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
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 Glycated hemoglobin(HbA1c),the gold standard for assessing glycemic control,has limited ability to reflect the risks of hypoglycemia and glycemic variability,raising great concerns,especially in patients wi...BACKGROUND Glycated hemoglobin(HbA1c),the gold standard for assessing glycemic control,has limited ability to reflect the risks of hypoglycemia and glycemic variability,raising great concerns,especially in patients with type 1 diabetes(T1D).The glycemia risk index(GRI),a composite metric derived from continuous glucose monitoring(CGM),has emerged as a potential solution by systematically in-tegrating both hypoglycemia and hyperglycemia risks into a single interpretable score.The GRI exhibited linear correlations with HbA1c(r=0.53),time in range(r=-0.90),time above range(r=0.63),time below range(TBR)(r=0.37),and co-efficient of variation(CV)(r=0.71).It correlated strongly with TBR and CV than HbA1c.The association between HbA1c levels and GRI was influenced by TBR and CV.At a given HbA1c,each 1%increase in TBR or CV raised GRI by 1.87[95%confidence interval(CI):1.72-2.01]and 1.94(95%CI:1.80-2.10),respectively(P<0.001).Clustering of the CGM data identified four subgroups:Moderate-risk glycemic fluctuations,high-risk hypoglycemia,optimal glycemic control,and high-risk hyperglycemia.The GRI and its components for hypoglycemia and hyperglycemia could distinguish between these subgroups.CONCLUSION The GRI offers a comprehensive view of glycemic control in T1D.Combining HbA1c with the GRI enables accurate assessment for managing glycemic control in patients with T1D.展开更多
BACKGROUND Despite being the gold standard,the use of glycated hemoglobin(HbA1c)and fasting plasma glucose(FPG)for diagnosing dysglycemia is imperfect.In particular,a low level of agreement between HbA1c and FPG in de...BACKGROUND Despite being the gold standard,the use of glycated hemoglobin(HbA1c)and fasting plasma glucose(FPG)for diagnosing dysglycemia is imperfect.In particular,a low level of agreement between HbA1c and FPG in detecting prediabetes and diabetes has led to difficulties in clinical interpretation.Glycated albumin(GA)and 1,5-anhydroglucitol(1,5-AG)may potentially serve as biomarkers for the detection and prediction of diabetes,as well as glycemic monitoring.AIM To explore the diagnostic performance of GA and 1,5-AG for screening dysglycemia;assess whether they can be used for glycemic monitoring in Chinese morbidly-obese patients;and examine their predictive ability for incident diabetes in a Chinese community-based cohort.METHODS GA and 1,5-AG concentrations were measured in 462 morbidly-obese patients from the Obese Chinese Cohort(OCC).A sub-group of diabetes subjects(n=24)was prospectively followed-up after bariatric surgery.Differences between baseline and post-surgery biomarker values were converted to percentage change from baseline to assess the response to glycemic control.Predictive ability of the biomarkers was assessed in 132 incident diabetes cases and 132 matched non-diabetes controls in the community-based Cardiovascular Risk Factor Prevalence Study(CRISPS).A prediction model was developed and compared with clinical models based on conventional risk factors.RESULTS GA exhibited an excellent diagnostic value with an area under the receiver operating characteristic curve(AUC)of 0.919(95%CI:0.884-0.955)for identifying diabetes and a high agreement in the classification of diabetes with both FPG and HbA1c in the OCC.GA demonstrated the fastest response to glycemic control.In CRISPS,the‘B3A’prediction model,which consisted of body mass index(BMI)and 3 biomarkers(HbA1c,GA and 1,5-AG),achieved a comparable predictive value[AUC(95%CI):0.793(0.744-0.843)]to that of a clinical model comprising BMI,HbA1c,FPG and 2-hour glucose(2hG)[AUC(95%CI):0.783(0.733-0.834);DeLong P value=0.736].The‘B3A’was significantly superior to a clinical model including BMI,HbA1c,FPG and triglycerides[AUC(95%CI):0.729(0.673-0.784);DeLong P value=0.027].CONCLUSION GA and 1,5-AG have the potential to act as robust biomarkers for the screening and risk prediction of diabetes.FPG and 2hG may be replaced by GA and 1,5-AG in future diabetes predictions.展开更多
BACKGROUND Achieving optimal glycemic control is a cornerstone of cardiovascular risk reduction in type 2 diabetes(T2D).However,the extent to which multifactorial interventions influence this relationship remains unce...BACKGROUND Achieving optimal glycemic control is a cornerstone of cardiovascular risk reduction in type 2 diabetes(T2D).However,the extent to which multifactorial interventions influence this relationship remains uncertain.AIM To evaluate the association between glycated hemoglobin(HbA1c)target achievement and long-term cardiovascular outcomes in patients receiving standard of care(SoC)or multifactorial intensive therapy(MT).METHODS This post-hoc analysis of the nephropathy in diabetes type 2 cluster-randomized trial included 323 patients with T2D,albuminuria,and retinopathy(SoC:n=139;MT:n=184),who underwent a 4-year intervention phase.Outcomes were major adverse cardiovascular events(MACE)and all-cause mortality.Associations with HbA1c target achievement(≤7%vs>7%)were assessed using Kaplan-Meier curves and shared frailty Cox regression models.RESULTS During a median follow-up of 12.1 years,190 MACEs and 139 deaths occurred.Achievement of the HbA1c target was not associated with reduced mortality in either group.However,a significant reduction in MACEs was observed only among SoC patients achieving HbA1c≤7%(P=0.031),whereas no benefit was seen in the MT group(P=0.645).In multivariable Cox regression models adjusted for cluster effect,in the MT group age[hazard ratio(HR)=1.07,P<0.001]and female sex(HR=0.38,P<0.001)were independent predictors of MACE,while in the SoC group only age(HR=1.04,P=0.009).For all-cause mortality,age(HR=1.11,P<0.001)and blood pressure control(HR=0.55,P=0.041)were significant predictors in the MT group,whereas age(HR=1.06,P=0.002)was independently associated with increased mortality in the SoC group.CONCLUSION In high-risk patients with T2D receiving standard care,achieving an HbA1c≤7%was associated with fewer cardiovascular events only under standard care,but not with reduced mortality.This association was not observed in patients managed with a multifactorial strategy.These findings suggest that the prognostic value of glycemic control depends on the broader treatment context and highlight the central role of comprehensive risk factor management in microvascularcomplicated T2D.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 Glycated hemoglobin(HbA1c)is a well-established biomarker for diagnosing and managing diabetes.However,its prognostic significance in patients without diagnosed diabetes undergoing percutaneous coronary int...BACKGROUND Glycated hemoglobin(HbA1c)is a well-established biomarker for diagnosing and managing diabetes.However,its prognostic significance in patients without diagnosed diabetes undergoing percutaneous coronary intervention(PCI)remains uncertain.This systematic review and meta-analysis evaluates the association between elevated HbA1c levels in the prediabetic range(≥5.7%)and adverse cardiovascular outcomes in this population.AIM To investigate the association between elevated HbA1c levels in the prediabetic range and adverse outcomes in patients without diagnosed diabetes undergoing PCI.METHODS We systematically searched PubMed,EMBASE,and Cochrane Central through April 2025 for studies comparing clinical outcomes in coronary artery disease(CAD)patients without a prior diabetes diagnosis,stratified by HbA1c levels(≥5.7% vs<5.7%).Risk ratios(RR)with 95%confidence intervals(CI)were pooled using a random-effects model.Statistical analysis was performed using R software(version 4.3.2).Primary outcomes were long-term allcause mortality and major adverse cardiovascular events(MACE);secondary outcomes included short-term mortality and cardiac death.RESULTS Ten studies involving 32403 patients(mean age:60 years;29% female)were included.Elevated HbA1c levels in patients without diagnosed diabetes were significantly associated with increased risk of long-term all-cause mortality(RR:1.30;95% CI:1.10-1.54;P<0.01;I2=41%)and MACEs(RR:1.31;95% CI:1.01-1.69;P=0.04;I2=61%).Although the risks of short-term all-cause mortality(RR:1.16;95% CI:0.88-1.53;P=0.29;I2=1%)and cardiac mortality(RR:1.76;95% CI:0.85-3.67;P=0.13;I2=94%)were elevated,they did not reach statistical significance.Sensitivity analyses confirmed the robustness of the findings despite moderate to high heterogeneity in some outcomes.CONCLUSION Among CAD patients without diagnosed diabetes,elevated HbA1c levels in the prediabetic range(≥5.7%)are independently associated with worse long-term outcomes following PCI.HbA1c may serve as a valuable biomarker for post-PCI risk stratification in this metabolically at-risk group.