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Background: Glycemic control is the basis for managing diabetes to prevent chronic complications in diabetes. HbaA1c levels reaching ≤7% is an indicator of achieving good glycemic control. The 3J principles (right type, amount, and schedule) in the pillars of meal management are not easy to apply, causing diabetes to have difficulty achieving glycemic targets. Objectives: Analyzing rice portion restriction and pre-meal fruit with HbA1c levels and abdominal fat in people with diabetes in Malang City. Methods: Experimental study type 'randomized controlled trial' with pre-posttest control group design involved 16 people with diabetes who were active in Prolanis activities at the Malang city health center. Respondents were randomly divided into 2 groups. HbA1c levels were taken 2 times, before and after the intervention. The t test and paired t test with a pvalue<0.05 were used to test the effect of the intervention on HbA1c levels, abdominal fat and abdominal circumference in people with diabetes for 3 months. Results: Both forms of intervention can reduce HbA1c levels in diabetic patients. Limiting the portion of rice significantly reduced HbA1c levels (p=0.003) and visceral fat levels. However, determining the amount of rice with added pre-meal fruit did not significantly decrease visceral fat and abdominal circumference (p>0.05). Conclusions: Limiting the portion of rice eaten by itself or combining it with pre-meal fruit may help diabetics lower their HbA1c levels. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the effect of the glycated hemoglobin A1c (HbA1c) level on the functional outcome (FOC) in patients with intracranial large artery atherosclerotic disease (ICLAD)-related acute ischemic stroke (AIS). Methods: This retrospective study enrolled patients with ICLAD-related AIS who were admitted to King Fahd University Hospital between January 2017 and September 2021. Patients were divided into two groups based on the optimal cutoff HbA1c level determined using receiver operating characteristic curve analysis--those with HbA1c =6.9% and those with HbA1c >6.9%. Demographic and other clinical characteristics were compared between the two groups using chi-square tests. The association between HbA1c and 90-day FOC was assessed using the chi-square test and odds ratios (ORs). Multivariate analysis was performed to adjust for confounding factors. Results: A total of 140 patients were included in the analysis. A significant association was observed between the HbA1c level and FOC. Compared to patients with HbA1c =6.9%, patients with HbA1c >6.9% were more likely to have an unfavorable FOC [p = <0.001, OR = 2.05, 95% confidence interval (CI) = 1.33-3.14]. The association between HbA1c >6.9% and unfavorable FOC was sustained even after adjusting for confounding factors (p = 0.008) and atherosclerosis risk factors (p = 0.01). HbA1c >6.9% was also associated with higher ORs for in-hospital complications (p = 0.06, OR = 1.34, 95% CI = 1.02-1.77) and mortality (p = 0.07, OR = 1.42, 95% CI = 1.06-1.92) although these associations did not attain significant p-values. Conclusion: HbA1c >6.9% was significantly associated with unfavorable FOC in ICLAD-related AIS. However, further studies with larger sample sizes are required to verify whether HbA1c is an independent predictor of poor FOC. Nevertheless, targeting HbA1c <7% should be the goal of physicians when managing patients at high risk of ICLAD. [ABSTRACT FROM AUTHOR]

Background. Stroke is the highest cause of death in Indonesia. Impaired glucose tolerance becomes one of the metabolic risk factors that contribute to ischemic stroke. This study will observe the role of HbA1c level on ischemic stroke in “Dr. Sardjito” General Hospital due to limited research data of this aspect in Indonesia. Objective. The objective of this study is to explore the role of HbA1c level on ischemic stroke in prediabetic patients of “Dr. Sardjito” General Hospital, Yogyakarta. Method. This study design is non-experimental, observational study with correlation analysis approach. The research collected 106 data of non-diabetic and prediabetic ischemic stroke patients’ medical records in “Dr. Sardjito” General Hospital, recorded from 2012 until 2015. Result. A Comparison of HbA1c level in prediabetic ischemic stroke patients were significantly higher (p

