BACKGROUND Type 2 diabetes mellitus(T2DM),driven by insulin resistance and β cell dysfunction,necessitates reliable assessment of β cell function.C-peptide(CP)measurement,a stable marker of endogenous insulin secret...BACKGROUND Type 2 diabetes mellitus(T2DM),driven by insulin resistance and β cell dysfunction,necessitates reliable assessment of β cell function.C-peptide(CP)measurement,a stable marker of endogenous insulin secretion,is useful for this clinically as it avoids interference from exogenous insulin.While fasting CP(FCP)and postprandial CP(PCP),along with glucose-adjusted indices and ratios,such as FCP/fasting plasma glucose(FPG),2 hours postprandial CP(2hCP)/postprandial blood glucose(PBG)and CP ratio,are used,their comparative efficacy in reflectingβcell function remains unclear.Hemoglobin A1c(HbA1c),a key glycemic control indicator,theoretically linksβcell function to complications,but limited studies have explored the associations between diverse CP indices,HbA1c,and diabetic microvascular complications.AIM To investigate the relationships between different CP indices and HbA1c as well as diabetic microvascular complications in T2DM.METHODS T2DM patients admitted to Department of Endocrinology at Beijing Hospital between July 1,2021 and December 31,2021 were included in the study.Clinical and laboratory data were collected,including CP levels,glucose levels,HbA1c levels and diabetic microvascular complications.Statistical analysis was performed using Statistical Package for the Social Sciences 24.0.RESULTS A total of 453 patients were included in the final analysis.Adjusted by confounding factors,CP ratio and CP/blood glucose(BG)ratio were not relevant to HbA1c,but FCP,2hCP,delta CP,FCP/FPG,2hCP/PBG and delta CP/BG were still negatively correlated to HbA1c,of which 2hCP/PBG showed the strongest negative correlation(r=-0.485,P<0.001).Independent of HbA1c and other confounding factors,2hCP,2hCP/PBG,delta CP and delta CP/BG were protective factors of diabetic retinopathy while 2hCP,delta CP and FCP/FPG were protective factors of diabetic peripheral neuropathy.CONCLUSION This study indicates that higher levels of CP indices suggest better glucose control and a lower prevalence of diabetic microvascular complications,and PCP indices,particularly 2hCP/PBG,were more relevant to HbA1c and diabetic microvascular complications than FCP indices.These results suggest CP-related indices could be useful biomarkers for diabetes management,warranting further research.展开更多
Objective:This study aimed to determine the effect of a culture-specificbehavior modificationprogram on glycated hemoglobin(HbA1c)and blood pressure among adults with diabetes and hypertension.Methods:This study was a...Objective:This study aimed to determine the effect of a culture-specificbehavior modificationprogram on glycated hemoglobin(HbA1c)and blood pressure among adults with diabetes and hypertension.Methods:This study was a single-blind randomized controlled trial design.From January to May 2024,a total of 60 patients with uncontrolled type 2 diabetes and hypertension from the primary care unit of a hospital in northeastern(Isan)Thailand were recruited.The intervention group received the usual care supplemented by a culture-specificbehavior modificationprogramm implemented through interactive classes and online web application consisting of information,motivation,and behavioral skills(diet,exercise,and medication use),the control group received the usual care.HbA1c and blood pressure measurements were collected at both baseline and at 12 weeks.Results:A total of 51 patients completed the study,the intervention group(n=26)and control group(n=25),respectively.After 12 weeks,23.1%of patients in the intervention group could maintain their HbA1c<7.0%;those with poorly controlled HbA1c decreased from 7.7%at baseline to 3.8%at 12 weeks.After 12 weeks,69.2%of intervention group participants could maintain systolic blood pressure<130 mmHg and 53.8%could keep diastolic blood pressure<80 mmHg.Analysis revealed that HbA1c,systolic and diastolic blood pressure levels in the intervention group were lower than the control group after the intervention(P<0.05).There was a statistically significantdifference a linear combination of HbA1c and blood pressure(systolic and diastolic BP levels)between time and group(P<0.05).Conclusion:These results suggest that healthcare providers can incorporate elements of this program to manage blood glucose and blood pressure effectively.Future studies should consider a longitudinal design with a larger sample size and include outcomes of lipid levels to confirmlong-term motivation.展开更多
BACKGROUND Advanced gastric cancer is characterized by fast tumor growth and aggressive biological behavior.During neoadjuvant chemotherapy,patients are at risk of distant metastasis or local progression.Anemia is a f...BACKGROUND Advanced gastric cancer is characterized by fast tumor growth and aggressive biological behavior.During neoadjuvant chemotherapy,patients are at risk of distant metastasis or local progression.Anemia is a frequent complication in these patients.AIM To analyze whether changes in hemoglobin and hematocrit can predict the survival and efficacy of neoadjuvant chemotherapy in patients with advanced gastric cancer.METHODS The clinical data of 185 patients with advanced gastric cancer admitted to the Third Affiliated Hospital of Chengdu Medical College,Pidu District People’s Hospital,Chengdu,China,between January 2016 and January 2021,were retrospectively analyzed.All patients underwent a tegafur+oxaliplatin+apatinib chemotherapy regimen.According to the efficacy of chemotherapy,they were divided into an effective group(complete or partial response,n=121)and an ineffective group(stable disease or disease progression,n=64).The factors related to chemotherapy efficacy in patients with advanced gastric cancer were analyzed by univariate and logistic multivariate analyses.The 3-year survival rates of the patients with different hemoglobin and hematocrit levels were compared.RESULTS Univariate analysis showed that the proportion of patients with a tumor diameter>5 cm,non-tubular adenocarcinoma,lymph node metastasis,hematocrit<33%,low mean red blood cell(RBC)protein content,low RBC distribution width,hemoglobin<107 g/L,and platelets>266×109/L in the ineffective group were significantly higher than those in the effective group(P<0.05).Logistic multivariate analysis showed that a tumor diameter>5 cm,lymph node metastasis,≤3 chemotherapy cycles,hematocrit<33%,and hemoglobin<107 g/L are risk factors for neoadjuvant chemotherapy failure in advanced gastric cancer(P<0.05).The 1-year,2-year,and 3-year survival rates in the effective group were 93.39%,83.47%,and 60.33%,respectively.These rates were significantly higher than those in the ineffective group(P<0.05).The 1-year,2-year,and 3-year survival rates of patients with hematocrit<33%were 74.67%,49.33%,and 29.33%,respectively,which were significantly lower than those of patients with hematocrit≥33%(P<0.05).The 1-year,2-year,and 3-year survival rates of patients with hemoglobin<107 g/L were 80.39%,58.82%,and 39.22%,respectively,which were significantly lower than those of patients with hemoglobin≥107 g/L(P<0.05).CONCLUSION Hematocrit<33%and hemoglobin<107 g/L are risk factors for chemotherapy failure in patients with advanced gastric cancer.They are associated with poorer prognosis and reduced 3-year survival rates.展开更多
BACKGROUND Objective and accurate assessment of blood loss during pancreaticoduodenectomy(PD)is crucial for ensuring the safety and efficacy of the procedure.While the visual method remains the most common clinical me...BACKGROUND Objective and accurate assessment of blood loss during pancreaticoduodenectomy(PD)is crucial for ensuring the safety and efficacy of the procedure.While the visual method remains the most common clinical metric,many scholars argue that it significantly differs from actual blood loss and is inherently subjective.AIM To assess blood loss in PD via delta hemoglobin(ΔHb)and compare it with the visual method to predict bleeding-related risk factors.METHODS In this retrospective analysis,1722 patients who underwent PD from 2017 to 2022 at Shandong Provincial Hospital were divided into three groups:Open PD(OPD),laparoscopic PD(LPD),and conversion to OPD(CTOPD).IntraoperativeΔHb(IΔHb)was calculated via preoperative and 72-hour-postoperative hemoglobin concentrations,and its association with visually obtained estimated blood loss(EBL)was analyzed.PerioperativeΔHb(PΔHb)was calculated via preoperative and predischarge hemoglobin concentrations.We compared the differences in IΔHb and PΔHb among the three groups,and performed univariate and multi-variate regression analyses of IΔHb and PΔHb.RESULTS The preoperative general information of patients showed no statistically si-gnificant difference among the three groups(P>0.05).The IΔHb in the OPD,LPD,and CTOPD groups were 22.00(12.00,36.00),21.00(10.00,33.00),and 33.00(18.12,52.24)g/L,respectively;And the PΔHb in the OPD,LPD,and CTOPD groups were 25.87(13.51,42.00),25.00(14.00,45.00),and 37.48(21.64,59.65)g/L,respectively,values significantly differed(P<0.05).IΔHb and EBL were significantly correlated(r=0.337,P<0.001).The results of univariate and multivariate regression analyses indicated that American Society of Anesthesiologists(ASA)classification IV[95%confidence interval(CI):2.330-37.811,P=0.049]and preoperative total bilirubin>200μmol/L(95%CI:2.805-8.673,P<0.001)were independent risk factors for IΔHb(P<0.05),and ASA classification IV(95%CI:45.934-105.485,P<0.001),body mass index>24 kg/m2(95%CI:1.285-9.890,P=0.011),and preoperative total bilirubin>200μmol/L(95%CI:6.948-16.797,P<0.001)were independent risk factors for PΔHb(P<0.05).CONCLUSION There is a correlation between IΔHb and EBL in PD,so we can assess the patients’intraoperative blood loss by theΔHb method.ASA classification IV,body mass index>24 kg/m²,and preoperative total bilirubin>200μmol/L increased perioperative bleeding risk.展开更多
