Association of HbA1c Values with Mortality and Cardiovascular Events in Diabetic Dialysis Patients. The INVOR Study and Review of the Literature

BACKGROUND: Improved glycemic control reduces complications in patients with diabetes mellitus (DM). However, it is discussed controversially whether patients with diabetes mellitus and end-stage renal disease benefit from strict glycemic control. METHODS: We followed 78 patients with DM initiating dialysis treatment of the region of Vorarlberg in a prospective cohort study applying a time-dependent Cox regression analysis using all measured laboratory values for up to more than seven years. This resulted in 880 HbA(1c) measurements (with one measurement every 3.16 patient months on average) during the entire observation period. Non-linear P-splines were used to allow flexible modeling of the association with mortality and cardiovascular disease (CVD) events. RESULTS: We observed a decreased mortality risk with increasing HbA(1c) values (HR = 0.72 per 1% increase, p = 0.024). Adjustment for age and sex and additional adjustment for other CVD risk factors only slightly attenuated the association (HR = 0.71, p = 0.044). A non-linear P-spline showed that the association did not follow a fully linear pattern with a highly significant non-linear component (p = 0.001) with an increased risk of all-cause mortality for HbA(1c) values up to 6-7%. Causes of death were associated with HbA(1c) values. The risk for CVD events, however, increased with increasing HbA(1c) values (HR = 1.24 per 1% increase, p = 0.048) but vanished after extended adjustments. CONCLUSIONS: This study considered the entire information collected on HbA(1c) over a period of more than seven years. Besides the methodological advantages our data indicate a significant inverse association between HbA(1c) levels and all-cause mortality. However, for CVD events no significant association could be found

Development of Fish ladder Gate Using Water Hydraulic System for Environment Conservation

Oil hydraulic system has long history and has been applying for various machines. But cleaner, hydraulic fluid is needed as are afraid that oil makes the natural condition dirty or fire when it leaks. We succeeded in improving the performance of water hydraulic servo control system compared with the performance of oil hydraulic servo control system. Our water hydraulic system based analyzing the advantage of the physical property of water for servo control. Furthermore, we can supply the simplest water servo control system consisting of minimum components which can cover wide dynamic performance range and can guarantee same application field as oil hydraulic systems. The important components are the wide dynamic ranged water hydraulic pump system and the high response, wide dynamic ranged water servo valve. The performance and durability of the system and components were experimented and verified. It is shown that this water hydraulic system can be applied for the fish ladder gate as the result of feasibility study for environment conservation

Correlates of low hemoglobin A1c in maintenance hemodialysis patients

PURPOSE: The optimal target for glycemic control has not been established for diabetic maintenance hemodialysis (MHD) patients. METHODS: A 6-year cohort (October 2001- December 2006) of 347 diabetic MHD patients with HbA1c data was examined for associations between HbA1c and mortality. Death hazard ratios (HR) were estimated using Cox regressions and cubic splines. RESULTS: In these 347 patients (age, 59 +/- 11 years; 49 % women; 28 % African Americans; and 55 % Hispanics), each 0.5 % decline in HbA1c below 6 % was associated with a 4.7 times higher death risk (HR = 4.7; 95 % CI 1.7-12.7) in the fully adjusted model. Factors associated with lower HbA1c levels (7 % showed a consistent trend toward elevated mortality risk (HR = 1.18; 95 % CI 0.99-1.41) after multivariate adjustment. CONCLUSIONS: In diabetic MHD patients with burnt-out diabetes, characterized by HbA1c <6 %, even lower HbA1c levels are associated with significantly higher death risk. Additional studies are needed to determine the optimal target for HbA1c levels in different subgroups of diabetic MHD patients