonalcoholic steatohepatitis(NASH), advanced fibrosis, and liver cirrhosis. The histological findings of NASH indicate hepatic steatosis and inflammation with characteristic hepatocyte injury(e.g., ballooning degeneration), as is observed in the patients with alcoholic liver disease. NASH is considered to be a potentially health-threatening disease that can progress to cirrhosis. A liver biopsy remains the most reliable diagnostic method to appropriately diagnose NASH, evaluate the severity of liver fibrosis, and determine the prognosis and optimal treatment. However, this invasive technique is associated with several limitations in routine use, and a number of biomarkers have been developed in order to predict the degree of liver fibrosis. In the present article, we review the current status of noninvasive biomarkers available to estimate liver fibrosis in the patients with NASH. We also discuss our recent findings on the use of the glycated albuminto-glycated hemoglobin ratio, which is a new index that correlates to various chronic liver diseases, including NASH.展开更多
AIM: To analyze the relationship between the glycated albumin (GA) to glycated hemoglobin (HbA1c) ratio and the histological grading of liver fibrosis.METHODS: The study retrospectively included consecutive hepatitis ...AIM: To analyze the relationship between the glycated albumin (GA) to glycated hemoglobin (HbA1c) ratio and the histological grading of liver fibrosis.METHODS: The study retrospectively included consecutive hepatitis C virus positive chronic liver disease patients (n = 142) who had undergone percutaneous liver biopsy between January 2008 and March 2010 at our institution. The ratios of GA/HbA1c were calculated in all patients to investigate the relationship with the degree of the liver fibrosis. The values of the aspartate aminotransferase-to-platelet ratio index (APRI), an excellent marker for the evaluation of liver fibrosis, were also calculated. In addition, we combined the ratio of GA/HbA1c and the APRI in order to improve our ability to detect the presence of significant liver fibrosis. RESULTS: Sixty-one (43%) patients had either no fibrosis or minimal fibrosis (METAVIR score: F0-F1), while 25 (17%) had intermediate fibrosis (F2). Fifty-six (39%) patients had severe fibrosis (F3-F4) and 27 of them had cirrhosis (F4). The mean values of the GA/HbA1c increased with the progression of the fibrosis (F0-1: 2.83 ± 0.24, F2: 2.85 ± 0.24, F3: 2.92 ± 0.35, F4: 3.14 ± 0.54). There was a significant dif- ference between the F0-F1 vs F4, F2 vs F4, and F3 vs F4 groups (P < 0.01, P < 0.01, P < 0.01 and P < 0.05, respectively). The GA/HbA1c ratio was significantly higher in the patients with cirrhosis (F4) than in those without cirrhosis (F0-F3) (3.14 ± 0.54 vs 2.85 ± 0.28, P < 0.0001). The GA/HbA1c ratio was also significantly higher in the patients with severe fibrosis (F3-F4) than in those without severe liver fibrosis (F0-F2) (3.03 ± 0.41 vs 2.84 ± 0.24, P < 0.001). Furthermore, the GA/ HbA1c ratio was also significantly higher in the patients with significant fibrosis (F2-F4) than in those without significant liver fibrosis (F0-F1) (2.98 ± 0.41 vs 2.83 ± 0.24, P < 0.001). The diagnostic performance of the increased GA/HbA1c ratio (> 3.0) was as follows: its sensitivity and specificity for the detection of 展开更多
Background It has been suggested that glycated hemoglobin （HbAlc） underestimate the actual glycemic control levels in maintenance hemodialysis （MHD） patients, because of anemia and the using of erythropoietin （EP...Background It has been suggested that glycated hemoglobin （HbAlc） underestimate the actual glycemic control levels in maintenance hemodialysis （MHD） patients, because of anemia and the using of erythropoietin （EPO）; it was recommended that glycated albumin （GA） should be an alternative marker. Therefore, the assessment performances of glycemic control were compared between GA and HbAlc in this research by referring to mean plasma glucose （MPG） in diabetes mellitus （DM） patients undergoing MHD or not. Methods MPG was calculated according to the data registered at enrollment and follow-up 2 months later and corresponding HbAlc, albumin （ALB）, GA, etc. were measured in 280 cases. A case-control study for comparing GA and HbAlc was done among the groups of MHD patients with DM （n=88） and without DM （NDM; n=90）, and non-MHD ones with DM （n=102） using MPG for an actual glycemic control standard. Results In these 3 groups, only for DM patients＇ （whether undergoing MHD or not）, GA and HbAlc correlated with MPG significantly （P 〈0.01）. Through linear regression analysis, it could be found that the regression curves of GA almost coincided in MHD and non-MHD patients with DM, because the intercepts （2.418 vs. 2.329） and slopes （0.053 vs. 0.057） were very close to each other. On the contrary, regression curves of HbAlc did not coincide in the two groups, because variance of the slopes （0.036 vs. 0.052） were relatively large. Through comparing receiver operating characteristic （ROC） areas under the curve （AUC）, it could be understood that the assessment performances of GA and HbAlc in MHD patients were lower than those in non-MHD ones, and assessment performance of HbAlc in MHD patients was better than GA （P 〈0.05）. In addition, the effects of Hb and EPO dose on HbAlc, or that of ALB on GA were unobvious in our study. Conclusions Actual glycemic control level in MHD patients with DM may be underestimated by HbAlc, and it could be avoided by GA; howe展开更多
Objective To investigate the optimal glycated haemoglobin （HbAlc） cut off points and evaluate the impact of HbAlc on diabetes and pre-diabetes in middle-aged and elderly population. Methods Subjects were recruited f...Objective To investigate the optimal glycated haemoglobin （HbAlc） cut off points and evaluate the impact of HbAlc on diabetes and pre-diabetes in middle-aged and elderly population. Methods Subjects were recruited from Shanghai Changfeng Study. A total of 1 973 community-based participants （age_〉45） without known diabetes underwent oral glucose tolerance test （OG3-r） by using a 75-g oral glucose load and HbAlc was measured by using high performance liquid chromatography （HPLC）. Subjects were classified as normal glucose tolerance （NGT）, pre-diabetes（impaired glucose regulation, IGR） and new diagnosed diabetes （NDD） per 1999 WHO criteria. Two tests are compared with receiver operating characteristic curve （ROC）. Results Among 1973 subjects, 271 （13.7%） were diagnosed as NDD and 474 （24.0%） as IGR by using OGTT. HbAlc was 5.7%_＋0.7% in this population. Use of 6.5% as the HbAIC cutoff point has sensitivity of 38.7% and specificity of 98.5%. We recommend 6.0% as a better cutoff value for diagnosis of diabetes in this population （AUC 0.829, 95% CI 0.798-0.860, P〈0.001） with its sensitivity and specificity as 66.1% and 86.8%. For IGR, the results showed low sensitivity （44.9%） and specificity （66.7%） with an AUC of 0.571 for HbAlc when 5.8% was used as the cutoff point. Participants detected with HbAlc_〉6.0% were associated with nearly the same metabolic characteristics, including body mass index （BMI）, blood pressure, lipid profile and urine albumin-creatinine ratio （uACR） compared with diabetic subjects detected by OGTT. Conclusion The optimum HbAlc cutoff point for diabetes in our study population was lower than ADA criteria, and HbAlc may not be used to identify IGR.展开更多
The aim of this study was to understand the characteristics of blood pressure （BP） variability in subjects with diabetic nephropathy （DN）, and identify the probable predictors affecting BP variability. Fifty-one c...The aim of this study was to understand the characteristics of blood pressure （BP） variability in subjects with diabetic nephropathy （DN）, and identify the probable predictors affecting BP variability. Fifty-one chronic kidney disease （CKD）-hypertensive patients without diabetes （NDN group） and sixty type 2 diabetic patients with overt DN （DN group） were enrolled in this study. The values of short-term BP variability were obtained from 24 h ambulatory BP monitoring （ABPM）. Variance analysis or nonparametric analysis revealed that 24-h systolic BP variability and night- time systolic BP variability of the DN group were significantly higher than those of the NDN group [（12.23±3.66） vs. （10.74±3.83） mmHg, P〈0.05; （11.23±4.82） vs. （9.48±3.69） mmHg, P〈0.05]. Then the patients of the DN group were divided into two groups according to glycated hemoglobin （HbAlc） level： Group A （HbA1c〈7%） and Group B （HbA1c〉7%）, and the t-test showed that patients in Group B had larger 24-h diastolic, daytime diastolic, and nighttime systolic/diastolic BP variability compared with Group A. In the DN group, partial correlation analysis revealed that HbAlc exhibited a strong association with 24-h diastolic, daytime diastolic, nighttime systolic and diastolic BP vari- ability （P〈0.001, P〈0.001, P〈0.05, and P〈0.001, respectively）. Taken together, larger short-term BP variability was detected in hypertensive type 2 diabetic patients with overt nephropathy and renal insufficiency. It may imply that the optimal BP variability level could benefit from a better glycaemic control.展开更多
