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

Urinary excretion of RAS, BMP, and WNT pathway components in diabetic kidney disease.

Abstract The renin-angiotensin system (RAS), bone morphogenetic protein (BMP), and WNT pathways are involved in pathogenesis of diabetic kidney disease (DKD). This study characterized assays for urinary angiotensinogen (AGT), gremlin-1, and matrix metalloproteinase 7 (MMP-7), components of the RAS, BMP, and WNT pathways and examined their excretion in DKD. We measured urine AGT, gremlin-1, and MMP-7 in individuals with type 1 diabetes and prevalent DKD (n = 20) or longstanding (n = 61) or new-onset (n = 10) type 1 diabetes without DKD. These urine proteins were also quantified in type 2 DKD (n = 11) before and after treatment with candesartan. The utilized immunoassays had comparable inter- and intra-assay and intraindividual variation to assays used for urine albumin. Median (IQR) urine AGT concentrations were 226.0 (82.1, 550.3) and 13.0 (7.8, 20.0) μg/g creatinine in type 1 diabetes with and without DKD, respectively (P < 0.001). Median (IQR) urine gremlin-1 concentrations were 48.6 (14.2, 254.1) and 3.6 (1.7, 5.5) μg/g, respectively (P < 0.001). Median (IQR) urine MMP-7 concentrations were 6.0 (3.8, 10.5) and 1.0 (0.4, 2.9) μg/g creatinine, respectively (P < 0.001). Treatment with candesartan was associated with a reduction in median (IQR) urine AGT/creatinine from 23.5 (1.6, 105.1) to 2.0 (1.4, 13.7) μg/g, which did not reach statistical significance. Urine gremlin-1 and MMP-7 excretion did not decrease with candesartan. In conclusion, DKD is characterized by markedly elevated urine AGT, MMP-7, and gremlin-1. AGT decreased in response to RAS inhibition, suggesting that this marker reflects therapeutic response. Urinary components of the RAS, BMP, and WNT pathways may identify risk of DKD and aid development of novel therapeutics

Relationship Between Obesity and Diabetes in a US Adult Population: Findings from the National Health and Nutrition Examination Survey, 1999–2006

# The Author(s) 2010. This article is published with open access at Springerlink.com Background Obesity is one of the most important modifiable risk factors for the prevention of type 2 diabetes. The aim of this study was to examine the prevalence of diabetes with increasing severity of obesity and the distribution of HbA1c levels in diabetics participating in the latest National Health and Nutrition Examination Survey (NHANES). Methods Data from a representative sample of adults with diabetes participating in the NHANES between 1999 and 2006 were reviewed. The prevalence of diabetes and levels of fasting glucose, insulin, c-peptide, and HbA1c were examined across different weight classes with normal weight, overweight, and obesity classes 1, 2, and 3 were defined as body mass index (BMI) of <25.0, 25.0–29.9, 30.0–34.9, 35.0–39.9, and equal to 40.0, respectively. The distribution of HbA1c levels among adults with diabetes was also examined. Results There were 2,894 adults with diabetes (13.6%) among the 21,205 surveyed participants. Among the adults with diabetes, the mean age was 59 years, the mean fasting glucose was 155±2 mg/dl, and the mean HbA1c was 7.2%; 80.3 % of diabetics were considered overweight (BMI≥25) and 49.1 % of diabetics were considered obese (BMI≥30). Presented as a poster presentation at the American Society fo

Longitudinal evaluation of cognitive functioning in young children with type 1 diabetes over 18 months

OBJECTIVE: Decrements in cognitive function may already be evident in young children with type 1 diabetes (T1D). Here we report prospectively acquired cognitive results over 18 months in a large cohort of young children with and without T1D. METHODS: 144 children with T1D (mean HbA1c: 7.9%) and 70 age-matched healthy controls (mean age both groups 8.5 years; median diabetes duration 3.9 yrs; mean age of onset 4.1 yrs) underwent neuropsychological testing at baseline and after 18-months of follow-up. We hypothesized that group differences observed at baseline would be more pronounced after 18 months, particularly in those T1D patients with greatest exposure to glycemic extremes. RESULTS: Cognitive domain scores did not differ between groups at the 18 month testing session and did not change differently between groups over the follow-up period. However, within the T1D group, a history of diabetic ketoacidosis (DKA) was correlated with lower Verbal IQ and greater hyperglycemia exposure (HbA1c area under the curve) was inversely correlated to executive functions test performance. In addition, those with a history of both types of exposure performed most poorly on measures of executive function. CONCLUSIONS: The subtle cognitive differences between T1D children and nondiabetic controls observed at baseline were not observed 18 months later. Within the T1D group, as at baseline, relationships between cognition (VIQ and executive functions) and glycemic variables (chronic hyperglycemia and DKA history) were evident. Continued longitudinal study of this T1D cohort and their carefully matched healthy comparison group is planned

The Prediabetes Detection and Physical Activity Intervention Delivery (PRE-PAID) Project

