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Shah VN, Kanapka LG, Karakus KE, Kollman C, Beck RW. The Association of High and Low Glycation With Incident Diabetic Retinopathy in Adults With Type 1 Diabetes. J Diabetes Sci Technol 2024:19322968241254811. [PMID: 38805364 DOI: 10.1177/19322968241254811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
BACKGROUND We investigated the risk of incident diabetic retinopathy (DR) among high glycator compared to low glycator patients based on the hemoglobin glycation index (HGI). Visit-to-visit variations in HGI also were assessed. METHODS Glycated hemoglobin (HbA1c) and continuous glucose monitoring data were collected up to 7 years prior to the date of eye examination defining incident DR or no retinopathy (control). Hemoglobin glycation index was calculated as difference in measured HbA1c and an estimated A1c from sensor glucose (eA1c) to define high (HbA1c - eA1c >0%) or low (HbA1c - eA1c <0%) glycator. Stable glycators were defined as ≥75% of visits with same HGI category. Logistic regression was used to assess the association between glycation category and incident DR. RESULTS Of 119 adults with type 1 diabetes (T1D), 49 (41%) were stable low glycator (HbA1c - eA1c <0%), 36 (30%) were stable high glycator (HbA1c - eA1c >0%), and 34 (29%) were unstable glycator. Using alternate criteria to define high vs low glycator (consistent difference in HbA1c - eA1c of > 0.4% or <0.4%, respectively), 53% of the adults were characterized as unstable glycator. Compared to low glycators, high glycators did not have a significantly higher risk for incident DR over time when adjusted for age, T1D duration and continuous glucose monitoring (CGM) sensor type (odds ratio [OR] = 1.31, 95% confidence interval [CI] = 0.48-3.62, P = .15). CONCLUSIONS The risk of diabetic retinopathy was not found to differ significantly comparing high glycators to low glycators in adults with T1D. Moreover, HbA1c - eA1c relationship was not stable in nearly 30% to 50% adults with T1D, suggesting that discordance in HbA1c and eA1c are mostly related either HbA1c measurements or estimation of A1c from sensor glucose rather than physiological reasons.
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Affiliation(s)
- Viral N Shah
- Division of Endocrinology & Metabolism and Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Kagan Ege Karakus
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Roy W Beck
- Jaeb Center for Health Research, Tampa, FL, USA
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Ho JPY, Lau ESH, Kwan O C, Fan B, Ko GTC, Kong APS, Ma RCW, Chow EYK, Chan JCN, Luk AOY. One-hour post-load plasma glucose level predicts future type 2 diabetes in a community-based study of Hong Kong Chinese workforce. Diabetes Res Clin Pract 2024; 212:111718. [PMID: 38796080 DOI: 10.1016/j.diabres.2024.111718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/08/2024] [Accepted: 05/19/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND We compared performance of high 1-hour PG level, impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) in predicting type 2 diabetes in a longitudinal community-based cohort of Hong Kong Chinese. METHODS Between 2001 and 2003, 472 adults aged 18-55 years without diabetes underwent 75-gram oral glucose tolerance test (OGTT). Between 2012 and 2014, progression to diabetes was ascertained by reviewing medical records or repeating OGTT and HbA1c. We defined high 1-hour PG as PG ≥ 8.6 mmol/L at 1-hour. RESULTS In this cohort, 23.5% had normal glucose tolerance and high 1-hour PG, 10.0% had isolated IGT, 4.2% had isolated IFG. Over 12-year follow-up, 9.3% developed type 2 diabetes. In logistic regression, high 1-hour PG was associated with progression to type 2 diabetes with adjusted odds ratio (95% CI) of 4.20 (1.60, 12.40), independent of IFG, IGT and other clinical variables. Areas under ROC (95% CI) for type 2 diabetes were similar between 1-hour (0.84 [0.78, 0.89], 2-hour (0.79 [0.72, 0.86]) and fasting PG (0.79 [0.71, 0.86]). CONCLUSION High 1-hour PG identified young Chinese with 5-fold increased risk of type 2 diabetes independent of other intermediate hyperglycaemia status and clinical factors. 1-hour PG is similar to fasting and 2-hour PG in predicting type 2 diabetes.
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Affiliation(s)
- Jane Pui-Ying Ho
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Eric Siu-Him Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Chun Kwan O
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Baoqi Fan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Gary Tin-Choi Ko
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Alice Pik-Shan Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Ronald Ching-Wan Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Elaine Yee-Kwan Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Juliana Chung-Ngor Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Andrea On-Yan Luk
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
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Low CG, Merchant M, Hung YY, Liu YH, Vu J, Pursnani S. Assessing Glycosylated Hemoglobin Thresholds for Development of Cardiovascular Disease by Racial and Ethnic Groups. J Am Heart Assoc 2024; 13:e033559. [PMID: 38761085 DOI: 10.1161/jaha.123.033559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/15/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Diabetes is the strongest risk factor for cardiovascular disease, and although glycosylated hemoglobin (HbA1c) levels are known to vary by race, no racial and ethnic-specific diagnostic thresholds exist for diabetes in prediction of cardiovascular disease events. The purpose of this study is to determine whether HbA1c thresholds for predicting major adverse cardiovascular events (MACEs) differ among racial and ethnic groups. METHODS AND RESULTS This is a retrospective cohort study of Kaiser Permanente Northern California adult members (n=309 636) with no history of cardiovascular disease who had HbA1c values and race and ethnicity data available between 2014 and 2019. Multivariable logistic regression was used to evaluate the odds of MACEs by the following racial and ethnic groups: Filipino, South Asian, East Asian, Black, White, and Hispanic. A Youden index was used to calculate HbA1c thresholds for MACE prediction by each racial and ethnic group, stratified by sex. Among studied racial and ethnic groups, South Asian race was associated with the greatest odds of MACEs (1.641 [95% CI, 1.456-1.843]; P<0.0001). HbA1c was a positive predictor for MACEs, with an odds ratio of 1.024 (95% CI, 1.022-1.025) for each 0.1% increment increase in HbA1c. HbA1c values varied between 6.0% and 7.6% in MACE prediction by race and ethnicity and sex. White individuals, South Asian individuals, East Asian women, and Black men had HbA1c thresholds for MACE prediction in the prediabetic range, between 6.0% and 6.2%. Black women, Hispanic men, and East Asian men had HbA1c thresholds of 6.2% to 6.6%, less than the typical threshold of 7.0% that is used as a treatment goal. CONCLUSIONS Findings suggest that the use of race and ethnic- and sex-specific HbA1c thresholds may need to be considered in treatment goals and cardiovascular disease risk estimation.
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Affiliation(s)
| | | | - Yun-Yi Hung
- Kaiser Permanente Division of Research Oakland CA
| | - Yu Hsin Liu
- Kaiser Permanente Medical Center Santa Clara CA
| | - Joseph Vu
- Kaiser Permanente Medical Center Santa Clara CA
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Bvumbi CW, Kouamou V, Kone N, Zaranyika T, Bowora L, Matarira HT, Chikwati RP. Diagnostic cut-off value of haemoglobin A1c for diabetes mellitus in Harare, Zimbabwe. Afr J Lab Med 2024; 13:2373. [PMID: 38725708 PMCID: PMC11079329 DOI: 10.4102/ajlm.v13i1.2373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/20/2024] [Indexed: 05/12/2024] Open
Abstract
Very little is known about the diagnostic performance of the American Diabetes Association glycated haemoglobin (HbA1c) cut-off of 6.5% in resource-limited settings. This study, conducted between February 2023 and May 2023, aimed to determine the optimal HbA1c cut-off for the diagnosis of diabetes mellitus by measuring HbA1c and fasting plasma glucose levels in 120 adults attending care at a tertiary hospital in Harare, Zimbabwe. The optimal HbA1c cut-off was 6.1% and glucose levels were strongly correlated with HbA1c values. The prevalence of diabetes mellitus was higher (28.3%) at our derived HbA1c cut-off than with the American Diabetes Association criterion (21.6%). What this study adds This study highlights the need for population-specific cut-off HbA1c values in the diagnosis of diabetes mellitus.
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Affiliation(s)
- Chido W Bvumbi
- Department of Laboratory Diagnostic and Investigative Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Vinie Kouamou
- Department of Primary Care and Health Sciences, Internal Medicine Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Ngalulawa Kone
- Department of Chemical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Chemical Pathology, National Health Laboratory Service, Johannesburg, South Africa
| | - Trust Zaranyika
- Department of Primary Care and Health Sciences, Internal Medicine Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Lloyd Bowora
- Department of Laboratory Diagnostic and Investigative Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Hilda T Matarira
- Department of Laboratory Diagnostic and Investigative Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Raylton P Chikwati
- Department of Chemical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Devineni D, Akbarpour M, Gong Y, Wong ND. Inadequate Use of Newer Treatments and Glycemic Control by Cardiovascular Risk and Sociodemographic Groups in US Adults with Diabetes in the NIH Precision Medicine Initiative All of Us Research Program. Cardiovasc Drugs Ther 2024; 38:347-357. [PMID: 36378394 PMCID: PMC10959811 DOI: 10.1007/s10557-022-07403-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE Data are limited on sodium glucose co-transport 2 inhibitors (SGLT2-is) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) among real-world cohorts of underrepresented patients. We examined these therapies and glycemic control in US adults with diabetes mellitus (DM) by atherosclerotic cardiovascular disease (ASCVD) risk and sociodemographic factors. METHODS In the NIH Precision Medicine Initiative All of Us Research Program, we categorized DM as (1) moderate risk, (2) high risk, and (3) with ASCVD. We examined proportions on DM therapies, including SGLT2-i or GLP-1 RA, and at glycemic control by sociodemographic factors and CVD risk groups. RESULTS Our 81,332 adults aged ≥ 18 years with DM across 340 US sites included 22.3% non-Hispanic Black, 17.2% Hispanic, and 1.8% Asian participants; 31.1%, 30.3%, and 38.6% were at moderate risk, high risk, or with ASCVD, respectively. Those with DM and ASCVD were most likely on SGLT2-i (8.6%) or GLP-1 RA (11.9%). SGLT2-i use was < 10% in those with heart failure or chronic kidney disease. The odds (95% CI) of SGLT2-i use were greater among men (1.35 [1.20, 1.53]) and Asian persons (2.31 [1.78, 2.96]), with GLP-1 RA being less common (0.78 [0.70, 0.86]) in men. GLP-1 RA use was greater among those with health insurance, and both GLP-1 RA and SGLT2-i greater within lower income groups. 72.0% of participants had HbA1c < 7%; Hispanic persons were least likely at glycemic control. CONCLUSIONS Treatment with SGLT2-is and GLP-1 RAs remains low, even among higher ASCVD risk persons with DM and use is even lower among underserved groups.
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Affiliation(s)
- Divya Devineni
- Heart Disease Prevention Program, Division of Cardiology, C240 Medical Sciences, University of California Irvine, Irvine, CA, 92697, USA
| | - Meleeka Akbarpour
- Heart Disease Prevention Program, Division of Cardiology, C240 Medical Sciences, University of California Irvine, Irvine, CA, 92697, USA
| | - Yufan Gong
- Department of Epidemiology, University of California, Los Angeles, USA
| | - Nathan D Wong
- Heart Disease Prevention Program, Division of Cardiology, C240 Medical Sciences, University of California Irvine, Irvine, CA, 92697, USA.
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Chan JC, O CK, Luk AO. Young-Onset Diabetes in East Asians: From Epidemiology to Precision Medicine. Endocrinol Metab (Seoul) 2024; 39:239-254. [PMID: 38626908 PMCID: PMC11066447 DOI: 10.3803/enm.2024.1968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 03/13/2024] [Accepted: 03/20/2024] [Indexed: 05/03/2024] Open
Abstract
Precision diagnosis is the keystone of clinical medicine. In East Asians, classical type 1 diabetes is uncommon in patients with youngonset diabetes diagnosed before age of 40, in whom a family history, obesity, and beta-cell and kidney dysfunction are key features. Young-onset diabetes affects one in five Asian adults with diabetes in clinic settings; however, it is often misclassified, resulting in delayed or non-targeted treatment. Complex aetiologies, long disease duration, aggressive clinical course, and a lack of evidence-based guidelines have contributed to variable care standards and premature death in these young patients. The high burden of comorbidities, notably mental illness, highlights the numerous knowledge gaps related to this silent killer. The majority of adult patients with youngonset diabetes are managed as part of a heterogeneous population of patients with various ages of diagnosis. A multidisciplinary care team led by physicians with special interest in young-onset diabetes will help improve the precision of diagnosis and address their physical, mental, and behavioral health. To this end, payors, planners, and providers need to align and re-design the practice environment to gather data systematically during routine practice to elucidate the multicausality of young-onset diabetes, treat to multiple targets, and improve outcomes in these vulnerable individuals.
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Affiliation(s)
- Juliana C.N. Chan
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity and Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | - Chun-Kwan O
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity and Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | - Andrea O.Y. Luk
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity and Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
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Vishnyakova O, Song X, Rockwood K, Elliott LT, Brooks-Wilson A. Physiological phenotypes have optimal values relevant to healthy aging: sweet spots deduced from the Canadian Longitudinal Study on Aging. GeroScience 2024; 46:1589-1605. [PMID: 37688655 PMCID: PMC10828371 DOI: 10.1007/s11357-023-00895-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 07/27/2023] [Indexed: 09/11/2023] Open
Abstract
Previous observations on a group of exceptionally healthy "Super-Seniors" showed a lower variance of multiple physiological measures relevant for health than did a less healthy group of the same age. The finding was interpreted as the healthier individuals having physiological measurement values closer to an optimal level, or "sweet spot." Here, we tested the generalizability of the sweet-spot hypothesis in a larger community sample, comparing differences in the variance between healthier and less healthy groups. We apply this method to the Canadian Longitudinal Study on Aging (CLSA) comprehensive cohort of 30,097 participants aged 45 to 85 years with deep phenotype data. Data from both sexes and four age ranges were analyzed. Five instruments were used to represent different aspects of health, physical, and cognitive functioning. We tested 231 phenotypic measures for lower variance in the most healthy vs. least healthy quartile of each sex and age group, as classified by the five instruments. Segmented regression was used to determine sex-specific optimal values. One hundred forty-two physiological measures (61%) showed lower variance in the healthiest than in the least healthy group, in at least one sex and age group. The difference in variance was most significant for hemoglobin A1c and was also significant for many body composition measurements, but not for bone mineral density. Ninety-four phenotypes showed a nonmonotonic relationship with health, consistent with the idea of a sweet spot; for these, we determined optimal values and 95% confidence intervals that were generally narrower than the ranges of current clinical reference intervals. These findings for sweet spot discovery validate the proposed approach for identifying traits important for healthy aging.
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Affiliation(s)
- Olga Vishnyakova
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
- Department of Statistics & Actuarial Science, Simon Fraser University, Room SC K10545, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Xiaowei Song
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
- Surrey Memorial Hospital, Fraser Health Authority, Surrey, BC, Canada
| | - Kenneth Rockwood
- Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | - Lloyd T Elliott
- Department of Statistics & Actuarial Science, Simon Fraser University, Room SC K10545, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
| | - Angela Brooks-Wilson
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada.
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada.