Atherosclerosis is a major complication of diabetes, increasing the risk of cardiovascular related morbidities and mortalities. The hallmark of diabetes is hyperglycemia which duration is best predicted by elevated gl...Atherosclerosis is a major complication of diabetes, increasing the risk of cardiovascular related morbidities and mortalities. The hallmark of diabetes is hyperglycemia which duration is best predicted by elevated glycated haemoglobin A1C(Hb A1C) levels. Diabetic complications are usually attributed to oxidative stress associated with glycation of major structural and functional proteins. This non-enzymatic glycation of long lived proteins such as collagen, albumin, fibrinogen, liver enzymes and globulins result in the formation of early and advanced glycation end products(AGEs) associated with the production of myriads of free radicles and oxidants that have detrimental effects leading to diabetic complications. AGEs have been extensively discussed in the literature as etiological factors in the advancement of atherogenic events. Mechanisms described include the effects of glycation on protein structure and function that lead to defective receptor binding, impairment of immune system and enzyme function and alteration of basement membrane structural integrity. Hemoglobin(Hb) is a major circulating protein susceptible to glycation. Glycated Hb, namely Hb A1 C is used as a useful tool in the diagnosis of diabetes progression. Many studies have shown strong positive associations between elevated Hb A1 C levels and existing cardiovascular disease and major risk factors. Also, several studies presented Hb A1 C as an independent predictor of cardiovascular risk. In spite of extensive reports on positive associations, limited evidence is available considering the role of glycated Hb in the etiology of atherosclerosis. This editorial highlights potential mechanisms by which glycated hemoglobin may contribute, as a causative factor, to the progression of atherosclerosis in diabetics.展开更多
Gestational diabetes mellitus is the most common endocrine disorder in pregnancy and a cause of maternal and fetal morbidities and mortalities. The oral glucose tolerance test is the gold standard for diagnosing gesta...Gestational diabetes mellitus is the most common endocrine disorder in pregnancy and a cause of maternal and fetal morbidities and mortalities. The oral glucose tolerance test is the gold standard for diagnosing gestational diabetes mellitus. Nevertheless, the oral glucose tolerance test is time-consuming and requires patient preparation. On the contrary, Glycated albumin does not require patient preparation or administration of any substance. Most studies on glycated albumin in pregnancy were among the non-African population, and black Americans have higher glycated albumin levels than Caucasians. This study determined the use of glycated albumin in diagnosing gestational diabetes mellitus among pregnant women. The study was a prospective study of 160 pregnant women between 24 and 28 weeks of gestation at the University of Port Harcourt Teaching Hospital. The diagnosis of gestational diabetes mellitus was based on the World Health Organization 2013 criteria. The diagnostic value of glycated albumin was determined using the area under the receiver operator characteristic curve. The prevalence of gestational diabetes mellitus was 9.4% and the mean glycated albumin was 16.91% (±2.77). The area under the receiver operator characteristic curve for glycated albumin was 0.845 (95% CI 0.733 - 0.956;p = 0.0001). The optimal cut-off value of glycated albumin in the diagnosis of gestational diabetes mellitus was 18.9%. Glycated albumin was useful in the diagnosis of gestational diabetes mellitus at 24 to 28 weeks of gestation.展开更多
AIM: To assess the effectiveness of the Chronic Disease Self-Management Program(CDSMP) on glycated hemoglobin A1c(HbA1c) and selected self-reported measures.METHODS: We compared patients who received a diabetes self-c...AIM: To assess the effectiveness of the Chronic Disease Self-Management Program(CDSMP) on glycated hemoglobin A1c(HbA1c) and selected self-reported measures.METHODS: We compared patients who received a diabetes self-care behavioral intervention, the CDSMP developed at the Stanford University, with controls whoreceived usual care on their HbA1c and selected self-reported measures, including diabetes self-care activities, health-related quality of life(HRQOL), pain and fatigue. The subjects were a subset of participants enrolled in a randomized controlled trial that took place at seven regional clinics of a university-affiliated integrated healthcare system of a multi-specialty group practice between January 2009 and June 2011. The primary outcome was change in HbA1c from randomization to 12 mo. Data were analyzed using multilevel statistical models and linear mixed models to provide unbiased estimates of intervention effects.RESULTS: Demographic and baseline clinical characteristics were generally comparable between the two groups. The average baseline HbA1c values in the CDSMP and control groups were 9.4% and 9.2%, respectively. Significant reductions in HbA1c were seen at 12 mo for the two groups, with adjusted changes around 0.6%(P < 0.0001), but the reductions did not differ significantly between the two groups(P = 0.885). Few significant differences were observed in participants' diabetes self-care activities. No significant differences were observed in the participants' HRQOL, pain, or fatigue measures.CONCLUSION: The CDSMP intervention may not lower HbA1c any better than good routine care in an integrated healthcare system. More research is needed to understand the benefits of self-management programs in primary care in different settings and populations.展开更多
Attaining and maintaining good glycemic control is a cornerstone of diabetes care. The monitoring of glycemic control is currently based on the self-monitoring of blood glucose(SMBG) and laboratory testing for hemoglo...Attaining and maintaining good glycemic control is a cornerstone of diabetes care. The monitoring of glycemic control is currently based on the self-monitoring of blood glucose(SMBG) and laboratory testing for hemoglobin A1 c(HbA1 c),which is a surrogate biochemical marker of the average glycemia level over the previous 2-3 mo period. Although hyperglycemia is a key biochemical feature of diabetes, both the level of and exposure to high glucose, as well as glycemic variability, contribute to the pathogenesis of diabetic complications and follow different patterns in type 1 and type 2 diabetes. HbA1 c provides a valuable,standardized and evidence-based parameter that is relevant for clinical decision making, but several biological and analytical confounders limit its accuracy in reflecting true glycemia. It has become apparent in recent years that other glycated proteins such as fructosamine, glycated albumin, and the nutritional monosaccharide 1,5-anhydroglucitol, as well as integrated measures from direct glucose testing by an SMBG/continuous glucose monitoring system, may provide valuable complementary data, particularly in circumstances when HbA1 c results may be unreliable or are insufficient to assess the risk of adverse outcomes. Long-term associations of these alternative biomarkers of glycemia with the risk of complications need to be investigated in order to provide clinically relevant cut-off values and to validate their utility in diverse populations of diabetes patients.展开更多
Gram-negative sepsis is a severe clinical syndrome associated with significant morbidity and mortality.Lipopolysaccharide(LPS),expressed on Gram-negative bacteria,is a potent pro-inflammatory toxin that induces inflam...Gram-negative sepsis is a severe clinical syndrome associated with significant morbidity and mortality.Lipopolysaccharide(LPS),expressed on Gram-negative bacteria,is a potent pro-inflammatory toxin that induces inflammation and coagulation via two separate receptor systems.One is Toll-like receptor 4(TLR4),expressed on cell surfaces and in endosomes,and the other is the cytosolic receptor caspase-11(caspases-4 and-5 in hu-mans).Extracellular LPS binds to high mobility group box 1(HMGB1)protein,a cytokine-like molecule.The HMGB1-LPS complex is transported via receptor for advanced glycated end products(RAGE)-endocytosis to the endolysosomal system to reach the cytosolic LPS receptor caspase-11 to induce HMGB1 release,inflammation,and coagulation that may cause multi-organ failure.The insight that LPS needs HMGB1 assistance to generate severe inflammation has led to successful therapeutic results in preclinical Gram-negative sepsis studies target-ing HMGB1.However,to date,no clinical studies have been performed based on this strategy.HMGB1 is also actively released by peripheral sensory nerves and this mechanism is fundamental for the initiation and prop-agation of inflammation during tissue injury.Homeostasis is achieved when other neurons actively restrict the inflammatory response via monitoring by the central nervous system and the vagus nerve through the cholinergic anti-inflammatory pathway.The neuronal control in Gram-negative sepsis needs further studies since a deeper understanding of the interplay between HMGB1 and acetylcholine may have beneficial therapeutic implications.Herein,we review the synergistic overlapping mechanisms of LPS and HMGB1 and discuss future treatment opportunities in Gram-negative sepsis.展开更多