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 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
Objectives To detect whether persisting or transient glucose metabolism disorder is responsible for admission hyperglycemia in patients with acute myocardic infarction （AMI）. Methods Two groups of patients were enro...Objectives To detect whether persisting or transient glucose metabolism disorder is responsible for admission hyperglycemia in patients with acute myocardic infarction （AMI）. Methods Two groups of patients were enrolled： AMI group and control group. Fasting plasma glucose, 2 hours plasma glucose, glycated albumin（GA） and glycated haemoglobin （ HbA1 c） were measured at baseline in both groups and 30 days after AMI attack in AMI group. Results （ 1 ） There were no significant differences in baseline characteristics between both groups; （2） Compared with the control group, the levels of GA and HbA1 c in AMI group at baseline were significantly higher. （ 3 ） At 30 day follow-up in AMI group, both FBG and 2hPG decreased to normal values, HbA1 c did not change, but only GA kept on increasing. Conclusions Hyperglycemia on admission in patients with AMI resulted from both preexisting metabolic disorder and stress reaction as well. GA is the only indicator that could recall the exaggeration of glucose metabolic disorder during AMI attack at 30 day follow-up. （ S Chin J Cardiol 2009; 10（4） ： 186 -189）展开更多
AIM: To analyze the relationship between the glycated albumin (GA) to glycated hemoglobin (HbA1c) ratio and the histological grading of liver fibrosis.METHODS: The study retrospectively included consecutive hepatitis ...AIM: To analyze the relationship between the glycated albumin (GA) to glycated hemoglobin (HbA1c) ratio and the histological grading of liver fibrosis.METHODS: The study retrospectively included consecutive hepatitis C virus positive chronic liver disease patients (n = 142) who had undergone percutaneous liver biopsy between January 2008 and March 2010 at our institution. The ratios of GA/HbA1c were calculated in all patients to investigate the relationship with the degree of the liver fibrosis. The values of the aspartate aminotransferase-to-platelet ratio index (APRI), an excellent marker for the evaluation of liver fibrosis, were also calculated. In addition, we combined the ratio of GA/HbA1c and the APRI in order to improve our ability to detect the presence of significant liver fibrosis. RESULTS: Sixty-one (43%) patients had either no fibrosis or minimal fibrosis (METAVIR score: F0-F1), while 25 (17%) had intermediate fibrosis (F2). Fifty-six (39%) patients had severe fibrosis (F3-F4) and 27 of them had cirrhosis (F4). The mean values of the GA/HbA1c increased with the progression of the fibrosis (F0-1: 2.83 ± 0.24, F2: 2.85 ± 0.24, F3: 2.92 ± 0.35, F4: 3.14 ± 0.54). There was a significant dif- ference between the F0-F1 vs F4, F2 vs F4, and F3 vs F4 groups (P < 0.01, P < 0.01, P < 0.01 and P < 0.05, respectively). The GA/HbA1c ratio was significantly higher in the patients with cirrhosis (F4) than in those without cirrhosis (F0-F3) (3.14 ± 0.54 vs 2.85 ± 0.28, P < 0.0001). The GA/HbA1c ratio was also significantly higher in the patients with severe fibrosis (F3-F4) than in those without severe liver fibrosis (F0-F2) (3.03 ± 0.41 vs 2.84 ± 0.24, P < 0.001). Furthermore, the GA/ HbA1c ratio was also significantly higher in the patients with significant fibrosis (F2-F4) than in those without significant liver fibrosis (F0-F1) (2.98 ± 0.41 vs 2.83 ± 0.24, P < 0.001). The diagnostic performance of the increased GA/HbA1c ratio (> 3.0) was as follows: its sensitivity and specificity for the detection of liver cirrhosis (F4) were 59.3% and 70.4%, respectively and its sensitivity and specificity for the detection of severe liver fibrosis (F3-F4) were 50.0% and 74.4%,respectively. With regard to the detection of significant fibrosis (F2-F4), its sensitivity was 44.4% and its specificity was 77.0%. Although even the excellent marker APRI shows low sensitivity (25.9%) for distinguishing patients with or without significant fibrosis, the combination of the APRI and GA/HbA1c ratio increased the sensitivity up to 42.0%, with only a modest decrease in the specificity (from 90.2% to 83.6%). CONCLUSION: The GA/HbA1c ratio increased in line with the histological severity of liver fibrosis, thus suggesting that this ratio is useful as a supportive index of liver fibrosis.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
Objective To investigate the optimal glycated haemoglobin （HbAlc） cut off points and evaluate the impact of HbAlc on diabetes and pre-diabetes in middle-aged and elderly population. Methods Subjects were recruited f...Objective To investigate the optimal glycated haemoglobin （HbAlc） cut off points and evaluate the impact of HbAlc on diabetes and pre-diabetes in middle-aged and elderly population. Methods Subjects were recruited from Shanghai Changfeng Study. A total of 1 973 community-based participants （age_〉45） without known diabetes underwent oral glucose tolerance test （OG3-r） by using a 75-g oral glucose load and HbAlc was measured by using high performance liquid chromatography （HPLC）. Subjects were classified as normal glucose tolerance （NGT）, pre-diabetes（impaired glucose regulation, IGR） and new diagnosed diabetes （NDD） per 1999 WHO criteria. Two tests are compared with receiver operating characteristic curve （ROC）. Results Among 1973 subjects, 271 （13.7%） were diagnosed as NDD and 474 （24.0%） as IGR by using OGTT. HbAlc was 5.7%_＋0.7% in this population. Use of 6.5% as the HbAIC cutoff point has sensitivity of 38.7% and specificity of 98.5%. We recommend 6.0% as a better cutoff value for diagnosis of diabetes in this population （AUC 0.829, 95% CI 0.798-0.860, P〈0.001） with its sensitivity and specificity as 66.1% and 86.8%. For IGR, the results showed low sensitivity （44.9%） and specificity （66.7%） with an AUC of 0.571 for HbAlc when 5.8% was used as the cutoff point. Participants detected with HbAlc_〉6.0% were associated with nearly the same metabolic characteristics, including body mass index （BMI）, blood pressure, lipid profile and urine albumin-creatinine ratio （uACR） compared with diabetic subjects detected by OGTT. Conclusion The optimum HbAlc cutoff point for diabetes in our study population was lower than ADA criteria, and HbAlc may not be used to identify IGR.展开更多