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Klonoff DC, Aaron RE, Tian T, DuNova AY, Pandey A, Rhee C, Fleming GA, Sacks DB, Pop-Busui R, Kerr D. Advanced Glycation Endproducts: A Marker of Long-term Exposure to Glycemia. J Diabetes Sci Technol 2024:19322968241240436. [PMID: 38525944 DOI: 10.1177/19322968241240436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
This article examines the importance of advanced glycation endproducts (AGEs) and summarizes the structure of AGEs, pathological changes associated with AGEs, the contribution of AGEs to metabolic memory, and the value of AGEs as a predictor of diabetic complications and cardiovascular disease in people with and without diabetes. As a practical focus, skin autofluorescence (SAF) is examined as an attractive approach for estimating AGE burden. The measurement of AGEs may be of significant value to specific individuals and groups, including Black and Hispanic/Latino Americans, as they appear to have higher concentrations of hemoglobin A1c (HbA1c) than would be predicted by other metrics of mean glycemia. We hypothesize that if the amount of glycation of HbA1c is greater than expected from measured glucose levels, and if AGEs are accumulating, then this accumulation of AGEs might account for the increased rate of complications of diabetes in populations with high rates of vascular disease and other complications. Thus, identifying and modifying the burden of AGEs based on measurement of AGEs by SAF may turn out to be a worthwhile metric to determine individuals who are at high risk for the complications of diabetes as well as others without diabetes at risk of vascular disease. We conclude that available evidence supports SAF as both a clinical measurement and as a means of evaluating interventions aimed at reducing the risks of vascular disease and diabetic complications.
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Affiliation(s)
- David C Klonoff
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA
| | | | - Tiffany Tian
- Diabetes Technology Society, Burlingame, CA, USA
| | | | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Connie Rhee
- VA Greater Los Angeles Healthcare System, UCLA, Los Angeles, CA, USA
| | | | | | | | - David Kerr
- Sutter Health Center for Health Systems Research, Santa Barbara, CA, USA
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Bovee LB, Hirsch IB. Should We Bury HbA1c? Diabetes Technol Ther 2024. [PMID: 38350127 DOI: 10.1089/dia.2024.0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Affiliation(s)
- Laura B Bovee
- University of Washington Medicine Diabetes Institute, Seattle, Washington, USA
| | - Irl B Hirsch
- University of Washington Medicine Diabetes Institute, Seattle, Washington, USA
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Aponte J, Figueroa K, Brennan NB, Diaz L, Samuels WE. Health and Racial Disparities: Importance of Accurate and Reliable Ethnicity, Race, and Language Data. HISPANIC HEALTH CARE INTERNATIONAL 2024:15404153241229687. [PMID: 38334042 DOI: 10.1177/15404153241229687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Introduction: Accurate demographic data are essential to identify and monitor differences, trends, and changes in diabetes-related conditions between Hispanics and non-Hispanic Blacks (NHBs). It also provides pertinent information to reduce health and racial disparities among English- and Spanish-speakers. Method: The study's design was a quantitative cross-sectional one. Electronic medical record (EMR) and survey data of the same sample were compared. Descriptive statistics were computed for ethnicity, preferred language, and physiological data. Frequency and percentages were calculated for each continuous and categorical variable. Chi-square was calculated to compare physiological variables by ethnicity and language. Results: During a 5-month period (September 2021-February 2022), 106 individuals from New York City with diabetes took part in this study. Among Hispanics, most from the EMR identified as Other (82.4%), whereas from the survey, most identified as White (57.1%). More Hispanics (19%) and Spanish speakers (18%) had high triglyceride levels compared to NHBs (2%) and English speakers (3%). Conclusion: Ensuring that demographic data are accurate can better inform programs. Because Hispanics and Spanish speakers had the highest triglyceride levels, diabetes programs need to include information on cardiovascular disease and must be available in Spanish, to further reduce risk factors, improve health outcomes, and promote health equity among these populations.
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Affiliation(s)
- Judith Aponte
- Hunter College School of Nursing, Hunter College, New York, NY, USA
- CUNY Institute of Health Equity, Bronx, New York, NY, USA
| | | | - Noreen B Brennan
- James J. Peters Veterans Administration Medical Center, New York, NY, USA
| | - Lillian Diaz
- New York City/Health + Hospitals/Lincoln Medical Center, Bronx, New York, NY, USA
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Kgosidialwa O, Newman C, Carmody L, McGrath B, O’Shea PM, Dunne F. Abnormal Glucose Tolerance in Women Diagnosed With Gestational Diabetes (WHO 2013) 10 Years After Index Pregnancy. J Endocr Soc 2024; 8:bvae013. [PMID: 38328480 PMCID: PMC10849116 DOI: 10.1210/jendso/bvae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Indexed: 02/09/2024] Open
Abstract
Context It is not clear if the risk of abnormal glucose tolerance (AGT) is attenuated in the long-term in women diagnosed with gestational diabetes (GDM) using the World Health Organization (WHO) 2013 criteria and who have received appropriate treatment during pregnancy. Objective We aimed to assess the long-term prevalence of AGT and other cardiovascular disease (CVD) risk factors in this cohort. Methods A retrospective cohort follow-up study was conducted of 37 and 107 women diagnosed with and without GDM respectively using the WHO 2013 criteria between June 2010 and December 2010. Women were invited to attend our center, where they underwent a 75-g oral glucose tolerance test, blood and urine collection, body measurements, and electrocardiography. Main outcome measure included the development of AGT using the American Diabetes Association criteria. Results Sixteen (43.2%) women with GDM compared to 5 (4.7%) women with normal glucose tolerance (NGT) at index pregnancy had AGT (P < .001). In the GDM group, 10 (27.0%), 7 (18.9%), and 4 (10.8%) women had impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and type 2 diabetes mellitus (T2DM), respectively. In the NGT group, 2 (1.9%), 3 (2.8%), and 1 (0.9%) woman had IFG, IGT, and T2DM, respectively. Women with AGT also had an unfavorable metabolic profile including obesity, hypertension, insulin resistance, and dyslipidemia. Conclusion Women treated for GDM (WHO 2013 criteria) remain at increased risk for developing AGT and adverse CVD risk factors as early as a decade after diagnosis. Continued efforts are needed to accurately follow this population to address modifiable risk factors.
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Affiliation(s)
- Oratile Kgosidialwa
- College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, H91TK33, Ireland
| | - Christine Newman
- College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, H91TK33, Ireland
| | - Louise Carmody
- College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, H91TK33, Ireland
| | - Brian McGrath
- College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, H91TK33, Ireland
| | - Paula M O’Shea
- College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, H91TK33, Ireland
| | - Fidelma Dunne
- College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, H91TK33, Ireland
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Marambire ET, Chingono RMS, Calderwood CJ, Larsson L, Sibanda S, Kavenga F, Nzvere FP, Olaru ID, Simms V, McHugh G, Bandason T, Redzo N, Gregson CL, Maunganidze AJV, Pasi C, Chiwanga M, Chonzi P, Ndhlovu CE, Mujuru H, Rusakaniko S, Ferrand RA, Kranzer K. Evaluation of a comprehensive health check offered to frontline health workers in Zimbabwe. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002328. [PMID: 38190397 PMCID: PMC10773946 DOI: 10.1371/journal.pgph.0002328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/05/2023] [Indexed: 01/10/2024]
Abstract
Health workers are essential for a functioning healthcare system, and their own health is often not addressed. During the COVID-19 pandemic health workers were at high risk of SARS-CoV-2 infection whilst coping with increased healthcare demand. Here we report the development, implementation, and uptake of an integrated health check combining SARS-CoV-2 testing with screening for other communicable and non-communicable diseases for health workers in Zimbabwe during the COVID-19 pandemic. Health checks were offered to health workers in public and private health facilities from July 2020 to June 2022. Data on the number of health workers accessing the service and yield of screening was collected. Workshops and in-depth interviews were conducted to explore the perceptions and experiences of clients and service providers. 6598 health workers across 48 health facilities accessed the service. Among those reached, 5215 (79%) were women, the median age was 37 (IQR: 29-44) years and the largest proportion were nurses (n = 2092, 32%). 149 (2.3%) healthcare workers tested positive for SARS-CoV-2. Uptake of screening services was almost 100% for all screened conditions except HIV. The most common conditions detected through screening were elevated blood pressure (n = 1249; 19%), elevated HbA1c (n = 428; 7.7%) and common mental disorder (n = 645; 9.8%). Process evaluation showed high acceptability of the service. Key enablers for health workers accessing the service included free and comprehensive service provision, and availability of reliable point-of-care screening methods. Implementation of a comprehensive health check for health workers was feasible, acceptable, and effective, even during a pandemic. Conventional occupational health programmes focus on infectious diseases. In a society where even health workers cannot afford health care, free comprehensive occupational health services may address unmet needs in prevention, diagnosis, and treatment for chronic non-communicable conditions.
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Affiliation(s)
- Edson T. Marambire
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- CIH Center for International Health, University Hospital, LMU Munich, Munich, Germany
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Munich, Germany
| | - Rudo M. S. Chingono
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Claire J. Calderwood
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Leyla Larsson
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Munich, Germany
| | - Sibusisiwe Sibanda
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Fungai Kavenga
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- National TB Programme, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Farirai P. Nzvere
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ioana D. Olaru
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Victoria Simms
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Grace McHugh
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Tsitsi Bandason
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Nicol Redzo
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Celia L. Gregson
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- Global Health and Ageing, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | | | | | | | | | - Chiratidzo E. Ndhlovu
- Internal Medicine Unit, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Hilda Mujuru
- Department of Paediatrics and Child Health, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Simbarashe Rusakaniko
- Department of Community Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Rashida A. Ferrand
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Katharina Kranzer
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Munich, Germany
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
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13
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Snoswell CL, Vitangcol KJ, Haydon HM, Gray LC, Leedie F, Smith AC, Caffery LJ. Cost-effectiveness of remote patient monitoring for First Nations peoples living with diabetes in regional Australia. J Telemed Telecare 2023; 29:3S-7S. [PMID: 38007695 DOI: 10.1177/1357633x231214019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Abstract
The aim of this study was to determine the cost-effectiveness of remote patient monitoring (RPM) with First Nations peoples living with diabetes. This study was set at the Goondir Health Service (GHS), an Aboriginal and Torres Strait Islander Community-Controlled Health in South-West Queensland. Electronic medical records and RPM data were provided by the GHS. Clinical effectiveness was determined by comparing mean HbA1c before and after enrolment in the RPM service. Our analysis found no statistically significant effect between the mean HbA1c before and after enrolment, so this analysis focused on net-benefit and return on investment for costs from the perspective of the GHS. The 6-month RPM service for 84 clients cost AUD $67,841 to cover RPM equipment, ongoing technology costs, and a dedicated Virtual Care Manager, equating to $808 per client. There were 199 additional client-clinician interactions in the period after enrolment resulting in an additional $4797 revenue for the GHS. Therefore, the program cost the GHS $63,044 to deliver, representing a return on investment of around 7 cents for every dollar they spent. Whilst the diabetes RPM service was equally effective as usual care and resulted in increased interactions with clients, the cost for the service was substantially more than the additional revenue generated from increased interactions. This evidence highlights the need for alternative funding models for RPM services and demonstrates the need to focus future research on long-term clinical effects and the extra-clinical benefits resulting from services of this type.
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Affiliation(s)
- Centaine L Snoswell
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Kathryn J Vitangcol
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Helen M Haydon
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Leonard C Gray
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | | | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Centre for Innovative Medical Technology, University of Southern Denmark, Odense, Denmark
| | - Liam J Caffery
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
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Anson M, Zhao SS, Essa H, Austin P, Ibarburu GH, Lip GYH, Alam U. Metformin and SGLT2i as First-line Combination Therapy in Type 2 Diabetes: A Real-world Study With a Focus on Ethnicity. Clin Ther 2023; 45:1259-1265. [PMID: 37648574 DOI: 10.1016/j.clinthera.2023.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/31/2023] [Accepted: 07/31/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE Suboptimal glucose control early in the diagnosis of type 2 diabetes (T2D) is strongly associated with subsequent morbidity and mortality, termed the 'glycaemic legacy'. Additionally, it is known that Asian and Black individuals are at increased risk of T2D, and its associated complications compared to their White counterparts. However, ethnicity does not currently feature in the treatment algorithm of T2D, unlike in other cardiovascular disease states such as hypertension. We therefore sought to evaluate the real-world impact of early intensive treatment with combination therapy on cardiorenal outcomes compared to standard treatment in T2D, with a focus on ethnicity. METHODS We performed a retrospective cohort study of all patients aged 18 or over with T2D using the TriNetX platform. TriNetX is a global collaborative network providing access to real time, anonymised medical records. We included patients who were initiated with Metformin and an SGLT2i within one month of diagnosis of T2D and compared this cohort with individuals who received Metformin only for a period of at least 1 year. We evaluated cardiovascular and renal outcomes at three years and stratified by ethnicity. We excluded individuals with a personal history of an outcome of interest. FINDINGS We identified 49,651 individuals with T2D who were treated with Metformin and an SGLT2i and 1,028,806 patients with T2D who were treated with Metformin alone. A total of 98,094 individuals were included in the core analysis. The Metformin only group had a greater risk of mortality (RR 1.44, [95% CI 1.34-1.55], P<0.0001), CKD (RR 1.10, [95% CI 1.04-1.16], P = 0.0004), diabetic nephropathy (RR 1.06, [95% CI 1.01-1.12], P = 0.0239), heart failure (RR 1.13, [95% CI 1.07-1.21], P < 0.0001) and hospitalisation (RR 1.24, [95% CI 1.21-1.27], P < 0.0001) compared to individuals treated with Metformin and SGLT2i. Black individuals had a reduced risk of mortality (RR 0.71, [95% CI 0.55-0.92], P = 0.0099) and IHD (RR 0.73, [95% CI 0.64-0.84], P < 0.0001) compared to White individuals. Asian individuals had a reduced risk of heart failure (RR 0.61, [95% CI 0.41-0.91], P = 0.0134) and hospitalisation (RR 0.76, [95% CI 0.66-0.87], P = 0.0001) compared to White individuals. IMPLICATIONS Initial combination treatment within the first year of T2D diagnosis confers favourable cardio-metabolic outcomes when compared to standard therapy, even in patients without established cardiovascular disease. Black and Asian individuals in particular demonstrate a greater degree of benefit compared to White individuals. Further prospective studies with a focus on ethnicity are now required to validate these findings.
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Affiliation(s)
- Matthew Anson
- Diabetes & Endocrinology Research and Pain Research Institute, Institute of Life Course and Medical Sciences, University of Liverpool and Liverpool University Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Sizheng Steven Zhao
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Science, School of Biological Sciences, Faculty of Biological Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Hani Essa
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | | | | | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom; Danish Centre for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Uazman Alam
- Diabetes & Endocrinology Research and Pain Research Institute, Institute of Life Course and Medical Sciences, University of Liverpool and Liverpool University Hospital NHS Foundation Trust, Liverpool, United Kingdom; Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, United Kingdom.