BACKGROUND The two-way relationship between periodontitis and type 2 diabetes mellitus(T2DM)is well established.Prolonged hyperglycemia contributes to increased periodontal destruction and severe periodontitis,accentu...BACKGROUND The two-way relationship between periodontitis and type 2 diabetes mellitus(T2DM)is well established.Prolonged hyperglycemia contributes to increased periodontal destruction and severe periodontitis,accentuating diabetic complications.An inflammatory link exists between diabetic retinopathy(DR)and periodontitis,but the studies regarding this association and the role of lipoprotein(a)[Lp(a)]and interleukin-6(IL-6)in these conditions are scarce in the literature.AIM To determine the correlation of periodontal inflamed surface area(PISA)with glycated Hb(HbA1c),serum IL-6 and Lp(a)in T2DM subjects with retinopathy.METHODS This cross-sectional study comprised 40 T2DM subjects with DR and 40 T2DM subjects without DR.All subjects were assessed for periodontal parameters[bleeding on probing(BOP),probing pocket depth,clinical attachment loss(CAL),oral hygiene index-simplified,plaque index(PI)and PISA],and systemic parameters[HbA1c,fasting plasma glucose and postprandial plasma glucose,fasting lipid profile,serum IL-6 and serum Lp(a)].RESULTS The proportion of periodontitis in T2DM with and without DR was 47.5%and 27.5%respectively.Severity of periodontitis,CAL,PISA,IL-6 and Lp(a)were higher in T2DM with DR group compared to T2DM without DR group.Significant difference was observed in the mean percentage of sites with BOP between T2DM with DR(69%)and T2DM without DR(41%),but there was no significant difference in PI(P>0.05).HbA1c was positively correlated with CAL(r=0.351,P=0.001),and PISA(r=0.393,P≤0.001)in study subjects.A positive correlation was found between PISA and IL-6(r=0.651,P<0.0001);PISA and Lp(a)(r=0.59,P<0.001);CAL and IL-6(r=0.527,P<0.0001)and CAL and Lp(a)(r=0.631,P<0.001)among study subjects.CONCLUSION Despite both groups having poor glycemic control and comparable plaque scores,the periodontal parameters were higher in DR as compared to T2DM without DR.Since a bidirectional link exists between periodontitis and DM,the presence of DR may have contributed to the severity of periodontal destruct展开更多
Background: Type II diabetes mellitus is associated with multiple metabolic derangements which can cause secondary pathophysiological changes in multiple organ systems. This in turn can impose a heavy burden of morbid...Background: Type II diabetes mellitus is associated with multiple metabolic derangements which can cause secondary pathophysiological changes in multiple organ systems. This in turn can impose a heavy burden of morbidity and mortality from micro‑ and macro‑vascular complications. This study aimed to describe the metabolic and therapeutic profile of a subgroup of type 2 diabetic patients who have treatment failure with oral anti-hyperglycemic agents with persistent hyperglycemia despite insulin treatment. Methods: 60 type 2 diabetic patients in treatment failure with oral antidiabetics and under insulin treatment, aged 35 to 70 years, were recruited at the Diabetes Clinic of the University Teaching Hospital of Treichville in Abidjan, Côte d’Ivoire. Blood samples were collected in tubes containing Ethylenediaminetetraacetic Acid (EDTA) to determine glycated hemoglobin (HbA1c). Results: The average age of the population was 54 ± 9.38 years with a sex ratio (M/F) of 0.3, an average BMI of 30.25 ± 5 kg/m<sup>2</sup>, and an average HbA1c of 10.1% ± 1.6% for an average diabetes duration of 11.8 ± 5.8 years. The average insulin dose was 74.556 ± 16.21 UI/day, and the average duration of insulin treatment was 5.4 ± 3.1 years. The average HbA1c value was 10.1% ± 1.87% in men against 10.03% ± 1.53% in women with no significant difference (p = 0.1). The mean HbA1c values according to patient weight were 10.08% ± 2.05% for normal weight, 9.55% ± 2.26% for overweight, and 10.57% for obese, with no significant difference between the three groups of patients (p = 0.1). Conclusion: This study showed a persistence increase in glycated hemoglobin regardless of the treatment regimen, duration, and dose of insulin treatment in the subpopulation of type 2 diabetic patients.展开更多
This study aims to investigate the link between glycated hemoglobin and diabetic complications with chronic periodontitis. A total of 207 patients with type 2 diabetes and chronic periodontitis （CP） were divided acc...This study aims to investigate the link between glycated hemoglobin and diabetic complications with chronic periodontitis. A total of 207 patients with type 2 diabetes and chronic periodontitis （CP） were divided according to tertiles of mean PISA （periodontal inflamed surface area） scores as low, middle and high PISA groups. Simultaneously a group of 67 periodontally healthy individuals （PH） was recruited. Periodontal examinations, including full-mouth assessment of probing depths （PPD）, bleeding on probing, clinical attachment level and plaque scores were determined. Blood analyses were carried out for glycated hemoglobin （HbA1c）, fasting plasma glucose （FPG）, 2 h post parandial glucose （PPG）. Individuals in PH group had significantly better glycemic control than CP group. Upon one-way analysis of variance, subjects with increased PISA had significantly higher HbA1c levels, retinopathy and nephropathy （P 〈 0.05）. After controlling for age, gender, body mass index （BMI）, socioeconomic status （SES）, family history of diabetes and periodontitis, duration of diabetes, the mean PISA in mm^2, PPD 4-6 mm （%） and PPD ≥7 mm （%） emerged as significant predictors for elevated HbAlc in regression model （P 〈 0.05）. Logistic regression analysis revealed that PISA was associated with higher risk of having retinopathy and neuropathy （odds ratio）. In our study, the association between glycemic control and diabetic complications with periodontitis was observed.展开更多
Introduction: One of the biological markers for monitoring glycaemic control in diabetic patients is glycated protein. The definition of a reference method to improve the accuracy of measurement tools is necessary. Th...Introduction: One of the biological markers for monitoring glycaemic control in diabetic patients is glycated protein. The definition of a reference method to improve the accuracy of measurement tools is necessary. The aim of our study was to assess the glycemic control of diabetic patients based on glycated hemoglobin. Patients and Method: This is a descriptive cross-sectional study conducted in April 2021 at the national university hospital center (CNHU-HKM) of Cotonou. All patients who consulted during the period and who gave their consent were included. After collecting the blood samples according to the classical standards of the pre-analytical phase, we measured the blood glucose level and the HbA1c. Results: The mean blood glucose level of the patients was 1.52 ± 0.16 g/L with extremes of 0.80 g/L and 3.5 g/L. The mean HbA1c proportion was 8.39% ± 0.60% with a minimum and maximum value of 5.40% and 16% respectively. We also noted that the mean body mass index (BMI) of the patients was 28.61 ± 1.46 Kg/m<sup>2</sup> with extremes of 17.50 Kg/m<sup>2</sup> and 46.02 Kg/m<sup>2</sup>. Oral anti diabetic and hygienic-dietary measures were used by 44 patients (80%) and hygienic-dietary measures (HDM) only used by 9.09%. A frequency of 87.53% of patients had at least one degenerative complication. Retinopathy was the most observed degenerative disease (36.36%) followed by cardiovascular disease (25.45%). Conclusion: This study showed that there is a poor correlation between fasting blood glucose and glycated haemoglobin levels, which could be due to several biological and clinical reasons. It also showed that despite the respect of hygienic dietary measures and a well conducted treatment, it is difficult to obtain a satisfactory glycemic balance in obese patients.展开更多
BACKGROUND Gestational diabetes mellitus(GDM)is characterized by glucose intolerance that is first diagnosed during pregnancy,making it the most common complication associated with this period.Early detection and targ...BACKGROUND Gestational diabetes mellitus(GDM)is characterized by glucose intolerance that is first diagnosed during pregnancy,making it the most common complication associated with this period.Early detection and targeted treatment of GDM can minimize foetal exposure to maternal hyperglycaemia and subsequently reduce the associated adverse pregnancy outcomes.Previous studies have inconsistently suggested that the level of glycated albumin(GA)might predict GDM.AIM To review and synthesize existing evidence to evaluate the relationship between GA levels and the development of GDM.METHODS We sought to compare GA levels between GDM and control groups in this metaanalysis by systematically searching the Web of Science,PubMed,Cochrane Library,and Embase databases for articles published up to June 2023.The analysis utilized the weighted mean difference(WMD)as the primary metric.The data were meticulously extracted,and the quality of the included studies was assessed.Additionally,we conducted a subgroup analysis based on study region and sample size.We assessed heterogeneity using I2 statistics and evaluated publication bias through funnel plots.Additionally,trim-and-fill analysis was employed to detect and address any potential publication bias.RESULTS The meta-analysis included a total of 11 studies involving 5477 participants,comprising 1900 patients with GDM and 3577 control individuals.The synthesized results revealed a notable correlation between elevated GA levels and increased susceptibility to GDM.The calculated WMD was 0.42,with a 95%confidence interval(95%CI)ranging from 0.11 to 0.74,yielding a P value less than 0.001.Concerning specific GA levels,the mean GA level in the GDM group was 12.6,while for the control group,it was lower,at 11.6.This discrepancy underscores the potential of GA as a biomarker for assessing GDM risk.Moreover,we explored the levels of glycated haemoglobin(HbA1c)in both cohorts.The WMD for HbA1c was 0.19,with a 95%CI ranging from 0.15 to 0.22 and a P value less than 0.001.This observatio展开更多
