Variability in the Control of Type 2 Diabetes in Primary Care and Its Association with Hospital Admissions for Vascular Events. The APNA Study.

Type 2 diabetes (T2D) is associated with increased cardiovascular morbidity, mortality, and hospital admissions. There is variability in clinical practice. The objectives are to analyze the variability in the control of Blood Pressure (BP), HbA1c, and LDL-C in T2D patients and its influence on admissions due to cardiovascular events (CVE) Methods: We analyzed the electronic records in Primary Care Health centers in Navarra (Spain) and hospital admission for CVE. We follow 480637 people from 2012 to 2016. We calculated indicators of control of patients with T2D for each year, percentage with: HbA1c < 7%; HbA1c >= 9%; BP <140/90 mmHg; LDL-C <100 mg/dl. We used logistic and Cox regression. Results: Patients in the best control GP practices cluster are 2.5 times more likely to have HbA1c <7% [OR: 2.46 (95% CI: 2.29-3.64)]. Poor HbA1c control ≥ 9% is more likely in the worst control cluster [OR: 1.73 (95% CI:1.63-1.83)]. The probability of admission for CVE increases with age, being male, low income, obesity, history of CVE, having HbA1c ≥ 9%, and belonging to a GP practice in the cluster of HbA1C ≥ 9% worst control. In contrast, it decreases in patients with HbA1c <7%, BP<140/90 mmHg and LDL <100 mg/dl.

Hubungan Antara Kontrol Glikemik (HBA1C), Durasi Penyakit, dan Profil Lipid Pada Pasien Diabetes Melitus Tipe II Dengan Kejadian Neuropati Diabetik: Scoping Review

Diabetes melitus merupakan penyakit gangguan metabolik kronik yang menjadi salah satu penyakit dengan prevalensi dan insidensi tinggi setiap tahun di seluruh dunia, termasuk di Indonesia. Penyakit ini menjadi masalah yang lebih serius ketika terjadi komplikasi mikroangiopati dan makroangiopati, salah satunya neuropati diabetik. Neuropati diabetik dapat terjadi karena berbagai faktor, antara lain kontrol glikemik yang buruk, durasi penyakit, dan kadar profil lipid yang abnormal. Penelitian bertujuan mengetahui hubungan kontrol HbA1c, durasi menderita diabetes, dan profil lipid dengan kejadian neuropati diabetik. Pencarian sistematis scoping review menggunakan 12 laporan penelitian yang diperoleh dari beberapa database jurnal, yaitu PubMed dan Science Direct yang dilakukan pada bulan Oktober — Desember 2020. Hasil yang didapatkan adalah dari 6 laporan penelitian yang melaporkan hubungan antara HbA1c dan kejadian neuropati diabetik. Didapatkan 5 laporan penelitian yang melaporkan hubungan antara durasi menderita diabetes dan kejadian neuropati diabetik. Didapatkan 4 laporan penelitian yang melaporkan hubungan antara profil lipid dan kejadian neuropati diabetik. Simpulan dari 12 laporan penelitian tersebut adalah terdapat hubungan kontrol glikemik, durasi menderita diabetes, dan profil lipid dengan kejadian neuropati diabetik. Relationship Between Glycemic Control (HBA1C),Disease Duration, and Lipid Profile and Diabetic Neuropathy of Type II Type Diabetes Mellitus Patients: Scoping ReviewDiabetes is a chronic metabolic disorder which is a disease with a high prevalence and incidence every year throughout the world, including in Indonesia. This disease becomes a more serious problem when there are complications, one of which is diabetic neuropathy. Diabetic neuropathy can occur due to various factors, including poor glycemic control, duration of diabetes, and abnormal levels of lipid profiles. This study aims to determine the relationship between HbA1c control, duration of diabetes, and lipid profile with the incidence of diabetic neuropathy. The scoping review systematic search used 12 research reports obtained from several journal databases, such PubMed and Science Direct lasts from October to November 2020. The results of the articles is there were 6 research reports that reported an association between glycemic control and the incidence of diabetic neuropathy. There were 5 research reports that reported an association between the duration of suffering from diabetes and the incidence of diabetic neuropathy. There were 4 research reports that reported an association between lipid profiles and the incidence of diabetic neuropathy. The conclusions of the 12 research reports are there is an association of glycemic control, duration of diabetes, and lipid profile with the incidence of diabetic neuropathy.

