Aims
Whether glycaemic control is associated with cardiovascular outcomes in patients with type 2 diabetes (T2D) is unclear. Consequently, we assessed the relationship between glycated haemoglobin ...(HbA1c) and cardiovascular outcomes in a placebo‐controlled randomized trial which demonstrated no cardiovascular effect of sitagliptin in patients with T2D and atherosclerotic vascular disease.
Methods and results
Secondary analysis of 14 656 TECOS participants with time to event analyses using multivariable Cox proportional hazard models. During a median 3.0 (interquartile range 2.3–3.8) year follow‐up, 456 (3.1% of 14 656) patients had first hospitalization for heart failure (HF), 1084 (11.5%) died, 1406 (9.6%) died or were hospitalized for HF, and 1689 (11.5%) had a non‐HF cardiovascular event (cardiovascular death, non‐fatal stroke, non‐fatal myocardial infarction, or hospitalization for unstable angina). Associations between baseline or time‐varying HbA1c and cardiovascular outcomes were U‐shaped, with the lowest risk when HbA1c was around 7%. Each one‐unit increase in the time‐varying HbA1c above 7% was associated with an adjusted hazard ratio (HR) of 1.21 95% confidence interval (CI) 1.11–1.33 for first HF hospitalization, 1.11 (1.03–1.21) for all‐cause death, 1.18 (1.09–1.26) for death or HF hospitalization, and 1.10 (1.02–1.17) for non‐HF cardiovascular events. Each one‐unit decrease in the time‐varying HbA1c below 7% was associated with an adjusted HR of 1.35 (95% CI 1.12–1.64) for first HF hospitalization, 1.37 (1.16–1.61) for death, 1.42 (1.23–1.64) for death or HF hospitalization, and 1.22 (1.06–1.41) for non‐HF cardiovascular events.
Conclusion
Glycated haemogobin exhibits a U‐shaped association with cardiovascular outcomes in patients with T2D and atherosclerotic vascular disease, with nadir around 7%.
Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT00790205.
Bariatric surgery is highly effective against obesity. Pre-surgical exercise programs are recommended to prepare the candidate physically and metabolically for surgery-related rapid weight loss. ...However, the ideal exercise prescription in this population is unknown. This study aimed to compare the metabolic effects of moderate-intensity constant (MICT) vs. a high-intensity interval training (HIIT) program in candidates to undergo bariatric surgery.
Twenty-five candidates (22 women) to undergo sleeve gastrectomy aged from 18 to 60 years old were recruited. At baseline, we measured body composition, physical activity levels, grip strength, and aerobic capacity. Further, we assessed metabolic function through glycemia and insulinemia (both fasting and after oral glucose tolerance test (OGTT)), homeostatic model assessment for insulin resistance (HOMA-IR), lipid profile, glycated haemoglobin (HbA1c), transaminases, fibroblast growth factor 21 (FGF21), growth differentiation factor 15 (GDF15), apelin, and adiponectin. Afterward, participants were randomized into MICT (n = 14) or HIIT (n = 11). Both training programs consisted of 10 sessions (2–3 times/week, 30 min per session) distributed during 4 weeks before the surgery. After this, all outcomes were measured again at the end of the training programs and 1 month after the surgery (follow-up). A mixed effect with Tukey's post-hoc analysis was performed to compare values at baseline vs. post-training vs. postsurgical follow-up. Both training programs increased aerobic capacity after training (p < 0.05), but only after MICT these changes were kept at follow-up (p < 0.05). However, only MICT decreased fat mass and increased total muscle mass and physical activity levels (p < 0.05). Metabolically, MICT decreased insulinemia after OGTT (p < 0.05), whereas HIIT increased adiponectin after training and GDF15 at follow-up (both p < 0.05).
