Evaluation of Glycated Albumin (GA) and GA/Hba1c Ratio for Diagnosis of Diabetes and Glycemic Control: A Comprehensive Review

Diabetes Mellitus (DM) is a group of metabolic diseases characterized by chronic high blood glucose concentrations (hyperglycemia). When it is left untreated or improperly managed, it can lead to acute complications including diabetic ketoacidosis and non-ketotic hyperosmolar coma. In addition, possible long-term complications include impotence, nerve damage, stroke, chronic kidney failure, cardiovascular disease, foot ulcers, and retinopathy. Historically, universal methods to measure glycemic control for the diagnosis of diabetes included fasting plasma glucose level (FPG), 2-h plasma glucose (2HP), and random plasma glucose. However, these measurements did not provide information about glycemic control over a long period of time. To address this problem, there has been a switch in the past decade to diagnosing diabetes and its severity through measurement of blood glycated proteins such as Hemoglobin A1c (HbA1c) and glycated albumin (GA). Diagnosis and evaluation of diabetes using glycated proteins has many advantages including high accuracy of glycemic control over a period of time. Currently, common laboratory methods used to measure glycated proteins are high-performance liquid chromatography (HPLC), immunoassay, and electrophoresis. HbA1c is one of the most important diagnostic factors for diabetes. However, some reports indicate that HbA1c is not a suitable marker to determine glycemic control in all diabetic patients. GA, which is not influenced by changes in the lifespan of erythrocytes, is thought to be a good alternative indicator of glycemic control in diabetic patients. Here, we review the literature that has investigated the suitability of HbA1c, GA and GA:HbA1c as indicators of long-term glycemic control and demonstrate the importance of selecting the appropriate glycated protein based on the patient’s health status in order to provide useful and modern point-of-care monitoring and treatment

FAKTOR-FAKTOR INTERNAL DAN EKSTERNAL YANG MEMPENGARUHI KETIDAKBERHASILAN PENGENDALIAN STATUS GLIKEMIK PADA DM TIPE II (STUDI KASUS DI TPK YAKES TELKOM AREA JATENG DAN DIY)