Bariatric surgery significantly improves glycemic control and can lead to type 2 diabetes remission.However,the reliability of glycated hemoglobin(HbA1c)as a type 2 diabetes biomarker post-surgery can be confounded by...Bariatric surgery significantly improves glycemic control and can lead to type 2 diabetes remission.However,the reliability of glycated hemoglobin(HbA1c)as a type 2 diabetes biomarker post-surgery can be confounded by conditions such as anemia and gastrointestinal complications.Hence,we explored the use of alter-native biomarkers such as glycated albumin(GA),1,5-anhydroglucitol(1,5-AG),and insulin-like growth factor binding protein-1(IGFBP-1)to monitor glycemic control more effectively in post-bariatric surgery patients.Measuring GA and 1,5-AG levels can detect glycemic variability more sensitively than HbA1c,especially under non-fasting conditions.GA shows promise for short-term monitoring post-surgery while 1,5-AG could be useful for real-time glucose monitoring.IGFBP-1 can be used to monitor metabolic improvement and to predict HbA1c normal-ization.However,challenges in assay standardization and cost remain significant barriers to their clinical adoption.Although these biomarkers could offer a more personalized approach to glucose monitoring(thereby addressing the limitations of utilizing HbA1c in this endeavor in post-bariatric surgery patients),this would require overcoming technical,logistical,and cost-related challenges.While using GA,1,5-AG,and IGFBP-1 shows promise for glycemic monitoring,further research and validation are crucial for their routine clinical implementation,espe-cially in the context of diabetes management post-bariatric surgery.展开更多
BACKGROUND Apolipoprotein E epsilon 4(APOE4)is recognized as a genetic risk factor for cognitive decline and neurodegeneration in both type 2 diabetes mellitus(T2DM)and Alzheimer’s disease,while glycated hemoglobin(H...BACKGROUND Apolipoprotein E epsilon 4(APOE4)is recognized as a genetic risk factor for cognitive decline and neurodegeneration in both type 2 diabetes mellitus(T2DM)and Alzheimer’s disease,while glycated hemoglobin(HbA1c)reflects persistent hyperglycemia and serves as a key indicator of long-term glycemic control in T2DM.Although both factors have been individually linked to neurobehavioral deficits,it remains uncertain whether HbA1c contributes to APOE4-related cognitive and olfactory impairment in individuals with T2DM.AIM To investigate the role of HbA1c in APOE4-associated cognitive and olfactory dysfunction in patients with T2DM.METHODS Of 636 T2DM patients were recruited from five medical centers in Wuhan,Hubei Province,China.APOE genotyping was evaluated by polymerase chain reaction using Gerard’s method.Cognitive and olfactory functions were assessed by mini-mental state examination and Connecticut chemosensory clinical research center test,respectively.Regression analysis was employed to assess the independent and interactive effects of HbA1c on APOE4-associated cognitive and olfactory function.RESULTS APOE4 was associated with increased risks of cognitive impairment[odds ratios(OR)=1.815,P=0.021]and olfactory dysfunction(OR=2.588,P<0.001).Higher HbA1c levels were also related to worse cognitive(OR=1.189,P<0.001)and olfactory performance(OR=1.149,P=0.011).HbA1c exerted a moderating effect,yet not a mediating effect,between APOE4 and its impacts on cognition and olfaction.Specifically,a higher level of HbA1c exacerbated the damaging effect of APOE4,as shown by significant interaction effects on both cognitive impairment(OR=2.687,P<0.001)and olfactory dysfunction(OR=1.440,P=0.027).CONCLUSION Elevated HbA1c levels are associated with increased risks of cognitive and olfactory impairments in patients with T2DM and may exacerbate the detrimental effects of APOE4.These findings underscore the need for early preventive strategies targeting individuals with both poor glycemic control and APOE4 carriage to mitigate neurodegenerative risk.展开更多
Dear Editor,The paper“Effects of a culture-specific behavior modification program on glycated hemoglobin and blood pressure among adults with diabetes and hypertension:A randomized controlled trial”[1]shows that an ...Dear Editor,The paper“Effects of a culture-specific behavior modification program on glycated hemoglobin and blood pressure among adults with diabetes and hypertension:A randomized controlled trial”[1]shows that an Information-Motivation-Behavioral Skills(IMB)-based,culturally tailored program combining dietary education,context-fit physical activity,and medication-adherence support via interactive classes and a mobile web app achieved significant 12-week reductions in HbA1c and blood pressure versus usual care.In practice,the cultural tailoring comprised Thai/Isan-specific diet guidance(the 6S-6O-1S limits on sugar[e.g.,“≤6 tsp sugar,≤6 tsp oil,≤1 tsp salt/day],oil/fat,and salt,alongside carbohydrate counting,glycemic index use,and label reading)and Soeng Isan dance to Mor Lam music for activity,while skills training covered correct medication use,individualized goal setting,and device-tracked self-monitoring reinforced by the app,nurses,and peers.展开更多
Background The relationship between glycated hemoglobin(HbA1c) and cognitive impairment in older adults with coronary heart disease(CHD) remains unclear.Methods The present study used a prospective cohort study design...Background The relationship between glycated hemoglobin(HbA1c) and cognitive impairment in older adults with coronary heart disease(CHD) remains unclear.Methods The present study used a prospective cohort study design and included 3244 participants aged ≥ 65 years in Beijing,China. The Mini-Mental State Examination(MMSE) and Montreal Cognitive Assessment(MoCA) were used to assess cognitive function. Serum HbA1c was detected at admission. All patients were divided into high HbA1c group(≥ 6.5 mmol/L) and low HbA1c group(< 6.5 mmol/L) based on their HbA1c levels. Logistic regression analyses were used to evaluate the association between HbA1c and cognitive impairment.Results In this study of 3244 participants, 1201(37.0%) patients were in high HbA1c group and 2045(63.0%) patients were in a state of cognitive impairment. Logistic regression analyses demonstrated that HbA1c was an independent risk factor for cognitive impairment regardless of whether the HbA1c was a continuous or categorical variable(OR = 1.27, 95% CI: 1.15–1.40, P < 0.001;OR = 1.79, 95% CI: 1.41–2.26, P ≤ 0.001, respectively). The restricted cubic spline curve exhibited that the relationship between the HbA1c and cognitive impairment was linear(p for non-linear = 0.323, P < 0.001).Conclusion Elevated levels of HbA1c were associated with an increased risk of cognitive impairment in older patients with CHD. These insights could be used to improve the accuracy and sensitivity of cognitive screening in these patient populations.展开更多