Objective:To explore the clinical application of nutritional management combined with clinical monitoring of glycated albumin(GA)in diabetic nephropathy(DN)dialysis patients.Methods:A total of 20 diabetic nephropathy ...Objective:To explore the clinical application of nutritional management combined with clinical monitoring of glycated albumin(GA)in diabetic nephropathy(DN)dialysis patients.Methods:A total of 20 diabetic nephropathy dialysis patients admitted to the People’s Hospital of Guandu District from January 2022 to February 2023 were included in the study.They were randomly divided into a conventional group(n=10)and an observation group(n=10).The study evaluated the blood glucose control,nutritional status,dialysis efficacy,and quality of life scores of both groups.Results:Before the intervention,there were no significant differences in fasting plasma glucose(FPG),GA,serum albumin,body mass index(BMI),dialysis efficiency values,urea clearance rate,or quality-of-life scores between the two groups(P>0.05).After the intervention,the observation group showed significantly lower FPG and GA levels,higher serum albumin,dialysis efficiency values,urea clearance rate,and improved quality-of-life scores compared to the conventional group(P<0.05),with no difference in BMI(P>0.05).Conclusion:Nutritional management combined with clinical monitoring of glycated albumin has a significant effect on the clinical application of diabetic nephropathy dialysis patients.It can effectively improve patients’blood glucose control and nutritional status,reduce the risk of complications,and enhance the quality of life,demonstrating clinical value for broader application.展开更多
BACKGROUND Glycated hemoglobin A1c(HbA1c)is considered the most suitable for diabetes mellitus diagnosis due to its accuracy and convenience.However,the effect of HbA1c on diabetic retinopathy(DR)in the Han and Korean...BACKGROUND Glycated hemoglobin A1c(HbA1c)is considered the most suitable for diabetes mellitus diagnosis due to its accuracy and convenience.However,the effect of HbA1c on diabetic retinopathy(DR)in the Han and Korean populations in Jilin,China,remains inconclusive.AIM To determine the best cut-off of HbA1c for diagnosing DR among the Chinese.METHODS This cross-sectional study included 1933 participants from the Yanbian area of Jilin Province,China.Trained investigators employed a questionnaire-based survey,physical examination,laboratory tests,and fundus photography for the investigation.The best cut-off value for HbA1c was established via the receiver operating characteristic curve.The factors associated with HbA1c-associated risk factors were determined via linear regression.RESULTS The analysis included 887 eligible Chinese Han and Korean participants,591 of whom were assigned randomly to the training set and 296 to the validation set.The prevalence of DR was 3.27% in the total population.HbA1c of 6.2% was the best cut-off value in the training set,while it was 5.9% in the validation set.In both Chinese Han and Korean populations,an HbA1c level of 6.2% was the best cut-off value.The optimal cut-off values of fasting blood glucose(FBG)≥7 mmol/L and<7 mmol/L were 8.1% and 6.2% respectively in Han populations,while those in Korean populations were 6.9%and 5.3%,respectively.Age,body mass index,and FBG were determined as the risk factors impacting HbA1c levels.CONCLUSION HbA1c may serve as a useful diagnostic indicator for DR.An HbA1c level of 6.2% may be an appropriate cut-off value for DR detection in the Chinese population.展开更多
BACKGROUND Islets of Langerhans beta cells diminish in autoimmune type 1 diabetes mellitus(T1DM).Teplizumab,a humanized anti-CD3 monoclonal antibody,may help T1DM.Its long-term implications on clinical T1DM developmen...BACKGROUND Islets of Langerhans beta cells diminish in autoimmune type 1 diabetes mellitus(T1DM).Teplizumab,a humanized anti-CD3 monoclonal antibody,may help T1DM.Its long-term implications on clinical T1DM development,safety,and efficacy are unknown.AIM To assess the effectiveness and safety of teplizumab as a therapeutic intervention for individuals with T1DM.METHODS A systematic search was conducted using four electronic databases(PubMed,Embase,Scopus,and Cochrane Library)to select publications published in peerreviewed journals written in English.The odds ratio(OR)and risk ratio(RR)were calculated,along with their 95%CI.We assessed heterogeneity using Cochrane Q and I2 statistics and the appropriate P value.RESULTS There were 8 randomized controlled trials(RCTs)in the current meta-analysis with a total of 1908 T1DM patients from diverse age cohorts,with 1361 patients receiving Teplizumab and 547 patients receiving a placebo.Teplizumab was found to have a substantial link with a decrease in insulin consumption,with an OR of 4.13(95%CI:1.72 to 9.90).Teplizumab is associated with an improved Cpeptide response(OR 2.49;95%CI:1.62 to 3.81)and a significant change in Glycated haemoglobin A1c(HbA1c)levels in people with type 1 diabetes[OR 1.75(95%CI:1.03 to 2.98)],and it has a RR of 0.71(95%CI:0.53 to 0.95).CONCLUSION In type 1 diabetics,teplizumab decreased insulin consumption,improved C-peptide response,and significantly changed HbA1c levels with negligible side effects.Teplizumab appears to improve glycaemic control and diabetes management with good safety and efficacy.展开更多
Background:The serum vitamin D level varies widely by population,and studies have linked vitamin D levels with the risk of type 2 diabetes mellitus(T2DM).However,the relationship is inconsistent and the impact of vita...Background:The serum vitamin D level varies widely by population,and studies have linked vitamin D levels with the risk of type 2 diabetes mellitus(T2DM).However,the relationship is inconsistent and the impact of vitamin D on T2DM among East Chinese adults is unclear.The study aimed to investigate the association between serum 25-hydroxyvitamin D(25[OH]D)levels and the risk of T2DM and evaluated whether the association is modified by genetic predisposition.Methods:In the Survey on Prevalence in East China for Metabolic Diseases and Risk Factors(SPECT-China)cohort,1862 participants free of T2DM at baseline were included.A weighted genetic risk score was calculated with 28 variants associated with T2DM.Hierarchical logistic models were used to examine the association of serum 25(OH)D and genetic risk with T2DM.Results:After a 5-year follow-up,132 cases of T2DM were documented.We observed no significant association between quartiles of serum 25(OH)D and T2DM risk after multivariable adjustment(χ^(2)=0.571,P_(for trend)=0.426).Compared to those in the lowest quartile of 25(OH)D,the odds ratios(ORs)(95%confidence interval[CI])for participants with increased quartiles were 1.29(0.74-2.25),1.35(0.77-2.36),and 1.27(0.72-2.24),respectively.We observed a positive association of glycated hemoglobin(HbA1c)with 25(OH)D at baseline(β=1.752,P=0.001)and after follow-up(β=1.385,P=0.003),and a negative association of ln conversion homeostasis model assessment(HOMA)-βwith 25(OH)D at baseline(β=-0.982,P=0.021).There was no significant interaction between 25(OH)D and diabetes genetic predisposition on the risk of T2DM(χ^(2)=2.710,P_(for interaction)=0.100).The lowest OR(95%CI)of T2DM was among participants with low genetic risk and the highest quartile of 25(OH)D(0.17[0.05-0.62]).Conclusion:Serum 25(OH)D may be irrelevant to the risk of incident T2DM among East Chinese adults regardless of genetic predisposition.展开更多
文摘Periodontitis is the commonest oral disease affecting population worldwide. This disease is notorious for the devastation of tooth supporting structures, ensuing in the loss of dentition. The etiology for this disease is bacterial biofilm, which accumulates on the teeth as dental plaque. In addition to the biofilm microorganisms, other factors such as environmental, systemic and genetic are also responsible in progression of periodontitis. Diabetes mellitus (DM) is metabolic disorder which has an impact on the global health. DM plays a crucial role in the pathogenesis of periodontitis. Periodontitis is declared as the “sixth” major complication of DM. Evidence based literature has depicted an enhanced incidence and severity of periodontitis in subjects with DM. A “two way” relationship has been purported between periodontitis and DM. Mutual management of both conditions is necessary. Periodontal therapy (PT) may assist to diminish the progression of DM and improve glycemic control. Various advanced technological facilities may be utilized for the purpose of patient education and disease management. The present paper clarifies the etio-pathogenesis of periodontitis, establishing it as a complication of DM and elaborating the various mechanisms involved in the pathogenesis. The role of PT in amelioration of DM and application of digital communication will be discussed. Overall, it is judicious to create an increased patient cognizance of the periodontitis-DM relationship. Conjunctive efforts must be undertaken by the medical and oral health care professionals for the management of periodontitis affected DM patients.