Background. Stroke is the highest cause of death in Indonesia. Impaired glucose tolerance becomes one of the metabolic risk factors that contribute to ischemic stroke. This study will observe the role of HbA1c level on ischemic stroke in “Dr. Sardjito” General Hospital due to limited research data of this aspect in Indonesia. Objective. The objective of this study is to explore the role of HbA1c level on ischemic stroke in prediabetic patients of “Dr. Sardjito” General Hospital, Yogyakarta. Method. This study design is non-experimental, observational study with correlation analysis approach. The research collected 106 data of non-diabetic and prediabetic ischemic stroke patients’ medical records in “Dr. Sardjito” General Hospital, recorded from 2012 until 2015. Result. A Comparison of HbA1c level in prediabetic ischemic stroke patients were signifi cantly higher (p<0.001), compared to non-diabetic ischemic stroke patients (mean rank 80.00 vs. 27.00). Multivariate analysis was performed and showed elevated HbA1c level, modified with decreased diastolic blood pressure, associated 70.8% in determining ischemic stroke in prediabetic patients of “Dr. Sardjito” General Hospital. Conclusion. Elevated HbA1c level, modified with decreased diastolic blood pressure, has significant predisposition role on ischemic stroke patients with prediabetes in “Dr. Sardjito” General Hospital. [ABSTRACT FROM AUTHOR]

ObjectiveThis study aimed to investigate the effect of the glycated hemoglobin A1c (HbA1c) level on the functional outcome (FOC) in patients with intracranial large artery atherosclerotic disease (ICLAD)-related acute ischemic stroke (AIS).MethodsThis retrospective study enrolled patients with ICLAD-related AIS who were admitted to King Fahd University Hospital between January 2017 and September 2021. Patients were divided into two groups based on the optimal cutoff HbA1c level determined using receiver operating characteristic curve analysis—those with HbA1c ≤6.9% and those with HbA1c >6.9%. Demographic and other clinical characteristics were compared between the two groups using chi-square tests. The association between HbA1c and 90-day FOC was assessed using the chi-square test and odds ratios (ORs). Multivariate analysis was performed to adjust for confounding factors.ResultsA total of 140 patients were included in the analysis. A significant association was observed between the HbA1c level and FOC. Compared to patients with HbA1c ≤6.9%, patients with HbA1c >6.9% were more likely to have an unfavorable FOC [p = 6.9% and unfavorable FOC was sustained even after adjusting for confounding factors (p = 0.008) and atherosclerosis risk factors (p = 0.01). HbA1c >6.9% was also associated with higher ORs for in-hospital complications (p = 0.06, OR = 1.34, 95% CI = 1.02–1.77) and mortality (p = 0.07, OR = 1.42, 95% CI = 1.06–1.92) although these associations did not attain significant p-values.ConclusionHbA1c >6.9% was significantly associated with unfavorable FOC in ICLAD-related AIS. However, further studies with larger sample sizes are required to verify whether HbA1c is an independent predictor of poor FOC. Nevertheless, targeting HbA1c

Background: The coronavirus disease (COVID-19) pandemic causes significant morbidities and mortalities. Lockdown is applied worldwide to counteract the spread of the disease. These circumstances limit diabetic patients from hospital visits and follow-ups. Objectives: To evaluate glycemic control for type 2 diabetic patients in the first visit after COVID-19 lockdown and to study the effect of COVID-19 lockdown on glycemic control. Methods: A cross-sectional study was conducted at Prince Mansour Military Hospital, Taif city, Western Saudi Arabia. It included type 2 diabetic patients of both genders aged over 20 years that were assigned to follow-up in the diabetic center. Data were collected from patients' medical records using a simple random technique. It included patients' gender, age group, body mass index, and three glycosylated hemoglobin (HbA1c) readings for each year (2018–2019) and one HbA1C reading upon the first visit after COVID-19 lockdown. HbA1c level was treated as a continuous variable. Results: The study included 420 diabetic patients. Females represented 51% of them, and more than a third (39.8%) were aged 60 years and over. The majority of them were either overweight (29.3%) or obese (61.2%). There was an increase in the overall level of HbA1c after curfew (8.72 ± 1.73) than before it (8.58 ± 1.72). However, the difference did not reach a statistically significant level, P = 0.056. Among females, the level of hemoglobin A1c (HbA1c) was statistically and significantly higher after curfew than before it (8.71 ± 1.82 vs. 8.43 ± 1.71), P = 0.005. Also, among obese subjects, the level of hemoglobin A1c was statistically and significantly higher after curfew than before it (8.55 ± 1.74 vs. 8.34 ± 1.63), P = 0.034. Conclusion: There was a relative increase in the level of HbA1c after the lockdown during COVID-19, indicating poorer glycemic control; this impact was more obvious among female and obese type 2 diabetic patients.