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15
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Ahmed SF, Hassan AA, Eltayeb MM, Omar SM, Adam I. Ethnicity, Age, and Gender Differences in Glycated Hemoglobin (HbA1c) Levels among Adults in Northern and Eastern Sudan: A Community-Based Cross-Sectional Study. Life (Basel) 2023; 13:2017. [PMID: 37895397 PMCID: PMC10608095 DOI: 10.3390/life13102017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The level of association between glycated hemoglobin (HbA1c) level and ethnicity, age, and gender is not yet settled. This study aimed to investigate the association between ethnicity, age, and gender and HbA1c level among adults who were known not to have diabetes mellitus in northern and eastern Sudan. METHODS A comparative community-based cross-sectional study was conducted. Sociodemographic and clinical characteristics data were collected. HbA1c levels were measured, and multiple linear regression analysis was performed. RESULTS A total of 898 adults (363 in northern Sudan and 535 in eastern Sudan) were included; 349 (38.9%) were males. The HbA1c level was significantly higher in eastern Sudan, and there was no significant difference in HbA1c levels between genders. In multiple linear regression, for adults with HbA1c <6.5%, ethnicity and BMI were associated with HbA1c, but age and gender were not associated with HbA1c. In northern Sudan, age was positively associated with HbA1c, and there was no association between gender, BMI, and HbA1c in adults with HbA1c <6.5%. In eastern Sudan, BMI was positively associated with HbA1c, and there was no significant association between age and gender and HbA1c level in adults with HbA1c <6.5%. CONCLUSION HbA1c levels are influenced by ethnicity and age but not by gender.
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Affiliation(s)
- Sumia F. Ahmed
- Biochemistry Department, Faculty of Medicine, Najran University, Najran 664621, Saudi Arabia; (S.F.A.); (M.M.E.)
| | - Ahmed A. Hassan
- Faculty of Medicine, University of Khartoum, Khartoum P.O. Box 102, Sudan;
| | - Majdolin M. Eltayeb
- Biochemistry Department, Faculty of Medicine, Najran University, Najran 664621, Saudi Arabia; (S.F.A.); (M.M.E.)
| | - Saeed M. Omar
- Faculty of Medicine, Gadarif University, Gadarif 32211, Sudan;
| | - Ishag Adam
- Department of Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah 56219, Saudi Arabia
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16
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Kone N, Cassim N, Maposa I, George JA. Diabetic control and compliance using glycated haemoglobin (HbA1C) testing guidelines in public healthcare facilities of Gauteng province, South Africa. PLoS One 2023; 18:e0278789. [PMID: 37585388 PMCID: PMC10431606 DOI: 10.1371/journal.pone.0278789] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 08/02/2023] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVE This study aimed at evaluating diabetic control and compliance with testing guidelines, across healthcare facilities of Gauteng Province, South Africa, as well as factors associated with time to achieve control. South Africa's estimated total unmet need for care for patients with type 2 diabetes mellitus is 80%. RESEARCH DESIGN, METHODS AND FINDINGS The data of 511 781 patients were longitudinally evaluated. Results were reported by year, age category, race, sex, facility and test types. HbA1C of ≤7% was reported as normal, >7 - ≤9% as poor control and >9% as very poor control. The chi-squared test was used to assess the association between a first-ever HbA1C status and variables listed above. The Kaplan-Meier analysis was used to assess probability of attaining control among those who started with out-of-control HbA1C. The extended Cox regression model assessed the association between time to attaining HbA1C control from date of treatment initiation and several covariates. We reported hazard ratios, 95% confidence intervals and p-values. Data is reported for 511 781 patients with 705 597 laboratory results. Poorly controlled patients constituted 51.5%, with 29.6% classified as very poor control. Most poorly controlled patients had only one test over the entire study period. Amongst those who started with poor control status and had at least two follow-up measurements, the likelihood of achieving good control was higher in males (adjusted Hazard Ratio (aHR) = 1.16; 95% CI:1.12-1.20; p<0.001) and in those attending care at hospitals (aHR = 1.99; 95% CI:1.92-2.06; p<0.001). CONCLUSION This study highlights poor adherence to guidelines for diabetes monitoring.
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Affiliation(s)
- Ngalulawa Kone
- Department of Chemical Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Service (NHLS), Johannesburg, South Africa
| | - Naseem Cassim
- National Health Laboratory Service (NHLS), Johannesburg, South Africa
- Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Innocent Maposa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Jaya Anna George
- Department of Chemical Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Service (NHLS), Johannesburg, South Africa
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Gough A, Sitch A, Ferris E, Marshall T. Within-subject variation of HbA1c: A systematic review and meta-analysis. PLoS One 2023; 18:e0289085. [PMID: 37531355 PMCID: PMC10395823 DOI: 10.1371/journal.pone.0289085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/11/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Glycosylated haemoglobin (HbA1c) measurement is used to diagnose and to guide treatment of diabetes mellitus. Within-subject variability in measured HbA1c affects its clinical utility and interpretation, but no comprehensive systematic review has described within-subject variability. METHODS A systematic review and meta-analysis was performed of within-subject variability of HbA1c. Multiple databases were searched from inception to November 2022 for follow-up studies of any design in adults or children, with repeated measures of HbA1c or glycosylated haemoglobin. Title and abstract screening was performed in duplicate, full text screening and data extraction by one reviewer and verified by a second. Risk of bias of included papers was assessed using a modified consensus-based standards for the selection of health measurement Instruments (COSMIN) tool. Intraclass correlation coefficient (ICC) results were pooled with a meta-analysis and coefficient of variation (CV) results were described by median and range. RESULTS Of 2675 studies identified, 111 met the inclusion criteria. Twenty-five studies reported variability data in healthy patients, 19 in patients with type 1 diabetes and 59 in patients with type 2 diabetes. Median within-subject coefficient of variation (CV) was 0.070 (IQR 0.034 to .09). For healthy subjects the median CV for HbA1c % was 0.017 (IQR 0.013 to 0.022), for patients with type 1 diabetes 0.084 (IQR 0.067 to 0.89) and for type 2 diabetes 0.083 (IQR 0.06 to 0.10). CV increased with mean population HbA1c. LIMITATIONS Assessment of variability was not the main aim of many of the included studies and some relevant papers may have been missed. Many included papers had few participants or few repeated measurements. CONCLUSIONS Within-subject variability of HbA1c is higher for patients with than without diabetes and increases with mean population HbA1c. This may confound observed relationships between HbA1c variability and health outcomes. Because of its importance in clinical decision-making there is a need for better estimates and understanding of factors associated with of HbA1c variability.
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Affiliation(s)
- Alex Gough
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Alice Sitch
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Erica Ferris
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Tom Marshall
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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Coetzee A, Hall DR, van de Vyver M, Conradie M. Early postpartum HbA1c after hyperglycemia first detected in pregnancy-Imperfect but not without value. PLoS One 2023; 18:e0282446. [PMID: 37289757 PMCID: PMC10249808 DOI: 10.1371/journal.pone.0282446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/11/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND South African women of childbearing age are disproportionally affected by obesity and at significant risk of Type 2 Diabetes Mellitus (T2DM). Unless pregnant, they do not readily undergo screening for T2DM. With a local focus on improved antenatal care, hyperglycemia is often first detected in pregnancy (HFDP). This may erroneously be attributed to Gestational Diabetes Mellitus (GDM) in all without considering T2DM. Glucose evaluation following pregnancy is essential for early detection and management of women with T2DM in whom persistent hyperglycemia is to be expected. Conventional testing with an oral glucose tolerance test (OGTT) is cumbersome, prompting investigation for alternate solutions. AIM To compare the diagnostic performance of HbA1c to the current gold standard OGTT in women with HFDP 4-12 weeks post-delivery. METHODS Glucose homeostasis was assessed with OGTT and HbA1c in 167 women with HFDP, 4-12 weeks after delivery. Glucose status was based on American Diabetes Association criteria. RESULTS Glucose homeostasis was assessed at 10 weeks (IQR 7-12) after delivery. Of the 167 participants, 52 (31%) had hyperglycemia, which was comprised of 34 (20%) prediabetes and 18 (11%) T2DM. Twelve women in the prediabetes subgroup had diagnostic fasting plasma glucose (FPG) and 2-hour plasma glucose (2hPG), but in two-thirds of the patients (22/34) only one time point proved diagnostic. The FPGs and the 2hPGs of six women with HbA1c-based T2DM were both within the prediabetes diagnostic range. According to the HbA1c measurements, 85% of 52 participants with gold standard OGTT defined hyperglycemia (prediabetes and T2DM) as well as 15 of 18 women with postpartum persistent T2DM were correctly classified. According to FPG, 15 women with persistent hyperglycemia would have been missed (11 with prediabetes and four with T2DM; 29%). When compared to an OGTT, a single HbA1c of 6.5% (48mmol/mol) postpartum demonstrated a sensitivity of 83% and specificity of 97% for the identification of T2DM. CONCLUSION HbA1c may improve access to postpartum testing in overburdened clinical settings where the required standards of OGTT cannot be guaranteed. HbA1c is a valuable test to detect women who will benefit most from early intervention but cannot unequivocally replace OGTT.
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Affiliation(s)
- Ankia Coetzee
- Department of Medicine, Division of Endocrinology Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - David R. Hall
- Department of Obstetrics & Gynecology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Mari van de Vyver
- Department of Medicine, Division of Clinical Pharmacology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Magda Conradie
- Department of Obstetrics & Gynecology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
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Lok CW, Wong MC, Yip KW, Ching WK, Choi EKY. Validation of the traditional Chinese version of the diabetes eating problem survey-revised and study of the prevalence of disordered eating patterns in Chinese patients with type 1 DM. BMC Psychiatry 2023; 23:382. [PMID: 37259043 DOI: 10.1186/s12888-023-04744-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/03/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Disordered eating behaviours (DEBs) in patients with type 1 diabetes mellitus (T1DM) are associated with an increased risk of complications and mortality. The Diabetes Eating Problem Survey-Revised (DEPS-R) was developed to screen for DEBs in T1DM patients. The objectives of this study were to develop a traditional Chinese version DEPS-R (electronic version) and to measure the prevalence of DEBs in a local population sample. METHODS The DEPS-R was translated into traditional Chinese, modified and developed into an electronic version. The psychometric properties of the C-DEPS-R were tested on T1DM patients from 15 to 64 years old. The factor structure of the traditional C-DEPS-R was examined by confirmatory factor analysis (CFA). The C-EDE-Q and the C-DES-20 were used for convergent and divergent validity testing, respectively. Module H of the CB-SCID-I/P was used as a diagnostic tool for eating disorders. A correlation study was conducted with the C-DEPS-R scores obtained and the clinical characteristics. Type 2 diabetic (T2DM) patients on insulin treatment were recruited as controls. RESULTS In total, 228 T1DM patients and 58 T2DM patients were recruited. There was good internal consistency of the traditional C-DEPS-R (electronic version), with the McDonald's omega of 0.825 and test-retest reliability of 0.991. A three-factor model of the traditional C-DEPS-R was confirmed by CFA. The cut-off score for the traditional C-DEPS-R was determined to be 24; 13.2% (95% CI 8.8%-17.5%) of T1DM patients were found to score above the cut-off score, while 7.5% (95% CI 4-10.9%) scored above the cut-off by the C-EDE-Q, and 4.4% (95% CI 2.1%-7.9%) were diagnosed with eating disorders by the CB-SCID-I/P Module H. Females with T1DM scored higher on the traditional C-DEPS-R. There was a significant correlation of the C-DEPS-R with BMI, occurrence of DKA, use of a continuous glucose monitoring system and positive diagnosis by the CB-SCID-I/P module H (p < 0.05). CONCLUSION The traditional Chinese-DEPS-R (electronic version) demonstrated good psychometric properties. It is a self-rated, time-efficient and reliable tool for the screening of disordered eating behaviours in T1DM patients in the Chinese population of Hong Kong. Disordered eating behaviours, such as insulin omission, are associated with an increased risk of diabetes mellitus-related complications and mortality. Generic screening tools for eating disorders may over- or underestimate such problems in diabetic patients. Type 1 diabetes mellitus patients are at particular risk of developing disordered eating behaviours or eating disorders, yet studies in Chinese populations are limited. This study developed and validated the traditional Chinese (electronic) version of the Diabetes Eating Problem Survey-Revised (DEPS-R). The traditional Chinese-DEPS-R is a self-rated, time-efficient and reliable tool for the screening of disordered eating behaviours in Type 1 diabetes mellitus patients in the Chinese population of Hong Kong. The study also estimated the prevalence of disordered eating behaviours in diabetic patients from the local Chinese population, and the clinical correlations of the symptoms and clinical parameters were explored. The study reflected a higher prevalence of eating problems in the Type 1 diabetes mellitus population and demonstrated significant correlations of eating problems with BMI as well as the occurrence of diabetic ketoacidosis. Correspondence: lcw891@ha.org.hk.
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Affiliation(s)
- Chi Wing Lok
- Department of Psychiatry, United Christian Hospital, Kowloon, Hong Kong.
| | - Mei Cheung Wong
- Department of Psychiatry, United Christian Hospital, Kowloon, Hong Kong
| | - Kim Wai Yip
- Department of Psychiatry, United Christian Hospital, Kowloon, Hong Kong
| | - Wing Ka Ching
- Department of Psychiatry, United Christian Hospital, Kowloon, Hong Kong
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Di Bonito P, Licenziati MR, Corica D, Wasniewska M, Di Sessa A, Miraglia del Giudice E, Morandi A, Maffeis C, Faienza MF, Mozzillo E, Calcaterra V, Franco F, Maltoni G, Valerio G. Which Is the Most Appropriate Cut-Off of HbA1c for Prediabetes Screening in Caucasian Youths with Overweight or Obesity? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20020928. [PMID: 36673682 PMCID: PMC9858643 DOI: 10.3390/ijerph20020928] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/30/2022] [Accepted: 01/01/2023] [Indexed: 06/12/2023]
Abstract
This cross-sectional study aimed to assess the best cut-off of HbA1c for detection of impaired fasting glucose (IFG), impaired glucose tolerance (IGT), beta-cell impairment and cardiometabolic risk (CMR) profile in overweight or obese (OW/OB) Caucasian youths. Two-hour oral glucose tolerance test was available in 1549 youths, one-hour glucose (G60) in 1430 youths and disposition index (DI) in 972 youths. Insulin resistance (IR) was calculated as Homeostatic Model Assessment for IR and insulin sensitivity (IS) as 1/fasting insulin. High G60 was defined by a value ≥ 133 mg/dL. The best cut-off of HbA1c for IFG or IGT was 5.5%. The frequency of individuals with HbA1c ≥ 5.5% was 32.5%, compared to 16.3% with HbA1c ≥ 5.7% (as proposed by the American Diabetes Association). HbA1c ≥ 5.5% showed higher sensitivity and lower specificity with respect to HbA1c ≥ 5.7% for all the abnormalities examined (IFG, IGT, high G60, IR, low IS, DI and CMR factors). In conclusion, this lower cut-off might represent a more appropriate screening marker of glucose dysmetabolism in youths with OW/OB. Prospective studies are needed to validate this cut-off for predicting prediabetes/diabetes in youths with OW/OB.