MAGISTER EPIDEMIOLOGI KONSENTRASI EPIDEMIOLOGI KESEHATAN PROGRAM PASCA SARJANA UNIVERSITAS DIPONEGORO SEMARANG 2008 ABSTRAK LILY KRESNOWATI FAKTOR-FAKTOR INTERNAL DAN EKSTERNAL YANG MEMPENGARUHI KETIDAKBERHASILAN PENGENDALIAN STATUS GLIKEMIK PADA DM TIPE II (STUDI KASUS DI TPK YAKES TELKOM AREA JATENG DAN DIY) Latar Belakang : Pengendalian status glikemik pada diabetisi yang tidak adekuat sampai saat ini masih menjadi masalah kesehatan mayor di berbagai negara, bahkan Amerika (AS) sekalipun. Yang dimaksud dengan pengendalian status glikemik adalah kadar HbA1c berada dalam batas yang ditentukan oleh konsensus yang ada. Tujuan penelitian ini adalah untuk mengetahui faktor internal dan eksternal yang mempengaruhi ketidakberhasilan pengendalian status glikemik. Metode penelitian : Penelitian ini merupakan studi epidemiologi observasional analitik dengan desain kasus-kontrol. Kasus adalah pasien rawat jalan di TPK dan TPK Khusus yang telah didiagnosis dokter sebagai pasien DMT2 dengan hasil pemeriksaan HbA1c rata-rata 6 bulan terakhir, tergolong status glikemik tak terkendali (HbA1c > 8%). Adapun kontrol adalah penderita DMT2 dengan status glikemik terkendali (HbA1c < 8 %). Analisis data menggunakan program SPSS versi 15.0 meliputi analisis univariat, analisis bivariat dengan uji X2 (Chi-Square) dan X2 linier for trends, serta analisis multivariat dengan uji Multiple Logistic Regression metode Backward Conditional. Hasil Penelitian : Analisis multivariat menunjukkan faktor yang terbukti berpengaruh terhadap ketidakberhasilan pengendalian status glikemi, yaitu : Edukasi Dokter/Internist yang tidak adekuat (OR Adjusted = 8,35 ; 95% CI : 2,72 – 25,61), Sikap yang negatif (OR = 7,28 ; 95% CI : 2,01 – 26,32), Praktik yang tidak baik (OR = 4,55; 95% CI : 1,60– 12,93), dan Kebiasaan Olah Raga yang Tidak Baik (OR = 8,90; 95% CI : 3,17 – 24,99). Individu dengan faktor-faktor tersebut di atas memiliki probabilitas untuk tidak berhasil mengendalikan status glikemik sebesar 99,23 %. Adapun faktor-faktor yang tidak terbukti mempengaruhi ketidakberhasilan pengendalian status glikemik adalah Tingkat Pendidikan, Status Sosioekonomi, Edukasi Ahli Gizi, Pengetahuan, Pengaturan Diet, Obesitas, Pola Minum Obat dan Depresi. Kesimpulan : Edukasi Dokter/Internist yang tidak adekuat , Sikap yang negatif, Praktik yang tidak baik dan Kebiasaan Olah Raga yang tidak baik terbukti mempengaruhi ketidakberhasilan pengendalian status glikemik Kata Kunci : Studi Kasus-Kontrol, Status glikemik, Pengendalian Kepustakaan : 73 (1990-2008) PDF created with pdfFactory Pro trial version www.pdffactory.com MASTER’S DEGREE OF EPIDEMIOLOGY CONSENTRATION OF HEALTH EPIDEMIOLOGY POST GRADUATE PROGRAM OF DIPONEGORO UNIVERSITY SEMARANG 2008 ABSTRACT LILY KRESNOWATI INTERNAL AND EXTERNAL FACTORS THAT AFFECTING UNSUCCESFUL GLYCEMIC CONTROL IN TYPE II DM (CASE STUDY AT TPK YAKES TELKOM AREA JATENG & DIY) Background : Inadequacy of glycemic control in diabetes still becoming major health problems in many country, even in United States of America (US). Controlled glycemic status means that the level of HbA1c is within boundaries set by Consensus on Diabetes. This research is aimed to find out what are internal and external factors that affecting glycemic control in type II diabetes. Methods : This research is observational analytic epidemiological study using Case-Control design. Cases are outpatients in TPK and TPK Khusus which had been diagnosed as Type II diabetician with average HbA1c of the last 6 months classified as uncontrolled (HbA1c > 8%), and Controls are those with average HbA1c controlled (HbA1c < 8%). Datas are analyzed by SPSS Program version 15.0 including univariate analysis, bivariate analysis using X2 (Chi-Square test) and X2 linier for trends, and multivariate analysis using Multiple logistic regression with Backward conditional method. Results : Multivariate analysis shows that factors which proved to affect glycemic control are : Inadequate Education from Doctor/Internist (OR Adjusted = 8,35 ; 95% CI : 2,72 – 25,62), Negative Attitude (OR = 7,28; 95% CI : 2,02 – 26,31), Bad Practice (OR = 4,55; 95% CI: 1,60 – 12,93), and Inadequate Exercises (OR = 8,90; 95% CI : 3,17 – 24,99). Individual with those factors has probability to unsuccesful glycemic control up to 99,23%. Factors which are not proved to affect glycemic control are : Level of Education, Socioeconomic status, Education from Nutritionist, Knowledge, Dietetic Arrangements, Drug-taking Patterns, Obesity, and Depression. Conclusion : Factors that proved to affect unsuccessful glycemic control are : Inadequate Education from Doctor/Internist, Negative Attitude, Bad Practice, and Inadequate Exercises. Keywords : Case-Control, Glycemic status, Control Bibliography : 73 (1990 – 2008) PDF created with pdfFactory Pro trial version www.pdffactory.co

Association Between Blood Pressure and Adverse Renal Events in Type 1 Diabetes.