The purpose of this study was to explore the variables of foot pressure according to glycated hemoglobin level during walking in diabetic patients with pes rectus. The subjects of this study were 39 people (78 feet) in their 40s and 60s, and they were divided into 11 pre-diabetic patients (22 feet) and 14 diabetic patients (28 feet) based on glycated hemoglobin; 14 patients without diabetes (28 feet) was used as a control. Foot pressure was measured using the EMED-LE Measurement system. The sole of the foot was divided into 12 parts, each of which was analyzed for pressure, force, contact area, and grounding time. For statistics, nonparametric Kruskal–Wallis and Wilcoxon signed rank test were used. Prediabetic and diabetic patients had lower hindfoot and second and third metatarsal foot pressure but higher first and third toe pressure compared to those without diabetes. In addition, the maximum and minimum force were high in all parts of the sole, and the contact time was long, signifying strong downward force for a long duration. Measurement of foot pressure by parts allowed detailed analysis of abnormal foot pressure and is valuable as basic data for diagnosis, prediction, and treatment of diabetic foot. Based on these data, maximum and minimum pressure better explain the problem of plantar pressure distribution rather than mean maximum pressure. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease (COVID-19) pandemic causes significant morbidities and mortalities. Lockdown is applied worldwide to counteract the spread of the disease. These circumstances limit diabetic patients from hospital visits and follow-ups. Objectives: To evaluate glycemic control for type 2 diabetic patients in the first visit after COVID-19 lockdown and to study the effect of COVID-19 lockdown on glycemic control. Methods: A cross-sectional study was conducted at Prince Mansour Military Hospital, Taif city, Western Saudi Arabia. It included type 2 diabetic patients of both genders aged over 20 years that were assigned to follow-up in the diabetic center. Data were collected from patients' medical records using a simple random technique. It included patients' gender, age group, body mass index, and three glycosylated hemoglobin (HbA1c) readings for each year (2018-2019) and one HbA1C reading upon the first visit after COVID-19 lockdown. HbA1c level was treated as a continuous variable. Results: The study included 420 diabetic patients. Females represented 51% of them, and more than a third (39.8%) were aged 60 years and over. The majority of them were either overweight (29.3%) or obese (61.2%). There was an increase in the overall level of HbA1c after curfew (8.72 ± 1.73) than before it (8.58 ± 1.72). However, the difference did not reach a statistically significant level, P = 0.056. Among females, the level of hemoglobin A1c (HbA1c) was statistically and significantly higher after curfew than before it (8.71 ± 1.82 vs. 8.43 ± 1.71), P = 0.005. Also, among obese subjects, the level of hemoglobin A1c was statistically and significantly higher after curfew than before it (8.55 ± 1.74 vs. 8.34 ± 1.63), P = 0.034. Conclusion: There was a relative increase in the level of HbA1c after the lockdown during COVID-19, indicating poorer glycemic control; this impact was more obvious among female and obese type 2 diabetic patients. [ABSTRACT FROM AUTHOR]

