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The association between estimated average glucose levels and fasting plasma glucose levels
Bozkaya, Giray;Ozgu, Emrah;Karaca, Baysal;
Clinics , 2010, DOI: 10.1590/S1807-59322010001100003
Abstract: objective: the level of hemoglobin a1c (hba1c), also known as glycated hemoglobin, determines how well a patient's blood glucose level has been controlled over the previous 8-12 weeks. hba1c levels help patients and doctors understand whether a particular diabetes treatment is working and whether adjustments need to be made to the treatment. because the hba1c level is a marker of blood glucose for the previous 120 days, average blood glucose levels can be estimated using hba1c levels. our aim in the present study was to investigate the relationship between estimated average glucose levels, as calculated by hba1c levels, and fasting plasma glucose levels. methods: the fasting plasma glucose levels of 3891 diabetic patient samples (1497 male, 2394 female) were obtained from the laboratory information system used for hba1c testing by the department of internal medicine at the izmir bozyaka training and research hospital in turkey. these samples were selected from patient samples that had hemoglobin levels between 12 and 16 g/dl. the estimated glucose levels were calculated using the following formula: 28.7 x hba1c - 46.7. glucose and hba1c levels were determined using hexokinase and high performance liquid chromatography (hplc) methods, respectively. results: a strong positive correlation between fasting plasma glucose levels and estimated average blood glucose levels (r=0.757, p<0.05) was observed. the difference was statistically significant. conclusion: reporting the estimated average glucose level together with the hba1c level is believed to assist patients and doctors determine the effectiveness of blood glucose control measures.
Detection accuracy of three glucose meters estimated by capillary blood glucose measurements compared with venous blood evaluated by the diabetes unit of the Hospital Evangélico de Curitiba, Brazil
Gama MP, Cruzeta CF, Ossowski AC, Bay MR, Michaelis MM, Camacho SL
Research and Reports in Endocrine Disorders , 2012, DOI: http://dx.doi.org/10.2147/RRED.S24631
Abstract: ection accuracy of three glucose meters estimated by capillary blood glucose measurements compared with venous blood evaluated by the diabetes unit of the Hospital Evangélico de Curitiba, Brazil Original Research (1588) Total Article Views Authors: Gama MP, Cruzeta CF, Ossowski AC, Bay MR, Michaelis MM, Camacho SL Published Date May 2012 Volume 2012:2 Pages 1 - 9 DOI: http://dx.doi.org/10.2147/RRED.S24631 Received: 28 July 2011 Accepted: 21 October 2011 Published: 22 May 2012 Mirnaluci Paulino Ribeiro Gama, Camile Fiorese Cruzeta, Ana Carolina Ossowski, Marina Rech Bay, Mariella Muller Michaelis, Stênio Lujan Camacho Endocrinology and Diabetes Service, Hospital Universitário Evangélico de Curitiba, Brazil Objective: To compare capillary blood glucose measurements between three different glucose meters and with the serum glucose values of inpatients at the diabetes unit of Hospital Universitário Evangélico de Curitiba, Brazil. Materials and methods: A total of 132 non-intensive care unit patients admitted for medical and surgical pathologies were evaluated. All patients reported a previous diagnosis of diabetes mellitus, were under 60 years of age, had no hematocrit alterations, remained hemodynamically stable during the time of data collection, and were given no ascorbic acid, acetaminophen, dopamine, or mannitol during follow-up. Capillary and serum blood glucose samples were collected simultaneously by finger-stick and venipuncture 2 hours after lunch, by the same observer, who was blinded to the serum glucose results. First, between July and November 2009, capillary glucose levels were measured using the blood glucose meters OneTouch SureStep and MediSense Optium . Between November 2009 and February 2010, capillary blood glucose levels were measured on the glucose meters OneTouch SureStep and Optium Xceed . The capillary glucose readings were analyzed between meters and also in relation to the serum blood glucose values by the t-test for paired samples and the Mood two-sample test. Results: The patients’ mean age was 50.45 years. The blood glucose means obtained using the meters OneTouch SureStep, MediSense Optium, and Optium Xceed were, respectively, 183.87 mg/dL, 178.49 mg/dL, and 192.73 mg/dL, and the mean for the serum glucose values was 174.58 mg/dL. A significant difference was found between the capillary measurements taken by the glucose meters and the serum glucose measurements (P < 0.05), and no significant interdevice difference was found. After stratification of the serum blood glucose values into two groups, below and above 180 mg/dL, the variance found for the glucose meter OneTouch SureStep was statistically greater (P = 0.03) in relation to the serum glucose levels above 180 mg/dL, which was not the case with the glucose meters MediSense Optium (P = 0.06) and Optium Xceed (P = 0.12). The percentage of capillary blood glucose values showing a variation of less than 20% compared with serum values was 64.94% for OneTouch SureStep,