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Affiliation(s)
- Procolo Di Bonito
- Department of Internal Medicine, “S. Maria delle Grazie” Hospital, 80078 Pozzuoli, Italy
| | - Maria Rosaria Licenziati
- Neuro-Endocrine Diseases and Obesity Unit, Department of Neurosciences, Santobono-Pausilipon Children’s Hospital, 80139 Napoli, Italy
| | - Domenico Corica
- Department of Human Pathology in Adulthood and Childhood, University of Messina, 98125 Messina, Italy
| | - Malgorzata Wasniewska
- Department of Human Pathology in Adulthood and Childhood, University of Messina, 98125 Messina, Italy
| | - Anna Di Sessa
- Department of Woman, Child and of General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Napoli, Italy
| | - Emanuele Miraglia del Giudice
- Department of Woman, Child and of General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Napoli, Italy
| | - Anita Morandi
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, 37126 Verona, Italy
| | - Claudio Maffeis
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, 37126 Verona, Italy
| | - Maria Felicia Faienza
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, 70121 Bari, Italy
| | - Enza Mozzillo
- Section of Pediatrics, Department of Translational Medical Science, Regional Center of Pediatric Diabetes, University of Naples “Federico II”, 80131 Napoli, Italy
| | - Valeria Calcaterra
- Pediatric Department, “V. Buzzi” Children’s Hospital, 20154 Milano, Italy
- Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
| | - Francesca Franco
- Pediatric Department, Azienda Sanitaria Universitaria Friuli Centrale, Hospital of Udine, 33100 Udine, Italy
| | - Giulio Maltoni
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Giuliana Valerio
- Department of Movement Sciences and Wellbeing, University of Napoli “Parthenope”, 80133 Napoli, Italy
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Lyon OAS, Inman M. A Statistical Simulation to Evaluate the Robustness of Hb A1c Measurement in the Presence of Quantitative Error. J Appl Lab Med 2023; 8:67-76. [PMID: 36610418 DOI: 10.1093/jalm/jfac103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 10/03/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND The performance requirements for hemoglobin (Hb) A1c analysis have been questioned as analytic methods have improved. We developed a statistical simulation that relates error to the clinical utility of an oft-used laboratory test, as a means of assessing test performance expectations. METHODS Finite mixture modeling of the Centers for Disease Control and Prevention-National Health and Nutrition Examination Survey (NHANES) 2017-2020 Hb A1c data in conjunction with Monte Carlo sampling were used to model and simulate a population prior to the introduction of error into the results. The impact of error on clinical utility was assessed by categorizing the results using the American Diabetes Association (ADA) diagnostic criteria and assessing the sensitivity and specificity of Hb A1c under various degrees of error (bias and imprecision). RESULTS With the current allowable total error threshold of 6% for Hb A1c measurement, the simulation estimated a worst case between 50% and 60% for both test sensitivity and specificity for the non-diabetic category. Similarly, sensitivity and specificity estimates for the pre-diabetic category were 30% to 40% and 60% to 70%, respectively. Finally, estimates for the diabetic category yielded values of 80% to 90% for sensitivity and >90% for specificity. CONCLUSIONS Bias and imprecision greatly affect the clinical utility of Hb A1c for all patient groups. The simulated error demonstrated in this modeling impacts 3 critical applications of the Hb A1c in diabetes management: the capacity to reliably screen, diagnostic accuracy, and utility in diabetes monitoring.
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Affiliation(s)
- Oliver A S Lyon
- Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Mark Inman
- Department of Pediatrics, University of Saskatchewan, Saskatoon, SK, Canada
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22
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Barreto APA, Barreto Filho MA, Duarte LC, Cerqueira-Silva T, Camelier A, Tavares NM, Barral-Netto M, Boaventura V, Lima MCC. Metabolic disorders and post-acute hospitalization in black/mixed-race patients with long COVID in Brazil: A cross-sectional analysis. PLoS One 2022; 17:e0276771. [PMID: 36315558 PMCID: PMC9621406 DOI: 10.1371/journal.pone.0276771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/22/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Although low-middle income countries have been disproportionately affected by the COVID-19 pandemic, there is scarce information about the impact of long COVID on their population. This study aimed to evaluate long COVID symptomatology, complications (hospital readmission and metabolic disorders), and main clinical features that impact Quality of Life (QoL). METHODS This cross-sectional study provides a detailed clinical and laboratory picture of individuals who presented residual symptoms after mild to severe acute COVID-19. Between Aug-2020 to Sep-2021, long COVID patients were evaluated in a reference center for long COVID in Bahia State, Brazil. The EQ-5D-5L questionnaire accessed QoL. RESULTS A total of 1164 (52 ±13.4 years, 57% female, 88% black/mixed-race) were evaluated 2.3 [IQR = 1.6-3.7] months after mild (n = 351, 30.2%), moderate (338, 29.0%) or severe (475, 40.8%) acute illness. Dyspnea (790, 67.9%), fatigue (738, 63.5%), and chest pain (525, 42.9%) were the most frequent residual symptoms regardless of acute severity, affecting the QoL of 88.9% of patients (n/N-826/925), mainly the domains of anxiety/depression and pain/discomfort. High levels of HbA1c were detected for 175 out of 664 patients (26.6%), 40% of them without a previous diagnosis of diabetes mellitus. Of note, hospital admission one-to-three months after the acute phase of disease was required for 51 (4.4%) patients. CONCLUSION In this majority-black/mixed-race population, long COVID was associated with post-acute hospitalization, newly diagnosed diabetes mellitus, and decreased QoL, particularly in women and regardless of disease severity of acute infection, suggesting important implications for health care system.
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Affiliation(s)
- Ana Paula Andrade Barreto
- Hospital Especializado Octávio Mangabeira (HEOM), Salvador, Brazil
- Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Brazil
| | - Marcio Andrade Barreto Filho
- Hospital Especializado Octávio Mangabeira (HEOM), Salvador, Brazil
- Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Brazil
| | - Lucimeire Cardoso Duarte
- Hospital Especializado Octávio Mangabeira (HEOM), Salvador, Brazil
- Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Brazil
| | - Thiago Cerqueira-Silva
- Instituto Gonçalo Moniz (Fiocruz-Bahia), Salvador, Brazil
- Universidade Federal da Bahia (UFBA), Salvador, Brazil
| | - Aquiles Camelier
- Hospital Especializado Octávio Mangabeira (HEOM), Salvador, Brazil
- Fundação Maria Emília Freire de Carvalho (FME), Salvador, Brazil
| | | | - Manoel Barral-Netto
- Instituto Gonçalo Moniz (Fiocruz-Bahia), Salvador, Brazil
- Universidade Federal da Bahia (UFBA), Salvador, Brazil
| | - Viviane Boaventura
- Instituto Gonçalo Moniz (Fiocruz-Bahia), Salvador, Brazil
- Universidade Federal da Bahia (UFBA), Salvador, Brazil
- * E-mail:
| | - Marcelo Chalhoub Coelho Lima
- Hospital Especializado Octávio Mangabeira (HEOM), Salvador, Brazil
- Universidade Salvador, (UNIFACS), Salvador, Brazil
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Blonde L, Umpierrez GE, Reddy SS, McGill JB, Berga SL, Bush M, Chandrasekaran S, DeFronzo RA, Einhorn D, Galindo RJ, Gardner TW, Garg R, Garvey WT, Hirsch IB, Hurley DL, Izuora K, Kosiborod M, Olson D, Patel SB, Pop-Busui R, Sadhu AR, Samson SL, Stec C, Tamborlane WV, Tuttle KR, Twining C, Vella A, Vellanki P, Weber SL. American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. Endocr Pract 2022; 28:923-1049. [PMID: 35963508 PMCID: PMC10200071 DOI: 10.1016/j.eprac.2022.08.002] [Citation(s) in RCA: 132] [Impact Index Per Article: 66.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The objective of this clinical practice guideline is to provide updated and new evidence-based recommendations for the comprehensive care of persons with diabetes mellitus to clinicians, diabetes-care teams, other health care professionals and stakeholders, and individuals with diabetes and their caregivers. METHODS The American Association of Clinical Endocrinology selected a task force of medical experts and staff who updated and assessed clinical questions and recommendations from the prior 2015 version of this guideline and conducted literature searches for relevant scientific papers published from January 1, 2015, through May 15, 2022. Selected studies from results of literature searches composed the evidence base to update 2015 recommendations as well as to develop new recommendations based on review of clinical evidence, current practice, expertise, and consensus, according to established American Association of Clinical Endocrinology protocol for guideline development. RESULTS This guideline includes 170 updated and new evidence-based clinical practice recommendations for the comprehensive care of persons with diabetes. Recommendations are divided into four sections: (1) screening, diagnosis, glycemic targets, and glycemic monitoring; (2) comorbidities and complications, including obesity and management with lifestyle, nutrition, and bariatric surgery, hypertension, dyslipidemia, retinopathy, neuropathy, diabetic kidney disease, and cardiovascular disease; (3) management of prediabetes, type 2 diabetes with antihyperglycemic pharmacotherapy and glycemic targets, type 1 diabetes with insulin therapy, hypoglycemia, hospitalized persons, and women with diabetes in pregnancy; (4) education and new topics regarding diabetes and infertility, nutritional supplements, secondary diabetes, social determinants of health, and virtual care, as well as updated recommendations on cancer risk, nonpharmacologic components of pediatric care plans, depression, education and team approach, occupational risk, role of sleep medicine, and vaccinations in persons with diabetes. CONCLUSIONS This updated clinical practice guideline provides evidence-based recommendations to assist with person-centered, team-based clinical decision-making to improve the care of persons with diabetes mellitus.
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Affiliation(s)
| | | | - S Sethu Reddy
- Central Michigan University, Mount Pleasant, Michigan
| | | | | | | | | | | | - Daniel Einhorn
- Scripps Whittier Diabetes Institute, La Jolla, California
| | | | | | - Rajesh Garg
- Lundquist Institute/Harbor-UCLA Medical Center, Torrance, California
| | | | | | | | | | | | - Darin Olson
- Colorado Mountain Medical, LLC, Avon, Colorado
| | | | | | - Archana R Sadhu
- Houston Methodist; Weill Cornell Medicine; Texas A&M College of Medicine; Houston, Texas
| | | | - Carla Stec
- American Association of Clinical Endocrinology, Jacksonville, Florida
| | | | - Katherine R Tuttle
- University of Washington and Providence Health Care, Seattle and Spokane, Washington
| | | | | | | | - Sandra L Weber
- University of South Carolina School of Medicine-Greenville, Prisma Health System, Greenville, South Carolina
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24
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Kasujja FX, Mayega RW, Daivadanam M, Kiracho EE, Kusolo R, Nuwaha F. Glycated haemoglobin and fasting plasma glucose tests in the screening of outpatients for diabetes and abnormal glucose regulation in Uganda: A diagnostic accuracy study. PLoS One 2022; 17:e0272515. [PMID: 35925994 PMCID: PMC9352087 DOI: 10.1371/journal.pone.0272515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/20/2022] [Indexed: 11/18/2022] Open
Abstract
Background and objectives To understand the utility of glycated haemoglobin (HBA1C) in screening for diabetes and Abnormal Glucose Regulation (AGR) in primary care, we compared its performance to that of the fasting plasma glucose (FPG) test. Methods This was a prospective diagnostic accuracy study conducted in eastern Uganda. Patients eligible for inclusion were consecutive adults, 30–75 years, receiving care at the outpatient department of a general hospital in eastern Uganda. We determined the sensitivity, specificity and optimum cut-off points for HBA1C and FPG tests using the oral glucose tolerance test (OGTT) as a clinical reference standard. Results A total of 1659 participants underwent FPG testing of whom 310 were also HBA1C and OGTT tested. A total of 113 tested positive for diabetes and 168 for AGR on the OGTT. At recommended cut-off points for diabetes, the HBA1C and FPG tests had comparable sensitivity [69.8% (95% CI 46.3–86.1) versus 62.6% (95% CI 41.5–79.8), respectively] and specificity [98.6% (95% CI 95.4–99.6) versus 99.4% (95% CI 98.9–99.7), respectively]. Similarly, the sensitivity of HBA1C and the FPG tests for Abnormal Glucose Regulation (AGR) at ADA cut-offs were comparable [58.9% (95% CI 46.7–70.2) vs 47.7% (95% CI 37.3–58.4), respectively]; however, the HBA1C test had lower specificity [70.7% (95% CI 65.1–75.8)] than the FPG test [93.5% (95% CI 88.6–96.4)]. At the optimum cut-offs points for diabetes [45.0 mmol/mol (6.3%) for HBA1C and 6.4 mmol/L (115.2 mg/dl) for FPG], HBA1C and FPG sensitivity [71.2% (95% CI 46.9–87.8) versus 72.7% (95% CI 49.5–87.8), respectively] and specificity [95.1% (95% CI91.8 97.2) versus 98.7% (95% CI 98.0 99.2), respectively] were comparable. Similarly, at the optimum cut-off points for AGR [42.0 mmol/mol (6.0%) for the HBA1C and 5.5 mmol/l (99.0 mg/dl) for the FPG test], HBA1C and FPG sensitivity [42.3% (95% CI 31.8–53.6) and 53.2 (95% CI 43.1–63.1), respectively] and specificity [89.1% (95% CI 84.1 92.7) and 92.7% (95% CI 91.0 94.1), respectively] were comparable. Discussion HBA1C is a viable alternative diabetes screening and confirmatory test to the FPG test; however, the utility of both tests in screening for prediabetes in this outpatient population is limited.
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Affiliation(s)
- Francis Xavier Kasujja
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
- Chronic Diseases and Cancer Theme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- * E-mail:
| | - Roy William Mayega
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Meena Daivadanam
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
- Department of Women’s and Children’s Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - Elizabeth Ekirapa Kiracho
- Department of Health Policy, Planning, and Management, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ronald Kusolo
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Fred Nuwaha
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
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Song BM, Lee JH, Woo HD, Cho MJ, Kim SS. Association between haemoglobin A1c and all-cause and cause-specific mortality in middle-aged and older Koreans: a prospective cohort study. Nutr Metab (Lond) 2022; 19:46. [PMID: 35836264 PMCID: PMC9284843 DOI: 10.1186/s12986-022-00682-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 06/30/2022] [Indexed: 11/21/2022] Open
Abstract
Background This study aimed to examine associations between haemoglobin A1c (HbA1c) levels over time and all-cause and cause-specific mortality in middle-aged and older Koreans. Methods Using 16 years of follow-up data from the Korean Genome and Epidemiology Study, we analysed 9294 individuals aged 40–69 years with no history of cardiovascular disease (CVD) or cancer. Participants were divided into a known diabetes group and five groups categorized by HbA1c levels (< 5.0%, 5.0–5.4%, 5.5–5.9%, 6.0–6.4%, and ≥ 6.5%). Hazard ratios (HRs) for all-cause and cause-specific mortality associated with HbA1c levels were calculated using a conventional and a time-dependent Cox proportional hazards model. Restricted cubic spline models were fitted to investigate the relationship between continuous HbA1c levels and mortality among people without known diabetes. Subgroup analyses were performed for age, sex, smoking, hypertension, liver diseases, and red blood cell counts. Results During a median follow-up period of 15.7 years, there were 944 deaths, including 185 deaths from CVD, 359 from cancer, and 125 from all external causes. Compared with participants with HbA1c levels of 5.5–5.9%, multivariate-adjusted HRs and 95% confidence intervals for all-cause death of participants with levels < 5.0%, 5.0–5.4%, 6.0–6.4%, and ≥ 6.5% and participants with known diabetes were 1.84 (1.35–2.51), 1.13 (0.95–1.34), 1.30 (1.04–1.62), 1.37 (0.97–1.93), and 2.03 (1.70–2.44), respectively. The risk of cancer mortality was significantly increased in HbA1c < 5.0% (HR, 2.21; 95% CI 1.42–3.44) and known diabetes (HR, 1.60; 95% CI 1.18–2.15). When we performed diverse subgroup analyses, low HbA1c levels at baseline were strongly associated with mortality in participants with liver diseases. Conclusions We found U-shaped associations between HbA1c levels at baseline and over time and all-cause mortality in middle-aged and older Koreans. Additionally, the risk of cancer mortality increased both in low and high HbA1c groups, but CVD mortality increased only in high HbA1c group. In particular, people with liver diseases and low HbA1c levels had a high risk of all-cause mortality. Therefore, more careful management of these groups is suggested to identify any deteriorating health conditions. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s12986-022-00682-4.