文摘Nonalcoholic fatty liver disease(NAFLD) is one of themajor causes of chronic liver injury. NAFLD includes a wide range of clinical conditions from simple steatosis to nonalcoholic steatohepatitis(NASH), advanced fibrosis, and liver cirrhosis. The histological findings of NASH indicate hepatic steatosis and inflammation with characteristic hepatocyte injury(e.g., ballooning degeneration), as is observed in the patients with alcoholic liver disease. NASH is considered to be a potentially health-threatening disease that can progress to cirrhosis. A liver biopsy remains the most reliable diagnostic method to appropriately diagnose NASH, evaluate the severity of liver fibrosis, and determine the prognosis and optimal treatment. However, this invasive technique is associated with several limitations in routine use, and a number of biomarkers have been developed in order to predict the degree of liver fibrosis. In the present article, we review the current status of noninvasive biomarkers available to estimate liver fibrosis in the patients with NASH. We also discuss our recent findings on the use of the glycated albuminto-glycated hemoglobin ratio, which is a new index that correlates to various chronic liver diseases, including NASH.
基金Supported by A Grant-in-Aid for Health and Labor Sciences Research from the Ministry of Health, Labour and Welfare of Japan
文摘AIM: To analyze the relationship between the glycated albumin (GA) to glycated hemoglobin (HbA1c) ratio and the histological grading of liver fibrosis.METHODS: The study retrospectively included consecutive hepatitis C virus positive chronic liver disease patients (n = 142) who had undergone percutaneous liver biopsy between January 2008 and March 2010 at our institution. The ratios of GA/HbA1c were calculated in all patients to investigate the relationship with the degree of the liver fibrosis. The values of the aspartate aminotransferase-to-platelet ratio index (APRI), an excellent marker for the evaluation of liver fibrosis, were also calculated. In addition, we combined the ratio of GA/HbA1c and the APRI in order to improve our ability to detect the presence of significant liver fibrosis. RESULTS: Sixty-one (43%) patients had either no fibrosis or minimal fibrosis (METAVIR score: F0-F1), while 25 (17%) had intermediate fibrosis (F2). Fifty-six (39%) patients had severe fibrosis (F3-F4) and 27 of them had cirrhosis (F4). The mean values of the GA/HbA1c increased with the progression of the fibrosis (F0-1: 2.83 ± 0.24, F2: 2.85 ± 0.24, F3: 2.92 ± 0.35, F4: 3.14 ± 0.54). There was a significant dif- ference between the F0-F1 vs F4, F2 vs F4, and F3 vs F4 groups (P < 0.01, P < 0.01, P < 0.01 and P < 0.05, respectively). The GA/HbA1c ratio was significantly higher in the patients with cirrhosis (F4) than in those without cirrhosis (F0-F3) (3.14 ± 0.54 vs 2.85 ± 0.28, P < 0.0001). The GA/HbA1c ratio was also significantly higher in the patients with severe fibrosis (F3-F4) than in those without severe liver fibrosis (F0-F2) (3.03 ± 0.41 vs 2.84 ± 0.24, P < 0.001). Furthermore, the GA/ HbA1c ratio was also significantly higher in the patients with significant fibrosis (F2-F4) than in those without significant liver fibrosis (F0-F1) (2.98 ± 0.41 vs 2.83 ± 0.24, P < 0.001). The diagnostic performance of the increased GA/HbA1c ratio (> 3.0) was as follows: its sensitivity and specificity for the detection of
基金The work was supported by the grants from the Major State Basic Research Development Program of China （2013CB530800）, National Natural Science Foundation of China （81270819）, National Key Technology R＆D Program （2011BAI10B00）.
文摘Background It has been suggested that glycated hemoglobin （HbAlc） underestimate the actual glycemic control levels in maintenance hemodialysis （MHD） patients, because of anemia and the using of erythropoietin （EPO）; it was recommended that glycated albumin （GA） should be an alternative marker. Therefore, the assessment performances of glycemic control were compared between GA and HbAlc in this research by referring to mean plasma glucose （MPG） in diabetes mellitus （DM） patients undergoing MHD or not. Methods MPG was calculated according to the data registered at enrollment and follow-up 2 months later and corresponding HbAlc, albumin （ALB）, GA, etc. were measured in 280 cases. A case-control study for comparing GA and HbAlc was done among the groups of MHD patients with DM （n=88） and without DM （NDM; n=90）, and non-MHD ones with DM （n=102） using MPG for an actual glycemic control standard. Results In these 3 groups, only for DM patients＇ （whether undergoing MHD or not）, GA and HbAlc correlated with MPG significantly （P 〈0.01）. Through linear regression analysis, it could be found that the regression curves of GA almost coincided in MHD and non-MHD patients with DM, because the intercepts （2.418 vs. 2.329） and slopes （0.053 vs. 0.057） were very close to each other. On the contrary, regression curves of HbAlc did not coincide in the two groups, because variance of the slopes （0.036 vs. 0.052） were relatively large. Through comparing receiver operating characteristic （ROC） areas under the curve （AUC）, it could be understood that the assessment performances of GA and HbAlc in MHD patients were lower than those in non-MHD ones, and assessment performance of HbAlc in MHD patients was better than GA （P 〈0.05）. In addition, the effects of Hb and EPO dose on HbAlc, or that of ALB on GA were unobvious in our study. Conclusions Actual glycemic control level in MHD patients with DM may be underestimated by HbAlc, and it could be avoided by GA; howe
基金supported by grants from National Key Technologies R&D Program (Grant No. 2008 BAI52B03 to X. Gao)the National Key Technologies R&D Program (Grant No. 2009BAI80B01 to H. Lin)the Major Project of Subject Construction of Shanghai Bureau of Health (Grant No.08GWZX0203 to X. Gao)
文摘Objective To investigate the optimal glycated haemoglobin （HbAlc） cut off points and evaluate the impact of HbAlc on diabetes and pre-diabetes in middle-aged and elderly population. Methods Subjects were recruited from Shanghai Changfeng Study. A total of 1 973 community-based participants （age_〉45） without known diabetes underwent oral glucose tolerance test （OG3-r） by using a 75-g oral glucose load and HbAlc was measured by using high performance liquid chromatography （HPLC）. Subjects were classified as normal glucose tolerance （NGT）, pre-diabetes（impaired glucose regulation, IGR） and new diagnosed diabetes （NDD） per 1999 WHO criteria. Two tests are compared with receiver operating characteristic curve （ROC）. Results Among 1973 subjects, 271 （13.7%） were diagnosed as NDD and 474 （24.0%） as IGR by using OGTT. HbAlc was 5.7%_＋0.7% in this population. Use of 6.5% as the HbAIC cutoff point has sensitivity of 38.7% and specificity of 98.5%. We recommend 6.0% as a better cutoff value for diagnosis of diabetes in this population （AUC 0.829, 95% CI 0.798-0.860, P〈0.001） with its sensitivity and specificity as 66.1% and 86.8%. For IGR, the results showed low sensitivity （44.9%） and specificity （66.7%） with an AUC of 0.571 for HbAlc when 5.8% was used as the cutoff point. Participants detected with HbAlc_〉6.0% were associated with nearly the same metabolic characteristics, including body mass index （BMI）, blood pressure, lipid profile and urine albumin-creatinine ratio （uACR） compared with diabetic subjects detected by OGTT. Conclusion The optimum HbAlc cutoff point for diabetes in our study population was lower than ADA criteria, and HbAlc may not be used to identify IGR.