Background: Right ventricular (RV) involvement has been reported in type 2 diabetes mellitus (T2DM). The relationship between glycemic control and RV function remains unknown. We aimed to investigate the association between glycemic control and RV function assessed by two-dimensional speckle-tracking echocardiography and three-dimensional echocardiography in T2DM individuals., Methods: This study prospectively enrolled 207 patients with T2DM and 84 individuals with normal glucose metabolism. The T2DM patients were divided into 2 subgroups according to glycated hemoglobin (HbA1c) level: controlled (HbA1c < 7.0%, n = 91) and uncontrolled subgroup (HbA1c ≥ 7.0%, n = 116). Right venticular free wall longitudinal strain (RVFWLS) was acquired by two-dimensional speckle-tracking echocardiography, and RV volumes and RV ejection fraction (RVEF) were assessed using three-dimensional echocardiography . Right ventricular coupling to pulmonary circulation was defined as the ratio of RVFWLS/pulmonary artery systolic pressure (PASP)., Results: Controlled and uncontrolled T2DM subgroups had impaired RV function as reflected by reduced RVFWLS and RVEF compared to the normal glucose metabolism group. The reduction in RVFWLS was more pronounced in the uncontrolled subgroup than in the controlled subgroup (P < .001), whereas no significant difference was found in RVEF between these 2 T2DM subgroups. Higher PASP and lower RVFWLS/PASP ratio were also noted in uncontrolled T2DM patients. Additionally, the incidence of RV dysfunction was significantly higher in the uncontrolled T2DM patients than in the controlled subgroup (43.1% vs 17.6%, P < .001). After adjustment for potential clinical confounders, PASP, and left ventricular parameters, HbA1c level was independently associated with RVFWLS (β = 0.290, P = .003) and RVFWLS/PASP ratio (β = 0.028, P = .006)., Conclusions: Subclinical RV myocardial dysfunction is present in T2DM patients and is more pronounced in patients with uncontrolled blood glucose. HbA1c level is independently associated with subclinical RV myocardial dysfunction, providing further insight into a possible link between poor glycemic control and diabetic cardiomyopathy., Competing Interests: Conflicts of Interest None., (Copyright © 2024 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.)

Background & Objective: Diabetes mellitus is widely prevalent and significantly impacts the perioperative outcome. We aimed to assess the perioperative practice for managing diabetes mellitus patients and variation across different establishments. Methodology: A questionnaire-based online survey was conducted for the present cross-sectional, multinational study; data collection followed a snowball method and was conducted from November 2020 to January 2021. Responses were presented in absolute number and percentage scale, and response rates among the subgroups were analyzed using Fisher's exact test; p < 0.05 was considered significant. Results: Responses from 556 out of 637 from six South Asian Association for Regional Cooperation countries were analyzed. A considerable amount of practice variation was noted; variation increased as the invasiveness of surgery increased. Perioperative insulin administration strategy and case postponement based on blood sugar level differed between the teaching and non-teaching sectors and private and public sectors. However, a majority (64.8%) of the respondents did not favor postponing a case based on the glycosylated hemoglobin (HbA1c) level. Confusion and diverse opinions were present even for emergency cases, including postponement based on blood sugar. Conclusion: There is a wide variation in the perioperative practice for managing diabetes mellitus patients. The variation increases with the increasing invasiveness of surgery. Although there were similar practices between private versus public sectors and teaching versus non-teaching institutions, significant differences were noticed about case postponement, indicating that an authoritative guideline is the need of the hour. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the effect of the status of retinal pigment epithelium (RPE) and HbA1c levels on the efficacy of the subthreshold micropulse laser (SMPL) in the treatment of center-involving diabetic macular edema (DME). A total of 20 eyes of 20 patients (mean age 57.9 ± 9.7 years) who were diagnosed with center-involving DME and treated with SMPL for refusing intravitreal injection and 20 eyes of 20 age- and sex-matched healthy participants were enrolled. All patients were followed up in the 1st and 3rd months after SMPL. For measurement of RPE area central 1000 microns, macular EDI-OCT scans were binarized by using the public domain software ImageJ, with a semi-automated technique. There was a significant increase in BCVA values and a significant decrease in CMT values during follow-up. The area of RPE before SMPL was significantly thinner in the patient group (p: 0.004). When the areas of RPE before and 3 months after SMPL were compared, no significant change was observed (p: 0.437). When the relationship between pre-treatment area of RPE and HbA1c was examined, an inverse correlation was observed (p: 0.018). The patients were evaluated by dividing them into 2 groups as 2nd session SMPL required and not required, and the area of RPE was smaller in the group requiring 2nd session SMPL (p: 0.030). The status of central RPE may be a determining factor on the response to treatment. Additionally, HbA1c levels may have an impact on treatment efficacy. [ABSTRACT FROM AUTHOR]