In population-based studies,including diabetic and nondiabetic cohorts,glycated hemoglobin A1c(HbA1c) has been reported as an independent predictor of allcause and cardiovascular disease mortality.Data on the prognost...In population-based studies,including diabetic and nondiabetic cohorts,glycated hemoglobin A1c(HbA1c) has been reported as an independent predictor of allcause and cardiovascular disease mortality.Data on the prognostic role of HbA1c in patients with acute myocardial infarction(MI) are not univocal since they stem from studies which mainly differ in patients' selection criteria,therapy(thrombolysis vs mechanical revascularization) and number consistency.The present review is focused on available evidence on the prognostic significance of HbA1c measured in the acute phase in patients with ST-elevation myocardial infarction(STEMI) submitted to primary percutaneous coronary intervention(PCI).We furthermore highlighted the role of HbA1c as a screening tool for glucose intolerance in patients with STEMI.According to available evidence,in contemporary cohorts of STEMI patients submitted to mechanical revascularization,HbA1c does not seem to be associated with short and long term mortality rates.However,HbA1c may represent a screening tool for glucose intolerance from the early phase on in STEMI patients.On a pragmatic ground,an HbA1c testhas several advantages over fasting plasma glucose or an oral glucose tolerance test in an acute setting.The test can be performed in the non-fasting state and reflects average glucose concentration over the preceding 2-3 mo.We therefore proposed an algorithm based on pragmatic grounds which could be applied in STEMI patients without known diabetes in order to detect glucose intolerance abnormalities from the early phase.The main advantage of this algorithm is that it may help in tailoring the follow-up program,by helping in identifying patients at risk for the development of glucose intolerance after MI.Further validation of this algorithm in prospective studies may be required in the contemporary STEMI population to resolve some of these uncertainties around HbA1c screening cutoff points.展开更多
BACKGROUND The two-way relationship between periodontitis and type 2 diabetes mellitus(T2DM)is well established.Prolonged hyperglycemia contributes to increased periodontal destruction and severe periodontitis,accentu...BACKGROUND The two-way relationship between periodontitis and type 2 diabetes mellitus(T2DM)is well established.Prolonged hyperglycemia contributes to increased periodontal destruction and severe periodontitis,accentuating diabetic complications.An inflammatory link exists between diabetic retinopathy(DR)and periodontitis,but the studies regarding this association and the role of lipoprotein(a)[Lp(a)]and interleukin-6(IL-6)in these conditions are scarce in the literature.AIM To determine the correlation of periodontal inflamed surface area(PISA)with glycated Hb(HbA1c),serum IL-6 and Lp(a)in T2DM subjects with retinopathy.METHODS This cross-sectional study comprised 40 T2DM subjects with DR and 40 T2DM subjects without DR.All subjects were assessed for periodontal parameters[bleeding on probing(BOP),probing pocket depth,clinical attachment loss(CAL),oral hygiene index-simplified,plaque index(PI)and PISA],and systemic parameters[HbA1c,fasting plasma glucose and postprandial plasma glucose,fasting lipid profile,serum IL-6 and serum Lp(a)].RESULTS The proportion of periodontitis in T2DM with and without DR was 47.5%and 27.5%respectively.Severity of periodontitis,CAL,PISA,IL-6 and Lp(a)were higher in T2DM with DR group compared to T2DM without DR group.Significant difference was observed in the mean percentage of sites with BOP between T2DM with DR(69%)and T2DM without DR(41%),but there was no significant difference in PI(P>0.05).HbA1c was positively correlated with CAL(r=0.351,P=0.001),and PISA(r=0.393,P≤0.001)in study subjects.A positive correlation was found between PISA and IL-6(r=0.651,P<0.0001);PISA and Lp(a)(r=0.59,P<0.001);CAL and IL-6(r=0.527,P<0.0001)and CAL and Lp(a)(r=0.631,P<0.001)among study subjects.CONCLUSION Despite both groups having poor glycemic control and comparable plaque scores,the periodontal parameters were higher in DR as compared to T2DM without DR.Since a bidirectional link exists between periodontitis and DM,the presence of DR may have contributed to the severity of periodontal destruction and periodontitis may have influenced the progression of DR.展开更多
BACKGROUND Glycated albumin(GA),the non-enzymatic glycation product of albumin in plasma,became a glycemic marker in the beginning of the 21st century.The assay is not affected by hemoglobin levels and reflects the gl...BACKGROUND Glycated albumin(GA),the non-enzymatic glycation product of albumin in plasma,became a glycemic marker in the beginning of the 21st century.The assay is not affected by hemoglobin levels and reflects the glycemic status over a shorter period as compared to HbA1c measurements.Thus,GA may contributes as an intermediate glucose index in the current diabetes mellitus(DM)diagnostic system.AIM To search and summarize the available data on glycated albumin measurements required for the diagnosis of diabetes mellitus.METHODS Databases,including PubMed,Embase,Web of Science,and Cochrane Central Register of Controlled Trials(CENTRAL),among others,were systematically searched.The Quality Assessment of Diagnostic Accuracy Studies-2 tool was applied for the assessment of quality,and the bivariate model was used to pool the sensitivity and specificity.The hierarchical summary receiver operator characteristic curves(HSROC)model was utilized to estimate the summary receiver operating characteristics curve(SROC).Sensitivity analysis was performed to investigate the association of the study design and patient characteristics with the test accuracy and meta-regression to find the source of heterogeneity.RESULTS Three studies regarding gestational diabetes mellitus(GDM)and a meta-analysis of 16 non-GDM studies,comprising a total sample size of 12876,were included in the work.Results reveal that the average cut-off values of GA reported for the diagnosis of GDM diagnosis was much lower than those for non-GDM.For non-GDM cases,diagnosing DM with a circulating GA cut-off of 14.0%had a sensitivity of 0.766(95%CI:0.539,0.901),specificity of 0.687(95%CI:0.364,0.894),and area under the curve of 0.80(95%CI:0.76,0.83)for the SROC.The estimated SROC at different GA cut-off values for non-GDM exhibited that the average location parameter lambda of 16 non-GDM studies was 2.354(95%CI:2.002,2.707),and the scale parameter beta was-0.163(95%CI:-0.614,0.288).These non-GDM studies with various thresholds had substantial heterogeneity,which may be attributed to the type of DM,age,and body mass index as possible sources.CONCLUSION Glycated albumin in non-DM exhibits a moderate diagnostic accuracy.Further research on the diagnostic accuracy of GA for GDM and combinational measurements of GA and other assays is suggested.展开更多