基金Project (Nos.2011SZ0215 and 2012SZ0027) supported by the Science and Technology Research Projects of Sichuan Province,China
文摘The aim of this study was to understand the characteristics of blood pressure （BP） variability in subjects with diabetic nephropathy （DN）, and identify the probable predictors affecting BP variability. Fifty-one chronic kidney disease （CKD）-hypertensive patients without diabetes （NDN group） and sixty type 2 diabetic patients with overt DN （DN group） were enrolled in this study. The values of short-term BP variability were obtained from 24 h ambulatory BP monitoring （ABPM）. Variance analysis or nonparametric analysis revealed that 24-h systolic BP variability and night- time systolic BP variability of the DN group were significantly higher than those of the NDN group [（12.23±3.66） vs. （10.74±3.83） mmHg, P〈0.05; （11.23±4.82） vs. （9.48±3.69） mmHg, P〈0.05]. Then the patients of the DN group were divided into two groups according to glycated hemoglobin （HbAlc） level： Group A （HbA1c〈7%） and Group B （HbA1c〉7%）, and the t-test showed that patients in Group B had larger 24-h diastolic, daytime diastolic, and nighttime systolic/diastolic BP variability compared with Group A. In the DN group, partial correlation analysis revealed that HbAlc exhibited a strong association with 24-h diastolic, daytime diastolic, nighttime systolic and diastolic BP vari- ability （P〈0.001, P〈0.001, P〈0.05, and P〈0.001, respectively）. Taken together, larger short-term BP variability was detected in hypertensive type 2 diabetic patients with overt nephropathy and renal insufficiency. It may imply that the optimal BP variability level could benefit from a better glycaemic control.
文摘Atherosclerosis is a major complication of diabetes, increasing the risk of cardiovascular related morbidities and mortalities. The hallmark of diabetes is hyperglycemia which duration is best predicted by elevated glycated haemoglobin A1C(Hb A1C) levels. Diabetic complications are usually attributed to oxidative stress associated with glycation of major structural and functional proteins. This non-enzymatic glycation of long lived proteins such as collagen, albumin, fibrinogen, liver enzymes and globulins result in the formation of early and advanced glycation end products(AGEs) associated with the production of myriads of free radicles and oxidants that have detrimental effects leading to diabetic complications. AGEs have been extensively discussed in the literature as etiological factors in the advancement of atherogenic events. Mechanisms described include the effects of glycation on protein structure and function that lead to defective receptor binding, impairment of immune system and enzyme function and alteration of basement membrane structural integrity. Hemoglobin(Hb) is a major circulating protein susceptible to glycation. Glycated Hb, namely Hb A1 C is used as a useful tool in the diagnosis of diabetes progression. Many studies have shown strong positive associations between elevated Hb A1 C levels and existing cardiovascular disease and major risk factors. Also, several studies presented Hb A1 C as an independent predictor of cardiovascular risk. In spite of extensive reports on positive associations, limited evidence is available considering the role of glycated Hb in the etiology of atherosclerosis. This editorial highlights potential mechanisms by which glycated hemoglobin may contribute, as a causative factor, to the progression of atherosclerosis in diabetics.
文摘Gestational diabetes mellitus is the most common endocrine disorder in pregnancy and a cause of maternal and fetal morbidities and mortalities. The oral glucose tolerance test is the gold standard for diagnosing gestational diabetes mellitus. Nevertheless, the oral glucose tolerance test is time-consuming and requires patient preparation. On the contrary, Glycated albumin does not require patient preparation or administration of any substance. Most studies on glycated albumin in pregnancy were among the non-African population, and black Americans have higher glycated albumin levels than Caucasians. This study determined the use of glycated albumin in diagnosing gestational diabetes mellitus among pregnant women. The study was a prospective study of 160 pregnant women between 24 and 28 weeks of gestation at the University of Port Harcourt Teaching Hospital. The diagnosis of gestational diabetes mellitus was based on the World Health Organization 2013 criteria. The diagnostic value of glycated albumin was determined using the area under the receiver operator characteristic curve. The prevalence of gestational diabetes mellitus was 9.4% and the mean glycated albumin was 16.91% (±2.77). The area under the receiver operator characteristic curve for glycated albumin was 0.845 (95% CI 0.733 - 0.956;p = 0.0001). The optimal cut-off value of glycated albumin in the diagnosis of gestational diabetes mellitus was 18.9%. Glycated albumin was useful in the diagnosis of gestational diabetes mellitus at 24 to 28 weeks of gestation.
基金Supported by The National Institutes of Health’s National Institute on Minority Health and Health Disparities,No.#1P20MD002295
文摘AIM: To assess the effectiveness of the Chronic Disease Self-Management Program(CDSMP) on glycated hemoglobin A1c(HbA1c) and selected self-reported measures.METHODS: We compared patients who received a diabetes self-care behavioral intervention, the CDSMP developed at the Stanford University, with controls whoreceived usual care on their HbA1c and selected self-reported measures, including diabetes self-care activities, health-related quality of life(HRQOL), pain and fatigue. The subjects were a subset of participants enrolled in a randomized controlled trial that took place at seven regional clinics of a university-affiliated integrated healthcare system of a multi-specialty group practice between January 2009 and June 2011. The primary outcome was change in HbA1c from randomization to 12 mo. Data were analyzed using multilevel statistical models and linear mixed models to provide unbiased estimates of intervention effects.RESULTS: Demographic and baseline clinical characteristics were generally comparable between the two groups. The average baseline HbA1c values in the CDSMP and control groups were 9.4% and 9.2%, respectively. Significant reductions in HbA1c were seen at 12 mo for the two groups, with adjusted changes around 0.6%(P < 0.0001), but the reductions did not differ significantly between the two groups(P = 0.885). Few significant differences were observed in participants' diabetes self-care activities. No significant differences were observed in the participants' HRQOL, pain, or fatigue measures.CONCLUSION: The CDSMP intervention may not lower HbA1c any better than good routine care in an integrated healthcare system. More research is needed to understand the benefits of self-management programs in primary care in different settings and populations.
文摘Attaining and maintaining good glycemic control is a cornerstone of diabetes care. The monitoring of glycemic control is currently based on the self-monitoring of blood glucose(SMBG) and laboratory testing for hemoglobin A1 c(HbA1 c),which is a surrogate biochemical marker of the average glycemia level over the previous 2-3 mo period. Although hyperglycemia is a key biochemical feature of diabetes, both the level of and exposure to high glucose, as well as glycemic variability, contribute to the pathogenesis of diabetic complications and follow different patterns in type 1 and type 2 diabetes. HbA1 c provides a valuable,standardized and evidence-based parameter that is relevant for clinical decision making, but several biological and analytical confounders limit its accuracy in reflecting true glycemia. It has become apparent in recent years that other glycated proteins such as fructosamine, glycated albumin, and the nutritional monosaccharide 1,5-anhydroglucitol, as well as integrated measures from direct glucose testing by an SMBG/continuous glucose monitoring system, may provide valuable complementary data, particularly in circumstances when HbA1 c results may be unreliable or are insufficient to assess the risk of adverse outcomes. Long-term associations of these alternative biomarkers of glycemia with the risk of complications need to be investigated in order to provide clinically relevant cut-off values and to validate their utility in diverse populations of diabetes patients.