Background:Traditional Chinese exercises(TCEs)have a positive effect on glycemic control and hemoglobin A1 c(HbA1 c),but there is no consensus on the benefits of TCEs for patients with prediabetes.Objective:The object...Background:Traditional Chinese exercises(TCEs)have a positive effect on glycemic control and hemoglobin A1 c(HbA1 c),but there is no consensus on the benefits of TCEs for patients with prediabetes.Objective:The objective of this study was to systematically investigate the effects of TCEs on blood glucose control in patients with prediabetes.Search strategy:Comprehensive retrieval of randomized controlled trials(RCTs)was carried out using PubMed,Cochrane Library,Embase,China National Knowledge Infrastructure,VIP Database for Chinese Technical Periodicals,Wanfang Data Knowledge Service Platform,China Biology Medicine disc,Google Scholar and Baidu academic databases.The retrieval window ranged from the establishment of the database to December 2018,and references related to the included trials were searched without language restrictions.Inclusion criteria:The study included RCTs with a clinical diagnosis of prediabetes that was also treated with TCEs.Data extraction and analysis:Literature screening,data extraction and literature quality assessment were performed independently by two researchers.In the case of disagreement,a third party was invited to negotiate and make a decision.Standardized mean difference(SMD)was used to estimate the therapeutic effect.Meta-analysis was performed using Review Manager 5.3.5 and Stata 15.0.Heterogeneity was assessed using Q test and I2,and the source of heterogeneity was determined using Galbraith diagram and sensitivity analysis.A Q test resulting in P<0.1 and I2>50%indicated significant difference and random effect model analysis was performed.Otherwise,a fixed effect model was applied.Begg’s and Egger’s tests were used to assess publication bias.Results:Nine RCTs involving 485 participants were included in this study.The results showed that TCEs could reduce fasting blood glucose(FBG),2 h blood glucose(2 hPBG)and HbA1 c in patients with prediabetes.The treatment subgroup showed that an intervention of 6 months had better results,while the Gongfa subgroup showed that the TCE Baduanjin yielded better results.(1)FBG:SMD=à0.73,95%confidence interval(CI)[à0.97,à0.50],P<0.00001;Baduanjin:SMD=à0.83,95%CI[à1.13,à0.53],P<0.00001;6-month treatment:SMD=à0.73,95%CI[à1.20,à0.26],P=0.002.(2)2 hPBG:SMD=à0.75,95%CI[à0.94,à0.57],P<0.00001;Baduanjin:SMD=à0.62,95%CI[à0.91,à0.32],P<0.00001;6-month treatment:SMD=à0.91,95%CI[à1.39,à0.44],P=0.0002.(3)HbA1 c:SMD=à0.56,95%CI[à0.89,à0.23],P=0.00008;Baduanjin:SMD=à0.46,95%CI[à0.83,à0.08],P=0.02;6-month treatment:SMD=à0.77,95%CI[à1.24,à0.29],P=0.002.Conclusion:TCEs had positive effects in improving blood glucose levels in patients with prediabetes.Hence,TCEs may be of potential therapeutic value for patients with prediabetes,as an adjuvant therapy along with other treatments.Although the evidence suggests that the intervention is effective for6 months,the mechanism of TCEs on glycemic control,the minimum exercise dose and their safety remain to be further studied.展开更多
Objective To investigate the relationship between glycosylated hemoglobin A1 c （HbA1 c） and blood glucose levels of eight different points throughout the day in well-glycemic-controlled medical nutrition therapy （...Objective To investigate the relationship between glycosylated hemoglobin A1 c （HbA1 c） and blood glucose levels of eight different points throughout the day in well-glycemic-controlled medical nutrition therapy （MNT） alone type 2 diabetic pafients. Methods Data were collected as＂ capillary blood glucose value of eight different sample points among sixteen observing days in thirty MNT alone type 2 diabetic patients. The correlation between HbAI c and capillary blood glucose value was evaluated by Pearson＇s correlation method. Results The r-values between HbA1c and capillary blood glucose of 3：00, 6：00, and bedtime （22：00-23：00） were 0. 81,0. 79, and 0. 78, respectively（P 〈0. 001 ）. The best correlation was found between the mean value of 8- point blood glucose value throughout the day and HbA1c （ r=0. 84, P 〈0. 001 ）. Conclustion Fasting blood glucose and postabsorptive blood glucose have better correlations with HbAlc compared with other points in this group of well-glycemic-controlled MNT alone type 2 diabetic patients.展开更多
BACKGROUND:Hyperglycemia has been detected in many critically ill patients in the department of emergency medicine.But its mechanism and prognosis have not been well elucidated.In this study,we measured the serum leve...BACKGROUND:Hyperglycemia has been detected in many critically ill patients in the department of emergency medicine.But its mechanism and prognosis have not been well elucidated.In this study,we measured the serum level of glycated hemoglobin A1C(HbA1c) in critically ill patients to evaluate the effects of hyperglycemia on the prognosis of the patients.METHODS:A total of 826 critically ill patients,who had been treated at the Department of Emergency Medicine of Chaoyang Hospital during October 2006 and November 2007,were divided into a diabetes mellitus group(n=184) and a non-diabetes mellitus group(642) according to whether they had diabetes mellitus.Fasting glucose and HbA1 c were measured in all patients.Those in the diabetes mellitus group were further assigned to a drug therapy subgroup and a non-drug therapy subgroup;the serum level of HbA1 c and its relationship with short-term outcome were evaluated.RESULTS:Fasting glucose increased in 78.8% of the patients(88.6%in the diabetes mellitus group,and 75.9%in the non-diabetes mellitus group,P<0.05),and HbA1 c was elevated in 45.5% of the patients(78.3% in the diabetes mellitus group,and 36.1%in the non-diabetes mellitus group,P<0.01).Fasting glucose,HbA1 c and 28-day mortality were improved more significantly(P<0.01) in the drug therapy subgroup than in the non-drug therapy subgroup.The 28-day mortality was more significantly different in patients with fasting blood glucose >8.33 mmol/L than in those with fasting blood glucose <8.33 mmol/L.CONCLUSIONS:Hyperglycemia of critically ill patients could not totally attribute to stress response,especially in those who have no history of diabetes mellitus.Prognosis of hyperglycemia may vary among critically ill patients.展开更多
Background There were few studies to explore the relationship between hemoglobin Alc （HbAlc）and contrast-induced acute renal injury （CI-AKI）in patients with type 2 diabetes mellitus （T2DM）. Methods Two hundred s...Background There were few studies to explore the relationship between hemoglobin Alc （HbAlc）and contrast-induced acute renal injury （CI-AKI）in patients with type 2 diabetes mellitus （T2DM）. Methods Two hundred seventy-nine patients with T2DM undergonging elective cardiac catheterization from Dongguan Kanghua Hospital were recruited. Patients were classified into quartiles based on HbAlc （ 〈 6.30%, 6.30- 6.70%, 6.71-7.70, and 〉 7.70%）. Baseline data, CI-AKI incidence and in-hospital outcomes were compared between the groups. Logistic regression was used to assess the relationship between HbAlc and CI-AKI. Results CI-AKI occurred in 26 （9.3%）patients. CI-AKI incidences of HbAlc quartiles were 4.6 %（3/65）, 2.8%（2/71）, 12.3%（9/73） and 17.1%（12/70） （P = 0.003）, respectively. There were no significant differences in in-hospital death or required renal replacement therapy among the four groups. Univariate logistic analysis showed that HbAlc was related with CI-AKI （OR = 1.319, 95%CI： 1.078-1.615, P = 0.007）. Multivariate analysis found that after adjusting eGFR 〈 60 ml/min/1.73 m2, age 〉 70 years and anemia, I-IbAlc 〉17% was still a significant independent risk factor for CI-AKI in patients with T2DM. Conclusions HbAlc is significantly associated with CI-AKI. HbAlc ≥ 7% may increase the risk of CI-AKI in patients with T2DM undergoing elective cardiac catheterization.展开更多
Low levels (ng/g) of musk ketone (MK),used as a fragrance additive in the formulation of personal care products,are frequently detected in the water and other environment.Thus,aquatic organisms can be continuously exp...Low levels (ng/g) of musk ketone (MK),used as a fragrance additive in the formulation of personal care products,are frequently detected in the water and other environment.Thus,aquatic organisms can be continuously exposed to MK.In this study,kinetics and dose-response assessments of 2-amino-MK (AMK) metabolite,bound to cysteine-hemoglobin (Hb) in rainbow trout,formed by enzymatic nitro-reduction of MK have been demonstrated.Trout were exposed to a single exposure of 0.010,0.030,0.10,and 0.30 mg MK/g fish.Tw...展开更多
BACKGROUND Glycated hemoglobin(Hb)(HbA1c)is an indicator that is used to diagnose and monitor the treatment of diabetes.Many factors can affect the detection of HbA1c.One of the most important of these factors is the ...BACKGROUND Glycated hemoglobin(Hb)(HbA1c)is an indicator that is used to diagnose and monitor the treatment of diabetes.Many factors can affect the detection of HbA1c.One of the most important of these factors is the Hb variant.Here,we report a rare Hb variant and evaluate its effect on HbA1c.CASE SUMMARY A 35-year-old man was suspected of harboring an Hb variant following the measurement of HbA1c with the Variant II Turbo 2.0 Hb detection system during a routine examination.Subsequently,we used the Arkray HA-8160 and ARCHITECT c4000 system to reanalyze HbA1c.Finally,the Hb variant was detected with a Capillary2FP analyzer that operates on the principle of capillary electrophoresis.We also used gene sequencing to investigate the mutation site.The value of HbA1c detected with the Variant II Turbo 2.0 system was 52.7%.However,the Arkray HA-8160 system did not display a result while the ARCHITECT c16000 system showed a result of 5.4%.The Capillary2FP analyzer did not reveal any abnormal Hb zones.However,gene sequencing identified the presence of a mutation in the Hbβ2 chain[CD2(CAC>TAC),His>Tyr,HBB:c.7C>T];the genotype was Hb Fukuoka.CONCLUSION Hb variants could cause abnormal HbA1c results.For patients with Hb variants,different methods should be used to detect HbA1c.展开更多