Early Postoperative Outcomes and Medication Cost Savings after Laparoscopic Sleeve Gastrectomy in Morbidly Obese Patients with Type 2 Diabetes  [PDF]
Bethany J. Slater,Nina Bellatorre,Dan Eisenberg
Journal of Obesity , 2011, DOI: 10.1155/2011/350523
Abstract: Background. We investigated the effect of laparoscopic sleeve gastrectomy (LSG) on morbidly obese diabetics and examined the short-term impact of LSG on diabetic medication cost. Methods. A prospective database of consecutive bariatric patients was reviewed. Morbidly obese patients with type 2 diabetes who underwent LSG were included in the study. Age, gender, body mass index (BMI), diabetic medication use, glucose, insulin, and HbA1c levels were documented preoperatively, and at 2 weeks, 2 months, 6 months, and 12 months postoperatively. Insulin resistance was estimated using the homeostatic model assessment (HOMA). Use and cost of diabetic medications were followed. Results. Of 178 patients, 22 were diabetics who underwent LSG. Diabetes remission was observed in 62% of patients within 2 months and in 75% of patients within 12 months. HOMA-IR improved after only two weeks following surgery (16.5 versus 6.6, ). Average number of diabetic medications decreased from 2.2 to <1, within 2 weeks after surgery; corresponding to a diabetes medication cost savings of 80%, 91%, 99%, and 99.7% after 2 weeks, 2 months, 6 months, and 12 months, respectively. Conclusion. Morbidly obese patients with diabetes who undergo LSG have high rates of diabetes remission early after surgery. This translates to a significant medication cost savings. 1. Introduction The problem of obesity in the United States has reached epidemic proportions. Over the past several decades, the prevalence of obesity has doubled, and it is now estimated that 20–30% of American adults are obese, and nearly two-thirds are either overweight or obese [1, 2]. Obesity-related comorbid conditions include type 2 diabetes, hypertension, and obstructive sleep apnea syndrome, which account for significant morbidity and mortality. The coexistence of obesity and diabetes increases the risk of cardiac disease and death [3]. Bariatric surgery has emerged as the most effective and durable method for weight loss in the morbidly obese, defined as a ?kg/m2 or ?kg/m2 with obesity-associated comorbid conditions [4]. In addition, certain bariatric procedures are associated with a significant improvement, and even remission, of comorbidities. The Roux-en-Y gastric bypass (RYGB) and the biliopancreatic diversion (BPD) have been shown to provide significant long-term improvement or remission of type 2 diabetes in the morbidly obese population [5, 6]. The laparoscopic sleeve gastrectomy (LSG), first described as a modification of the BPD, is emerging as a popular single-stage operation for the treatment of morbid obesity,
Early Postoperative Outcomes and Medication Cost Savings after Laparoscopic Sleeve Gastrectomy in Morbidly Obese Patients with Type 2 Diabetes  [PDF]
Bethany J. Slater,Nina Bellatorre,Dan Eisenberg
Journal of Obesity , 2011, DOI: 10.1155/2011/350523
Abstract: Background. We investigated the effect of laparoscopic sleeve gastrectomy (LSG) on morbidly obese diabetics and examined the short-term impact of LSG on diabetic medication cost. Methods. A prospective database of consecutive bariatric patients was reviewed. Morbidly obese patients with type 2 diabetes who underwent LSG were included in the study. Age, gender, body mass index (BMI), diabetic medication use, glucose, insulin, and HbA1c levels were documented preoperatively, and at 2 weeks, 2 months, 6 months, and 12 months postoperatively. Insulin resistance was estimated using the homeostatic model assessment (HOMA). Use and cost of diabetic medications were followed. Results. Of 178 patients, 22 were diabetics who underwent LSG. Diabetes remission was observed in 62% of patients within 2 months and in 75% of patients within 12 months. HOMA-IR improved after only two weeks following surgery (16.5 versus 6.6, <0.001). Average number of diabetic medications decreased from 2.2 to <1, within 2 weeks after surgery; corresponding to a diabetes medication cost savings of 80%, 91%, 99%, and 99.7% after 2 weeks, 2 months, 6 months, and 12 months, respectively. Conclusion. Morbidly obese patients with diabetes who undergo LSG have high rates of diabetes remission early after surgery. This translates to a significant medication cost savings.