BACKGROUND Metabolic memory is important for the diagnosis and treatment of diabetes in the early stage,and in maintaining blood glucose concentrations within the normal range.The clinical diagnosis of diabetes mellit...BACKGROUND Metabolic memory is important for the diagnosis and treatment of diabetes in the early stage,and in maintaining blood glucose concentrations within the normal range.The clinical diagnosis of diabetes mellitus is currently made using fasting plasma glucose,2 h-plasma glucose(2h-PG)during a 75 g oral glucose tolerance test,and hemoglobin A1c(HbA1c)level.However,the fasting plasma glucose test requires fasting,which is a barrier to screening,and reproducibility of the 2h-PG level is poor.HbA1c is affected by a shortened red blood cell lifespan.In patients with anemia and hemoglobinopathies,the measured HbA1c levels may be inaccurate.Compared with HbA1c,glycated albumin(GA)is characterized by more rapid and greater changes,and can be used to diagnose new-onset diabetes especially if urgent early treatment is required,for example in gestational diabetes.In this study,we provided cutoff values for GA and evaluated its utility as a screening and diagnostic tool for diabetes in a large high-risk group study.AIM To evaluate the utility of GA in identifying subjects with diabetes in northeast China,and to assess the diagnostic accuracy of the proposed GA cutoff in the diagnosis of diabetes mellitus.METHODS This cross-sectional study included 1935 subjects,with suspected diabetes or in high-risk groups,from 2014 to 2015 in the Second Affiliated Hospital of Harbin Medical University(Harbin,China).The use of GA to identify diabetes was investigated using the area under the receiver operating characteristic curve(AUC).The GA cutoffs were derived from different 2h-PG values with hemoglobin A1c cutoffs used as a calibration curve.RESULTS The GA cutoff for the diagnosis of diabetes mellitus was 15.15%from the receiver operating characteristic(ROC)curve.ROC analysis demonstrated that GA was an efficient marker for detecting diabetes,with an AUC of 90.3%.CONCLUSION Our study supports the use of GA as a biomarker for the diagnosis of diabetes.展开更多
BACKGROUNDYoung people with type 1 diabetes in low-and-middle income countries facemany challenges in accessing care, with various essential supplies needed forsurvival and long-term health.AIMTo study insulin deliver...BACKGROUNDYoung people with type 1 diabetes in low-and-middle income countries facemany challenges in accessing care, with various essential supplies needed forsurvival and long-term health.AIMTo study insulin delivery devices and glycated haemoglobin (HbA1c) testing.METHODSA survey was conducted in 2019 of leading diabetes centres in 41 countriessupported by the Life for a Child Program. The survey covered numerous aspectsconcerning availability and costs at all levels of the health system, local usagepatterns and attitudes, obstacles, and other aspects.RESULTSThirty-seven countries returned the survey (90.2% response rate). Key findingsincluded: Syringe use was most common (83.1%), followed by insulin pens(16.7%) and pumps (0.2%). 48.6% of public health systems did not providesyringes, even with a co-payment. Use of suboptimal syringe/needlecombinations was common. Needles were generally reused in almost all countries(94.3%, n = 35). Aside from donated supplies, there was variable access to HbA1ctesting within public health facilities, and, when available, patients often had tocover the cost. Provision was further compromised by numerous problemsincluding stock-outs, and challenges with understanding the test, equipmentmaintenance, and refrigeration.CONCLUSIONLarge gaps exist for adequate access to appropriate insulin delivery devices andHbA1c testing. Public health systems in low-and-middle income countries shouldincrease affordable provision. There are also needs for specific health professional training and diabetes education;elimination of customs duties and taxes;development of inexpensive, robust HbA1c testing methods that do not requirerefrigeration of testing supplies;differential pricing schemes;and other solutions.展开更多
A new strategy for quantitative analysis of a major clinical biochemical indicator called glycatedhemoglobin(Hb·A1c)was proposed.The technique was based on the simultaneous near-infrared(NIR)spectral determinatio...A new strategy for quantitative analysis of a major clinical biochemical indicator called glycatedhemoglobin(Hb·A1c)was proposed.The technique was based on the simultaneous near-infrared(NIR)spectral determination of hemoglobin(Hb)and absolute HbAlc content(Hb·HbA1c)inhuman hemolysate samples.Wavelength selections were accomplished using the improvedmoving window partial least square(MWPLS)method for stability.Each model was establishedusing an approach based on randomness,similarity,and stability to obtain objective,stable,andpractical models.The optimal wavebands obtained using MWPLS were 958 to 1036 nm for Hband 1492 to 1858 nm for Hb·HbA1c,which were within the NIR overtone region.The validationroot mean square error and validation correlation coeficients of prediction(V-SEP,V-Rp)were 3.4g L^(-1) and 0.967 for Hb,respectively,whereas the corresponding values for Hb.HbAic were 0.63 g L^(-1) and 0.913.The corresponding V-SEP and V-Rp were 0.40% and 0.829 for the relativepercentage of HbA1c.The experimental results confirm the feasibility for the quantification of HbAlc based on simultaneous NIR spectroscopic analyses of Hb and Hb·HbA1c.展开更多
BACKGROUND Gestational diabetes mellitus(GDM)is characterized by glucose intolerance that is first diagnosed during pregnancy,making it the most common complication associated with this period.Early detection and targ...BACKGROUND Gestational diabetes mellitus(GDM)is characterized by glucose intolerance that is first diagnosed during pregnancy,making it the most common complication associated with this period.Early detection and targeted treatment of GDM can minimize foetal exposure to maternal hyperglycaemia and subsequently reduce the associated adverse pregnancy outcomes.Previous studies have inconsistently suggested that the level of glycated albumin(GA)might predict GDM.AIM To review and synthesize existing evidence to evaluate the relationship between GA levels and the development of GDM.METHODS We sought to compare GA levels between GDM and control groups in this metaanalysis by systematically searching the Web of Science,PubMed,Cochrane Library,and Embase databases for articles published up to June 2023.The analysis utilized the weighted mean difference(WMD)as the primary metric.The data were meticulously extracted,and the quality of the included studies was assessed.Additionally,we conducted a subgroup analysis based on study region and sample size.We assessed heterogeneity using I2 statistics and evaluated publication bias through funnel plots.Additionally,trim-and-fill analysis was employed to detect and address any potential publication bias.RESULTS The meta-analysis included a total of 11 studies involving 5477 participants,comprising 1900 patients with GDM and 3577 control individuals.The synthesized results revealed a notable correlation between elevated GA levels and increased susceptibility to GDM.The calculated WMD was 0.42,with a 95%confidence interval(95%CI)ranging from 0.11 to 0.74,yielding a P value less than 0.001.Concerning specific GA levels,the mean GA level in the GDM group was 12.6,while for the control group,it was lower,at 11.6.This discrepancy underscores the potential of GA as a biomarker for assessing GDM risk.Moreover,we explored the levels of glycated haemoglobin(HbA1c)in both cohorts.The WMD for HbA1c was 0.19,with a 95%CI ranging from 0.15 to 0.22 and a P value less than 0.001.This observation suggested that both GA and HbA1c levels were elevated in individuals in the GDM group compared to those in the control group.CONCLUSION Our meta-analysis revealed a substantial correlation between elevated GA levels and increased GDM risk.Furthermore,our findings revealed elevated levels of HbA1c in GDM patients,emphasizing the significance of monitoring both GA and HbA1c levels for early GDM detection and effective management.展开更多
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 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.
基金Supported by the Noncommunicable Chronic Diseases-National Science and Technology Major Project,No.2023ZD0508201the National Key R and D Program of China,No.2022YFC2010100+3 种基金the National Natural Science Foundation of China,No.82070812the Natural Science Foundation of Hunan Province,No.2024JJ9049,No.2023JJ30762 and No.2021JC0003Sinocare Diabetes Foundation,No.2020SD08the National Clinical Research Center for Metabolic Diseases Clinical Diagnosis and Treatment Capacity Enhancement Program,No.2023ZLNL003.