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Affiliation(s)
- Bo Mi Song
- Division of Population Health Research, Department of Precision Medicine, Korea National Institute of Health, Korea Disease Control and Prevention Agency, Cheongju, Chungcheongbuk-do, South Korea
| | - Jung Hyun Lee
- Division of Population Health Research, Department of Precision Medicine, Korea National Institute of Health, Korea Disease Control and Prevention Agency, Cheongju, Chungcheongbuk-do, South Korea
| | - Hae Dong Woo
- Division of Population Health Research, Department of Precision Medicine, Korea National Institute of Health, Korea Disease Control and Prevention Agency, Cheongju, Chungcheongbuk-do, South Korea
| | - Mi Jin Cho
- Division of Population Health Research, Department of Precision Medicine, Korea National Institute of Health, Korea Disease Control and Prevention Agency, Cheongju, Chungcheongbuk-do, South Korea
| | - Sung Soo Kim
- Department of Chronic Disease Convergence Research, Korea National Institute of Health, Korea Disease Control and Prevention Agency, Cheongju, Chungcheongbuk-do, South Korea.
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Datta R, Lucas JA, Marino M, Aceves B, Ezekiel-Herrera D, Vasquez Guzman CE, Giebultowicz S, Chung-Bridges K, Kaufmann J, Bazemore A, Heintzman J. Diabetes Screening and Monitoring Among Older Mexican-Origin Populations in the U.S. Diabetes Care 2022; 45:1568-1573. [PMID: 35587616 PMCID: PMC9274220 DOI: 10.2337/dc21-2483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/17/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of the study is to examine diabetes screening and monitoring among Latino individuals as compared with non-Latino White individuals and to better understand how we can use neighborhood data to address diabetes care inequities. RESEARCH DESIGN AND METHODS This is a retrospective observational study linked with neighborhood-level Latino subgroup data obtained from the American Community Survey. We used generalized estimating equation negative binomial and logistic regression models adjusted for patient-level covariates to compare annual rates of glycated hemoglobin (HbA1c) monitoring for those with diabetes and odds of HbA1c screening for those without diabetes by ethnicity and among Latinos living in neighborhoods with low (0.0-22.0%), medium (22.0-55.7%), and high (55.7-98.0%) population percent of Mexican origin. RESULTS Latino individuals with diabetes had 18% higher rates of HbA1c testing than non-Latino White individuals with diabetes (adjusted rate ratio [aRR] 1.18 [95% CI 1.07-1.29]), and Latinos without diabetes had 25% higher odds of screening (adjusted odds ratio 1.25 [95% CI 1.15-1.36]) than non-Latino White individuals without diabetes. In the analyses in which neighborhood-level percent Mexican population was the main independent variable, all Latinos without diabetes had higher odds of HbA1c screening compared with non-Latino White individuals, yet only those living in low percent Mexican-origin neighborhoods had increased monitoring rates (aRR 1.31 [95% CI 1.15-1.49]). CONCLUSIONS These findings reveal novel variation in health care utilization according to Latino subgroup neighborhood characteristics and could inform the delivery of diabetes care for a growing and increasingly diverse Latino patient population. Clinicians and researchers whose work focuses on diabetes care should take steps to improve equity in diabetes and prevent inequity in treatment.
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Affiliation(s)
- Roopradha Datta
- Department of Family Medicine, Oregon Health & Science University, Portland, OR
| | - Jennifer A Lucas
- Department of Family Medicine, Oregon Health & Science University, Portland, OR
| | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, Portland, OR
| | - Benjamin Aceves
- Social Interventions Research and Evaluation Network, University of California, San Francisco, San Francisco, CA
| | | | | | | | | | - Jorge Kaufmann
- Department of Family Medicine, Oregon Health & Science University, Portland, OR
| | - Andrew Bazemore
- American Board of Family Medicine, Lexington, KY.,Center for Professionalism and Value in Health Care, Washington, DC
| | - John Heintzman
- Department of Family Medicine, Oregon Health & Science University, Portland, OR.,OCHIN Inc., Portland, OR
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Kengne AP, Matsha TE, Sacks DB, Zemlin AE, Erasmus RT, Sumner AE. Combining HbA 1c and glycated albumin improves detection of dysglycaemia in mixed-ancestry South Africans. EClinicalMedicine 2022; 48:101443. [PMID: 35783481 PMCID: PMC9249545 DOI: 10.1016/j.eclinm.2022.101443] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/18/2022] [Accepted: 04/21/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Combining HbA1c with glycated albumin (GA) may improve detection of dysglycaemia. As BMI correlates positively with HbA1c and negatively with GA, HbA1c may be more effective in obese and GA in nonobese individuals. METHODS To relate these findings to Africans, we assessed in 1274 South Africans living in CapeTown (male 26%; age 48±16y; BMI 28.7 kg/m2 (range 15.6-73.8); obesity 39.9% and no prior diabetes history) the: (1) correlation of BMI with HbA1c and GA, (2) ability of HbA1c and GA separately and jointly, to detect OGTT-diagnosed dysglycaemia (diabetes plus prediabetes). Data collection took place between 2014 and 2016 in the City of Cape Town. Dysglycaemia was diagnosed by glucose criteria for the OGTT. Youden index was used to optimize diagnostic thresholds for HbA1c and GA. FINDINGS Normal glucose tolerance, prediabetes and diabetes occurred in 76%, 17% and 7%, respectively. BMI positively correlated with HbA1c [r = 0·34 [95%CI: 0·29,0·39)] and negatively with GA [-0·08 (0·13,0·03)]. For HbA1c the optimal threshold by Youden-index for dysglycaemia diagnosis was: 6·0% (95%CI: 5·8,6·2) and for GA: 13·44% (12·72,14·71). In the nonobese, obese and total cohort, HbA1c-alone detected: 51% (42-60), 72% (65,78), 63% (57,68), respectively; GA-alone detected 55% (52% (46,63), 52% (44, 59) and 53% (47,53), respectively; whereas: HbA1c+GA detected: 69% (60,76), 82% (75,87) and 76% (71, 81). Therefore, for the total cohort detection of dysglycaemia HbA1c-alone vs HbA1c+GA detected 63% (57,68) vs 76% (71,81). INTERPRETATION The opposite correlations of HbA1c and GA with BMI have now been demonstrated in an African-based population. Improving detection of dysglycaemia by combining HbA1c and GA has important implications for diabetes risk screening. FUNDING AES is supported by the intramural programs of the National Institute of Diabetes and Digestive and Kidney Diseases and the National Institute of Minority Health and Health Disparities of the National Institutes of Health (NIH, Bethesda, Maryland, USA). DBS is supported by the intramural program of the Clinical Center of NIH. The South African Medical Research Council (SAMRC) funded the VMH study with funds from the National Treasury under its Economic Competitiveness and Support Package (MRC-RFA-UFSP-01-2013/VMH Study).
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Affiliation(s)
- Andre Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, PO Box 19070, Tygerberg, Cape Town 7505, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Corresponding author at: Non-Communicable Diseases Research Unit, South African Medical Research Council, PO Box 19070, Tygerberg, Cape Town 7505, South Africa.
| | - Tandi E. Matsha
- SAMRC/CPUT/Cardiometabolic Health Research Unit, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - David B. Sacks
- National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Annalise E. Zemlin
- Division of Chemical Pathology, Faculty of Medicine and Health Sciences, National Health Laboratory Service (NHLS), University of Stellenbosch, Cape Town, South Africa
| | - Rajiv T Erasmus
- Division of Chemical Pathology, Faculty of Medicine and Health Sciences, National Health Laboratory Service (NHLS), University of Stellenbosch, Cape Town, South Africa
| | - Anne E. Sumner
- Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Health, Bethesda, MD, USA
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
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Livadas S, Anagnostis P, Bosdou JK, Bantouna D, Paparodis R. Polycystic ovary syndrome and type 2 diabetes mellitus: A state-of-the-art review. World J Diabetes 2022; 13:5-26. [PMID: 35070056 PMCID: PMC8771268 DOI: 10.4239/wjd.v13.i1.5] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/30/2021] [Accepted: 12/25/2021] [Indexed: 02/06/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) often coexists with a wide spectrum of dysglycemic conditions, ranging from impaired glucose tolerance to type 2 diabetes mellitus (T2D), which occur to a greater extent compared to healthy body mass index-matched women. This concurrence of disorders is mainly attributed to common pathogenetic pathways linking the two entities, such as insulin resistance. However, due to methodological flaws in the available studies and the multifaceted nature of the syndrome, there has been substantial controversy as to the exact association between T2D and PCOS which has not yet been elucidated. The aim of this review is to present the best available evidence regarding the epidemiology of dysglycemia in PCOS, the unique pathophysiological mechanisms underlying the progression of dysglycemia, the most appropriate methods for assessing glycemic status and the risk factors for T2D development in this population, as well as T2D risk after transition to menopause. Proposals for application of a holistic approach to enable optimal management of T2D risk in PCOS are also provided. Specifically, adoption of a healthy lifestyle with adherence to improved dietary patterns, such the Mediterranean diet, avoidance of consumption of endocrine-disrupting foods and beverages, regular exercise, and the effect of certain medications, such as metformin and glucagon-like peptide 1 receptor agonists, are discussed. Furthermore, the maintenance of a healthy weight is highlighted as a key factor in achievement of a significant reduction of T2D risk in women with PCOS.
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Affiliation(s)
| | - Panagiotis Anagnostis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - Julia K Bosdou
- Unit for Human Reproduction, 1st Department of Obstetrics and Gynaecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - Dimitra Bantouna
- Department of Pathology and Cytology, University of Patras School of Medicine, Patras 10563, Greece
| | - Rodis Paparodis
- Center for Diabetes and Endocrine Research, University of Toledo College of Medicine and Life Sciences, Toledo, OH 23456, United States
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Gossain VV, Rao SD. Endocrinologists of Indian Origin: A Global Force that can (and should) Collaborate. Indian J Endocrinol Metab 2022; 26:26-29. [PMID: 35662752 PMCID: PMC9162261 DOI: 10.4103/2230-8210.343878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Ved V. Gossain
- Professor of Medicine and Chief, Division of Endocrinology (Emeritus), Michigan State University, East Lansing, Michigan, USA
| | - Sudhaker D. Rao
- Bone and Mineral Disorders, Division of Endocrinology, Diabetes, and Bone and Mineral Disorders, Director, Bone and Mineral Research Laboratory, Henry Ford Health System, Detroit, Michigan, USA
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30
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Stark D, Ritter K. AIM and Gender Aspects. Artif Intell Med 2022. [DOI: 10.1007/978-3-030-64573-1_244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Zhao Q, Ding L, Yang Y, Sun J, Wang M, Li X, Liu M. Clinical Characteristics of Patients With HNF1-alpha MODY: A Literature Review and Retrospective Chart Review. Front Endocrinol (Lausanne) 2022; 13:900489. [PMID: 35795147 PMCID: PMC9252268 DOI: 10.3389/fendo.2022.900489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
The clinical manifestation of hepatocyte nuclear factor-1-alpha (HNF1-alpha) maturity-onset diabetes of the young (MODY) is highly variable. This study aims to investigate the clinical characteristics of patients with HNF1-alpha MODY in general, by geographical regions (Asian or non-Asian), HNF1-alpha mutations, and islet autoantibody status. A literature review and a chart review of patients with HNF1-alpha MODY were performed. The means and proportions from studies were pooled using the inverse variance method for pooling, and subgroup analyses were performed. A total of 109 studies involving 1,325 patients [41.5%, 95% confidence interval (CI): 35.2, 48.1; male] were identified. The mean age of diagnosis was 20.3 years (95% CI: 18.3-22.2), and the mean glycated hemoglobin was 7.3% (95% CI: 7.2-7.5). In comparison, Asian patients exhibited significantly higher HbA1c (p = 0.007) and 2-h post-load C-peptide (p = 0.012) levels and lower levels of triglyceride (TG) (p < 0.001), total cholesterol (TC) (p < 0.001), and high-density lipoprotein cholesterol (HDL-c) (p < 0.001) and less often had macrovascular complications (p = 0.014). The age of diagnosis was oldest in patients with mutations in the transactivation domain (p < 0.001). The levels of 2-h post-load C-peptide (p < 0.001), TG (p = 0.007), TC (p = 0.017), and HDL-c (p = 0.001) were highest and the prevalence of diabetic neuropathy was lowest (p = 0.024) in patients with DNA-binding domain mutations. The fasting (p = 0.004) and 2-h post-load glucose (p = 0.003) levels and the prevalence of diabetic neuropathy (p = 0.010) were higher among patients with positive islet autoantibodies. The study demonstrated that the clinical manifestations of HNF1-alpha MODY differed by geographical regions, HNF1-alpha mutations, and islet autoantibody status.
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Affiliation(s)
- Qinying Zhao
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Li Ding
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Ying Yang
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Jinhong Sun
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Min Wang
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Xin Li
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
- *Correspondence: Xin Li, ; Ming Liu,
| | - Ming Liu
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
- National Health Commission (NHC) Key Laboratory of Hormones and Development, Tianjin Medical University, Tianjin, China
- Tianjin Institute of Endocrinology, Tianjin, China
- *Correspondence: Xin Li, ; Ming Liu,
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Catherine JP, Russell MV, Peter CH. The impact of race and socioeconomic factors on paediatric diabetes. EClinicalMedicine 2021; 42:101186. [PMID: 34805811 PMCID: PMC8585622 DOI: 10.1016/j.eclinm.2021.101186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/12/2021] [Accepted: 10/19/2021] [Indexed: 12/16/2022] Open
Abstract
There are over 29,000 children and young people (CYP) with Type 1 diabetes mellitus (T1DM) in England and Wales and another 726 with Type 2 diabetes mellitus (T2DM). There is little effect of deprivation on the prevalence of T1DM whereas the association of deprivation on the percentage of CYP with T2DM is striking with 45% of cases drawn from the most deprived backgrounds. A number that has not changed over the last 4 years. Data from the UK and USA as well as other countries demonstrate the impact of deprivation on outcomes in diabetes mellitus with clear effects on measures of long-term control and complications. In the UK black CYP had higher glycosylated haemoglobin (HbA1c) values compared to other groups. Within the black group, CYP from a Caribbean background had a higher mean HbA1c (77.0 mmol/mol (9.2%)) than those from Africa (70.4 mmol/mol (8.6%)). Treatment regimen (multiple daily injections or insulin pump therapy) explained the largest proportion of the variability in HbA1c followed by deprivation. Those in the least deprived areas had an average HbA1c 5.88 mmol/mol (0.5%) lower than those living in the most deprived areas. The picture is complex as UK data also show that deprivation and ethnicity is associated with less use of technology that is likely to improve diabetes control. Increased usage of pump therapy and continuous glucose monitoring was associated with a younger age of patient (less than 10 years of age), living in the least deprived areas and white ethnicity. This gap between pump usage amongst CYP with T1DM living in the most and least deprived areas has widened with time. In 2014/15 the gap was 7.9% and by 2018/19 had increased to 13.5%. To attain an equitable service for CYP with diabetes mellitus we need to consider interventions at the patient, health care professional, community, and health care system levels.