Detection accuracy of three glucose meters estimated by capillary blood glucose measurements compared with venous blood evaluated by the diabetes unit of the Hospital Evangélico de Curitiba, Brazil  [cached]
Gama MP,Cruzeta CF,Ossowski AC,Bay MR
Research and Reports in Endocrine Disorders , 2012,
Abstract: Mirnaluci Paulino Ribeiro Gama, Camile Fiorese Cruzeta, Ana Carolina Ossowski, Marina Rech Bay, Mariella Muller Michaelis, Stênio Lujan CamachoEndocrinology and Diabetes Service, Hospital Universitário Evangélico de Curitiba, BrazilObjective: To compare capillary blood glucose measurements between three different glucose meters and with the serum glucose values of inpatients at the diabetes unit of Hospital Universitário Evangélico de Curitiba, Brazil.Materials and methods: A total of 132 non-intensive care unit patients admitted for medical and surgical pathologies were evaluated. All patients reported a previous diagnosis of diabetes mellitus, were under 60 years of age, had no hematocrit alterations, remained hemodynamically stable during the time of data collection, and were given no ascorbic acid, acetaminophen, dopamine, or mannitol during follow-up. Capillary and serum blood glucose samples were collected simultaneously by finger-stick and venipuncture 2 hours after lunch, by the same observer, who was blinded to the serum glucose results. First, between July and November 2009, capillary glucose levels were measured using the blood glucose meters OneTouch SureStep and MediSense Optium . Between November 2009 and February 2010, capillary blood glucose levels were measured on the glucose meters OneTouch SureStep and Optium Xceed . The capillary glucose readings were analyzed between meters and also in relation to the serum blood glucose values by the t-test for paired samples and the Mood two-sample test.Results: The patients’ mean age was 50.45 years. The blood glucose means obtained using the meters OneTouch SureStep, MediSense Optium, and Optium Xceed were, respectively, 183.87 mg/dL, 178.49 mg/dL, and 192.73 mg/dL, and the mean for the serum glucose values was 174.58 mg/dL. A significant difference was found between the capillary measurements taken by the glucose meters and the serum glucose measurements (P < 0.05), and no significant interdevice difference was found. After stratification of the serum blood glucose values into two groups, below and above 180 mg/dL, the variance found for the glucose meter OneTouch SureStep was statistically greater (P = 0.03) in relation to the serum glucose levels above 180 mg/dL, which was not the case with the glucose meters MediSense Optium (P = 0.06) and Optium Xceed (P = 0.12). The percentage of capillary blood glucose values showing a variation of less than 20% compared with serum values was 64.94% for OneTouch SureStep, 47.83% for Medisense Optium, and 51.61% for Optium Xceed, when serum glucose was gre
Long-term effect of metformin on blood glucose control in non-obese patients with type 2 diabetes mellitus
Hiroyuki Ito, Hidenori Ishida, Yuichiro Takeuchi, Shinichi Antoku, Mariko Abe, Mizuo Mifune, Michiko Togane
Nutrition & Metabolism , 2010, DOI: 10.1186/1743-7075-7-83
Abstract: A retrospective study was performed in 213 patients with type 2 diabetes mellitus under the administration of metformin for more than one year. The clinical parameters were investigated for 3 years. The obese and non-obese individuals were defined as a body mass index (BMI) of 25 kg/m2 or over (n = 105) and a BMI of less than 25 kg/m2 (n = 108), respectively.HbA1c levels were significantly decreased compared with those at the baseline time. The course of HbA1c was similar between the non-obese and the obese groups, while the dose of metformin required to control blood glucose was significantly lower in the non-obese group than in the obese group. The reductions in HbA1c were 1.2% and 1.1% at 12 months, 0.9% and 0.9% at 24 months, and 0.8% and 1.0% at 36 months in the non-obese and obese groups, respectively. BMI did not change during the observation periods. Approximately half of all patients required no additional antidiabetic agents or a reduction in other treatments after the initiation of metformin in either of the two groups.The present study demonstrated the long-term beneficial effect of metformin in non-obese (BMI < 25 kg/m2) diabetic patients. This