BACKGROUND Glycated hemoglobin A1c(HbA1c)is considered the most suitable for diabetes mellitus diagnosis due to its accuracy and convenience.However,the effect of HbA1c on diabetic retinopathy(DR)in the Han and Korean...BACKGROUND Glycated hemoglobin A1c(HbA1c)is considered the most suitable for diabetes mellitus diagnosis due to its accuracy and convenience.However,the effect of HbA1c on diabetic retinopathy(DR)in the Han and Korean populations in Jilin,China,remains inconclusive.AIM To determine the best cut-off of HbA1c for diagnosing DR among the Chinese.METHODS This cross-sectional study included 1933 participants from the Yanbian area of Jilin Province,China.Trained investigators employed a questionnaire-based survey,physical examination,laboratory tests,and fundus photography for the investigation.The best cut-off value for HbA1c was established via the receiver operating characteristic curve.The factors associated with HbA1c-associated risk factors were determined via linear regression.RESULTS The analysis included 887 eligible Chinese Han and Korean participants,591 of whom were assigned randomly to the training set and 296 to the validation set.The prevalence of DR was 3.27% in the total population.HbA1c of 6.2% was the best cut-off value in the training set,while it was 5.9% in the validation set.In both Chinese Han and Korean populations,an HbA1c level of 6.2% was the best cut-off value.The optimal cut-off values of fasting blood glucose(FBG)≥7 mmol/L and<7 mmol/L were 8.1% and 6.2% respectively in Han populations,while those in Korean populations were 6.9%and 5.3%,respectively.Age,body mass index,and FBG were determined as the risk factors impacting HbA1c levels.CONCLUSION HbA1c may serve as a useful diagnostic indicator for DR.An HbA1c level of 6.2% may be an appropriate cut-off value for DR detection in the Chinese population.展开更多
Phenothiazine-coated silver electrode prepared by a simple reaction of phenothiazine with the metal is very stable and can make the reduction of hemoglobin possible.
The carcinogenic tobacco-specific nitrosamines N-nitrosonornicotine (NNN) and 4-(methylnitrosamino)-l-(3-pyridyl)-l-butanone (NNK) form hemoglobin adducts in laboratory animals and humans. These adducts release 4-hydr...The carcinogenic tobacco-specific nitrosamines N-nitrosonornicotine (NNN) and 4-(methylnitrosamino)-l-(3-pyridyl)-l-butanone (NNK) form hemoglobin adducts in laboratory animals and humans. These adducts release 4-hydroxy-l-(3-pyridyl)-l-butanone (HPB) upon mild base hydrolysis. HPB released from human hemoglobin can be quantified by gas chromatography-mass spectrometry. It is the only available biochemical marker for determination of exposure to, and metabolic activation of, carcinogens present only in tobacco. Levels of HPB were highest in snuff-dippers, followed by smokers and nonsmokers. Large interindividual variations in adduct levels were observed. The relationship between HPB levels in globin and DNA of rats treated with NNK has been investigated in order to aid in interpretation of the data from humans. These studies have provided the initial database for understanding the metabolic activation of tobacco-specific nitrosamines in humans.展开更多
Atherosclerosis is a major complication of diabetes, increasing the risk of cardiovascular related morbidities and mortalities. The hallmark of diabetes is hyperglycemia which duration is best predicted by elevated gl...Atherosclerosis is a major complication of diabetes, increasing the risk of cardiovascular related morbidities and mortalities. The hallmark of diabetes is hyperglycemia which duration is best predicted by elevated glycated haemoglobin A1C(Hb A1C) levels. Diabetic complications are usually attributed to oxidative stress associated with glycation of major structural and functional proteins. This non-enzymatic glycation of long lived proteins such as collagen, albumin, fibrinogen, liver enzymes and globulins result in the formation of early and advanced glycation end products(AGEs) associated with the production of myriads of free radicles and oxidants that have detrimental effects leading to diabetic complications. AGEs have been extensively discussed in the literature as etiological factors in the advancement of atherogenic events. Mechanisms described include the effects of glycation on protein structure and function that lead to defective receptor binding, impairment of immune system and enzyme function and alteration of basement membrane structural integrity. Hemoglobin(Hb) is a major circulating protein susceptible to glycation. Glycated Hb, namely Hb A1 C is used as a useful tool in the diagnosis of diabetes progression. Many studies have shown strong positive associations between elevated Hb A1 C levels and existing cardiovascular disease and major risk factors. Also, several studies presented Hb A1 C as an independent predictor of cardiovascular risk. In spite of extensive reports on positive associations, limited evidence is available considering the role of glycated Hb in the etiology of atherosclerosis. This editorial highlights potential mechanisms by which glycated hemoglobin may contribute, as a causative factor, to the progression of atherosclerosis in diabetics.展开更多
Two-third of the world's population lives in the Asia Pacific region where prevalence of diabetes has reached epidemic proportion.With China and India being the most populous nations on the globe,it is believed th...Two-third of the world's population lives in the Asia Pacific region where prevalence of diabetes has reached epidemic proportion.With China and India being the most populous nations on the globe,it is believed that over 150 million diabetes reside in the region with more than 95%being of type 2 diabetes mellitus(T2DM).Furthermore,other Pacific islands in the region have high rales of T2DM including Tonga.Fiji.French Polynesia,and Nauru.The latter has the highest prevalence of T2DM per population in the world.Over the past two decades,in Australia and New Zealand,the prevalence of T2DM has more than doubled,mainly amongst the Aboriginal and Torres Strait Islander and Maori peoples respectively.With the increasing prevalence of dialietes in the Asia Pacific region coupled with the limited number of resources,use of a reliable and effective mode of diagnosis for T3DVI is warranted.Yet to date,only New Zealand has adopted the American Diabetes Association recommendation of using hemoglobin A1C in the diagnosis of the disease.The aim of this review is to discuss the clinical usefulness of hemoglobin A1C and highlight its diagnostic role in the Asia Pacific region where T2DM is increasingly encountered.展开更多
AIM To determine whether successful treatment with direc-tacting antivirals(DAA) is associated with improvements in hemoglobin A1 c(HbA1 c) and if type 2 diabetes mellitus(T2 DM) or metabolic syndrome affects sustaine...AIM To determine whether successful treatment with direc-tacting antivirals(DAA) is associated with improvements in hemoglobin A1 c(HbA1 c) and if type 2 diabetes mellitus(T2 DM) or metabolic syndrome affects sustained virologic response(SVR).METHODS We performed a retrospective analysis of all hepatitis C virus(HCV) patients at the VA Greater Los Angeles Healthcare System treated with varying DAA therapy between 2014-2016. Separate multivariable logistic regression was performed to determine predictors of HbA1 c decrease ≥ 0.5 after DAA treatment and predictors of SVR 12-wk post treatment(SVR12).RESULTS A total of 1068 patients were treated with DAA therapy between 2014-2016. The presence of T2 DM or metabolic syndrome did not adversely affect SVR12. 106 patients had both HCV and T2 DM. Within that cohort,patients who achieved SVR12 had lower mean HbA1 c pre treatment(7.35 vs 8.60,P = 0.02),and lower mean HbA1 c post-treatment compared to non-responders(6.55 vs 8.61,P = 0.01). The mean reduction in HbA1 c after treatment was greater for those who achieved SVR12 than for non-responders(0.79 vs 0.01,P = 0.03). In adjusted models,patients that achieved SVR12 were more likely to have a HbA1 c decrease of ≥ 0.5 than those that did not achieve SVR12(adjusted OR = 7.24,95%CI: 1.22-42.94). CONCLUSION In HCV patients with T2 DM,successful treatment with DAA was associated with a significant reduction in HbA1 c suggesting that DAA may have a role in improving insulin sensitivity. Furthermore,the presence of T2 DM or metabolic syndrome does not adversely affect SVR12 rates in patients treated with DAA.展开更多
基金Supported by National High Level Hospital Clinical Research Funding,No.BJ-2022-145China Endocrinology and Metabolism Young Scientific Talent Research Project,No.2021-N-03.