文摘BACKGROUND Glycated hemoglobin(HbA1c),the gold standard for assessing glycemic control,has limited ability to reflect the risks of hypoglycemia and glycemic variability,raising great concerns,especially in patients with type 1 diabetes(T1D).The glycemia risk index(GRI),a composite metric derived from continuous glucose monitoring(CGM),has emerged as a potential solution by systematically in-tegrating both hypoglycemia and hyperglycemia risks into a single interpretable score.The GRI exhibited linear correlations with HbA1c(r=0.53),time in range(r=-0.90),time above range(r=0.63),time below range(TBR)(r=0.37),and co-efficient of variation(CV)(r=0.71).It correlated strongly with TBR and CV than HbA1c.The association between HbA1c levels and GRI was influenced by TBR and CV.At a given HbA1c,each 1%increase in TBR or CV raised GRI by 1.87[95%confidence interval(CI):1.72-2.01]and 1.94(95%CI:1.80-2.10),respectively(P<0.001).Clustering of the CGM data identified four subgroups:Moderate-risk glycemic fluctuations,high-risk hypoglycemia,optimal glycemic control,and high-risk hyperglycemia.The GRI and its components for hypoglycemia and hyperglycemia could distinguish between these subgroups.CONCLUSION The GRI offers a comprehensive view of glycemic control in T1D.Combining HbA1c with the GRI enables accurate assessment for managing glycemic control in patients with T1D.
基金Supported by the Hong Kong Research Grants Council Area of Excellence,No.AoE/M/707-18.
文摘BACKGROUND Despite being the gold standard,the use of glycated hemoglobin(HbA1c)and fasting plasma glucose(FPG)for diagnosing dysglycemia is imperfect.In particular,a low level of agreement between HbA1c and FPG in detecting prediabetes and diabetes has led to difficulties in clinical interpretation.Glycated albumin(GA)and 1,5-anhydroglucitol(1,5-AG)may potentially serve as biomarkers for the detection and prediction of diabetes,as well as glycemic monitoring.AIM To explore the diagnostic performance of GA and 1,5-AG for screening dysglycemia;assess whether they can be used for glycemic monitoring in Chinese morbidly-obese patients;and examine their predictive ability for incident diabetes in a Chinese community-based cohort.METHODS GA and 1,5-AG concentrations were measured in 462 morbidly-obese patients from the Obese Chinese Cohort(OCC).A sub-group of diabetes subjects(n=24)was prospectively followed-up after bariatric surgery.Differences between baseline and post-surgery biomarker values were converted to percentage change from baseline to assess the response to glycemic control.Predictive ability of the biomarkers was assessed in 132 incident diabetes cases and 132 matched non-diabetes controls in the community-based Cardiovascular Risk Factor Prevalence Study(CRISPS).A prediction model was developed and compared with clinical models based on conventional risk factors.RESULTS GA exhibited an excellent diagnostic value with an area under the receiver operating characteristic curve(AUC)of 0.919(95%CI:0.884-0.955)for identifying diabetes and a high agreement in the classification of diabetes with both FPG and HbA1c in the OCC.GA demonstrated the fastest response to glycemic control.In CRISPS,the‘B3A’prediction model,which consisted of body mass index(BMI)and 3 biomarkers(HbA1c,GA and 1,5-AG),achieved a comparable predictive value[AUC(95%CI):0.793(0.744-0.843)]to that of a clinical model comprising BMI,HbA1c,FPG and 2-hour glucose(2hG)[AUC(95%CI):0.783(0.733-0.834);DeLong P value=0.736].The‘B3A’was significantly superior to a clinical model including BMI,HbA1c,FPG and triglycerides[AUC(95%CI):0.729(0.673-0.784);DeLong P value=0.027].CONCLUSION GA and 1,5-AG have the potential to act as robust biomarkers for the screening and risk prediction of diabetes.FPG and 2hG may be replaced by GA and 1,5-AG in future diabetes predictions.
基金Supported by the Ministero dell’Universitàe della Ricerca(Italian Ministry of University and Research),No.2007PSYLRX.
文摘BACKGROUND Achieving optimal glycemic control is a cornerstone of cardiovascular risk reduction in type 2 diabetes(T2D).However,the extent to which multifactorial interventions influence this relationship remains uncertain.AIM To evaluate the association between glycated hemoglobin(HbA1c)target achievement and long-term cardiovascular outcomes in patients receiving standard of care(SoC)or multifactorial intensive therapy(MT).METHODS This post-hoc analysis of the nephropathy in diabetes type 2 cluster-randomized trial included 323 patients with T2D,albuminuria,and retinopathy(SoC:n=139;MT:n=184),who underwent a 4-year intervention phase.Outcomes were major adverse cardiovascular events(MACE)and all-cause mortality.Associations with HbA1c target achievement(≤7%vs>7%)were assessed using Kaplan-Meier curves and shared frailty Cox regression models.RESULTS During a median follow-up of 12.1 years,190 MACEs and 139 deaths occurred.Achievement of the HbA1c target was not associated with reduced mortality in either group.However,a significant reduction in MACEs was observed only among SoC patients achieving HbA1c≤7%(P=0.031),whereas no benefit was seen in the MT group(P=0.645).In multivariable Cox regression models adjusted for cluster effect,in the MT group age[hazard ratio(HR)=1.07,P<0.001]and female sex(HR=0.38,P<0.001)were independent predictors of MACE,while in the SoC group only age(HR=1.04,P=0.009).For all-cause mortality,age(HR=1.11,P<0.001)and blood pressure control(HR=0.55,P=0.041)were significant predictors in the MT group,whereas age(HR=1.06,P=0.002)was independently associated with increased mortality in the SoC group.CONCLUSION In high-risk patients with T2D receiving standard care,achieving an HbA1c≤7%was associated with fewer cardiovascular events only under standard care,but not with reduced mortality.This association was not observed in patients managed with a multifactorial strategy.These findings suggest that the prognostic value of glycemic control depends on the broader treatment context and highlight the central role of comprehensive risk factor management in microvascularcomplicated T2D.
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.
文摘BACKGROUND Glycated hemoglobin(HbA1c)is a well-established biomarker for diagnosing and managing diabetes.However,its prognostic significance in patients without diagnosed diabetes undergoing percutaneous coronary intervention(PCI)remains uncertain.This systematic review and meta-analysis evaluates the association between elevated HbA1c levels in the prediabetic range(≥5.7%)and adverse cardiovascular outcomes in this population.AIM To investigate the association between elevated HbA1c levels in the prediabetic range and adverse outcomes in patients without diagnosed diabetes undergoing PCI.METHODS We systematically searched PubMed,EMBASE,and Cochrane Central through April 2025 for studies comparing clinical outcomes in coronary artery disease(CAD)patients without a prior diabetes diagnosis,stratified by HbA1c levels(≥5.7% vs<5.7%).Risk ratios(RR)with 95%confidence intervals(CI)were pooled using a random-effects model.Statistical analysis was performed using R software(version 4.3.2).Primary outcomes were long-term allcause mortality and major adverse cardiovascular events(MACE);secondary outcomes included short-term mortality and cardiac death.RESULTS Ten studies involving 32403 patients(mean age:60 years;29% female)were included.Elevated HbA1c levels in patients without diagnosed diabetes were significantly associated with increased risk of long-term all-cause mortality(RR:1.30;95% CI:1.10-1.54;P<0.01;I2=41%)and MACEs(RR:1.31;95% CI:1.01-1.69;P=0.04;I2=61%).Although the risks of short-term all-cause mortality(RR:1.16;95% CI:0.88-1.53;P=0.29;I2=1%)and cardiac mortality(RR:1.76;95% CI:0.85-3.67;P=0.13;I2=94%)were elevated,they did not reach statistical significance.Sensitivity analyses confirmed the robustness of the findings despite moderate to high heterogeneity in some outcomes.CONCLUSION Among CAD patients without diagnosed diabetes,elevated HbA1c levels in the prediabetic range(≥5.7%)are independently associated with worse long-term outcomes following PCI.HbA1c may serve as a valuable biomarker for post-PCI risk stratification in this metabolically at-risk group.