effect appears to be maintained even after the observation period of this study, because metformin was limited to a relatively low dose in the non-obese group and the observed worsening in glycemic control over time can probably be attenuated by increasing the dose of metformin.Metformin, one of the biguanide agents, has been recommended for the treatment of patients with type 2 diabetes mellitus according to the consensus algorithm published by the European Association for the Study of Diabetes (EASD) and American Diabetes Association (ADA), because it is economical, induces less weight gain and does not cause hypoglycemic attacks, in addition to its glucose-lowering effect [1]. The UK Prospective Diabetes Study (UKPDS) demonstrated that metformin is as effective as sulfonylurea to control the blood glucose leve
Short-Term Stability in Refractive Status Despite Large Fluctuations in Glucose Levels in Diabetes Mellitus Type 1 and 2  [PDF]
Byki Huntjens, W. Neil Charman, Helena Workman, Sarah L. Hosking, Clare O’Donnell
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0052947
Abstract: Purpose This work investigates how short-term changes in blood glucose concentration affect the refractive components of the diabetic eye in patients with long-term Type 1 and Type 2 diabetes. Methods Blood glucose concentration, refractive error components (mean spherical equivalent MSE, J0, J45), central corneal thickness (CCT), anterior chamber depth (ACD), crystalline lens thickness (LT), axial length (AL) and ocular aberrations were monitored at two-hourly intervals over a 12-hour period in: 20 T1DM patients (mean age ± SD) 38±14 years, baseline HbA1c 8.6±1.9%; 21 T2DM patients (mean age ± SD) 56±11 years, HbA1c 7.5±1.8%; and in 20 control subjects (mean age ± SD) 49±23 years, HbA1c 5.5±0.5%. The refractive and biometric results were compared with the corresponding changes in blood glucose concentration. Results Blood glucose concentration at different times was found to vary significantly within (p<0.0005) and between groups (p<0.0005). However, the refractive error components and ocular aberrations were not found to alter significantly over the day in either the diabetic patients or the control subjects (p>0.05). Minor changes of marginal statistical or optical significance were observed in some biometric parameters. Similarly there were some marginally significant differences between the baseline biometric parameters of well-controlled and poorly-controlled diabetic subjects. Conclusion This work suggests that normal, short-term fluctuations (of up to about 6 mM/l on a timescale of a few hours) in the blood glucose levels of diabetics are not usually associated with acute changes in refractive error or ocular wavefront aberrations. It is therefore possible that factors other than refractive error fluctuations are sometimes responsible for the transient visual problems often reported by diabetic patients.
Safety Issues of Long-Term Glucose Load in Patients on Peritoneal Dialysis—A 7-Year Cohort Study  [PDF]
Hon-Yen Wu, Kuan-Yu Hung, Tao-Min Huang, Fu-Chang Hu, Yu-Sen Peng, Jenq-Wen Huang, Shuei-Liong Lin, Yung-Ming Chen, Tzong-Shinn Chu, Tun-Jun Tsai, Kwan-Dun Wu
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0030337
Abstract: Background Effects of long-term glucose load on peritoneal dialysis (PD) patient safety and outcomes have seldom been reported. This study demonstrates the influence of long-term glucose load on patient and technique survival. Methods We surveyed 173 incident PD patients. Long-term glucose load was evaluated by calculating the average dialysate glucose concentration since initiation of PD. Risk factors were assessed by fitting Cox's models with repeatedly measured time-dependent covariates. Results We noted that older age, higher glucose concentration, and lower residual renal function (RRF) were significantly associated with a worse patient survival. We found that female gender, absence of diabetes, lower glucose concentration, use of icodextrin, higher serum high density lipoprotein cholesterol, and higher RRF were significantly associated with a better technique survival. Conclusions Long-term glucose load predicted mortality and technique failure in chronic PD patients. These findings emphasize the importance of minimizing glucose load in PD patients.