文摘BACKGROUND Type 2 diabetes mellitus(T2DM),driven by insulin resistance and β cell dysfunction,necessitates reliable assessment of β cell function.C-peptide(CP)measurement,a stable marker of endogenous insulin secretion,is useful for this clinically as it avoids interference from exogenous insulin.While fasting CP(FCP)and postprandial CP(PCP),along with glucose-adjusted indices and ratios,such as FCP/fasting plasma glucose(FPG),2 hours postprandial CP(2hCP)/postprandial blood glucose(PBG)and CP ratio,are used,their comparative efficacy in reflectingβcell function remains unclear.Hemoglobin A1c(HbA1c),a key glycemic control indicator,theoretically linksβcell function to complications,but limited studies have explored the associations between diverse CP indices,HbA1c,and diabetic microvascular complications.AIM To investigate the relationships between different CP indices and HbA1c as well as diabetic microvascular complications in T2DM.METHODS T2DM patients admitted to Department of Endocrinology at Beijing Hospital between July 1,2021 and December 31,2021 were included in the study.Clinical and laboratory data were collected,including CP levels,glucose levels,HbA1c levels and diabetic microvascular complications.Statistical analysis was performed using Statistical Package for the Social Sciences 24.0.RESULTS A total of 453 patients were included in the final analysis.Adjusted by confounding factors,CP ratio and CP/blood glucose(BG)ratio were not relevant to HbA1c,but FCP,2hCP,delta CP,FCP/FPG,2hCP/PBG and delta CP/BG were still negatively correlated to HbA1c,of which 2hCP/PBG showed the strongest negative correlation(r=-0.485,P<0.001).Independent of HbA1c and other confounding factors,2hCP,2hCP/PBG,delta CP and delta CP/BG were protective factors of diabetic retinopathy while 2hCP,delta CP and FCP/FPG were protective factors of diabetic peripheral neuropathy.CONCLUSION This study indicates that higher levels of CP indices suggest better glucose control and a lower prevalence of diabetic microvascular complications,and PCP indices,particularly 2hCP/PBG,were more relevant to HbA1c and diabetic microvascular complications than FCP indices.These results suggest CP-related indices could be useful biomarkers for diabetes management,warranting further research.
基金supported by the 90th Anniversary of Chulalong-korn University Scholarship(Ratchadaphiseksomphot Endowment Fund)。
文摘Objective:This study aimed to determine the effect of a culture-specificbehavior modificationprogram on glycated hemoglobin(HbA1c)and blood pressure among adults with diabetes and hypertension.Methods:This study was a single-blind randomized controlled trial design.From January to May 2024,a total of 60 patients with uncontrolled type 2 diabetes and hypertension from the primary care unit of a hospital in northeastern(Isan)Thailand were recruited.The intervention group received the usual care supplemented by a culture-specificbehavior modificationprogramm implemented through interactive classes and online web application consisting of information,motivation,and behavioral skills(diet,exercise,and medication use),the control group received the usual care.HbA1c and blood pressure measurements were collected at both baseline and at 12 weeks.Results:A total of 51 patients completed the study,the intervention group(n=26)and control group(n=25),respectively.After 12 weeks,23.1%of patients in the intervention group could maintain their HbA1c<7.0%;those with poorly controlled HbA1c decreased from 7.7%at baseline to 3.8%at 12 weeks.After 12 weeks,69.2%of intervention group participants could maintain systolic blood pressure<130 mmHg and 53.8%could keep diastolic blood pressure<80 mmHg.Analysis revealed that HbA1c,systolic and diastolic blood pressure levels in the intervention group were lower than the control group after the intervention(P<0.05).There was a statistically significantdifference a linear combination of HbA1c and blood pressure(systolic and diastolic BP levels)between time and group(P<0.05).Conclusion:These results suggest that healthcare providers can incorporate elements of this program to manage blood glucose and blood pressure effectively.Future studies should consider a longitudinal design with a larger sample size and include outcomes of lipid levels to confirmlong-term motivation.
文摘BACKGROUND Advanced gastric cancer is characterized by fast tumor growth and aggressive biological behavior.During neoadjuvant chemotherapy,patients are at risk of distant metastasis or local progression.Anemia is a frequent complication in these patients.AIM To analyze whether changes in hemoglobin and hematocrit can predict the survival and efficacy of neoadjuvant chemotherapy in patients with advanced gastric cancer.METHODS The clinical data of 185 patients with advanced gastric cancer admitted to the Third Affiliated Hospital of Chengdu Medical College,Pidu District People’s Hospital,Chengdu,China,between January 2016 and January 2021,were retrospectively analyzed.All patients underwent a tegafur+oxaliplatin+apatinib chemotherapy regimen.According to the efficacy of chemotherapy,they were divided into an effective group(complete or partial response,n=121)and an ineffective group(stable disease or disease progression,n=64).The factors related to chemotherapy efficacy in patients with advanced gastric cancer were analyzed by univariate and logistic multivariate analyses.The 3-year survival rates of the patients with different hemoglobin and hematocrit levels were compared.RESULTS Univariate analysis showed that the proportion of patients with a tumor diameter>5 cm,non-tubular adenocarcinoma,lymph node metastasis,hematocrit<33%,low mean red blood cell(RBC)protein content,low RBC distribution width,hemoglobin<107 g/L,and platelets>266×109/L in the ineffective group were significantly higher than those in the effective group(P<0.05).Logistic multivariate analysis showed that a tumor diameter>5 cm,lymph node metastasis,≤3 chemotherapy cycles,hematocrit<33%,and hemoglobin<107 g/L are risk factors for neoadjuvant chemotherapy failure in advanced gastric cancer(P<0.05).The 1-year,2-year,and 3-year survival rates in the effective group were 93.39%,83.47%,and 60.33%,respectively.These rates were significantly higher than those in the ineffective group(P<0.05).The 1-year,2-year,and 3-year survival rates of patients with hematocrit<33%were 74.67%,49.33%,and 29.33%,respectively,which were significantly lower than those of patients with hematocrit≥33%(P<0.05).The 1-year,2-year,and 3-year survival rates of patients with hemoglobin<107 g/L were 80.39%,58.82%,and 39.22%,respectively,which were significantly lower than those of patients with hemoglobin≥107 g/L(P<0.05).CONCLUSION Hematocrit<33%and hemoglobin<107 g/L are risk factors for chemotherapy failure in patients with advanced gastric cancer.They are associated with poorer prognosis and reduced 3-year survival rates.
基金Supported by the Shandong Provincial Natural Science Foundation General Project,No.ZR2020MH248.