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Wong TY, Travis RC, Tong TYN. Blood biomarker levels by total sleep duration: cross-sectional analyses in UK Biobank. Sleep Med 2021; 88:256-261. [PMID: 34798442 DOI: 10.1016/j.sleep.2021.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/06/2021] [Accepted: 10/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Short or long sleep duration has been associated with some major chronic diseases, but whether disease-related blood biomarkers vary according to habitual sleep duration is unclear. This cross-sectional study aimed to assess blood biomarker levels in relation to total sleep duration. METHODS The analysis includes 459,796 white British adults aged 40-69 during 2006-2010 in UK Biobank. At recruitment, blood samples and self-reported information on total sleep duration were collected from participants. A panel of blood biomarkers were measured. Using linear regression, we estimated geometric mean concentrations of blood biomarkers and mean ratio of ApoB/ApoA1 by sleep duration adjusted for sex, age at data collection, time of blood collection, and lifestyle covariates. RESULTS Percentage differences in the concentrations of most biomarkers by sleep duration were modest. The largest differences were for C-reactive protein (CRP, an inflammatory biomarker) and gamma glutamyltransferase (GGT, a liver function biomarker), and the differences were markedly attenuated after multivariable-adjustment. The multivariable-adjusted geometric means of CRP and of GGT were 14% and 14% higher in <6 h vs 7-8 h of sleep; and 22% and 12% higher in >9 h vs 7-8 h of sleep, respectively. CONCLUSION In white British adults, most blood biomarker levels varied only modestly with sleep duration and the remaining associations may be due to residual confounding.
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Affiliation(s)
- T Y Wong
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK.
| | - Ruth C Travis
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Tammy Y N Tong
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
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Goldenberg RM, Aroda VR, Billings LK, Christiansen ASL, Meller Donatsky A, Parvaresh Rizi E, Podgorski G, Raslova K, Klonoff DC, Bergenstal RM. Effect of insulin degludec versus insulin glargine U100 on time in range: SWITCH PRO, a crossover study of basal insulin-treated adults with type 2 diabetes and risk factors for hypoglycaemia. Diabetes Obes Metab 2021; 23:2572-2581. [PMID: 34322967 PMCID: PMC9290717 DOI: 10.1111/dom.14504] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/09/2021] [Accepted: 07/26/2021] [Indexed: 01/10/2023]
Abstract
AIMS To compare time in range (TIR) with use of insulin degludec U100 (degludec) versus insulin glargine U100 (glargine U100) in people with type 2 diabetes. MATERIALS AND METHODS We conducted a randomized, crossover, multicentre trial comparing degludec and glargine U100 in basal insulin-treated adults with type 2 diabetes and ≥1 hypoglycaemia risk factor. There were two treatment periods, each with 16-week titration and 2-week maintenance phases (with evaluation of glucose using blinded professional continuous glucose monitoring). The once-weekly titration (target: 3.9-5.0 mmol/L) was based on pre-breakfast self-measured blood glucose. The primary endpoint was percentage of TIR (3.9─10.0 mmol/L). Secondary endpoints included overall and nocturnal percentage of time in tight glycaemic range (3.9-7.8 mmol/L), and mean glycated haemoglobin (HbA1c) and glucose levels. RESULTS At baseline, participants (n = 498) had a mean (SD) age of 62.8 (9.8) years, a diabetes duration of 15.1 (7.7) years and an HbA1c level of 59.6 (11.0) mmol/mol (7.6 [1.0]%). Noninferiority and superiority were confirmed for degludec versus glargine U100 for the primary endpoint, with a mean TIR of 72.1% for degludec versus 70.7% for glargine U100 (estimated treatment difference [ETD] 1.43% [95% confidence interval (CI): 0.12, 2.74; P = 0.03] or 20.6 min/d). Overall time in tight glycaemic range favoured degludec versus glargine U100 (ETD 1.5% [95% CI: 0.15, 2.89] or 21.9 min/d). Degludec also reduced nocturnal time below range (TBR; <3.9 mmol/L) compared with glargine U100 (ETD -0.88% [95% CI: -1.34, -0.42] or 12.7 min/night; post hoc) and significantly fewer nocturnal hypoglycaemic episodes of <3.0 mmol/L were observed. CONCLUSIONS Degludec, compared with glargine U100, provided more TIR and time in tight glycaemic range, and reduced nocturnal TBR in insulin-treated people with type 2 diabetes.
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Affiliation(s)
| | - Vanita R. Aroda
- Diabetes Clinical Research, Division of Endocrinology, Diabetes & HypertensionBrigham and Women's Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Liana K. Billings
- Department of MedicineNorthShore University HealthSystem/University of Chicago Pritzker School of MedicineSkokieIllinoisUSA
| | | | | | | | | | | | - David C. Klonoff
- Diabetes Research InstituteMills‐Peninsula Medical CenterSan MateoCAUSA
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Yoo JH, Yang SH, Kim G, Kim JH. Glucose Management Indicator for People with Type 1 Asian Diabetes Is Different from That of the Published Equation: Differences by Glycated Hemoglobin Distribution. Diabetes Technol Ther 2021; 23:745-752. [PMID: 34160289 DOI: 10.1089/dia.2021.0185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: We aimed to determine whether there are racial differences in glucose management indicator (GMI) equation for Asians and propose an adjusted GMI equation specific to Asians. Methods: This was a 24-week, prospective, observational study. A total of 106 Korean subjects with type 1 diabetes was included in the analyses. Continuous glucose monitoring (CGM: Dexcom G5) data and glycated hemoglobin (HbA1c) were obtained at the end of 3 months (n = 106) and 6 months (n = 70) of use of a CGM device. Full 3-month CGM data were collected from 176 patients. Results: Linear regression analysis between HbA1c and CGM-derived mean glucose (GMI [%] = 2.814 + 0.026 × mean glucose [mg/dL], R2 = 0.739, P < 0.001) showed significant correlation. An increase corresponding to each 25 mg/dL increase of mean glucose was higher with the Asian-Dexcom-specific GMI (0.7%) than with the published GMI (0.6%). The mean Asian-Dexcom-specific GMI was significantly lower than the published GMI (P = 0.022), especially in patients with HbA1c <7.0% (<6.0%: P = 0.003, 6.0%-6.9%: P = 0.001). Conclusions: The GMI equation specific for Asian Type 1 diabetes was different from the published GMI equation. For a given CGM-derived mean glucose, GMI calculated with the published equation could overestimate HbA1c in Asian subjects with HbA1c <7.0%. Although race partially explains the differences in GMI equation between published and Asian data, future research with larger databases is needed to develop a specific formula for Asian populations.
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Affiliation(s)
- Jee Hee Yoo
- Division of Endocrinology and Metabolism, Department of Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung Hee Yang
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gyuri Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Seoul, Republic of Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Seoul, Republic of Korea
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Colagiuri S. Definition and Classification of Diabetes and Prediabetes and Emerging Data on Phenotypes. Endocrinol Metab Clin North Am 2021; 50:319-336. [PMID: 34399948 DOI: 10.1016/j.ecl.2021.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Diabetes diagnosis has important implications for individuals. Diagnostic criteria for fasting and 2-hour plasma glucose and HbA1c are universally agreed. Intermediate hyperglycemia/prediabetes is a risk factor for diabetes and cardiovascular disease. Because risk is a continuum, determining cut-point is problematic and reflected in significant differences in recommended fasting glucose and HbA1c criteria. Many types of diabetes are recognized. Diabetes classification systems are limited by a lack of understanding of etiopathogenetic pathways leading to diminished β-cell function. The World Health Organization classification system is designed to assist clinical care decisions. Newly recognized phenotypic clusters of diabetes might inform future classification systems.
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Affiliation(s)
- Stephen Colagiuri
- Boden Collaboration, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales 2006, Australia.
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37
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Bak JCG, Mul D, Serné EH, de Valk HW, Sas TCJ, Geelhoed-Duijvestijn PH, Kramer MHH, Nieuwdorp M, Verheugt CL. DPARD: rationale, design and initial results from the Dutch national diabetes registry. BMC Endocr Disord 2021; 21:122. [PMID: 34134677 PMCID: PMC8207714 DOI: 10.1186/s12902-021-00782-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 05/18/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Treatment of diabetes mellitus has majorly improved over the past century, however, the disease burden is high and its prevalence still expanding. Further insight in the diabetes population is imperative to improve the quality of diabetes care by enhancement of knowledge-based diabetes management strategies. To this end, in 2017 a Dutch nationwide consortium of diabetologists, paediatric endocrinologists, and diabetes patients has founded a national outpatient diabetes care registry named Dutch Pediatric and Adult Registry of Diabetes (DPARD). We aim to describe the implementation of DPARD and to provide an overview of the characteristics of patients included during the first 2 years. METHODS For the DPARD cohort with long-term follow-up of observational nature, hospital data are gathered directly from electronic health records and securely transferred and stored. DPARD provides weekly updated clinical information on the diabetes population care on a hospital-level benchmarked against the national average. RESULTS Between November 2017 and January 2020, 20,857 patients were included from 8 (11%) Dutch hospitals with a level of care distribution representative of all diabetic outpatients in the Netherlands. Among patients with known diabetes type, 41% had type 1 diabetes, 51% type 2 diabetes, and 8% had diabetes due to other causes. Characteristics of the total patient population were similar to patients with unknown diabetes classification. HbA1c levels decreased over the years, while BMI levels showed an increase over time. CONCLUSIONS The national DPARD registry aims to facilitate investigation of prevalence and long-term outcomes of Dutch outpatients with diabetes mellitus and their treatment, thus allowing for quality improvement of diabetes care as well as allowing for comparison of diabetes care on an international level.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Biomarkers/blood
- Blood Glucose/analysis
- Child
- Child, Preschool
- Diabetes Mellitus, Type 1/epidemiology
- Diabetes Mellitus, Type 1/metabolism
- Diabetes Mellitus, Type 1/pathology
- Diabetes Mellitus, Type 1/prevention & control
- Diabetes Mellitus, Type 2/epidemiology
- Diabetes Mellitus, Type 2/metabolism
- Diabetes Mellitus, Type 2/pathology
- Diabetes Mellitus, Type 2/prevention & control
- Female
- Follow-Up Studies
- Humans
- Hypoglycemic Agents/therapeutic use
- Male
- Middle Aged
- Netherlands/epidemiology
- Prognosis
- Registries/statistics & numerical data
- Young Adult
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Affiliation(s)
- Jessica C G Bak
- Department of Vascular Medicine, Amsterdam University Medical Centres, location AMC, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
- Dutch Institute for Clinical Auditing, Leiden, The Netherlands
| | - Dick Mul
- Diabeter, Centre for paediatric and adult diabetes care and research, Rotterdam, The Netherlands
| | - Erik H Serné
- Department of Vascular Medicine, Amsterdam University Medical Centres, location AMC, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Harold W de Valk
- Department of Internal Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Theo C J Sas
- Diabeter, Centre for paediatric and adult diabetes care and research, Rotterdam, The Netherlands
- Department of Pediatric Endocrinology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | - Mark H H Kramer
- Department of Vascular Medicine, Amsterdam University Medical Centres, location AMC, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Max Nieuwdorp
- Department of Vascular Medicine, Amsterdam University Medical Centres, location AMC, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Carianne L Verheugt
- Department of Vascular Medicine, Amsterdam University Medical Centres, location AMC, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
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Freitas PAC, Hernandez MK, Camargo JL. Factors associated with glycated albumin in adults without diabetes. Med Pharm Rep 2021; 94:170-175. [PMID: 34013187 PMCID: PMC8118215 DOI: 10.15386/mpr-1743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/14/2020] [Accepted: 08/30/2020] [Indexed: 11/23/2022] Open
Abstract
Background and aims Glycated albumin is a glycemic marker useful in short-term monitoring and in situations when a glycated hemoglobin test is not reliable. This study aims to evaluate glycated albumin levels and its associated factors in normoglycemic adults from Southern Brazil. Method 136 individuals, without diabetes or pre-diabetes, were included in this cross-sectional study. Levels of glycated albumin, glycated hemoglobin, and other biochemical markers were measured. Results Glycated albumin levels ranged from 11.1% to 17.5% (2.5th and 97.5th percentiles). Glycated albumin/glycated hemoglobin ratio was 2.8±0.2. Glycated albumin did not differ according to gender and age groups. However, in overweight individuals, levels of glycated albumin and glycated albumin/glycated hemoglobin ratio were lower and weakly and negatively correlated with body mass index. Conclusions Glycated albumin levels in Brazilians were similar to those previously described in other populations. Glycated albumin seems to be irrespective of gender or age, but weakly correlated with weight. These aspects should be taken into account in the interpretation of glycated albumin results.
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Affiliation(s)
| | - Mayana Kieling Hernandez
- Laboratory Diagnosis Department, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Joíza Lins Camargo
- Experimental Research Center and Endocrinology Department, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.,Diabetes and Metabolism Group, Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
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Elkhader J, Elemento O. Artificial intelligence in oncology: From bench to clinic. Semin Cancer Biol 2021; 84:113-128. [PMID: 33915289 DOI: 10.1016/j.semcancer.2021.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 03/22/2021] [Accepted: 04/15/2021] [Indexed: 02/07/2023]
Abstract
In the past few years, Artificial Intelligence (AI) techniques have been applied to almost every facet of oncology, from basic research to drug development and clinical care. In the clinical arena where AI has perhaps received the most attention, AI is showing promise in enhancing and automating image-based diagnostic approaches in fields such as radiology and pathology. Robust AI applications, which retain high performance and reproducibility over multiple datasets, extend from predicting indications for drug development to improving clinical decision support using electronic health record data. In this article, we review some of these advances. We also introduce common concepts and fundamentals of AI and its various uses, along with its caveats, to provide an overview of the opportunities and challenges in the field of oncology. Leveraging AI techniques productively to provide better care throughout a patient's medical journey can fuel the predictive promise of precision medicine.
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Affiliation(s)
- Jamal Elkhader
- HRH Prince Alwaleed Bin Talal Bin Abdulaziz Alsaud Institute for Computational Biomedicine, Dept. of Physiology and Biophysics, Weill Cornell Medicine, New York, NY 10021, USA; Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, 10021, USA; Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, NY, 10065, USA; Tri-Institutional Training Program in Computational Biology and Medicine, New York, NY, 10065, USA
| | - Olivier Elemento
- HRH Prince Alwaleed Bin Talal Bin Abdulaziz Alsaud Institute for Computational Biomedicine, Dept. of Physiology and Biophysics, Weill Cornell Medicine, New York, NY 10021, USA; Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, 10021, USA; Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, NY, 10065, USA; Tri-Institutional Training Program in Computational Biology and Medicine, New York, NY, 10065, USA.