Evaluation of Microalbuminuria and Glycosylated Hemoglobin in the Assessment of Diabetes Control in Children with Type 1 Diabetes Mellitus Hospitalized with Diabetic Ketoacidosis

Background: Microalbuminuria is thought to be an early predictor of impending diabetic nephropathy, while glycosylated hemoglobin (HbA1c) is a biochemical marker of long-term glycemic control in children with type 1 diabetes mellitus (T1DM). Objectives: The study aimed to evaluate the prevalence of microalbuminuria and its association with HbA1c on admission and duration of diabetes. Also, changes in HbA1c level on admission and three months after admission were studied to assess diabetes control in children with T1DM. Methods: This prospective study was conducted among 38 children (< 18 years) diagnosed with TIDM presenting with clinical signs, symptoms, and biochemical parameters of DKA. The presence of microalbuminuria, HbA1c level, and the number of past episodes of DKA were recorded. HbA1c level was again estimated after three months. The resultant data was tabulated and analyzed statistically (P < 0.05). Results: Microalbuminuria and poor HbA1c control were observed in 18% and 60% of the sample population, respectively. A significant association was found between HbA1c > 9% (P = 0.032) and the duration of diabetes > 4 years (P = 0.032) and microalbuminuria. Significant improvement in glycemic control was noted from the time of admission to three months after admission (9.76 ± 2.77 vs. 7.75 ± 1.28; P = 0.00012). A significant difference was observed between past DKA episodes according to HbA1c control (P < 0.001). Conclusions: Microalbuminuria assessment is needed in T1DM children, especially those with HbA1c > 9% and duration of diabetes > four years, to evaluate diabetic nephropathy. Good glycemic control can be achieved with effective insulin therapy accompanied by appropriate counseling and regular follow-up.

Vitamin D Deficiency May Not Be an Independent Risk Factor for Peripheral Arterial Disease in Middle-Aged and Elderly Patients with Type 2 Diabetes in China

Background. Vitamin D deficiency can lead to the increased severity and prevalence of metabolic disorders. However, the relationship between levels of 25-hydroxyvitamin D (25(OH)D) and peripheral arterial disease (PAD) is controversial. Therefore, the purpose of our study was to explore the relationship between 25(OH)D levels and PAD in middle-aged and elderly type 2 diabetes mellitus (T2DM) patients in China. Methods. In this study, a total of 183 patients with T2DM were enrolled and categorized into groups with or without PAD. Clinical and biochemical parameters were assessed, and a Pearson analysis was used to identify a possible association between levels of 25(OH)D and glycated hemoglobin (HbA1c). Some biochemical parameters were also assessed in the T2DM patients with PAD according to vitamin D status. Interactions were also explored among HbA1c control, 25(OH)D levels, and PAD. The possible risk factors for PAD were measured by multivariable logistic regression analyses. Results. Firstly, the parameters including age, HbA1c, and disease duration between T2DM and T2DM+PAD groups showed significantly different. In addition, the frequency of smoking in the group of T2DM patients was significantly less than that in the T2DM patients with the PAD group, while the frequency of well-controlled HbA1c in the patients with T2DM was significantly higher. There is a trend that the levels of 25(OH)D and HbA1c are correlated, but no interactions among vitamin D deficiency, HbA1c control, and PAD were found. However, HbA1c significantly differed between groups with vitamin D deficiency and insufficiency in the T2DM patients with PAD. According to the multivariate logistic regression analyses, the PAD risk factors of T2DM patients were family history of diabetes, smoking, age, disease duration, HbA1c, and LDL. Conclusions. The findings demonstrate that the deficiency of vitamin D level is not related to PAD, but HbA1c may be linked to the presence of PAD in middle-aged and elderly patients with T2DM in China.