文摘BACKGROUND Objective and accurate assessment of blood loss during pancreaticoduodenectomy(PD)is crucial for ensuring the safety and efficacy of the procedure.While the visual method remains the most common clinical metric,many scholars argue that it significantly differs from actual blood loss and is inherently subjective.AIM To assess blood loss in PD via delta hemoglobin(ΔHb)and compare it with the visual method to predict bleeding-related risk factors.METHODS In this retrospective analysis,1722 patients who underwent PD from 2017 to 2022 at Shandong Provincial Hospital were divided into three groups:Open PD(OPD),laparoscopic PD(LPD),and conversion to OPD(CTOPD).IntraoperativeΔHb(IΔHb)was calculated via preoperative and 72-hour-postoperative hemoglobin concentrations,and its association with visually obtained estimated blood loss(EBL)was analyzed.PerioperativeΔHb(PΔHb)was calculated via preoperative and predischarge hemoglobin concentrations.We compared the differences in IΔHb and PΔHb among the three groups,and performed univariate and multi-variate regression analyses of IΔHb and PΔHb.RESULTS The preoperative general information of patients showed no statistically si-gnificant difference among the three groups(P>0.05).The IΔHb in the OPD,LPD,and CTOPD groups were 22.00(12.00,36.00),21.00(10.00,33.00),and 33.00(18.12,52.24)g/L,respectively;And the PΔHb in the OPD,LPD,and CTOPD groups were 25.87(13.51,42.00),25.00(14.00,45.00),and 37.48(21.64,59.65)g/L,respectively,values significantly differed(P<0.05).IΔHb and EBL were significantly correlated(r=0.337,P<0.001).The results of univariate and multivariate regression analyses indicated that American Society of Anesthesiologists(ASA)classification IV[95%confidence interval(CI):2.330-37.811,P=0.049]and preoperative total bilirubin>200μmol/L(95%CI:2.805-8.673,P<0.001)were independent risk factors for IΔHb(P<0.05),and ASA classification IV(95%CI:45.934-105.485,P<0.001),body mass index>24 kg/m2(95%CI:1.285-9.890,P=0.011),and preoperative total bilirubin>200μmol/L(95%CI:6.948-16.797,P<0.001)were independent risk factors for PΔHb(P<0.05).CONCLUSION There is a correlation between IΔHb and EBL in PD,so we can assess the patients’intraoperative blood loss by theΔHb method.ASA classification IV,body mass index>24 kg/m²,and preoperative total bilirubin>200μmol/L increased perioperative bleeding risk.
基金Supported by Basic Science Research Program through the National Research Foundation of Korea(NRF)funded by the Ministry of Education,No.NRF-RS 2023-00237287.
文摘Bariatric surgery significantly improves glycemic control and can lead to type 2 diabetes remission.However,the reliability of glycated hemoglobin(HbA1c)as a type 2 diabetes biomarker post-surgery can be confounded by conditions such as anemia and gastrointestinal complications.Hence,we explored the use of alter-native biomarkers such as glycated albumin(GA),1,5-anhydroglucitol(1,5-AG),and insulin-like growth factor binding protein-1(IGFBP-1)to monitor glycemic control more effectively in post-bariatric surgery patients.Measuring GA and 1,5-AG levels can detect glycemic variability more sensitively than HbA1c,especially under non-fasting conditions.GA shows promise for short-term monitoring post-surgery while 1,5-AG could be useful for real-time glucose monitoring.IGFBP-1 can be used to monitor metabolic improvement and to predict HbA1c normal-ization.However,challenges in assay standardization and cost remain significant barriers to their clinical adoption.Although these biomarkers could offer a more personalized approach to glucose monitoring(thereby addressing the limitations of utilizing HbA1c in this endeavor in post-bariatric surgery patients),this would require overcoming technical,logistical,and cost-related challenges.While using GA,1,5-AG,and IGFBP-1 shows promise for glycemic monitoring,further research and validation are crucial for their routine clinical implementation,espe-cially in the context of diabetes management post-bariatric surgery.
基金Supported by the China Postdoctoral Science Foundation General Program,No.2024M762504the Intramural Research Program of Liyuan Hospital,Tongji Medical College,Huazhong University of Science and Technology,No.2023 LYYYGZRP0004.
文摘BACKGROUND Apolipoprotein E epsilon 4(APOE4)is recognized as a genetic risk factor for cognitive decline and neurodegeneration in both type 2 diabetes mellitus(T2DM)and Alzheimer’s disease,while glycated hemoglobin(HbA1c)reflects persistent hyperglycemia and serves as a key indicator of long-term glycemic control in T2DM.Although both factors have been individually linked to neurobehavioral deficits,it remains uncertain whether HbA1c contributes to APOE4-related cognitive and olfactory impairment in individuals with T2DM.AIM To investigate the role of HbA1c in APOE4-associated cognitive and olfactory dysfunction in patients with T2DM.METHODS Of 636 T2DM patients were recruited from five medical centers in Wuhan,Hubei Province,China.APOE genotyping was evaluated by polymerase chain reaction using Gerard’s method.Cognitive and olfactory functions were assessed by mini-mental state examination and Connecticut chemosensory clinical research center test,respectively.Regression analysis was employed to assess the independent and interactive effects of HbA1c on APOE4-associated cognitive and olfactory function.RESULTS APOE4 was associated with increased risks of cognitive impairment[odds ratios(OR)=1.815,P=0.021]and olfactory dysfunction(OR=2.588,P<0.001).Higher HbA1c levels were also related to worse cognitive(OR=1.189,P<0.001)and olfactory performance(OR=1.149,P=0.011).HbA1c exerted a moderating effect,yet not a mediating effect,between APOE4 and its impacts on cognition and olfaction.Specifically,a higher level of HbA1c exacerbated the damaging effect of APOE4,as shown by significant interaction effects on both cognitive impairment(OR=2.687,P<0.001)and olfactory dysfunction(OR=1.440,P=0.027).CONCLUSION Elevated HbA1c levels are associated with increased risks of cognitive and olfactory impairments in patients with T2DM and may exacerbate the detrimental effects of APOE4.These findings underscore the need for early preventive strategies targeting individuals with both poor glycemic control and APOE4 carriage to mitigate neurodegenerative risk.
文摘Dear Editor,The paper“Effects of a culture-specific behavior modification program on glycated hemoglobin and blood pressure among adults with diabetes and hypertension:A randomized controlled trial”[1]shows that an Information-Motivation-Behavioral Skills(IMB)-based,culturally tailored program combining dietary education,context-fit physical activity,and medication-adherence support via interactive classes and a mobile web app achieved significant 12-week reductions in HbA1c and blood pressure versus usual care.In practice,the cultural tailoring comprised Thai/Isan-specific diet guidance(the 6S-6O-1S limits on sugar[e.g.,“≤6 tsp sugar,≤6 tsp oil,≤1 tsp salt/day],oil/fat,and salt,alongside carbohydrate counting,glycemic index use,and label reading)and Soeng Isan dance to Mor Lam music for activity,while skills training covered correct medication use,individualized goal setting,and device-tracked self-monitoring reinforced by the app,nurses,and peers.
基金funded by National Natural Science Foundation of China (grant numbers 82270258,82100260)National Key Research&Development Prog ram of China (grant number 2020YFC2004800)。
文摘Background The relationship between glycated hemoglobin(HbA1c) and cognitive impairment in older adults with coronary heart disease(CHD) remains unclear.Methods The present study used a prospective cohort study design and included 3244 participants aged ≥ 65 years in Beijing,China. The Mini-Mental State Examination(MMSE) and Montreal Cognitive Assessment(MoCA) were used to assess cognitive function. Serum HbA1c was detected at admission. All patients were divided into high HbA1c group(≥ 6.5 mmol/L) and low HbA1c group(< 6.5 mmol/L) based on their HbA1c levels. Logistic regression analyses were used to evaluate the association between HbA1c and cognitive impairment.Results In this study of 3244 participants, 1201(37.0%) patients were in high HbA1c group and 2045(63.0%) patients were in a state of cognitive impairment. Logistic regression analyses demonstrated that HbA1c was an independent risk factor for cognitive impairment regardless of whether the HbA1c was a continuous or categorical variable(OR = 1.27, 95% CI: 1.15–1.40, P < 0.001;OR = 1.79, 95% CI: 1.41–2.26, P ≤ 0.001, respectively). The restricted cubic spline curve exhibited that the relationship between the HbA1c and cognitive impairment was linear(p for non-linear = 0.323, P < 0.001).Conclusion Elevated levels of HbA1c were associated with an increased risk of cognitive impairment in older patients with CHD. These insights could be used to improve the accuracy and sensitivity of cognitive screening in these patient populations.
