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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]

Background: Technological advances make it possible to use device-supported, automated algorithms to aid basal insulin (BI) dosing titration in patients with type 2 diabetes., Methods: A systematic review and meta-analysis of randomized controlled trials were performed to evaluate the efficacy, safety, and quality of life of automated BI titration versus conventional care. The literature in Medline, Embase, Web of Science, and the Cochrane databases from January 2000 to February 2022 were searched to identify relevant studies. Risk ratios (RRs), mean differences (MDs), and their 95% confidence intervals (CIs) were calculated using random-effect meta-analyses. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach., Findings: Six of the 7 eligible studies (889 patients) were included in meta-analyses. Low- to moderate-quality evidence suggests that patients who use automated BI titration versus conventional care may have a higher probability of reaching a target of HbA 1c <7.0% (RR, 1.82 [95% CI, 1.16-2.86]); and a lower level of HbA 1c (MD, -0.25% [95% CI, -0.43 to -0.06%]). No statistically significant differences were detected between the two groups in fasting glucose results, incidences of hypoglycemia, severe or nocturnal hypoglycemia, and quality of life, with low to very low certainty for all the evidence., Interpretation: Automated BI titration is associated with small benefits in reducing HbA 1c without increasing the risk of hypoglycemia. Future studies should explore patient attitudes and the cost-effectiveness of this approach., Funding: Sponsored by the Chinese Geriatric Endocrine Society., Competing Interests: Within the past 4 years, Yong Mong Bee and Daisuke Yabe have received consulting remuneration from a commercial entity or other organization with an interest related to the subjectiveness of the meeting or work; Siew Pheng Chan, Margaret McGill, Daisuke Yabe or their research teams have received support from a commercial entity or other organization with an interest related to the subjectiveness of the meeting or work respectively; Siew Pheng Chan also has received non-monetary support valued at more than US $1000 (including equipment, facilities, research assistants, paid travel meetings, etc.). Ketut Suastika received honoraria for scientific symposium or webinar on basal insulin from several pharmaceutical companies, almost the events collaborated with Indonesia Society of Endocrinology. Alice Pik Shan Kong received research grants and/or speaker honoraria from Abbott, Astra Zeneca, Bayer, Boehringer Ingelheim, Eli-Lilly, Kyowa Kirin, Merck Serono, Nestle, Novo-Nordisk, Pfizer and Sanofi. Khue Nguyen Thy received an honorarium for the chair in scientific meetings from Servier, Boehringer Ingelheim and Eisai. Soo Lim received research funding from MSD and CKD, and honoraria for lectures from Novo Nordisk, Sanofi, Boehringer Ingelheim, AstraZeneca and MSD. Linong Ji has received consulting and lecture fees from Eli Lilly, Novo Nordisk, Merck, Bayer, Sanofi-Aventis, Roche, MSD, Metronics AstraZeneca, Boehinger Ingelheim, and Abbott. Other authors declare no competing interest., (© 2023 The Author(s).)

Aims: Metformin is the most widely used drug for the first-line treatment of type 2 diabetes mellitus (T2DM), but its use and schedule have been poorly investigated in elderly patients., Methods: We conducted an observational, cross-sectional, multicentric study on metformin in T2DM outpatients older than 65 years who were taking the drug for at least 6 months and referred to Italian Endocrinology and Diabetology Services. The primary endpoint was daily metformin dose, and secondary endpoints were the correlations between metformin dose and age, comorbidities, and concomitant use of other drugs. The study was open to all members of AME (Associazione Medici Endocrinologi)., Results: Fifteen Italian centers recruited 751 consecutive participants (42.9% older than 75 years, 48.6% females). T2DM duration was 12.9 ± 9.7 years (longer than 10 years in 53.8%). Metformin had been used for 10.3 ± 6.8 years (longer than 10 years in 52.4%). Metformin dose was 1.6 ± 0.9 g/day (>1.5 g/day in 63.4%). As compared to the youngest, participants older than 75 years did not differ for metformin daily dose or number of administrations. Metformin dose was significantly directly correlated to eGFR, diabetes duration, and metformin treatment duration., Conclusion: In this real-world study, the minimum daily effective dose of metformin was prescribed in more than half of older T2DM outpatients., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)