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.
基金Suppored by Science and Technol ogy Planning Project of Guangdong Province,China (2007B031505009)Science and Technology Planning project of Guangdong Province,China(2006B36008007)
文摘Objectives To detect whether persisting or transient glucose metabolism disorder is responsible for admission hyperglycemia in patients with acute myocardic infarction （AMI）. Methods Two groups of patients were enrolled： AMI group and control group. Fasting plasma glucose, 2 hours plasma glucose, glycated albumin（GA） and glycated haemoglobin （ HbA1 c） were measured at baseline in both groups and 30 days after AMI attack in AMI group. Results （ 1 ） There were no significant differences in baseline characteristics between both groups; （2） Compared with the control group, the levels of GA and HbA1 c in AMI group at baseline were significantly higher. （ 3 ） At 30 day follow-up in AMI group, both FBG and 2hPG decreased to normal values, HbA1 c did not change, but only GA kept on increasing. Conclusions Hyperglycemia on admission in patients with AMI resulted from both preexisting metabolic disorder and stress reaction as well. GA is the only indicator that could recall the exaggeration of glucose metabolic disorder during AMI attack at 30 day follow-up. （ S Chin J Cardiol 2009; 10（4） ： 186 -189）
基金Supported by A Grant-in-Aid for Health and Labor Sciences Research from the Ministry of Health, Labour and Welfare of Japan
文摘AIM: To analyze the relationship between the glycated albumin (GA) to glycated hemoglobin (HbA1c) ratio and the histological grading of liver fibrosis.METHODS: The study retrospectively included consecutive hepatitis C virus positive chronic liver disease patients (n = 142) who had undergone percutaneous liver biopsy between January 2008 and March 2010 at our institution. The ratios of GA/HbA1c were calculated in all patients to investigate the relationship with the degree of the liver fibrosis. The values of the aspartate aminotransferase-to-platelet ratio index (APRI), an excellent marker for the evaluation of liver fibrosis, were also calculated. In addition, we combined the ratio of GA/HbA1c and the APRI in order to improve our ability to detect the presence of significant liver fibrosis. RESULTS: Sixty-one (43%) patients had either no fibrosis or minimal fibrosis (METAVIR score: F0-F1), while 25 (17%) had intermediate fibrosis (F2). Fifty-six (39%) patients had severe fibrosis (F3-F4) and 27 of them had cirrhosis (F4). The mean values of the GA/HbA1c increased with the progression of the fibrosis (F0-1: 2.83 ± 0.24, F2: 2.85 ± 0.24, F3: 2.92 ± 0.35, F4: 3.14 ± 0.54). There was a significant dif- ference between the F0-F1 vs F4, F2 vs F4, and F3 vs F4 groups (P < 0.01, P < 0.01, P < 0.01 and P < 0.05, respectively). The GA/HbA1c ratio was significantly higher in the patients with cirrhosis (F4) than in those without cirrhosis (F0-F3) (3.14 ± 0.54 vs 2.85 ± 0.28, P < 0.0001). The GA/HbA1c ratio was also significantly higher in the patients with severe fibrosis (F3-F4) than in those without severe liver fibrosis (F0-F2) (3.03 ± 0.41 vs 2.84 ± 0.24, P < 0.001). Furthermore, the GA/ HbA1c ratio was also significantly higher in the patients with significant fibrosis (F2-F4) than in those without significant liver fibrosis (F0-F1) (2.98 ± 0.41 vs 2.83 ± 0.24, P < 0.001). The diagnostic performance of the increased GA/HbA1c ratio (> 3.0) was as follows: its sensitivity and specificity for the detection of liver cirrhosis (F4) were 59.3% and 70.4%, respectively and its sensitivity and specificity for the detection of severe liver fibrosis (F3-F4) were 50.0% and 74.4%,respectively. With regard to the detection of significant fibrosis (F2-F4), its sensitivity was 44.4% and its specificity was 77.0%. Although even the excellent marker APRI shows low sensitivity (25.9%) for distinguishing patients with or without significant fibrosis, the combination of the APRI and GA/HbA1c ratio increased the sensitivity up to 42.0%, with only a modest decrease in the specificity (from 90.2% to 83.6%). CONCLUSION: The GA/HbA1c ratio increased in line with the histological severity of liver fibrosis, thus suggesting that this ratio is useful as a supportive index of liver fibrosis.
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 grants from National Key Technologies R&D Program (Grant No. 2008 BAI52B03 to X. Gao)the National Key Technologies R&D Program (Grant No. 2009BAI80B01 to H. Lin)the Major Project of Subject Construction of Shanghai Bureau of Health (Grant No.08GWZX0203 to X. Gao)
文摘Objective To investigate the optimal glycated haemoglobin （HbAlc） cut off points and evaluate the impact of HbAlc on diabetes and pre-diabetes in middle-aged and elderly population. Methods Subjects were recruited from Shanghai Changfeng Study. A total of 1 973 community-based participants （age_〉45） without known diabetes underwent oral glucose tolerance test （OG3-r） by using a 75-g oral glucose load and HbAlc was measured by using high performance liquid chromatography （HPLC）. Subjects were classified as normal glucose tolerance （NGT）, pre-diabetes（impaired glucose regulation, IGR） and new diagnosed diabetes （NDD） per 1999 WHO criteria. Two tests are compared with receiver operating characteristic curve （ROC）. Results Among 1973 subjects, 271 （13.7%） were diagnosed as NDD and 474 （24.0%） as IGR by using OGTT. HbAlc was 5.7%_＋0.7% in this population. Use of 6.5% as the HbAIC cutoff point has sensitivity of 38.7% and specificity of 98.5%. We recommend 6.0% as a better cutoff value for diagnosis of diabetes in this population （AUC 0.829, 95% CI 0.798-0.860, P〈0.001） with its sensitivity and specificity as 66.1% and 86.8%. For IGR, the results showed low sensitivity （44.9%） and specificity （66.7%） with an AUC of 0.571 for HbAlc when 5.8% was used as the cutoff point. Participants detected with HbAlc_〉6.0% were associated with nearly the same metabolic characteristics, including body mass index （BMI）, blood pressure, lipid profile and urine albumin-creatinine ratio （uACR） compared with diabetic subjects detected by OGTT. Conclusion The optimum HbAlc cutoff point for diabetes in our study population was lower than ADA criteria, and HbAlc may not be used to identify IGR.