基金Major Natural Science Project of Anhui Province Universities(No.KJ2018ZD029)National Clinical Key Specialist(Chinese Medicine Nursing)Open Foundation Project(No.2017zkkfzd001)。
文摘Background:Traditional Chinese exercises(TCEs)have a positive effect on glycemic control and hemoglobin A1 c(HbA1 c),but there is no consensus on the benefits of TCEs for patients with prediabetes.Objective:The objective of this study was to systematically investigate the effects of TCEs on blood glucose control in patients with prediabetes.Search strategy:Comprehensive retrieval of randomized controlled trials(RCTs)was carried out using PubMed,Cochrane Library,Embase,China National Knowledge Infrastructure,VIP Database for Chinese Technical Periodicals,Wanfang Data Knowledge Service Platform,China Biology Medicine disc,Google Scholar and Baidu academic databases.The retrieval window ranged from the establishment of the database to December 2018,and references related to the included trials were searched without language restrictions.Inclusion criteria:The study included RCTs with a clinical diagnosis of prediabetes that was also treated with TCEs.Data extraction and analysis:Literature screening,data extraction and literature quality assessment were performed independently by two researchers.In the case of disagreement,a third party was invited to negotiate and make a decision.Standardized mean difference(SMD)was used to estimate the therapeutic effect.Meta-analysis was performed using Review Manager 5.3.5 and Stata 15.0.Heterogeneity was assessed using Q test and I2,and the source of heterogeneity was determined using Galbraith diagram and sensitivity analysis.A Q test resulting in P<0.1 and I2>50%indicated significant difference and random effect model analysis was performed.Otherwise,a fixed effect model was applied.Begg’s and Egger’s tests were used to assess publication bias.Results:Nine RCTs involving 485 participants were included in this study.The results showed that TCEs could reduce fasting blood glucose(FBG),2 h blood glucose(2 hPBG)and HbA1 c in patients with prediabetes.The treatment subgroup showed that an intervention of 6 months had better results,while the Gongfa subgroup showed that the TCE Baduanjin yielded better results.(1)FBG:SMD=à0.73,95%confidence interval(CI)[à0.97,à0.50],P<0.00001;Baduanjin:SMD=à0.83,95%CI[à1.13,à0.53],P<0.00001;6-month treatment:SMD=à0.73,95%CI[à1.20,à0.26],P=0.002.(2)2 hPBG:SMD=à0.75,95%CI[à0.94,à0.57],P<0.00001;Baduanjin:SMD=à0.62,95%CI[à0.91,à0.32],P<0.00001;6-month treatment:SMD=à0.91,95%CI[à1.39,à0.44],P=0.0002.(3)HbA1 c:SMD=à0.56,95%CI[à0.89,à0.23],P=0.00008;Baduanjin:SMD=à0.46,95%CI[à0.83,à0.08],P=0.02;6-month treatment:SMD=à0.77,95%CI[à1.24,à0.29],P=0.002.Conclusion:TCEs had positive effects in improving blood glucose levels in patients with prediabetes.Hence,TCEs may be of potential therapeutic value for patients with prediabetes,as an adjuvant therapy along with other treatments.Although the evidence suggests that the intervention is effective for6 months,the mechanism of TCEs on glycemic control,the minimum exercise dose and their safety remain to be further studied.
文摘Objective To investigate the relationship between glycosylated hemoglobin A1 c （HbA1 c） and blood glucose levels of eight different points throughout the day in well-glycemic-controlled medical nutrition therapy （MNT） alone type 2 diabetic pafients. Methods Data were collected as＂ capillary blood glucose value of eight different sample points among sixteen observing days in thirty MNT alone type 2 diabetic patients. The correlation between HbAI c and capillary blood glucose value was evaluated by Pearson＇s correlation method. Results The r-values between HbA1c and capillary blood glucose of 3：00, 6：00, and bedtime （22：00-23：00） were 0. 81,0. 79, and 0. 78, respectively（P 〈0. 001 ）. The best correlation was found between the mean value of 8- point blood glucose value throughout the day and HbA1c （ r=0. 84, P 〈0. 001 ）. Conclustion Fasting blood glucose and postabsorptive blood glucose have better correlations with HbAlc compared with other points in this group of well-glycemic-controlled MNT alone type 2 diabetic patients.
文摘BACKGROUND:Hyperglycemia has been detected in many critically ill patients in the department of emergency medicine.But its mechanism and prognosis have not been well elucidated.In this study,we measured the serum level of glycated hemoglobin A1C(HbA1c) in critically ill patients to evaluate the effects of hyperglycemia on the prognosis of the patients.METHODS:A total of 826 critically ill patients,who had been treated at the Department of Emergency Medicine of Chaoyang Hospital during October 2006 and November 2007,were divided into a diabetes mellitus group(n=184) and a non-diabetes mellitus group(642) according to whether they had diabetes mellitus.Fasting glucose and HbA1 c were measured in all patients.Those in the diabetes mellitus group were further assigned to a drug therapy subgroup and a non-drug therapy subgroup;the serum level of HbA1 c and its relationship with short-term outcome were evaluated.RESULTS:Fasting glucose increased in 78.8% of the patients(88.6%in the diabetes mellitus group,and 75.9%in the non-diabetes mellitus group,P<0.05),and HbA1 c was elevated in 45.5% of the patients(78.3% in the diabetes mellitus group,and 36.1%in the non-diabetes mellitus group,P<0.01).Fasting glucose,HbA1 c and 28-day mortality were improved more significantly(P<0.01) in the drug therapy subgroup than in the non-drug therapy subgroup.The 28-day mortality was more significantly different in patients with fasting blood glucose >8.33 mmol/L than in those with fasting blood glucose <8.33 mmol/L.CONCLUSIONS:Hyperglycemia of critically ill patients could not totally attribute to stress response,especially in those who have no history of diabetes mellitus.Prognosis of hyperglycemia may vary among critically ill patients.
文摘Background There were few studies to explore the relationship between hemoglobin Alc （HbAlc）and contrast-induced acute renal injury （CI-AKI）in patients with type 2 diabetes mellitus （T2DM）. Methods Two hundred seventy-nine patients with T2DM undergonging elective cardiac catheterization from Dongguan Kanghua Hospital were recruited. Patients were classified into quartiles based on HbAlc （ 〈 6.30%, 6.30- 6.70%, 6.71-7.70, and 〉 7.70%）. Baseline data, CI-AKI incidence and in-hospital outcomes were compared between the groups. Logistic regression was used to assess the relationship between HbAlc and CI-AKI. Results CI-AKI occurred in 26 （9.3%）patients. CI-AKI incidences of HbAlc quartiles were 4.6 %（3/65）, 2.8%（2/71）, 12.3%（9/73） and 17.1%（12/70） （P = 0.003）, respectively. There were no significant differences in in-hospital death or required renal replacement therapy among the four groups. Univariate logistic analysis showed that HbAlc was related with CI-AKI （OR = 1.319, 95%CI： 1.078-1.615, P = 0.007）. Multivariate analysis found that after adjusting eGFR 〈 60 ml/min/1.73 m2, age 〉 70 years and anemia, I-IbAlc 〉17% was still a significant independent risk factor for CI-AKI in patients with T2DM. Conclusions HbAlc is significantly associated with CI-AKI. HbAlc ≥ 7% may increase the risk of CI-AKI in patients with T2DM undergoing elective cardiac catheterization.
文摘Low levels (ng/g) of musk ketone (MK),used as a fragrance additive in the formulation of personal care products,are frequently detected in the water and other environment.Thus,aquatic organisms can be continuously exposed to MK.In this study,kinetics and dose-response assessments of 2-amino-MK (AMK) metabolite,bound to cysteine-hemoglobin (Hb) in rainbow trout,formed by enzymatic nitro-reduction of MK have been demonstrated.Trout were exposed to a single exposure of 0.010,0.030,0.10,and 0.30 mg MK/g fish.Tw...