Diabetes mellitus is a chronic metabolic disease that results in micro-vascular and macro-vascular complications. Further, uncontrolled hyperglycemia can damage blood vessels and alters the anagen and telogen phases of hair growth leading to alopecia. We report a case of a 54-year-old woman diagnosed with type 2 diabetes mellitus (DM) and hypertension suffering from hair loss on the right side of scalp without any signs and symptoms of scalp inflammation. All the possible causes such as lipid profile, side effects of hypoglycemic agents and anti-hypertensive therapy, trichotillomania, and dermatological diseases were ruled out. Here, we emphasize that damaged blood vessels that hinder oxygen supply and nutrients to hair follicles could be the reason behind alopecia in DM patients. Furthermore, insulin plays an important role in cell proliferation and regrowth of hair follicles. It was also noted that patients’ response to glycemic control was remarkable, and timely initiation of insulin in patients with DM and alopecia restores normal hair growth. Still, more extensive research is required in this field, which will ultimately be helpful in the prevention of alopecia in DM patients.

Background : HbA1c is one of the parameters that can be useful for diagnosing diabetes mellitus that can occur in obesity. Monocyte as an inflammatory cell is widely studied in relation to diabetes mellitus and obesity. The purpose of this study is to analyze the correlation between HbA1c levels and monocyte percentage in obesity. Methods : A Cross-sectional study of 30 medical students at a private laboratory in Semarang on March – April 2017 was done. The monocyte percentage included incomplete blood count was examined with the Sysmex XS-800i hematology analyzer, while HbA1c level was examined with Hemocue HbA1c 501 System. Spearman test was done for analyzing data with p

Diabetes mellitus (DM) is a chronic hyperglycemic that can cause complications in several organs. It could lead glycosylated hemoglobin or HbA1c formation which has ability undergo further changes into Advanced Glycation End Products (AGEs) and stimulate activation of transcription factors such as nuclear factor kappa B (NF-κB). Some studies showed that anthocyanin has antioxidant and anti-inflammatory activity and it has been found Rosa damascene contain high level of anthocyanin. Total anthocyanin content was 0.459 ± 0.003 mg/L. The aim of this study was to investigate inhibitory effect of R. damascena extract on HbA1c levels and NF-κB activation in diabetic rats. Male wistar rats (n=24) were divided into 6 groups as normal control (KN), streptozotocin-induced diabetic control (KP), diabetic treated with R. damascene (P1, P2, P3; 250, 500 and 1000 mg/kg/d respectively) and diabetic treated with metformin (KM; 500 mg/kg/d). This was carried out for 28 days. The inhibition mode of R. damascene extract was examined by measuring HbA1c levels and expression of NFκB by immunohistochemistry. The results showed p values ​​> 0.05 for HbA1c and p < 0.05 for NFκB. From immunohistochemical staining, it seen the expression of NFκB was low in treated group (P1, P2, P3 and KM) compared with KP. Thus, oral administration of R. damascene extract for 28 days could not reduce HbA1c levels, but can supress NFκB expression.

Abstract Background As an insulin-dependent disease, type 1 diabetes requires paying close attention to the glycemic control. Studies have shown that mobile health (mHealth) can improve the management of chronic diseases. However, the effectiveness of mHealth in controlling the glycemic control remains uncertain. The objective of this study was to carry out a systematic review and meta-analysis using the available literature reporting findings on mHealth interventions, which may improve the management of type 1 diabetes. Methods We performed a systematic literature review of all studies in the PubMed, Web of Science, and EMbase databases that used mHealth (including mobile phones) in diabetes care and reported glycated hemoglobin (HbA1c) values as a measure of glycemic control. The fixed effects model was used for this meta-analysis. Results This study analyzed eight studies, which involved a total of 602 participants. In the meta-analysis, the fixed effects model showed a statistically significant decrease in the mean of HbA1c in the intervention group: − 0.25 (95% confidence interval: − 0.41, − 0.09; P = 0.003, I 2 = 12%). Subgroup analyses indicated that the patient’s age, the type of intervention, and the duration of the intervention influenced blood glucose control. Funnel plots showed no publication bias. Conclusions Mobile health interventions may be effective among patients with type 1 diabetes. A significant reduction in HbA1c levels was associated with adult age, the use of a mobile application, and the long-term duration of the intervention.