Abstract 14434: Identification and Predictors for Cardiovascular Disease Risk Equivalents Among Adults With Diabetes Mellitus

Background: It is not well quantified if diabetes mellitus (DM) as a cardiovascular disease (CVD) risk equivalent depends on DM severity and other CVD risk factors. Methods: We pooled 4 US community-based cohorts (ARIC, JHS, MESA, FHS Offspring) and classified subjects by baseline DM/CVD status. DM+/CVD- was further classified by DM duration, HbA1c control or DM medication. Hazard ratios (HR) were estimated for CVD during a median follow-up of 14 years. Subgroup analysis comparing the HR of DM+/CVD- vs. DM-/CVD+ was done by CVD risk factors. We integrated all factors that impacted DM-conferred CVD risk and defined one with DM+/CVD- as CVD risk equivalent when his/her CVD risk was as high or higher than that if he/she had DM-/CVD+. CVD risk profile and event risk were compared between the CVD risk equivalent subgroups in DM+/CVD-. Results: The pooled cohort included 27,732 adults (mean age of 58 years, 45% males). CVD event rates per 1000 P-Y were 16.3, 33.3, 40.9 and 69.0 among those with DM-/CVD-, DM+/CVD-, DM-/CVD+ and DM+/CVD+, respectively. DM participants with HbA1c≥7%, DM duration over 10 years, or DM medication use had similar CVD risk as those with DM-/CVD+ while those without these factors had lower CVD risk; DM+/CVD- had similar CVD risk as those DM-/CVD+ among women, age <55 years, White race, or high triglyceride groups (Figure). Among those with DM+/CVD-, 17.5% were found to be CVD risk equivalents. Compared to those non-CVD risk equivalent DM, they had lower 10-year PCE scores (14.8% vs. 22.7%, p<0.0001) however higher actual CVD event rates (44.9 vs. 31.0 per 1000 P-Y). Conclusion: Among CVD-free adults with DM, fewer than 20% are actually CVD risk equivalents. Poor HbA1c control, long DM duration, and current diabetes medication use were identified as predictors of CVD risk equivalent status and DM was more detrimental for CVD risk if one is female, younger age, White, or with high triglycerides. These risk enhancing factors should be considered in the treatment decision.

Profile of HbA1c, Cholesterol and Triglyceride in Type 2 Diabetes Mellitus

Diabetes mellitus type 2 (DM Type-2) is a metabolic disease which characterized by hyperglycemia due to failure of insulin secretion, insulin action or both. If DM is not handled properly, then it will arise complications in various organs of the body. The criterias of DM control including HbA1c levels and lipid fractions. Lipid pattern in patients with DM type 2 is very dependent on HbA1c control. High HbA1c is associated with high triglycerides and cholesterol. Research objective to find out the description of Hba1c, cholesterol and triglyceride levels in patients of DM type 2 at the Outpatient Poly of RSUD Tidar Magelang. Research method the research type was descriptive with observational design. Primary data were obtained from levels measurements of HbA1c, cholesterol and triglycerides.. The normal HbA1c levels 4-5,80%, good control 6,1-6,5%, moderate 6,6-7,8%, bad 8,8-14,1% respectively as much as 65,96%, 12,77%, 10,64%, and 10,90%. The normal cholesterol levels 100-160 mg/dL, moderate 200-220 mg/dL, and high 250-300 mg/dL, respectively 74,47%, 10,64%, and 14,89%. The normal triglyceride levels 70-140 mg/dL, high limit 150-165 mg/dL, and high 200-252 mg/dL respectively as much as 63,83%, 19,15% and 17,02%. Based on the age of normal HbA1c levels as much as 65,96%, normal cholesterol 74,47%, and triglycerides 63,83%. The levels of HbA1c, cholesterol, and triglycerides were mostly normal in age groups of elderly, and male. The high levels of HbA1c, cholesterol, and triglycerides were more common in elderly than in other age groups.