文摘BACKGROUND Glycated hemoglobin(Hb)(HbA1c)is an indicator that is used to diagnose and monitor the treatment of diabetes.Many factors can affect the detection of HbA1c.One of the most important of these factors is the Hb variant.Here,we report a rare Hb variant and evaluate its effect on HbA1c.CASE SUMMARY A 35-year-old man was suspected of harboring an Hb variant following the measurement of HbA1c with the Variant II Turbo 2.0 Hb detection system during a routine examination.Subsequently,we used the Arkray HA-8160 and ARCHITECT c4000 system to reanalyze HbA1c.Finally,the Hb variant was detected with a Capillary2FP analyzer that operates on the principle of capillary electrophoresis.We also used gene sequencing to investigate the mutation site.The value of HbA1c detected with the Variant II Turbo 2.0 system was 52.7%.However,the Arkray HA-8160 system did not display a result while the ARCHITECT c16000 system showed a result of 5.4%.The Capillary2FP analyzer did not reveal any abnormal Hb zones.However,gene sequencing identified the presence of a mutation in the Hbβ2 chain[CD2(CAC>TAC),His>Tyr,HBB:c.7C>T];the genotype was Hb Fukuoka.CONCLUSION Hb variants could cause abnormal HbA1c results.For patients with Hb variants,different methods should be used to detect HbA1c.
基金Supported by National Key R&D Program of China,No.2016YFC1305700.
文摘BACKGROUND Glycated hemoglobin A1c(HbA1c)is considered the most suitable for diabetes mellitus diagnosis due to its accuracy and convenience.However,the effect of HbA1c on diabetic retinopathy(DR)in the Han and Korean populations in Jilin,China,remains inconclusive.AIM To determine the best cut-off of HbA1c for diagnosing DR among the Chinese.METHODS This cross-sectional study included 1933 participants from the Yanbian area of Jilin Province,China.Trained investigators employed a questionnaire-based survey,physical examination,laboratory tests,and fundus photography for the investigation.The best cut-off value for HbA1c was established via the receiver operating characteristic curve.The factors associated with HbA1c-associated risk factors were determined via linear regression.RESULTS The analysis included 887 eligible Chinese Han and Korean participants,591 of whom were assigned randomly to the training set and 296 to the validation set.The prevalence of DR was 3.27% in the total population.HbA1c of 6.2% was the best cut-off value in the training set,while it was 5.9% in the validation set.In both Chinese Han and Korean populations,an HbA1c level of 6.2% was the best cut-off value.The optimal cut-off values of fasting blood glucose(FBG)≥7 mmol/L and<7 mmol/L were 8.1% and 6.2% respectively in Han populations,while those in Korean populations were 6.9%and 5.3%,respectively.Age,body mass index,and FBG were determined as the risk factors impacting HbA1c levels.CONCLUSION HbA1c may serve as a useful diagnostic indicator for DR.An HbA1c level of 6.2% may be an appropriate cut-off value for DR detection in the Chinese population.
文摘Phenothiazine-coated silver electrode prepared by a simple reaction of phenothiazine with the metal is very stable and can make the reduction of hemoglobin possible.
文摘The carcinogenic tobacco-specific nitrosamines N-nitrosonornicotine (NNN) and 4-(methylnitrosamino)-l-(3-pyridyl)-l-butanone (NNK) form hemoglobin adducts in laboratory animals and humans. These adducts release 4-hydroxy-l-(3-pyridyl)-l-butanone (HPB) upon mild base hydrolysis. HPB released from human hemoglobin can be quantified by gas chromatography-mass spectrometry. It is the only available biochemical marker for determination of exposure to, and metabolic activation of, carcinogens present only in tobacco. Levels of HPB were highest in snuff-dippers, followed by smokers and nonsmokers. Large interindividual variations in adduct levels were observed. The relationship between HPB levels in globin and DNA of rats treated with NNK has been investigated in order to aid in interpretation of the data from humans. These studies have provided the initial database for understanding the metabolic activation of tobacco-specific nitrosamines in humans.
文摘Atherosclerosis is a major complication of diabetes, increasing the risk of cardiovascular related morbidities and mortalities. The hallmark of diabetes is hyperglycemia which duration is best predicted by elevated glycated haemoglobin A1C(Hb A1C) levels. Diabetic complications are usually attributed to oxidative stress associated with glycation of major structural and functional proteins. This non-enzymatic glycation of long lived proteins such as collagen, albumin, fibrinogen, liver enzymes and globulins result in the formation of early and advanced glycation end products(AGEs) associated with the production of myriads of free radicles and oxidants that have detrimental effects leading to diabetic complications. AGEs have been extensively discussed in the literature as etiological factors in the advancement of atherogenic events. Mechanisms described include the effects of glycation on protein structure and function that lead to defective receptor binding, impairment of immune system and enzyme function and alteration of basement membrane structural integrity. Hemoglobin(Hb) is a major circulating protein susceptible to glycation. Glycated Hb, namely Hb A1 C is used as a useful tool in the diagnosis of diabetes progression. Many studies have shown strong positive associations between elevated Hb A1 C levels and existing cardiovascular disease and major risk factors. Also, several studies presented Hb A1 C as an independent predictor of cardiovascular risk. In spite of extensive reports on positive associations, limited evidence is available considering the role of glycated Hb in the etiology of atherosclerosis. This editorial highlights potential mechanisms by which glycated hemoglobin may contribute, as a causative factor, to the progression of atherosclerosis in diabetics.
基金Supported by Australia's James Cook University Faculty Research(Grant No.JCL-ECR 6250-2013)
文摘Two-third of the world's population lives in the Asia Pacific region where prevalence of diabetes has reached epidemic proportion.With China and India being the most populous nations on the globe,it is believed that over 150 million diabetes reside in the region with more than 95%being of type 2 diabetes mellitus(T2DM).Furthermore,other Pacific islands in the region have high rales of T2DM including Tonga.Fiji.French Polynesia,and Nauru.The latter has the highest prevalence of T2DM per population in the world.Over the past two decades,in Australia and New Zealand,the prevalence of T2DM has more than doubled,mainly amongst the Aboriginal and Torres Strait Islander and Maori peoples respectively.With the increasing prevalence of dialietes in the Asia Pacific region coupled with the limited number of resources,use of a reliable and effective mode of diagnosis for T3DVI is warranted.Yet to date,only New Zealand has adopted the American Diabetes Association recommendation of using hemoglobin A1C in the diagnosis of the disease.The aim of this review is to discuss the clinical usefulness of hemoglobin A1C and highlight its diagnostic role in the Asia Pacific region where T2DM is increasingly encountered.
文摘AIM To determine whether successful treatment with direc-tacting antivirals(DAA) is associated with improvements in hemoglobin A1 c(HbA1 c) and if type 2 diabetes mellitus(T2 DM) or metabolic syndrome affects sustained virologic response(SVR).METHODS We performed a retrospective analysis of all hepatitis C virus(HCV) patients at the VA Greater Los Angeles Healthcare System treated with varying DAA therapy between 2014-2016. Separate multivariable logistic regression was performed to determine predictors of HbA1 c decrease ≥ 0.5 after DAA treatment and predictors of SVR 12-wk post treatment(SVR12).RESULTS A total of 1068 patients were treated with DAA therapy between 2014-2016. The presence of T2 DM or metabolic syndrome did not adversely affect SVR12. 106 patients had both HCV and T2 DM. Within that cohort,patients who achieved SVR12 had lower mean HbA1 c pre treatment(7.35 vs 8.60,P = 0.02),and lower mean HbA1 c post-treatment compared to non-responders(6.55 vs 8.61,P = 0.01). The mean reduction in HbA1 c after treatment was greater for those who achieved SVR12 than for non-responders(0.79 vs 0.01,P = 0.03). In adjusted models,patients that achieved SVR12 were more likely to have a HbA1 c decrease of ≥ 0.5 than those that did not achieve SVR12(adjusted OR = 7.24,95%CI: 1.22-42.94). CONCLUSION In HCV patients with T2 DM,successful treatment with DAA was associated with a significant reduction in HbA1 c suggesting that DAA may have a role in improving insulin sensitivity. Furthermore,the presence of T2 DM or metabolic syndrome does not adversely affect SVR12 rates in patients treated with DAA.