文摘Gram-negative sepsis is a severe clinical syndrome associated with significant morbidity and mortality.Lipopolysaccharide(LPS),expressed on Gram-negative bacteria,is a potent pro-inflammatory toxin that induces inflammation and coagulation via two separate receptor systems.One is Toll-like receptor 4(TLR4),expressed on cell surfaces and in endosomes,and the other is the cytosolic receptor caspase-11(caspases-4 and-5 in hu-mans).Extracellular LPS binds to high mobility group box 1(HMGB1)protein,a cytokine-like molecule.The HMGB1-LPS complex is transported via receptor for advanced glycated end products(RAGE)-endocytosis to the endolysosomal system to reach the cytosolic LPS receptor caspase-11 to induce HMGB1 release,inflammation,and coagulation that may cause multi-organ failure.The insight that LPS needs HMGB1 assistance to generate severe inflammation has led to successful therapeutic results in preclinical Gram-negative sepsis studies target-ing HMGB1.However,to date,no clinical studies have been performed based on this strategy.HMGB1 is also actively released by peripheral sensory nerves and this mechanism is fundamental for the initiation and prop-agation of inflammation during tissue injury.Homeostasis is achieved when other neurons actively restrict the inflammatory response via monitoring by the central nervous system and the vagus nerve through the cholinergic anti-inflammatory pathway.The neuronal control in Gram-negative sepsis needs further studies since a deeper understanding of the interplay between HMGB1 and acetylcholine may have beneficial therapeutic implications.Herein,we review the synergistic overlapping mechanisms of LPS and HMGB1 and discuss future treatment opportunities in Gram-negative sepsis.
文摘BACKGROUND The two-way relationship between periodontitis and type 2 diabetes mellitus(T2DM)is well established.Prolonged hyperglycemia contributes to increased periodontal destruction and severe periodontitis,accentuating diabetic complications.An inflammatory link exists between diabetic retinopathy(DR)and periodontitis,but the studies regarding this association and the role of lipoprotein(a)[Lp(a)]and interleukin-6(IL-6)in these conditions are scarce in the literature.AIM To determine the correlation of periodontal inflamed surface area(PISA)with glycated Hb(HbA1c),serum IL-6 and Lp(a)in T2DM subjects with retinopathy.METHODS This cross-sectional study comprised 40 T2DM subjects with DR and 40 T2DM subjects without DR.All subjects were assessed for periodontal parameters[bleeding on probing(BOP),probing pocket depth,clinical attachment loss(CAL),oral hygiene index-simplified,plaque index(PI)and PISA],and systemic parameters[HbA1c,fasting plasma glucose and postprandial plasma glucose,fasting lipid profile,serum IL-6 and serum Lp(a)].RESULTS The proportion of periodontitis in T2DM with and without DR was 47.5%and 27.5%respectively.Severity of periodontitis,CAL,PISA,IL-6 and Lp(a)were higher in T2DM with DR group compared to T2DM without DR group.Significant difference was observed in the mean percentage of sites with BOP between T2DM with DR(69%)and T2DM without DR(41%),but there was no significant difference in PI(P>0.05).HbA1c was positively correlated with CAL(r=0.351,P=0.001),and PISA(r=0.393,P≤0.001)in study subjects.A positive correlation was found between PISA and IL-6(r=0.651,P<0.0001);PISA and Lp(a)(r=0.59,P<0.001);CAL and IL-6(r=0.527,P<0.0001)and CAL and Lp(a)(r=0.631,P<0.001)among study subjects.CONCLUSION Despite both groups having poor glycemic control and comparable plaque scores,the periodontal parameters were higher in DR as compared to T2DM without DR.Since a bidirectional link exists between periodontitis and DM,the presence of DR may have contributed to the severity of periodontal destruct
文摘Background: Type II diabetes mellitus is associated with multiple metabolic derangements which can cause secondary pathophysiological changes in multiple organ systems. This in turn can impose a heavy burden of morbidity and mortality from micro‑ and macro‑vascular complications. This study aimed to describe the metabolic and therapeutic profile of a subgroup of type 2 diabetic patients who have treatment failure with oral anti-hyperglycemic agents with persistent hyperglycemia despite insulin treatment. Methods: 60 type 2 diabetic patients in treatment failure with oral antidiabetics and under insulin treatment, aged 35 to 70 years, were recruited at the Diabetes Clinic of the University Teaching Hospital of Treichville in Abidjan, Côte d’Ivoire. Blood samples were collected in tubes containing Ethylenediaminetetraacetic Acid (EDTA) to determine glycated hemoglobin (HbA1c). Results: The average age of the population was 54 ± 9.38 years with a sex ratio (M/F) of 0.3, an average BMI of 30.25 ± 5 kg/m<sup>2</sup>, and an average HbA1c of 10.1% ± 1.6% for an average diabetes duration of 11.8 ± 5.8 years. The average insulin dose was 74.556 ± 16.21 UI/day, and the average duration of insulin treatment was 5.4 ± 3.1 years. The average HbA1c value was 10.1% ± 1.87% in men against 10.03% ± 1.53% in women with no significant difference (p = 0.1). The mean HbA1c values according to patient weight were 10.08% ± 2.05% for normal weight, 9.55% ± 2.26% for overweight, and 10.57% for obese, with no significant difference between the three groups of patients (p = 0.1). Conclusion: This study showed a persistence increase in glycated hemoglobin regardless of the treatment regimen, duration, and dose of insulin treatment in the subpopulation of type 2 diabetic patients.
文摘This study aims to investigate the link between glycated hemoglobin and diabetic complications with chronic periodontitis. A total of 207 patients with type 2 diabetes and chronic periodontitis （CP） were divided according to tertiles of mean PISA （periodontal inflamed surface area） scores as low, middle and high PISA groups. Simultaneously a group of 67 periodontally healthy individuals （PH） was recruited. Periodontal examinations, including full-mouth assessment of probing depths （PPD）, bleeding on probing, clinical attachment level and plaque scores were determined. Blood analyses were carried out for glycated hemoglobin （HbA1c）, fasting plasma glucose （FPG）, 2 h post parandial glucose （PPG）. Individuals in PH group had significantly better glycemic control than CP group. Upon one-way analysis of variance, subjects with increased PISA had significantly higher HbA1c levels, retinopathy and nephropathy （P 〈 0.05）. After controlling for age, gender, body mass index （BMI）, socioeconomic status （SES）, family history of diabetes and periodontitis, duration of diabetes, the mean PISA in mm^2, PPD 4-6 mm （%） and PPD ≥7 mm （%） emerged as significant predictors for elevated HbAlc in regression model （P 〈 0.05）. Logistic regression analysis revealed that PISA was associated with higher risk of having retinopathy and neuropathy （odds ratio）. In our study, the association between glycemic control and diabetic complications with periodontitis was observed.
文摘Introduction: One of the biological markers for monitoring glycaemic control in diabetic patients is glycated protein. The definition of a reference method to improve the accuracy of measurement tools is necessary. The aim of our study was to assess the glycemic control of diabetic patients based on glycated hemoglobin. Patients and Method: This is a descriptive cross-sectional study conducted in April 2021 at the national university hospital center (CNHU-HKM) of Cotonou. All patients who consulted during the period and who gave their consent were included. After collecting the blood samples according to the classical standards of the pre-analytical phase, we measured the blood glucose level and the HbA1c. Results: The mean blood glucose level of the patients was 1.52 ± 0.16 g/L with extremes of 0.80 g/L and 3.5 g/L. The mean HbA1c proportion was 8.39% ± 0.60% with a minimum and maximum value of 5.40% and 16% respectively. We also noted that the mean body mass index (BMI) of the patients was 28.61 ± 1.46 Kg/m<sup>2</sup> with extremes of 17.50 Kg/m<sup>2</sup> and 46.02 Kg/m<sup>2</sup>. Oral anti diabetic and hygienic-dietary measures were used by 44 patients (80%) and hygienic-dietary measures (HDM) only used by 9.09%. A frequency of 87.53% of patients had at least one degenerative complication. Retinopathy was the most observed degenerative disease (36.36%) followed by cardiovascular disease (25.45%). Conclusion: This study showed that there is a poor correlation between fasting blood glucose and glycated haemoglobin levels, which could be due to several biological and clinical reasons. It also showed that despite the respect of hygienic dietary measures and a well conducted treatment, it is difficult to obtain a satisfactory glycemic balance in obese patients.