文摘In population-based studies,including diabetic and nondiabetic cohorts,glycated hemoglobin A1c(HbA1c) has been reported as an independent predictor of allcause and cardiovascular disease mortality.Data on the prognostic role of HbA1c in patients with acute myocardial infarction(MI) are not univocal since they stem from studies which mainly differ in patients' selection criteria,therapy(thrombolysis vs mechanical revascularization) and number consistency.The present review is focused on available evidence on the prognostic significance of HbA1c measured in the acute phase in patients with ST-elevation myocardial infarction(STEMI) submitted to primary percutaneous coronary intervention(PCI).We furthermore highlighted the role of HbA1c as a screening tool for glucose intolerance in patients with STEMI.According to available evidence,in contemporary cohorts of STEMI patients submitted to mechanical revascularization,HbA1c does not seem to be associated with short and long term mortality rates.However,HbA1c may represent a screening tool for glucose intolerance from the early phase on in STEMI patients.On a pragmatic ground,an HbA1c testhas several advantages over fasting plasma glucose or an oral glucose tolerance test in an acute setting.The test can be performed in the non-fasting state and reflects average glucose concentration over the preceding 2-3 mo.We therefore proposed an algorithm based on pragmatic grounds which could be applied in STEMI patients without known diabetes in order to detect glucose intolerance abnormalities from the early phase.The main advantage of this algorithm is that it may help in tailoring the follow-up program,by helping in identifying patients at risk for the development of glucose intolerance after MI.Further validation of this algorithm in prospective studies may be required in the contemporary STEMI population to resolve some of these uncertainties around HbA1c screening cutoff points.
文摘BACKGROUND The two-way relationship between periodontitis and type 2 diabetes mellitus(T2DM)is well established.Prolonged hyperglycemia contributes to increased periodontal destruction and severe periodontitis,accentuating diabetic complications.An inflammatory link exists between diabetic retinopathy(DR)and periodontitis,but the studies regarding this association and the role of lipoprotein(a)[Lp(a)]and interleukin-6(IL-6)in these conditions are scarce in the literature.AIM To determine the correlation of periodontal inflamed surface area(PISA)with glycated Hb(HbA1c),serum IL-6 and Lp(a)in T2DM subjects with retinopathy.METHODS This cross-sectional study comprised 40 T2DM subjects with DR and 40 T2DM subjects without DR.All subjects were assessed for periodontal parameters[bleeding on probing(BOP),probing pocket depth,clinical attachment loss(CAL),oral hygiene index-simplified,plaque index(PI)and PISA],and systemic parameters[HbA1c,fasting plasma glucose and postprandial plasma glucose,fasting lipid profile,serum IL-6 and serum Lp(a)].RESULTS The proportion of periodontitis in T2DM with and without DR was 47.5%and 27.5%respectively.Severity of periodontitis,CAL,PISA,IL-6 and Lp(a)were higher in T2DM with DR group compared to T2DM without DR group.Significant difference was observed in the mean percentage of sites with BOP between T2DM with DR(69%)and T2DM without DR(41%),but there was no significant difference in PI(P>0.05).HbA1c was positively correlated with CAL(r=0.351,P=0.001),and PISA(r=0.393,P≤0.001)in study subjects.A positive correlation was found between PISA and IL-6(r=0.651,P<0.0001);PISA and Lp(a)(r=0.59,P<0.001);CAL and IL-6(r=0.527,P<0.0001)and CAL and Lp(a)(r=0.631,P<0.001)among study subjects.CONCLUSION Despite both groups having poor glycemic control and comparable plaque scores,the periodontal parameters were higher in DR as compared to T2DM without DR.Since a bidirectional link exists between periodontitis and DM,the presence of DR may have contributed to the severity of periodontal destruction and periodontitis may have influenced the progression of DR.
文摘BACKGROUND Glycated albumin(GA),the non-enzymatic glycation product of albumin in plasma,became a glycemic marker in the beginning of the 21st century.The assay is not affected by hemoglobin levels and reflects the glycemic status over a shorter period as compared to HbA1c measurements.Thus,GA may contributes as an intermediate glucose index in the current diabetes mellitus(DM)diagnostic system.AIM To search and summarize the available data on glycated albumin measurements required for the diagnosis of diabetes mellitus.METHODS Databases,including PubMed,Embase,Web of Science,and Cochrane Central Register of Controlled Trials(CENTRAL),among others,were systematically searched.The Quality Assessment of Diagnostic Accuracy Studies-2 tool was applied for the assessment of quality,and the bivariate model was used to pool the sensitivity and specificity.The hierarchical summary receiver operator characteristic curves(HSROC)model was utilized to estimate the summary receiver operating characteristics curve(SROC).Sensitivity analysis was performed to investigate the association of the study design and patient characteristics with the test accuracy and meta-regression to find the source of heterogeneity.RESULTS Three studies regarding gestational diabetes mellitus(GDM)and a meta-analysis of 16 non-GDM studies,comprising a total sample size of 12876,were included in the work.Results reveal that the average cut-off values of GA reported for the diagnosis of GDM diagnosis was much lower than those for non-GDM.For non-GDM cases,diagnosing DM with a circulating GA cut-off of 14.0%had a sensitivity of 0.766(95%CI:0.539,0.901),specificity of 0.687(95%CI:0.364,0.894),and area under the curve of 0.80(95%CI:0.76,0.83)for the SROC.The estimated SROC at different GA cut-off values for non-GDM exhibited that the average location parameter lambda of 16 non-GDM studies was 2.354(95%CI:2.002,2.707),and the scale parameter beta was-0.163(95%CI:-0.614,0.288).These non-GDM studies with various thresholds had substantial heterogeneity,which may be attributed to the type of DM,age,and body mass index as possible sources.CONCLUSION Glycated albumin in non-DM exhibits a moderate diagnostic accuracy.Further research on the diagnostic accuracy of GA for GDM and combinational measurements of GA and other assays is suggested.
基金Youth Fund Project of the Second Affiliated Hospital of Harbin Medical University,No.QN2010-20.
文摘BACKGROUND Metabolic memory is important for the diagnosis and treatment of diabetes in the early stage,and in maintaining blood glucose concentrations within the normal range.The clinical diagnosis of diabetes mellitus is currently made using fasting plasma glucose,2 h-plasma glucose(2h-PG)during a 75 g oral glucose tolerance test,and hemoglobin A1c(HbA1c)level.However,the fasting plasma glucose test requires fasting,which is a barrier to screening,and reproducibility of the 2h-PG level is poor.HbA1c is affected by a shortened red blood cell lifespan.In patients with anemia and hemoglobinopathies,the measured HbA1c levels may be inaccurate.Compared with HbA1c,glycated albumin(GA)is characterized by more rapid and greater changes,and can be used to diagnose new-onset diabetes especially if urgent early treatment is required,for example in gestational diabetes.In this study,we provided cutoff values for GA and evaluated its utility as a screening and diagnostic tool for diabetes in a large high-risk group study.AIM To evaluate the utility of GA in identifying subjects with diabetes in northeast China,and to assess the diagnostic accuracy of the proposed GA cutoff in the diagnosis of diabetes mellitus.METHODS This cross-sectional study included 1935 subjects,with suspected diabetes or in high-risk groups,from 2014 to 2015 in the Second Affiliated Hospital of Harbin Medical University(Harbin,China).The use of GA to identify diabetes was investigated using the area under the receiver operating characteristic curve(AUC).The GA cutoffs were derived from different 2h-PG values with hemoglobin A1c cutoffs used as a calibration curve.RESULTS The GA cutoff for the diagnosis of diabetes mellitus was 15.15%from the receiver operating characteristic(ROC)curve.ROC analysis demonstrated that GA was an efficient marker for detecting diabetes,with an AUC of 90.3%.CONCLUSION Our study supports the use of GA as a biomarker for the diagnosis of diabetes.