Both MICT and HIIT conferred benefits in candidates to undergo bariatric surgery, however, several of those effects were program-specific, suggesting that exercise intensity should be considered when preparing these patients. Future studies should explore the potential benefits of prescribing MICT or HIIT in a customized fashion depending on a pretraining screening, along with possible summatory effects by combining these two exercise programs (MICT + HIIT).
International Traditional Medicine Clinical Trial Registry, N° ISRCTN42273422.
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•Pre-surgical exercise programs are recommended for bariatric surgery.•MICT and HIIT conferred differential metabolic benefits before and after the surgery.•This highlight the relevancy of exercise intensity when preparing this population.•A careful examination of the patient is needed to choose the proper exercise program.
Aim
Poor outcomes of coronavirus disease 2019 (COVID‐19) have been linked to diabetes, but its relation to pre‐infection glycaemic control is still unclear.
Materials and Methods
To address this ...question, we report here the association between pre‐infection Haemoglobin A1c (HbA1c) levels and COVID‐19 severity as assessed by need for hospitalization in a cohort of 2068 patients with diabetes tested for COVID‐19 in Leumit Health Services (LHSs), Israel, between 1 February and 30 April 2020. Using the LHS‐integrated electronic medical records system, we were able to collect a large amount of clinical information including age, sex, socio‐economic status, weight, height, body mass index, HbA1c, prior diagnosis of ischaemic heart disease, depression/anxiety, schizophrenia, dementia, hypertension, cerebrovascular accident, congestive heart failure, smoking, and chronic lung disease.
Results
Of the patients included in the cohort, 183 (8.85%) were diagnosed with COVID‐19 and 46 were admitted to hospital. More hospitalized patients were female, came from higher socio‐economic background and had a higher baseline HbA1c. A prior diagnosis of cerebrovascular accident and chronic lung disease conferred an increased risk of hospitalization but not obesity or smoking status. In a multivariate analysis, controlling for multiple prior clinical conditions, the only parameter associated with a significantly increased risk for hospitalization was HbA1c ≥ 9%.
Conclusion
Using pre‐infection glycaemic control data, we identify HbA1c as a clear predictor of COVID‐19 severity. Pre‐infection risk stratification is crucial to successfully manage this disease, efficiently allocate resources, and minimize the economic and social burden associated with an undiscriminating approach.
Introduction: India bears a high burden of Type 2 Diabetes Mellitus (T2DM) and Thyroid Dysfunction (TD). Though the coexistence of T2DM and TD has been evaluated, such studies from the perspective of ...metropolitan cities, including Mumbai, are lacking. Aim: To assess the prevalence of TD in patients with T2DM and to evaluate the association of TD with glycaemic control, duration, and complications of T2DM. Materials and Methods: The present observational cross-sectional study was performed in the Department of General Medicine, The Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India, from January 2016 to December 2017. The study involved 220 diagnosed patients with T2DM, of either gender, aged 18 years or more. All patients were evaluated for TD by performing thyroid profile {T3, T4 and Thyroid Stimulating Hormone (TSH)}. The association of TD prevalence with age, gender, Body Mass Index (BMI), duration of T2DM, Glycated Haemoglobin (HbA1c), and complications was assessed. The qualitative and quantitative parameters were compared with Chi- square and independent sample t-test, respectively, with a p-value <0.05 considered statistically significant. Results: The patients were predominantly males, 127 (57.7%) with a mean±Standard Deviation (SD) age and BMI of 63.4±14.02 years and 25.9±4.5 Kg/m2, respectively. The prevalence of TD was 36.8%. The predominant TD in patients with T2DM was subclinical hypothyroidism (75.9%). TD was significantly associated with advancing age (p-value=0.0167). However, gender and BMI were not significantly associated with TD. Poor glycaemic control was significantly associated with subclinical hypothyroidism (p-value=0.0255). The duration of T2DM was significantly associated with the prevalence of subclinical hypothyroidism (p-value=0.0144), primary hypothyroidism (p-value=0.0257), and subclinical hyperthyroidism (p-value=0.0310). TD was found to be significantly associated with both micro and macrovascular complications of T2DM (all p-values <0.05). Conclusion: In Mumbai, the prevalence of T2DM-associated TD was 36.8%. TD was significantly associated with advancing age, duration of T2DM, high HbA1c levels, and both micro and macrovascular complications.