文摘BACKGROUND Gestational diabetes mellitus(GDM)is characterized by glucose intolerance that is first diagnosed during pregnancy,making it the most common complication associated with this period.Early detection and targeted treatment of GDM can minimize foetal exposure to maternal hyperglycaemia and subsequently reduce the associated adverse pregnancy outcomes.Previous studies have inconsistently suggested that the level of glycated albumin(GA)might predict GDM.AIM To review and synthesize existing evidence to evaluate the relationship between GA levels and the development of GDM.METHODS We sought to compare GA levels between GDM and control groups in this metaanalysis by systematically searching the Web of Science,PubMed,Cochrane Library,and Embase databases for articles published up to June 2023.The analysis utilized the weighted mean difference(WMD)as the primary metric.The data were meticulously extracted,and the quality of the included studies was assessed.Additionally,we conducted a subgroup analysis based on study region and sample size.We assessed heterogeneity using I2 statistics and evaluated publication bias through funnel plots.Additionally,trim-and-fill analysis was employed to detect and address any potential publication bias.RESULTS The meta-analysis included a total of 11 studies involving 5477 participants,comprising 1900 patients with GDM and 3577 control individuals.The synthesized results revealed a notable correlation between elevated GA levels and increased susceptibility to GDM.The calculated WMD was 0.42,with a 95%confidence interval(95%CI)ranging from 0.11 to 0.74,yielding a P value less than 0.001.Concerning specific GA levels,the mean GA level in the GDM group was 12.6,while for the control group,it was lower,at 11.6.This discrepancy underscores the potential of GA as a biomarker for assessing GDM risk.Moreover,we explored the levels of glycated haemoglobin(HbA1c)in both cohorts.The WMD for HbA1c was 0.19,with a 95%CI ranging from 0.15 to 0.22 and a P value less than 0.001.This observatio
基金Project of People’s Hospital of Guandu District,Kunming,Yunnan Province“Study on the Correlation Between Glycated Albumin and the Nutritional Status of Diabetic Dialysis Patients”(Project No.2022-03-05-012)。
文摘Objective:To explore the clinical application of nutritional management combined with clinical monitoring of glycated albumin(GA)in diabetic nephropathy(DN)dialysis patients.Methods:A total of 20 diabetic nephropathy dialysis patients admitted to the People’s Hospital of Guandu District from January 2022 to February 2023 were included in the study.They were randomly divided into a conventional group(n=10)and an observation group(n=10).The study evaluated the blood glucose control,nutritional status,dialysis efficacy,and quality of life scores of both groups.Results:Before the intervention,there were no significant differences in fasting plasma glucose(FPG),GA,serum albumin,body mass index(BMI),dialysis efficiency values,urea clearance rate,or quality-of-life scores between the two groups(P>0.05).After the intervention,the observation group showed significantly lower FPG and GA levels,higher serum albumin,dialysis efficiency values,urea clearance rate,and improved quality-of-life scores compared to the conventional group(P<0.05),with no difference in BMI(P>0.05).Conclusion:Nutritional management combined with clinical monitoring of glycated albumin has a significant effect on the clinical application of diabetic nephropathy dialysis patients.It can effectively improve patients’blood glucose control and nutritional status,reduce the risk of complications,and enhance the quality of life,demonstrating clinical value for broader application.
基金Supported by National Key R&D Program of China,No.2016YFC1305700.
文摘BACKGROUND Glycated hemoglobin A1c(HbA1c)is considered the most suitable for diabetes mellitus diagnosis due to its accuracy and convenience.However,the effect of HbA1c on diabetic retinopathy(DR)in the Han and Korean populations in Jilin,China,remains inconclusive.AIM To determine the best cut-off of HbA1c for diagnosing DR among the Chinese.METHODS This cross-sectional study included 1933 participants from the Yanbian area of Jilin Province,China.Trained investigators employed a questionnaire-based survey,physical examination,laboratory tests,and fundus photography for the investigation.The best cut-off value for HbA1c was established via the receiver operating characteristic curve.The factors associated with HbA1c-associated risk factors were determined via linear regression.RESULTS The analysis included 887 eligible Chinese Han and Korean participants,591 of whom were assigned randomly to the training set and 296 to the validation set.The prevalence of DR was 3.27% in the total population.HbA1c of 6.2% was the best cut-off value in the training set,while it was 5.9% in the validation set.In both Chinese Han and Korean populations,an HbA1c level of 6.2% was the best cut-off value.The optimal cut-off values of fasting blood glucose(FBG)≥7 mmol/L and<7 mmol/L were 8.1% and 6.2% respectively in Han populations,while those in Korean populations were 6.9%and 5.3%,respectively.Age,body mass index,and FBG were determined as the risk factors impacting HbA1c levels.CONCLUSION HbA1c may serve as a useful diagnostic indicator for DR.An HbA1c level of 6.2% may be an appropriate cut-off value for DR detection in the Chinese population.
文摘BACKGROUND Islets of Langerhans beta cells diminish in autoimmune type 1 diabetes mellitus(T1DM).Teplizumab,a humanized anti-CD3 monoclonal antibody,may help T1DM.Its long-term implications on clinical T1DM development,safety,and efficacy are unknown.AIM To assess the effectiveness and safety of teplizumab as a therapeutic intervention for individuals with T1DM.METHODS A systematic search was conducted using four electronic databases(PubMed,Embase,Scopus,and Cochrane Library)to select publications published in peerreviewed journals written in English.The odds ratio(OR)and risk ratio(RR)were calculated,along with their 95%CI.We assessed heterogeneity using Cochrane Q and I2 statistics and the appropriate P value.RESULTS There were 8 randomized controlled trials(RCTs)in the current meta-analysis with a total of 1908 T1DM patients from diverse age cohorts,with 1361 patients receiving Teplizumab and 547 patients receiving a placebo.Teplizumab was found to have a substantial link with a decrease in insulin consumption,with an OR of 4.13(95%CI:1.72 to 9.90).Teplizumab is associated with an improved Cpeptide response(OR 2.49;95%CI:1.62 to 3.81)and a significant change in Glycated haemoglobin A1c(HbA1c)levels in people with type 1 diabetes[OR 1.75(95%CI:1.03 to 2.98)],and it has a RR of 0.71(95%CI:0.53 to 0.95).CONCLUSION In type 1 diabetics,teplizumab decreased insulin consumption,improved C-peptide response,and significantly changed HbA1c levels with negligible side effects.Teplizumab appears to improve glycaemic control and diabetes management with good safety and efficacy.
基金Clinical Research Plan of SHDC(No.SHDC2020CR4006)Shanghai Ninth People’s Hospital(No.YBKB202218)+1 种基金Shanghai Municipal Human Resources and Social Security Bureau(No.2020074)National Natural Science Foundation of China(No.82170870)
文摘Background:The serum vitamin D level varies widely by population,and studies have linked vitamin D levels with the risk of type 2 diabetes mellitus(T2DM).However,the relationship is inconsistent and the impact of vitamin D on T2DM among East Chinese adults is unclear.The study aimed to investigate the association between serum 25-hydroxyvitamin D(25[OH]D)levels and the risk of T2DM and evaluated whether the association is modified by genetic predisposition.Methods:In the Survey on Prevalence in East China for Metabolic Diseases and Risk Factors(SPECT-China)cohort,1862 participants free of T2DM at baseline were included.A weighted genetic risk score was calculated with 28 variants associated with T2DM.Hierarchical logistic models were used to examine the association of serum 25(OH)D and genetic risk with T2DM.Results:After a 5-year follow-up,132 cases of T2DM were documented.We observed no significant association between quartiles of serum 25(OH)D and T2DM risk after multivariable adjustment(χ^(2)=0.571,P_(for trend)=0.426).Compared to those in the lowest quartile of 25(OH)D,the odds ratios(ORs)(95%confidence interval[CI])for participants with increased quartiles were 1.29(0.74-2.25),1.35(0.77-2.36),and 1.27(0.72-2.24),respectively.We observed a positive association of glycated hemoglobin(HbA1c)with 25(OH)D at baseline(β=1.752,P=0.001)and after follow-up(β=1.385,P=0.003),and a negative association of ln conversion homeostasis model assessment(HOMA)-βwith 25(OH)D at baseline(β=-0.982,P=0.021).There was no significant interaction between 25(OH)D and diabetes genetic predisposition on the risk of T2DM(χ^(2)=2.710,P_(for interaction)=0.100).The lowest OR(95%CI)of T2DM was among participants with low genetic risk and the highest quartile of 25(OH)D(0.17[0.05-0.62]).Conclusion:Serum 25(OH)D may be irrelevant to the risk of incident T2DM among East Chinese adults regardless of genetic predisposition.