Prediabetes is a prevalent condition which is a precursor to type 2 diabetes (T2D) and physical activity is known to counter T2D. Given the potential for alleviating health care expenditures through the prevention or delay of T2D, targeting individuals with prediabetes using physical activity intervention is a critical research question. The aim of this project was to; i) identify persons with prediabetes and thus at high risk for developing T2D, ii) engage individuals with prediabetes in community-based, culturally-preferred physical activity classes led by culturally-matched instructors with the goal of improving glycemic control and iii) investigate how two modes of laboratory-based aerobic exercise intervention (high intensity intervals versus continuous moderate intensity) impact glycemic control in persons with prediabetes. Participants were recruited in various ethnic communities known to have high prevalence rates of T2D. Critical blood biomarkers and measures of physical and physiological fitness were assessed at different time points to ascertain the effectiveness of both community-based physical activity classes and two modes of laboratory-based exercise. The results of this project show that the PRE-PAID risk questionnaire coupled with point-of-care testing of glycated hemoglobin (A1C) are an effective tool for identifying persons with prediabetes who are at high risk for T2D. Individuals, who participated in community-based culturally matched physical activity classes, experienced improved glycemic control evidenced by reductions in A1C after 3 and 6 months plus improvements in resting blood pressure, combined hand grip strength and aerobic fitness after 6 months. There were no differences between the laboratory-based aerobic exercise interventions of high intensity intervals vs. continuous moderate intensity for any of the measured outcomes. However, the participants who underwent both laboratory exercise modes experienced significant improvements in glycemic control, beta cell function, waist circumference and aerobic fitness following 3 months of supervised exercise. This research provides evidence for early detection of persons with prediabetes and strategies for improving glycemic control and physical plus physiological fitness in this population. The observed improvements could potentially help prevent or delay the onset of T2D

Type 1 Diabetes: Factors That Affect Youth/Parent Dyads’ Health Related Quality of Life and Youth Metabolic Control

ABSTRACT TYPE 1 DIABETES: FACTORS THAT AFFECT YOUTH/PARENT DYADS’ QUALITY OF LIFE AND YOUTH METABOLIC CONTROL by Joan Pennington Totka The University of Wisconsin-Milwaukee, 2016 Under the Supervision of Professor Julia Snethen Type 1 Diabetes (T1D) is one of the most psychologically and behaviorally demanding of all chronic illnesses for youth (preadolescents and adolescents) with T1D and their primary caregivers. T1D affects one out of every 400 to 600 youth, making it one of the most common chronic conditions in school-aged youth in the United States. Advances in technology and treatment continue; however, more than 80% of youth do not meet goals for metabolic control measured by glycosylated hemoglobin (A1c test result). A higher A1c increases the risks for blindness, nephropathy, neuropathy, amputations and heart disease. The purpose of this secondary analysis was to explore associations of the health-related quality of life (HRQOL) survey and subscales of youth/parent dyads and the A1c of youth with T1D. Additionally, the study examined associations between other individual, family, and diabetes specific factors such as age, gender, ethnicity, socioeconomic status (SES), and use of technology with both HRQOL and A1c of youth with T1D. Results of this study indicate that the youth with T1D’s A1c is predicted in part by the youth’s HRQOL and their ethnicity. Poor A1c was associated with lower HRQOL of youth with T1D. Analysis of preadolescents aged eight to twelve and adolescents aged thirteen to sixteen indicated that their A1c was predicted by different factors. The factor most significantly predictive of A1c of preadolescents was SES; however, the need to eliminate all diversity from this analysis due to the outlier status of non-white youth suggested particular vulnerability associated with ethnicity in that age group. The factors most predictive of A1c results in adolescents were two subscale scores; adolescent HRQOL Treatment 1 subscale and parent HRQOL Social Functioning subscale were predictive of A1c, which may have clinical implications. Tailored interventions based on developmental and individual needs may impact outcomes for youth with T1D and their parents

Adherence to the management of type i diabetes among Palestinian patients in Nablus city: a cross-sectional study

The purpose of this study is to investigate the adherence to the management of Type I Diabetes and to investigate factors associated with non-adherence among Palestinian Type 1 Diabetes patients. One hundred and twenty-six patients diagnosed with Type 1 Diabetes were enrolled in an observational cross-sectional study. Diabetes self-care adherence was measured using the Self Care Inventory (SCI). The patients were recruited from a diabetes clinic in Nablus city in Palestine. One-way ANOVA test and simple linear regressions were used in the statistical analysis. Participants age ranged from 3-43 years; 56% of them were females. The mean age at diagnosis for them was 10 years (+/-6.25). The mean glycosylated hemoglobin (A1C) was 9 +/-2.32. 66% of patients reported significant non-adherence to glucose testing, 89% reported non-adherence to diet recommendations, 79% reported non-adherence to exercise, and 21% reported non-adherence to administering insulin on time. Age (r = 0.29, P < 0.05), A1C (r = 0.21, P < 0.05), sex (P < 0.05), and patient educational level (P< 0.05) were significantly related to adherence score. Adherence to treatment among patients with Type 1 Diabetes is poor and is associated with age, sex, A1C, and patient educational level. Designed education programs should be implemented among patients with Type 1 Diabetes, which address the importance of adherence to the management of the diseases. More strategies should focus on monitoring the diet and insulin administration. © 2022, An-Najah National University. All rights reserved