ObjectiveTo compare different blood pressure (BP) levels in their association with the risk of renal outcomes in type 1 diabetes and to determine whether an intensive glycemic control strategy modifies this association.Research design and methodsWe included 1,441 participants with type 1 diabetes between the ages of 13 and 39 years who had previously been randomized to receive intensive versus conventional glycemic control in the Diabetes Control and Complications Trial (DCCT). The exposures of interest were time-updated systolic BP (SBP) and diastolic BP (DBP) categories. Outcomes included macroalbuminuria (&gt;300 mg/24 h) or stage III chronic kidney disease (CKD) (sustained estimated glomerular filtration rate &lt;60 mL/min/1.73 m2).ResultsDuring a median follow-up time of 24 years, there were 84 cases of stage III CKD and 169 cases of macroalbuminuria. In adjusted models, SBP in the &lt;120 mmHg range was associated with a 0.59 times higher risk of macroalbuminuria (95% CI 0.37-0.95) and a 0.32 times higher risk of stage III CKD (95% CI 0.14-0.75) compared with SBPs between 130 and 140 mmHg. DBP in the &lt;70 mmHg range were associated with a 0.73 times higher risk of macroalbuminuria (95% CI 0.44-1.18) and a 0.47 times higher risk of stage III CKD (95% CI 0.21-1.05) compared with DBPs between 80 and 90 mmHg. No interaction was noted between BP and prior DCCT-assigned glycemic control strategy (all P &gt; 0.05).ConclusionsA lower BP (&lt;120/70 mmHg) was associated with a substantially lower risk of adverse renal outcomes, regardless of the prior assigned glycemic control strategy. Interventional trials may be useful to help determine whether the currently recommended BP target of 140/90 mmHg may be too high for optimal renal protection in type 1 diabetes

Trust and glycemic control in black patients with diabetic retinopathy: A pilot study

Diabetic retinopathy (DR) is more prevalent in blacks than whites because, compared to whites, blacks on average have worse glycemic control. Both of these racial disparities reflect differences in sociocultural determinants of health, including physician mistrust. This randomized, controlled 6-month pilot trial compared the efficacy of a culturally tailored behavioral health/ophthalmologic intervention called Collaborative Care for Depression and Diabetic Retinopathy (CC-DDR) to enhanced usual care (EUC) for improving glycemic control in black patients with DR (n = 33). The mean age of participants was 68 years (SD 6.1 years), 76% were women, and the mean A1C was 8.7% (SD 1.5%). At baseline, 14 participants (42%) expressed mistrust about ophthalmologic diagnoses. After 6 months, CC-DDR participants had a clinically meaningful decline in A1C of 0.6% (SD 2.1%), whereas EUC participants had an increase of 0.2% (SD 1.1%) (f [1, 28] = 1.9; P = 0.176). Within CC-DDR, participants with trust had a reduction in A1C (1.4% [SD 2.5%]), whereas participants with mistrust had an increase in A1C (0.44% [SD 0.7%]) (f [1, 11] = 2.11; P = 0.177). EUC participants with trust had a reduction in A1C (0.1% [SD 1.1%]), whereas those with mistrust had an increase in A1C (0.70% [SD 1.1%]) (f [1, 16] = 2.01; P = 0.172). Mistrust adversely affected glycemic control independent of treatment. This finding, coupled with the high rate of mistrust, highlights the need to target mistrust in new interventions to improve glycemic control in black patients with DR. © 2019 by the American Diabetes Association

Mobile Healthcare System for Preventive of Metabolic Syndrome

Recently, metabolic syndrome affects a great number of people in Japan. Glycemic control can delay the onset and slow the progression of vascular complications. Lifestyle modification including weight reduction can contribute significantly to glycemic control. This paper describes the mobile application of the healthcare support system for metabolic patients

In vitro determination of hemoglobin A1c for diabetes diagnosis and management: technology update

It is fascinating to consider the analytical improvements that have occurred since glycated hemoglobin was first used in routine clinical laboratories for diabetes monitoring around 1977; at that time methods displayed poor precision, there were no calibrators or material with assayed values for quality control purposes. This review outlines the major improvements in hemoglobin A1c (HbA1c) measurement that have occurred since its introduction, and reflects on the increased importance of this hemoglobin fraction in the monitoring of glycemic control. The use of HbA1c as a diagnostic tool is discussed in addition to its use in monitoring the patient with diabetes; the biochemistry of HbA1c formation is described, and how these changes to the hemoglobin molecule have been used to develop methods to measure this fraction. Standardization of HbA1c is described in detail; the development of the IFCC Reference Measurement Procedure for HbA1c has enabled global standardization to be achieved which has allowed global targets to be set for glycemic control and diagnosis. The importance of factors that may interfere in the measurement of HbA1c are highlighted