Background: Diabetes mellitus is the most common endocrine disorder in the world that can increase the incidence of complications and mortality in patients. So, it is necessary to identify the factors affecting the incidence of diabetes complications, especially the diabetic foot. This study aimed to investigate the relationship between the grade of diabetic foot ulcer based on the HbA1C levels and severity of complications based on the Texas classification. Materials and Methods: This study was performed on 245 patients with diabetic foot ulcers. Demographic information of patients was recorded and HbA1C levels and the severity of complications were also recorded based on the Texas classification. Data obtained were compared using Chi-square, independent t-test, and Mann-Whitney. Results: The results of our study showed that the mean level of HbA1C was highest (8.23%) and lowest (7.34%) in patients with grades III and I diabetic foot ulcers, respectively based on the Texas classification. This difference was statistically significant, which remained significant by grouping based on demographic and clinical characteristics. Conclusion: High HbA1C (poor blood sugar control) is associated with an increased incidence of the higher grades of diabetic foot ulcers. Educating patients about proper glycemic control and regular HbA1C testing can prevent the progression of diabetic foot ulcers. However, this requires further investigation in future studies. [ABSTRACT FROM AUTHOR]

Background:HbA1c is an established diagnostic index which is used to assess diabetes mellitus. The aim of this study was to evaluate the association between HbA1c level with the types of stroke as well as the extent and functional status of ischemic stroke (IS) and hemorrhagic stroke (HS) in patients. Methods: In this cross-sectional study, we evaluated 120 patients with IS and HS. The functional outcome was evaluated based on the MRS criteria. The extent of the lesion was determined according to CT scan and MRI. We measured the blood hemoglobin A1c (HbA1c) levels in all patients after stroke. Results:HbA1c level in the IS group was significantly higher compared to the HS group (p < 0.05). There was a statistically significant difference between the extent of the lesion and the functional status of patients with the type of stroke (P < 0.001). History of smoking, in the IS group, was significantly associated with exposure to worse functional outcome (p

Hemoglobin A1c (HbA1c) is a reliable marker of insulin resistance in normal glucose tolerance patients; however, several physiological, environmental, and genetic factors may affect HbA1c and cause false results. Therefore, it is essential to use new biomarkers due to increasing diabetes predictive value. Recently, it has been indicated that microRNAs (miRNAs) are involved in the pathophysiology of diabetes, particularly, in insulin resistance pathways. Therefore, miRNAs have the potential to be introduced as new glycemic control biomarkers. The aim of this study was to investigate the association between plasma level of miRNA-135a and HbA1c in patients with prediabetes and type 2 diabetes. In this case-control study, 120 samples were enrolled (healthy individuals, people with type 2 diabetes, and prediabetes) and HbA1c and miR-135a expression level in their plasma samples were evaluated. Multinomial logistic regression and ROC curve analysis were conducted to assess the diagnostic accuracy of plasma miR-135a in T2D , prediabetes, and healthy control groups. Data analysis indicated that miR-135a was significantly elevated in both diabetes/prediabetes samples. Then, subjects were reclassified based on the calculated cutoff value of miRNA. Logistic Regression analysis showed that an increased level of miRNA positively correlated with HbA1c level in prediabetes (Adjusted OR = 1.14, p value = 0.033) and diabetic status (Adjusted OR = 1.27, p value = 0.024). miR-135 may provide an assistant marker for HbA1c to detect type 2 diabetes. [ABSTRACT FROM AUTHOR]

The objective of the study to examine the effect of Yogic Practices on Glycated Haemoglobin (HbA1C) level of Type-II Diabetes Mellitus in Urban Adults. This study has been conducted in Delhi NCR. 40 participants were selected through purposive sampling from Navadha Yoga Health Care Institute. Pre-Post experimental control group research design has been used in this study. The duration of yogic intervention was twelve weeks (except Sunday and government holidays). The result revealed that the effect of Yogic Practices have significant effect on Glycated Haemoglobin (HbA1C) level of Type-II Diabetes Mellitus in Urban Adults.