Elevated fasting glucagon concentrations and/or attenuated postprandial glucagon suppression are characteristics of type 2 diabetes (T2D) and contribute to hyperglycaemia. This study shows that ...hyperglucagonaemia is more prominent in males than females after a nutrient load in T2D, adding insights into sex differences in relation to the pathophysiology of T2D.
•It’s unclear why early-onset diabetes is associated with an increased risk of complications.•Those with early-onset diabetes had lower frequency of HbA1c testing and sub-optimal control.•Those with ...early-onset diabetes had lower concordance with guideline recommended care.•Strategies to improve diabetes management in those with early-onset diabetes are needed.
Adults with early-onset diabetes (age < 40 years) have an increased risk of complications, and it is unclear whether they are receiving guideline recommended care. We compared the frequency and results of haemoglobin A1c (HbA1c) testing in adults with early-onset and usual-onset diabetes and assessed factors related to guideline concordance.
Population-level databases from Alberta, Canada (∼4.5 million) were used to identify adults with incident diabetes. The cohort was stratified by age at diagnosis (< 40 vs. ≥ 40 years) and then followed for 365 days for HbA1c testing. Adjusted multivariable analyses were used to identify clinical and sociodemographic factors associated with guideline concordance.
Among 23,643 adults with incident diabetes (mean age 54.1 ± 15.4 years; 42.1 % female), 18.9 % had early-onset diabetes. Early-onset diabetes was associated with lower frequency of testing (adjusted odds ratio (aOR), 0.80; 95 % CI 0.70–0.90) and above target glycaemic levels compared to usual-onset diabetes (aOR, 1.45; 95 % CI 1.29–1.64). Factors associated with guideline concordant frequency of HbA1c testing were rural residence and insulin use.
In our universal care setting with premium-free health care, early-onset diabetes was associated with lower rates of HbA1c testing and sub-optimal glycaemic control compared to those with usual-onset diabetes.
Introduction: Anaemia is frequently observed in diabetes, affecting the quality of life and also contributing to the pathogenesis of microvascular complications. However, according to the literature, ...there have been no previous studies on the prevalence of Anaemia in Type 2 Diabetes (T2D) without Diabetic Kidney Disease (DKD) in the south Indian population. Aim: To estimate the prevalence of anaemia in T2D and study its association with glycaemic control and diabetes-related microvascular complications. Materials and Methods: The present study was a cross-sectional study that included 100 patients with T2D visiting the Department of Endocrinology at Sri Ramachandra Hospital, Chennai between June and September 2019. After obtaining informed consent, samples for complete blood count, Fasting Plasma Glucose (FPG), Glycosylated Haemoglobin (HbA1c), renal function tests, lipid profile, and urine microalbumin were collected from participants. Gestational diabetes, Type 1 Diabetes (T1D), and DKD on erythropoietin were excluded from this study. The test of Proportions was performed using the Chi-square test. Results: The mean age of the study population was 57.91±9.50 years. The overall prevalence of anaemia in the present study was 60%, and it was higher among women (p=0.023). Anaemia was also observed to be more common in those with poor glycaemic control (p=0.340) and in cases where at least one microvascular complication had occurred (p=0.796). Conclusion: Anaemia was observed in almost two-thirds of patients with T2D in this study. The prevalence of anaemia was higher in individuals with poor glycaemic control and diabetes-related microvascular complications.
Type 2 diabetes is a heterogeneous disease, with the underlying mechanism ranging from predominantly insulin resistance with relative insulin deficiency, to predominantly an insulin secretory defect ...with lesser degrees of insulin resistance.
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