Effect of vitamin D3 supplement in glycemic control of pediatrics with type 1 diabetes mellitus and vitamin D deficiency

Background: Glycemic control prevents microvascular complications in patients with type I diabetes mellitus such as retinopathy, nephropathy and neuropathy that influences quality of life. Some studies show the immunomodulatory effect of vitamin D in synthesis and secretion of insulin. Aims: In this study we evaluate glycemic changes after vitamin D3 supplement in children with type I diabetes mellitus and vitamin D deficiency. Materials and Methods: In children with type I diabetes mellitus, level of vitamin D and HbA1C was measured. Patients with type I diabetes mellitus who had vitamin D deficiency (25OHD 9.9. This supplement transfer patients toward better glycemic control for the entire group (p-value < 0.0001). Conclusion: Vitamin D3 supplement improves HbA1C in pediatrics with type I diabetes mellitus and vitamin D deficiency. © 2015, Journal of Clinical and Diagnostic Research. All Rights Reserved

Hubungan Kontrol Gula Darah Dengan Kejadian Dermatofitosis Pada Pasien Dengan Riwayat Diabetes Melitus Di Rumah Sakit Umum Daerah Dr Moewardi Surakarta

BACKGROUND: Diabetes mellitus patients are highly susceptible to infections that can lead to morbidity and mortality. Diabetes mellitus with poor glycemic control, making dermatophyte infections more severe, recurrent, and difficult to cure, and can caused morbidity in the patients. The aim of this study was to determine the correlation of blood glucose control and frequency of dermatophytosis among diabetic patients. METHOD: This research used analytic observational research design with cross sectional approach. The subjects of this study were 64 who treated in Dermatovenereology Clinic Dr. Moewardi General Hospital of Surakarta and had diabetes mellitus history. RESULTS: The result show that there was 13 (44,8%) patients had poor glycemic control and 16 (55.2%) from group of dermatophytosis patients, while in the non dermatophytosis group 5 (14,3% ) patients had poor glycemic control. Statistically this difference was significant 0.007 (p <0.05), that means there is a correlation between glycemic control with dermatophytosis among diabetes mellitus patients in Dr. Moewardi General Hospital of Surakarta. CONCLUSION: This research suggest that there is a significant relation between glycemic control with dermatophytosis among diabetes mellitus patients in Dr. Moewardi General Hospital of Surakarta. Keywords: Dermatophytosis, Glycemic Control, Diabetes Mellitus

Pasta consumption and connected dietary habits: Associations with glucose control, adiposity measures, and cardiovascular risk factors in people with type 2 diabetes—TOSCA.IT study

Background: Pasta is a refined carbohydrate with a low glycemic index. Whether pasta shares the metabolic advantages of other low glycemic index foods has not really been investigated. The aim of this study is to document, in people with type-2 diabetes, the consumption of pasta, the connected dietary habits, and the association with glucose control, measures of adiposity, and major cardiovascular risk factors. Methods: We studied 2562 participants. The dietary habits were assessed with the European Prospective Investigation into Cancer and Nutrition (EPIC) questionnaire. Sex-specific quartiles of pasta consumption were created in order to explore the study aims. Results: A higher pasta consumption was associated with a lower intake of proteins, total and saturated fat, cholesterol, added sugar, and fiber. Glucose control, body mass index, prevalence of obesity, and visceral obesity were not significantly different across the quartiles of pasta intake. No relation was found with LDL cholesterol and triglycerides, but there was an inverse relation with HDL-cholesterol. Systolic blood pressure increased with pasta consumption; but this relation was not confirmed after correction for confounders. Conclusions: In people with type-2 diabetes, the consumption of pasta, within the limits recommended for total carbohydrates intake, is not associated with worsening of glucose control, measures of adiposity, and major cardiovascular risk factors