AimIncretins [dipeptidyl peptidase-4 inhibitors (DPP-4i) and glucagon-like peptide 1 RA (GLP-1 RA)] and sodium-glucose cotransporter-2 inhibitors (SGLT-2i) groups are now routinely used for type 2 diabetes therapy and comprise a large number of medicinal products. The long term therapeutic and economic effect of the incretins’ and SGLT-2i in real life setting is not well documented. The goal of the current study is to analyze the cost and results of incretins and SGLT-2i based therapy for type 2 diabetes in Bulgaria.MethodsThe study uses information about the changes in glycated hemoglobin (HbA1c) level from the National diabetes register for 6122 patients and cost paid by the National Health Insurance Fund (NHIF) for diabetes complications, and medicine prices.ResultsThe results show that after the therapy patients achieved excellent diabetes control. There were no HbA1c values less than 6% before treatment. After the therapy, 3356 people showed values less than 7% HbA1c. It is considered very good diabetic control. The number of people with HbA1c above 8% is decreasing significantly. The number of people with values above 9% is decreasing by almost four times. HbA1c level decreases with the highest percentage for the patients treated with GLP-1 RA, followed by those treated with DPP-4i and SGLT-2i. For a year NHIF reimbursed 5.25 million BGN for incretins and SGLT-2i therapy. NHIF can save between 306 and 510 thousand BGN from incidents that have not occurred as a result of 5 years of therapy.ConclusionIncretins [dipeptidyl peptidase-4 inhibitors (DPP-4i) and glucagon-like peptide 1 receptor agonists (GLP-1 RA)] and sodium-glucose linked transporter-2 inhibitors (SGLT-2i) therapy steadily decreases the HbA1c level, and risk of developing diabetic incidents is reduced to between 333 and 465 cases among 6122 treated patients. Avoided cost for therapy of diabetes incidents account for between 305 and 510 thousand BGN.

Background: T1DM is divided into 1A (immune-mediated), 1B (virus-triggered, genetic and idiopathic). Presence of auto-antibodies may be correlated to glycemic control.Aim: Assessment relation between the autoantibodies and the poor glycemic control in T1DM.Methods: 60 patients T1DM 30 males, 30 females, subjected to full history, clinical, anthropometric assessment and laboratory assessment of fasting C-peptide, FBS, 2 h PP glucose, HbA1c, GADA, ICA and IAA level. Classified into two groups; Group I: negative auto-antibodies, Group II: positive auto-antibodies, Group II was further classified into 3 sub-groups, Group II a:1 positive autoantibody, Group II b: 2 positive autoantibodies and Group II c: 3 positive autoantibodies.Results: HbA1c was significantly higher in group II than group I (11.85 ± 1.61% vs. 8.52 ± 0.41%, p = 0.000). HbA1c was highest in group IIc followed by IIb then IIa (12.25 ± 1.48% vs. 11.57 ± 1.59% vs. 10.78 ± 1.73%, p = 0.038). Total insulin units per day was significantly higher in group II than group I (109.83 ± 7.77 U/day vs. 100.83 ± 1.83 U/day, p = 0.007). Duration of diabetes was significantly higher in group I than group II (10.17 ± 1.94 years vs. 8.11 ± 2.20 years, p = 0.033). HbA1c, total insulin units per day and duration of diabetes were independent predictive factors for presence of autoantibodies (p = 0.007, p = 0.033 and p = 0.043 respectively).Conclusion: Autoantibodies affect the glycemic control presented by high HbA1c; also it causes increase in total insulin units needed by patients; the more autoantibodies, the higher HbA1c, the more insulin units required to control glycemic state. [ABSTRACT FROM AUTHOR]