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Ahuja V, Aronen P, Pramodkumar TA, Looker H, Chetrit A, Bloigu AH, Juutilainen A, Bianchi C, La Sala L, Anjana RM, Pradeepa R, Venkatesan U, Jebarani S, Baskar V, Fiorentino TV, Timpel P, DeFronzo RA, Ceriello A, Del Prato S, Abdul-Ghani M, Keinänen-Kiukaanniemi S, Dankner R, Bennett PH, Knowler WC, Schwarz P, Sesti G, Oka R, Mohan V, Groop L, Tuomilehto J, Ripatti S, Bergman M, Tuomi T. Accuracy of 1-Hour Plasma Glucose During the Oral Glucose Tolerance Test in Diagnosis of Type 2 Diabetes in Adults: A Meta-analysis. Diabetes Care 2021; 44:1062-1069. [PMID: 33741697 PMCID: PMC8578930 DOI: 10.2337/dc20-1688] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 01/11/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE One-hour plasma glucose (1-h PG) during the oral glucose tolerance test (OGTT) is an accurate predictor of type 2 diabetes. We performed a meta-analysis to determine the optimum cutoff of 1-h PG for detection of type 2 diabetes using 2-h PG as the gold standard. RESEARCH DESIGN AND METHODS We included 15 studies with 35,551 participants from multiple ethnic groups (53.8% Caucasian) and 2,705 newly detected cases of diabetes based on 2-h PG during OGTT. We excluded cases identified only by elevated fasting plasma glucose and/or HbA1c. We determined the optimal 1-h PG threshold and its accuracy at this cutoff for detection of diabetes (2-h PG ≥11.1 mmol/L) using a mixed linear effects regression model with different weights to sensitivity/specificity (2/3, 1/2, and 1/3). RESULTS Three cutoffs of 1-h PG, at 10.6 mmol/L, 11.6 mmol/L, and 12.5 mmol/L, had sensitivities of 0.95, 0.92, and 0.87 and specificities of 0.86, 0.91, and 0.94 at weights 2/3, 1/2, and 1/3, respectively. The cutoff of 11.6 mmol/L (95% CI 10.6, 12.6) had a sensitivity of 0.92 (0.87, 0.95), specificity of 0.91 (0.88, 0.93), area under the curve 0.939 (95% confidence region for sensitivity at a given specificity: 0.904, 0.946), and a positive predictive value of 45%. CONCLUSIONS The 1-h PG of ≥11.6 mmol/L during OGTT has a good sensitivity and specificity for detecting type 2 diabetes. Prescreening with a diabetes-specific risk calculator to identify high-risk individuals is suggested to decrease the proportion of false-positive cases. Studies including other ethnic groups and assessing complication risk are warranted.
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Affiliation(s)
- Vasudha Ahuja
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Pasi Aronen
- Biostatistics Unit, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - T A Pramodkumar
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialties Centre, ICMR Centre for Advanced Research on Diabetes and IDF Centre of Excellence in Diabetes, Chennai, India
| | - Helen Looker
- Phoenix Epidemiology and Clinical Research Branch, National Institute for Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | - Angela Chetrit
- Unit for Cardiovascular Epidemiology, Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan, Israel
| | - Aini H Bloigu
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Auni Juutilainen
- University of Eastern Finland, Kuopio University Hospital, Kuopio, Finland
| | - Cristina Bianchi
- Section of Diabetes and Metabolic Diseases, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Lucia La Sala
- Department of Cardiovascular and Dysmetabolic Diseases, IRCCS MultiMedica, Milan, Italy
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialties Centre, ICMR Centre for Advanced Research on Diabetes and IDF Centre of Excellence in Diabetes, Chennai, India
| | - Rajendra Pradeepa
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialties Centre, ICMR Centre for Advanced Research on Diabetes and IDF Centre of Excellence in Diabetes, Chennai, India
| | - Ulagamadesan Venkatesan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialties Centre, ICMR Centre for Advanced Research on Diabetes and IDF Centre of Excellence in Diabetes, Chennai, India
| | - Sarvanan Jebarani
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialties Centre, ICMR Centre for Advanced Research on Diabetes and IDF Centre of Excellence in Diabetes, Chennai, India
| | - Viswanathan Baskar
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialties Centre, ICMR Centre for Advanced Research on Diabetes and IDF Centre of Excellence in Diabetes, Chennai, India
| | - Teresa Vanessa Fiorentino
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Patrick Timpel
- Department of Medicine III, Technical University of Dresden, Dresden, Germany
| | - Ralph A DeFronzo
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Antonio Ceriello
- Department of Cardiovascular and Dysmetabolic Diseases, IRCCS MultiMedica, Milan, Italy
| | - Stefano Del Prato
- Section of Diabetes and Metabolic Diseases, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Muhammad Abdul-Ghani
- Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Sirkka Keinänen-Kiukaanniemi
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Healthcare and Social Services of Selänne, Pyhäjärvi, Finland
| | - Rachel Dankner
- Unit for Cardiovascular Epidemiology, Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan, Israel.,Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Peter H Bennett
- Phoenix Epidemiology and Clinical Research Branch, National Institute for Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | - William C Knowler
- Phoenix Epidemiology and Clinical Research Branch, National Institute for Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | - Peter Schwarz
- Department of Medicine III, Technical University of Dresden, Dresden, Germany.,Paul Langerhans Institute of the Helmholtz Zentrum München at the University Hospital Carl Gustav Carus and the Medical Faculty of TU Dresden (PLID), Dresden, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Rie Oka
- Department of Internal Medicine, Hokuriku Central Hospital, Toyama, Japan
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialties Centre, ICMR Centre for Advanced Research on Diabetes and IDF Centre of Excellence in Diabetes, Chennai, India
| | - Leif Groop
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland.,Lund University Diabetes Centre, Lund University, Malmö, Sweden
| | - Jaakko Tuomilehto
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland.,Saudi Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Samuli Ripatti
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland.,Department of Public Health, Clinicum, University of Helsinki, Helsinki, Finland.,Broad Institute of the Massachusetts Institute of Technology and Harvard University, Cambridge, MA
| | - Michael Bergman
- Division of Endocrinology and Metabolism, Department of Medicine and Department of Population Health, and NYU Langone Diabetes Prevention Program, NYU Grossman School of Medicine, New York, NY
| | - Tiinamaija Tuomi
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland.,Lund University Diabetes Centre, Lund University, Malmö, Sweden.,Abdominal Centre, Endocrinology, Helsinki University Hospital, and Folkhalsan Research Centre, Biomedicum, and Research Program Unit, Clinical and Molecular Medicine, University of Helsinki, Helsinki, Finland
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Khosla L, Bhat S, Fullington LA, Horlyck-Romanovsky MF. HbA 1c Performance in African Descent Populations in the United States With Normal Glucose Tolerance, Prediabetes, or Diabetes: A Scoping Review. Prev Chronic Dis 2021; 18:E22. [PMID: 33705304 PMCID: PMC7986971 DOI: 10.5888/pcd18.200365] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction African descent populations in the United States have high rates of type 2 diabetes and are incorrectly represented as a single group. Current glycated hemoglobin A1c (HbA1c) cutoffs (5.7% to <6.5% for prediabetes; ≥6.5% for type 2 diabetes) may perform suboptimally in evaluating glycemic status among African descent groups. We conducted a scoping review of US-based evidence documenting HbA1c performance to assess glycemic status among African American, Afro-Caribbean, and African people. Methods A PubMed, Scopus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) search (January 2020) yielded 3,238 articles published from January 2000 through January 2020. After review of titles, abstracts, and full texts, 12 met our criteria. HbA1c results were compared with other ethnic groups or validated against the oral glucose tolerance test (OGTT), fasting plasma glucose (FPG), or previous diagnosis. We classified study results by the risk of false positives and risk of false negatives in assessing glycemic status. Results In 5 studies of African American people, the HbA1c test increased risk of false positives compared with White populations, regardless of glycemic status. Three studies of African Americans found that HbA1c of 5.7% to less than 6.5% or HbA1c of 6.5% or higher generally increased risk of overdiagnosis compared with OGTT or previous diagnosis. In one study of Afro-Caribbean people, HbA1c of 6.5% or higher detected fewer type 2 diabetes cases because of a greater risk of false negatives. Compared with OGTT, HbA1c tests in 4 studies of Africans found that HbA1c of 5.7% to less than 6.5% or HbA1c of 6.5% or higher leads to underdiagnosis. Conclusion HbA1c criteria inadequately characterizes glycemic status among heterogeneous African descent populations. Research is needed to determine optimal HbA1c cutoffs or other test strategies that account for risk profiles unique to African American, Afro-Caribbean, and African people living in the United States.
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Affiliation(s)
- Lakshay Khosla
- Department of Health and Nutrition Sciences, Brooklyn College, City University of New York, Brooklyn, New York.,College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Sonali Bhat
- Department of Health and Nutrition Sciences, Brooklyn College, City University of New York, Brooklyn, New York.,College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Lee Ann Fullington
- Library Department, Brooklyn College, City University of New York, Brooklyn, New York
| | - Margrethe F Horlyck-Romanovsky
- Department of Health and Nutrition Sciences, Brooklyn College, City University of New York, Brooklyn, New York.,Center for Systems and Community Design, Graduate School of Public Health and Health Policy, City University of New York, New York, New York.,City University of New York, Brooklyn College, 2900 Bedford Ave, Brooklyn, NY 11210.
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42
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Trocmé C, Gonnet N, Di Tommaso M, Samouda H, Cracowski JL, Cracowski C, Lambert-Porcheron S, Laville M, Nobécourt E, Gaddhab C, Le Lay A, Bohn T, Poitou C, Clément K, Al-Mulla F, Bitar MS, Bottari SP. Serum IRAP, a Novel Direct Biomarker of Prediabetes and Type 2 Diabetes? Front Mol Biosci 2021; 7:596141. [PMID: 33665204 PMCID: PMC7921167 DOI: 10.3389/fmolb.2020.596141] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/23/2020] [Indexed: 01/03/2023] Open
Abstract
Insulin resistance (IR), currently called prediabetes (PD), affects more than half of the adult population worldwide. Type 2 diabetes (T2D), which often follows in the absence of treatment, affects more than 475 million people and represents 10–20% of the health budget in industrialized countries. A preventive public health policy is urgently needed in order to stop this constantly progressing epidemic. Indeed, early management of prediabetes does not only strongly reduce its evolution toward T2D but also strongly reduces the appearance of cardiovascular comorbidity as well as that of associated cancers. There is however currently no simple and reliable test available for the diagnosis or screening of prediabetes and it is generally estimated that 20–60% of diabetics are not diagnosed. We therefore developed an ELISA for the quantitative determination of serum Insulin-Regulated AminoPeptidase (IRAP). IRAP is associated with and translocated in a stoechiometric fashion to the plasma membrane together with GLUT4 in response to insulin in skeletal muscle and adipose tissue which are the two major glucose storage sites. Its extracellular domain (IRAPs) is subsequently cleaved and secreted in the blood stream. In T2D, IRAP translocation in response to insulin is strongly decreased. Our patented sandwich ELISA is highly sensitive (≥10.000-fold “normal” fasting concentrations) and specific, robust and very cost-effective. Dispersion of fasting plasma concentration values in a healthy population is very low (101.4 ± 15.9 μg/ml) as compared to those of insulin (21–181 pmol/l) and C-peptide (0.4–1.7 nmol/l). Results of pilot studies indicate a clear correlation between IRAPs levels and insulin sensitivity. We therefore think that plasma IRAPs may be a direct marker of insulin sensitivity and that the quantitative determination of its plasma levels should allow large-scale screening of populations at risk for PD and T2D, thereby allow the enforcement of a preventive health policy aiming at efficiently reducing this epidemic.
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Affiliation(s)
- Candice Trocmé
- Department of Biochemistry, Molecular Biology and Environmental Toxicology, Centre Hospitalier Grenoble-Alpes, La Tronche, France
| | - Nicolas Gonnet
- Centre d'Investigation Clinique, Centre Hospitalier Grenoble-Alpes, La Tronche, France
| | - Margaux Di Tommaso
- Population Health Department, Nutrition and Health Research Group, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Hanen Samouda
- Population Health Department, Nutrition and Health Research Group, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Jean-Luc Cracowski
- Centre d'Investigation Clinique, Centre Hospitalier Grenoble-Alpes, La Tronche, France.,Medical School, Université Grenoble Alpes, La Tronche, France.,INSERM U1042 Laboratoire Hypoxie et Physiopathologies cardiovasculaires et respiratoires (HP2), Grenoble, France
| | - Claire Cracowski
- Centre d'Investigation Clinique, Centre Hospitalier Grenoble-Alpes, La Tronche, France
| | | | - Martine Laville
- Centre de Recherche en Nutrition Humaine Rhône-Alpes, Pierre-Bénite, France.,CH Lyon Sud, Lyon, France.,INSERM U1060 Laboratoire de Recherche en Cardiovasculaire, Métabolisme, diabétologie et Nutrition, Oullins, France
| | - Estelle Nobécourt
- Department of Endocrinology, Metabolic Diseases and Nutrition, Centre Hospitalier Universitaire de La Réunion, Saint-Denis, France
| | - Chiraz Gaddhab
- Department of Pediatrics, Diabetes and Endocrinology Care, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Allan Le Lay
- CHU Grenoble-Alpes, Department of Biochemistry, Molecular Biology and Environmental Toxicology, Grenoble, France
| | - Torsten Bohn
- Population Health Department, Nutrition and Health Research Group, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Christine Poitou
- INSERM UMR-S 1269, NutriOmics, Paris, France.,Medical School, Sorbonne Universités, Paris, France
| | - Karine Clément
- INSERM UMR-S 1269, NutriOmics, Paris, France.,Medical School, Sorbonne Universités, Paris, France
| | - Fahd Al-Mulla
- Department of Genomics and Bioinformatics, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Milad S Bitar
- Department of Genomics and Bioinformatics, Dasman Diabetes Institute, Kuwait City, Kuwait.,Department of Pharmacology, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Serge P Bottari
- Population Health Department, Nutrition and Health Research Group, Luxembourg Institute of Health, Luxembourg, Luxembourg.,GREPI, UMR5525 Techniques de l'Ingénierie Médicale et de la Complexité Informatique, Mathématiques et Applications, Grenoble (TIMC-IMAG), La Tronche, France.,Faculté de Médecine, Université Grenoble Alpes, La Tronche, France.,Centre Hospitalier Grenoble-Alpes, La Tronche, France
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Pham Q, Gamble A, Hearn J, Cafazzo JA. The Need for Ethnoracial Equity in Artificial Intelligence for Diabetes Management: Review and Recommendations. J Med Internet Res 2021; 23:e22320. [PMID: 33565982 PMCID: PMC7904401 DOI: 10.2196/22320] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/02/2020] [Accepted: 01/16/2021] [Indexed: 12/13/2022] Open
Abstract
There is clear evidence to suggest that diabetes does not affect all populations equally. Among adults living with diabetes, those from ethnoracial minority communities—foreign-born, immigrant, refugee, and culturally marginalized—are at increased risk of poor health outcomes. Artificial intelligence (AI) is actively being researched as a means of improving diabetes management and care; however, several factors may predispose AI to ethnoracial bias. To better understand whether diabetes AI interventions are being designed in an ethnoracially equitable manner, we conducted a secondary analysis of 141 articles included in a 2018 review by Contreras and Vehi entitled “Artificial Intelligence for Diabetes Management and Decision Support: Literature Review.” Two members of our research team independently reviewed each article and selected those reporting ethnoracial data for further analysis. Only 10 articles (7.1%) were ultimately selected for secondary analysis in our case study. Of the 131 excluded articles, 118 (90.1%) failed to mention participants’ ethnic or racial backgrounds. The included articles reported ethnoracial data under various categories, including race (n=6), ethnicity (n=2), race/ethnicity (n=3), and percentage of Caucasian participants (n=1). Among articles specifically reporting race, the average distribution was 69.5% White, 17.1% Black, and 3.7% Asian. Only 2 articles reported inclusion of Native American participants. Given the clear ethnic and racial differences in diabetes biomarkers, prevalence, and outcomes, the inclusion of ethnoracial training data is likely to improve the accuracy of predictive models. Such considerations are imperative in AI-based tools, which are predisposed to negative biases due to their black-box nature and proneness to distributional shift. Based on our findings, we propose a short questionnaire to assess ethnoracial equity in research describing AI-based diabetes interventions. At this unprecedented time in history, AI can either mitigate or exacerbate disparities in health care. Future accounts of the infancy of diabetes AI must reflect our early and decisive action to confront ethnoracial inequities before they are coded into our systems and perpetuate the very biases we aim to eliminate. If we take deliberate and meaningful steps now toward training our algorithms to be ethnoracially inclusive, we can architect innovations in diabetes care that are bound by the diverse fabric of our society.