The utility of fasting plasma glucose in predicting glycosylated hemoglobin in type 2 diabetes  [cached]
Al-Lawati Jawad,Al-Lawati Alya
Annals of Saudi Medicine , 2007,
Abstract: Background: Access to glycosylated hemoglobin (HbA1c) assays in clinical practice remains limited. We investigated the relationship of fasting plasma glucose and HbA1c to determine optimal glucose levels for predicting HbA1c. Patients and Methods: We retrospectively analyzed data on 2888 patients with type 2 diabetes mellitus aged 220 years using a linear regression of HbA1c against fasting plasma glucose. A receiver-operating charac--teristic analysis was used to determine optimal cut-points for fasting glucose in relation to HbA1c, area under the curve, sensitivity and specificity, and 95% confidence intervals (CI) for each cut-point. Results: The mean (standard deviation) for the age of patients was 52±11.6 years. The average HbA1c was 8.9±2.46% and mean fasting plasma glucose was 10.1±3.62 mmol/L. The prevalence of HbA1c 27.0% and> 6.5% was 76% and 82%, respectively. Overall, fasting plasma glucose and HbA1c were linearly correlated (r=0.62, P=0.001). A fasting plasma glucose of> 9.0 mmol/L predicted HbA1c 27.0% with an area under the curve = 0.807 (95% CI, 0. 0.794 to 0.821), while fasting plasma glucose> 8.2 mmol/L predicted HbA1c>6 .5 %, with an area under the curve = 0.805 (95% CI, 0.791 to 0.818). The sensitivity of both cut-points was 64.5% and 70.7%, the specificity was 82.7% and 76.4%, the positive likelihood ratio was 3.73 and 2.99, and the positive predictive value was 92.2% and 93.2%, respectively. Conclusion: When HbA1c determination is not available, fasting plasma glucose levels may be used to identify patients with uncontrolled type 2 diabetes and initiate timely intensification of therapy to avoid long-term complications of diabetes.
Short-term use of continuous glucose monitoring system adds to glycemic control in young type 1 diabetes mellitus patients in the long run: A clinical trial  [PDF]
Bukara-Radujkovi? Gordana,Zdravkovi? Dragan,Laki? Sini?a
Vojnosanitetski Pregled , 2011, DOI: 10.2298/vsp1108650b
Abstract: Background/Aim. Balancing strict glycemic control with setting realistic goals for each individual child and family can optimize growth, ensure normal pubertal development and emotional maturation, and control long term complications in children with type 1 diabetes (T1DM). The aim of this study was to evaluate the efficacy of short-term continuous glucose monitoring system (CGMS) application in improvement of glycemic control in pediatric type 1 diabetes mellitus (T1DM) patients. Methods. A total of 80 pediatric T1DM patients were randomly assigned into the experimental and the control group. The experimental group wore CGMS sensor for 72 hours at the beginning of the study. Self-monitored blood glucose (SMBG) levels and hemoglobin A1c (HbA1c) levels were obtained for both groups at baseline, and at 3 and 6 months. Results. There was a significant improvement in HbA1c (p < 0.001), in both the experimental and the control group, without a significant difference between the groups. Nevertheless, after 6 months the improvement of mean glycemia was noticed only in the experimental group. This finding was accompanied with a decrease in the number of hyperglycemic events and no increase in the number of hypoglycemic events in the experimental group. Conclusions. The results suggest that the CGMS can be considered as a valuable tool in treating pediatric T1DM patients, however further research is needed to more accurately estimate to what extent, if any, it outperforms intensive self-monitoring of blood glucose.
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