基金We thank the survey respondents in all countries for their time and insights. Thecentres were: The Endocrine Center (Azerbaijan), Bangladesh Institute of Research andRehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM)(Bangladesh), Centro Vivir con Diabetes (Bolivia), CHU Yalgado Ouedraogo (BurkinaFaso), PNILMCNT - MSPLS (Burundi), Clinique Diabetique de Bangui (CentralAfrican Republic), MEMISA Belgique en RDC (Democratic Republic of Congo),Aprendiendo a Vivir (Dominican Republic), FUVIDA (Ecuador), Central HealthLaboratory (Eritrea), Ethiopian Diabetes Association (Ethiopia), Komfo AnokyeTeaching Hospital (Ghana), Asociacion Creciendo con Diabetes (Guatemala), GuyanaDiabetic Association (Guyana), FHADIMAC (Haiti), Diacare, Ahmedabad (India),Diabetes Association of Jamaica (Jamaica), Ganta United Methodist Hospital (Liberia),Diabetes Society of Maldives (Maldives), Santé Diabète (Mali), AMLCD (Mauritania),Federacion Mexicana de Diabetes (Mexico), Patan Hospital (Nepal), Lagos UniversityTeaching Hospital (Nigeria), Choe Kyong Tae Endocrine Research (North Korea),National Institute of Child Health (Pakistan), Cardinal Santos Medical Center(Philippines), Maison Bleue du Diabète (Republic of Congo), Rwandan Diabetes Association (Rwanda), Diabetes Association of Sri Lanka (Sri Lanka), St. LuciaDiabetes and Hypertension Association (St Lucia), National Republican EndocrinologyCentre (Tajikistan), Tanzanian Diabetes Association (Tanzania), Centre ATD dePrévention du Diabète (Togo), St Francis Hospital (Uganda), Endocrinological andDiabetes Association of Uzbekistan (Uzbekistan), and Hue Central Hospital (Vietnam).We also thank Jayanthi Maniam for assistance in submitting the manuscript.
文摘BACKGROUNDYoung people with type 1 diabetes in low-and-middle income countries facemany challenges in accessing care, with various essential supplies needed forsurvival and long-term health.AIMTo study insulin delivery devices and glycated haemoglobin (HbA1c) testing.METHODSA survey was conducted in 2019 of leading diabetes centres in 41 countriessupported by the Life for a Child Program. The survey covered numerous aspectsconcerning availability and costs at all levels of the health system, local usagepatterns and attitudes, obstacles, and other aspects.RESULTSThirty-seven countries returned the survey (90.2% response rate). Key findingsincluded: Syringe use was most common (83.1%), followed by insulin pens(16.7%) and pumps (0.2%). 48.6% of public health systems did not providesyringes, even with a co-payment. Use of suboptimal syringe/needlecombinations was common. Needles were generally reused in almost all countries(94.3%, n = 35). Aside from donated supplies, there was variable access to HbA1ctesting within public health facilities, and, when available, patients often had tocover the cost. Provision was further compromised by numerous problemsincluding stock-outs, and challenges with understanding the test, equipmentmaintenance, and refrigeration.CONCLUSIONLarge gaps exist for adequate access to appropriate insulin delivery devices andHbA1c testing. Public health systems in low-and-middle income countries shouldincrease affordable provision. There are also needs for specific health professional training and diabetes education;elimination of customs duties and taxes;development of inexpensive, robust HbA1c testing methods that do not requirerefrigeration of testing supplies;differential pricing schemes;and other solutions.
基金supported by National Natural Science Foundation of China(No.61078040)the Science and Technology,Project of Guangdong Province(No.2012B031800917).
文摘A new strategy for quantitative analysis of a major clinical biochemical indicator called glycatedhemoglobin(Hb·A1c)was proposed.The technique was based on the simultaneous near-infrared(NIR)spectral determination of hemoglobin(Hb)and absolute HbAlc content(Hb·HbA1c)inhuman hemolysate samples.Wavelength selections were accomplished using the improvedmoving window partial least square(MWPLS)method for stability.Each model was establishedusing an approach based on randomness,similarity,and stability to obtain objective,stable,andpractical models.The optimal wavebands obtained using MWPLS were 958 to 1036 nm for Hband 1492 to 1858 nm for Hb·HbA1c,which were within the NIR overtone region.The validationroot mean square error and validation correlation coeficients of prediction(V-SEP,V-Rp)were 3.4g L^(-1) and 0.967 for Hb,respectively,whereas the corresponding values for Hb.HbAic were 0.63 g L^(-1) and 0.913.The corresponding V-SEP and V-Rp were 0.40% and 0.829 for the relativepercentage of HbA1c.The experimental results confirm the feasibility for the quantification of HbAlc based on simultaneous NIR spectroscopic analyses of Hb and Hb·HbA1c.
文摘BACKGROUND Gestational diabetes mellitus(GDM)is characterized by glucose intolerance that is first diagnosed during pregnancy,making it the most common complication associated with this period.Early detection and targeted treatment of GDM can minimize foetal exposure to maternal hyperglycaemia and subsequently reduce the associated adverse pregnancy outcomes.Previous studies have inconsistently suggested that the level of glycated albumin(GA)might predict GDM.AIM To review and synthesize existing evidence to evaluate the relationship between GA levels and the development of GDM.METHODS We sought to compare GA levels between GDM and control groups in this metaanalysis by systematically searching the Web of Science,PubMed,Cochrane Library,and Embase databases for articles published up to June 2023.The analysis utilized the weighted mean difference(WMD)as the primary metric.The data were meticulously extracted,and the quality of the included studies was assessed.Additionally,we conducted a subgroup analysis based on study region and sample size.We assessed heterogeneity using I2 statistics and evaluated publication bias through funnel plots.Additionally,trim-and-fill analysis was employed to detect and address any potential publication bias.RESULTS The meta-analysis included a total of 11 studies involving 5477 participants,comprising 1900 patients with GDM and 3577 control individuals.The synthesized results revealed a notable correlation between elevated GA levels and increased susceptibility to GDM.The calculated WMD was 0.42,with a 95%confidence interval(95%CI)ranging from 0.11 to 0.74,yielding a P value less than 0.001.Concerning specific GA levels,the mean GA level in the GDM group was 12.6,while for the control group,it was lower,at 11.6.This discrepancy underscores the potential of GA as a biomarker for assessing GDM risk.Moreover,we explored the levels of glycated haemoglobin(HbA1c)in both cohorts.The WMD for HbA1c was 0.19,with a 95%CI ranging from 0.15 to 0.22 and a P value less than 0.001.This observation suggested that both GA and HbA1c levels were elevated in individuals in the GDM group compared to those in the control group.CONCLUSION Our meta-analysis revealed a substantial correlation between elevated GA levels and increased GDM risk.Furthermore,our findings revealed elevated levels of HbA1c in GDM patients,emphasizing the significance of monitoring both GA and HbA1c levels for early GDM detection and effective management.