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Affiliation(s)
- Quynh Pham
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Anissa Gamble
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Jason Hearn
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada.,Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Joseph A Cafazzo
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
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Goyal A, Gupta Y, Kubihal S, Kalaivani M, Bhatla N, Tandon N. Utility of Screening Fasting Plasma Glucose and Glycated Hemoglobin to Circumvent the Need for Oral Glucose Tolerance Test in Women with Prior Gestational Diabetes. Adv Ther 2021; 38:1342-1351. [PMID: 33474706 PMCID: PMC7816830 DOI: 10.1007/s12325-020-01618-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 12/31/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Our aim is to propose an evidence-based strategy for screening postpartum dysglycemia. METHODS This study included adult non-pregnant women who were diagnosed with gestational diabetes (GDM) using International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria during their index pregnancy (2012-2019). Eligible participants underwent a concurrent oral glucose tolerance test (OGTT) and glycated hemoglobin (HbA1c) test. A detailed questionnaire documenting relevant personal and medical history was filled, and the relevant anthropometric parameters were recorded. RESULTS We evaluated data from 377 women at a mean (± SD) age of 32.1 ± 4.6 years and at a median duration of 15 (10-33) months following childbirth. Diabetes was diagnosed in 42 (11.1%) women. Use of a combination cutoff [fasting plasma glucose (FPG) ≥ 6.1 mmol/L or glycated hemoglobin (HbA1c) ≥ 6.0% (42 mmol/mol)] avoided OGTT in 80.9% of the study cohort, without missing the diagnosis of diabetes in any study subject. The diagnosis was missed in 2.4% of women with diabetes (and 0.3% of whole cohort) using only the FPG criterion (≥ 5.6 mmol/L) or HbA1c criterion [HbA1c ≥ 5.7% (39 mmol/mol)] alone. These tests avoided the need for an OGTT in 75.3% and 65.5% of women, respectively. CONCLUSIONS The proposed strategies are likely to be both patient- and physician-friendly and have the potential to address several barriers for postpartum screening among women with prior GDM.
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Affiliation(s)
- Alpesh Goyal
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Yashdeep Gupta
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India.
| | - Suraj Kubihal
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Mani Kalaivani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Neerja Bhatla
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
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AIM and Gender Aspects. Artif Intell Med 2021. [DOI: 10.1007/978-3-030-58080-3_244-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zhao Y, He L, Han C, Oldenburg B, Sum G, Haregu TN, Liu X. Urban-rural differences in the impacts of multiple chronic disease on functional limitations and work productivity among Chinese adults. Glob Health Action 2021; 14:1975921. [PMID: 34530701 PMCID: PMC8451617 DOI: 10.1080/16549716.2021.1975921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/28/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Chronic disease multimorbidity has become a major challenge for health systems. While a lot of research has evaluated the direct economic burden of multimorbidity on health care utilization and cost, little attention has been given to the impacts on work productivity and functional limitations, as indirect indicators of disease burden. OBJECTIVES This study aims to examine the prevalence of multimorbidity among Chinese adults and its impact on functional disability and work productivity. It also investigates urban-rural differences in these relationships. METHOD This study utilized the data from the China Health and Retirement Longitudinal Study (CHARLS) in 2015, including 11,176 participants aged 45 years and older. Multivariable logistic regression models were used to estimate the effect of multimorbidity on functional disability (i.e. ADL: activities of daily life; IADL: instrumental activities of daily life), and work productivity loss due to health problems. Negative binomial regression models were used to assess the association of multimorbidity with sickness absences from agricultural work and employed non-agricultural work. RESULTS 68.8% of total participants in CHARLS had multimorbidity in China in 2015. Rural residents with multimorbidity reported higher proportions of physical functions and days of sick leave than urban residents. Multimorbidity was positively associated with ADL limitation (odds ratio 1.924, 95% CI 1.656-2.236), IADL limitation (1.522, 1.326-1.748), limited work due to health problems (1.868, 1.601-2.178) and days of sick leave (for agricultural work, incidence rate ratio 1.676, 95% CI 1.390-2.020; for employed non-agricultural work, 2.418, 1.245-4.696). For the rural group, the impact of multimorbidity on functional limitations and work productivity loss (except for early retirement), was less than the urban group. CONCLUSIONS Multimorbidity poses significant challenges for functional health and work productivity These have significant negative economic consequences for individuals, the Chinese health system and the society.
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Affiliation(s)
- Yang Zhao
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Li He
- College of Physical Education and Sport, Beijing Normal University, Beijing, China
| | - Chunlei Han
- College of Public Health and Management, Binzhou Medical University, Yantai, Shandong 264003, China
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Brian Oldenburg
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Academic Research Collaboration in Health, Alfred Hospital, Melbourne, Victoria, Australia
| | - Grace Sum
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | - Xiaoyun Liu
- China Centre for Health Development Studies, Peking University, Beijing, China
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Kaur G, Lakshmi PVM, Rastogi A, Bhansali A, Jain S, Teerawattananon Y, Bano H, Prinja S. Diagnostic accuracy of tests for type 2 diabetes and prediabetes: A systematic review and meta-analysis. PLoS One 2020; 15:e0242415. [PMID: 33216783 PMCID: PMC7678987 DOI: 10.1371/journal.pone.0242415] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 11/02/2020] [Indexed: 12/16/2022] Open
Abstract
Aim This systematic review aimed to ascertain the diagnostic accuracy (sensitivity and specificity) of screening tests for early detection of type 2 diabetes and prediabetes in previously undiagnosed adults. Methods This systematic review included published studies that included one or more index tests (random and fasting tests, HbA1c) for glucose detection, with 75-gram Oral Glucose Tolerance Test (or 2-hour post load glucose) as a reference standard (PROSPERO ID CRD42018102477). Seven databases were searched electronically (from their inception up to March 9, 2020) accompanied with bibliographic and website searches. Records were manually screened and full text were selected based on inclusion and exclusion criteria. Subsequently, data extraction was done using standardized form and quality assessment of studies using QUADAS-2 tool. Meta-analysis was done using bivariate model using Stata 14.0. Optimal cut offs in terms of sensitivity and specificity for the tests were analysed using R software. Results Of 7,151 records assessed by title and abstract, a total of 37 peer reviewed articles were included in this systematic review. The pooled sensitivity, specificity, positive (LR+) and negative likelihood ratio (LR-) for diagnosing diabetes with HbA1c (6.5%; venous sample; n = 17 studies) were 50% (95% CI: 42–59%), 97.3% (95% CI: 95.3–98.4), 18.32 (95% CI: 11.06–30.53) and 0.51 (95% CI: 0.43–0.60), respectively. However, the optimal cut-off for diagnosing diabetes in previously undiagnosed adults with HbA1c was estimated as 6.03% with pooled sensitivity of 73.9% (95% CI: 68–79.1%) and specificity of 87.2% (95% CI: 82–91%). The optimal cut-off for Fasting Plasma Glucose (FPG) was estimated as 104 milligram/dL (mg/dL) with a sensitivity of 82.3% (95% CI: 74.6–88.1%) and specificity of 89.4% (95% CI: 85.2–92.5%). Conclusion Our findings suggest that at present recommended threshold of 6.5%, HbA1c is more specific and less sensitive in diagnosing the newly detected diabetes in undiagnosed population from community settings. Lowering of thresholds for HbA1c and FPG to 6.03% and 104 mg/dL for early detection in previously undiagnosed persons for screening purposes may be considered.
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Affiliation(s)
- Gunjeet Kaur
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - P. V. M. Lakshmi
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashu Rastogi
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anil Bhansali
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Jain
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Yot Teerawattananon
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Health Intervention Technology Assessment Program, Nonthaburi, Thailand
| | - Henna Bano
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- * E-mail:
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48
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Ryu R, Tran H, Bahjri K. Association of Sacubitril/Valsartan with Metabolic Parameters in Patients with Reduced Ejection Fraction Heart Failure at a Multidisciplinary Clinic. Metab Syndr Relat Disord 2020; 19:115-118. [PMID: 33155868 DOI: 10.1089/met.2020.0100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Sacubitril/valsartan was approved for New York Heart Association (NYHA) class II-IV heart failure with reduced ejection fraction (HFrEF) in 2015, based on the results of the PARADIGM-HF trial, which showed a reduction in cardiovascular (CV) death and heart failure hospitalization, compared with enalapril. A subsequent subgroup analysis of the trial showed glycemic improvement for patients on sacubitril/valsartan compared with those on enalapril. Methods: This was a retrospective observational study at the Loma Linda University (LLU) International Heart Institute (IHI). The aim was to evaluate the association of sacubitril/valsartan with glycemic index and other metabolic parameters, including change in hemoglobin A1C (HbA1C), blood pressure (BP), ejection fraction (EF), body weight, and lipid profile from baseline and at 3, 6, and 12 months. The rates of CV-related hospitalizations and total hospitalizations were also assessed. Results: The change in mean HbA1C from baseline was not significantly different at 1 year (P = 0.993). The mean EF was significantly higher and the mean diastolic BP was significantly lowered. Body weight and lipid parameters remained unchanged. Both the rates of CV-related hospitalizations and total hospitalizations were significantly lowered. For the prespecified subgroup analysis of diabetic HFrEF patients, the mean HbA1C was nonsignificant at 12 months (mean difference -0.48, P = 0.993). Conclusion: A non-significant reduction in HbA1C was associated in HFrEF patients with diabetes mellitus. Large randomized trials are needed to confirm our findings regarding the potential metabolic benefits of sacubitril/valsartan.
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Affiliation(s)
- Rachel Ryu
- Department of Pharmacy Practice and Administration, Western University College of Pharmacy, Pomona, California, USA
| | - Huyentran Tran
- Department of Pharmacy Practice, Loma Linda University School of Pharmacy, Loma Linda, California, USA
| | - Khaled Bahjri
- Department of Pharmaceutical and Administrative Sciences, Loma Linda University School of Pharmacy, Loma Linda, California, USA
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49
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Bergonsi de Farias C, Coelli S, Satler F, Brondani L, Zelmanovitz T, Silveiro SP. Glycated Hemoglobin and Blood Pressure Levels in Adults With Type 2 Diabetes: How Many Patients Are on Target? Can J Diabetes 2020; 45:334-340. [PMID: 33277195 DOI: 10.1016/j.jcjd.2020.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/29/2020] [Accepted: 10/02/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Achieving glycated hemoglobin (A1C) and blood pressure targets is an important strategy for preventing chronic vascular complications in diabetes. Our aim in this study was to determine the proportion of type 2 diabetes patients who meet the recommended A1C and arterial blood pressure targets and to identify the determinants of failure to do so. METHODS A cross-sectional study was conducted in an outpatient endocrine clinic at a university hospital. The A1C goal was 7% in general and 8% for patients with advanced chronic complications. Regarding blood pressure, the overall expected target was 140/90 mmHg. RESULTS A total of 602 type 2 diabetes patients were analyzed: 62% were female, 14% self-reported as black, mean age was 63±11 years, mean diabetes duration was 17±9 years and median A1C was 8.0% (interquartile range, 7.0% to 9.5%). Macrovascular disease was present in 33% of the patients, diabetic retinopathy in 47%, peripheral neuropathy in 43% and diabetic kidney disease in 56%. Regarding metabolic control, 403 (67%) patients were not at the adjusted target A1C level, and being female, black, young and an insulin user were the main determinants of poor glycemic control. Regarding blood pressure, 348 (58%) patients were not at the recommended targets, and a more advanced age was the main associated factor. CONCLUSIONS Because more than half of type 2 diabetes outpatients do not meet the recommended A1C and blood pressure target values, there is a major call to overcome the therapeutic inertia and target treatment of patients on an individual basis.
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Affiliation(s)
- Camila Bergonsi de Farias
- Programa de Pós-graduação em Ciências Médicas: Endocrinologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Sabrina Coelli
- Programa de Pós-graduação em Ciências Médicas: Endocrinologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Fabiola Satler
- Programa de Pós-graduação em Ciências Médicas: Endocrinologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Endocrine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Leticia Brondani
- Programa de Pós-graduação em Ciências Médicas: Endocrinologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Themis Zelmanovitz
- Programa de Pós-graduação em Ciências Médicas: Endocrinologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Endocrine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Sandra Pinho Silveiro
- Programa de Pós-graduação em Ciências Médicas: Endocrinologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Endocrine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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50
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Renz PB, Chume FC, Timm JRT, Pimentel AL, Camargo JL. Diagnostic accuracy of glycated hemoglobin for gestational diabetes mellitus: a systematic review and meta-analysis. Clin Chem Lab Med 2020; 57:1435-1449. [PMID: 30893053 DOI: 10.1515/cclm-2018-1191] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 01/19/2019] [Indexed: 11/15/2022]
Abstract
Background We conducted a systematic review and meta-analysis to establish the overall accuracy of glycated hemoglobin (HbA1c) in the diagnosis of gestational diabetes mellitus (GDM) diagnosis. Methods We searched MEDLINE, EMBASE, SCOPUS and ClinicalTrials.gov up to October 2018, using keywords related to GDM, HbA1c and diagnosis. Studies were included that were carried out with pregnant women without previous diabetes that assessed the performance of HbA1c (index test) compared to the 75 g oral glucose tolerance test (OGTT) (reference test) for the diagnosis of GDM, that measured HbA1c by standardized methods and presented data necessary for drawing 2 × 2 tables. Results This meta-analysis included eight studies, totaling 6406 pregnant women, of those 1044 had GDM. The diagnostic accuracy of HbA1c was reported at different thresholds ranging from 5.4% (36 mmol/mol) to 6.0% (42 mmol/mol), and the area under the curve (AUC) was 0.825 (95% confidence interval [CI] 0.751-0.899), indicating a good level of overall accuracy. The pooled sensitivities and specificities were 50.3% (95% CI 24.8%-75.7%) and 83.7% (67.5%-92.7%); 24.7% (10.3%-48.5%) and 95.5% (85.7%-98.7%); 10.8% (5.7%-19.41%) and 98.7% (96.2%-99.5%); 12.9% (5.5%-27.5%) and 98.7% (97.6%-99.3%), for the cut-offs of 5.4% (36 mmol/mol), 5.7% (39 mmol/mol), 5.8% (40 mmol/mol) and 6.0% (42 mmol/mol), respectively. Conclusions We observed a high heterogeneity among the studies. The effect of ethnicities, different criteria for OGTT interpretation and the individual performance of HbA1c methods may have contributed to this heterogeneity. The HbA1c test presents high specificity but low sensitivity regardless of the threshold used to diagnose GDM. These findings point to the usefulness of HbA1c as a rule-in test. HbA1c should be used in association with other standard diagnostic tests for GDM diagnosis.
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Affiliation(s)
- Paula B Renz
- Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Fernando C Chume
- Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Universidade Zambeze, Beira, Mozambique
| | - João R T Timm
- Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Ana L Pimentel
- Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Joíza L Camargo
- Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Experimental Research Centre and Endocrinology Division, Hospital de Clínicas de Porto Alegre. Rua Ramiro Barcelos, 2350; Prédio 12 - CPE, 4° andar. Porto Alegre, RS 90035-903, Brasil
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