Aim: Incretins [dipeptidyl peptidase-4 inhibitors (DPP-4i) and glucagon-like peptide 1 RA (GLP-1 RA)] and sodium-glucose cotransporter-2 inhibitors (SGLT-2i) groups are now routinely used for type 2 diabetes therapy and comprise a large number of medicinal products. The long term therapeutic and economic effect of the incretins' and SGLT-2i in real life setting is not well documented. The goal of the current study is to analyze the cost and results of incretins and SGLT-2i based therapy for type 2 diabetes in Bulgaria. Methods: The study uses information about the changes in glycated hemoglobin (HbA1c) level from the National diabetes register for 6122 patients and cost paid by the National Health Insurance Fund (NHIF) for diabetes complications, and medicine prices. Results: The results show that after the therapy patients achieved excellent diabetes control. There were no HbA1c values less than 6% before treatment. After the therapy, 3356 people showed values less than 7% HbA1c. It is considered very good diabetic control. The number of people with HbA1c above 8% is decreasing significantly. The number of people with values above 9% is decreasing by almost four times. HbA1c level decreases with the highest percentage for the patients treated with GLP-1 RA, followed by those treated with DPP-4i and SGLT-2i. For a year NHIF reimbursed 5.25 million BGN for incretins and SGLT-2i therapy. NHIF can save between 306 and 510 thousand BGN from incidents that have not occurred as a result of 5 years of therapy. Conclusion: Incretins [dipeptidyl peptidase-4 inhibitors (DPP-4i) and glucagon-like peptide 1 receptor agonists (GLP-1 RA)] and sodium-glucose linked transporter-2 inhibitors (SGLT-2i) therapy steadily decreases the HbA1c level, and risk of developing diabetic incidents is reduced to between 333 and 465 cases among 6122 treated patients. Avoided cost for therapy of diabetes incidents account for between 305 and 510 thousand BGN. [ABSTRACT FROM AUTHOR]

Background: HbA1c is an established diagnostic index which is used to assess diabetes mellitus. The aim of this study was to evaluate the association between HbA1c level with the types of stroke as well as the extent and functional status of ischemic stroke (IS) and hemorrhagic stroke (HS) in patients. Methods: In this cross-sectional study, we evaluated 120 patients with IS and HS. The functional outcome was evaluated based on the MRS criteria. The extent of the lesion was determined according to CT scan and MRI. We measured the blood hemoglobin A1c (HbA1c) levels in all patients after stroke. Results: HbA1c level in the IS group was significantly higher compared to the HS group (p < 0.05). There was a statistically significant difference between the extent of the lesion and the functional status of patients with the type of stroke (P < 0.001). History of smoking, in the IS group, was significantly associated with exposure to worse functional outcome (p<0.05). In the HS group, there was a significant relationship between hyperlipidemia histories with worse functional outcome. However, the relationship between HbA1c level and MRS score was inversely significant (p<0.05). Data analysis showed that, only in the IS group, the relationship between some independent variables, history of HLP and smoking, and the extent of stroke was significant (p<0.05). Conclusion: Findings of this study showed that there was a significant association between HbA1c levels as well as the extent and functional status with the type of stroke. There was a significant inverse relationship between HbA1c levels with the MRS score. [ABSTRACT FROM AUTHOR]

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Objective Type 1 diabetes mellitus (T1DM) is a chronic immune-mediated disease. Diabetic peripheral neuropathy (DPN) is an important microvascular complication of T1DM. One of the most important risk factors for the development of DPN is poor glycemic control. We evaluated the prevalence of DPN among T1DM patients and determined the association between DPN and glycated hemoglobin (HbA1c) level. Materials & Methods The subjects were recruited prospectively upon initial evaluation at Imam Reza Hospital, Mashhad, Iran from Jan 2013 to Jan 2015. Patients with T1DM were selected based on the inclusion criteria (i.e., age of 6≤yr and absence of other co-morbidities). DPN was assessed through electrodiagnostic studies and neurological examinations, while diabetes control was evaluated by measuring the HbA1c level. Results Fifty patients with T1DM were enrolled in this study. The mean diabetes duration of patients was 8.38±3.79 yr (mean age16.68±6.68 yr). The mean HbA1c level was 8.6±2.1% in patients without DPN and 10.5±3 in those with DPN (P=0.016). Overall, 24% of the subjects were presented with DPN according to nerve conduction velocity study (NCV) findings. A positive correlation was found between NCV and clinical symptoms with signs (P<0.001, r=0.45 and P<0.001, r=0.644, respectively). Sensitivity and specificity of neurological examination for DPN diagnosis were 91.7% and 63.2%, respectively. Poor diabetes control is associated with DPN. Moreover, HbA1c level was used as an index for glycemic control over the past 3 months. Conclusion Rigid blood glucose control and periodic neurological examinations were the best strategies to prevent DPN. [ABSTRACT FROM AUTHOR]