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Objectives The development of continuous glucose monitoring (CGM) systems has allowed for identification of blood sugar variations and trends in real-time that is not feasible with conventional self-monitoring of blood glucose. However, there is inconsistent data to show that the use of CGM leads to better glycemic control as measured by Hemoglobin A1c (HbA1c) in pediatric patients with type 1 diabetes mellitus. Our study aimed to compare the average HbA1c level in the 1–2 years prior to starting a CGM to the average HbA1c level in the 1–2 years immediately following CGM initiation in a sample of 1–20 year olds with type 1 diabetes mellitus. Methods Participants were 90 youth (ages 1–20) followed for type 1 diabetes care at our institution who used a CGM for at least a 6 month time period. We performed a retrospective chart review to obtain up to four HbA1c values pre and post-CGM initiation each. We evaluated pre- and post-CGM initiation changes in mean HbA1c via dependent samples t-tests using IBM SPSS 24.0. Results The mean HbA1c was 8.7% pre-CGM and decreased to 8.27% 9–12 months after CGM initiation in the overall sample. A statistically significant decrease in HbA1c was seen in patients who used multiple daily injections (p=0.02), those with a pre-CGM HbA1c greater than 9% (p=0.01), and those with a diabetes duration of 5–10 years (p=0.02). Conclusion CGM use was associated with a decrease in HbA1c over time which was statistically significant in some subgroups.

Aims To examine trends in the management of patients with diabetes by primary health care nurses, its association with diabetes education and how valued and supported nurses feel in Auckland, New Zealand. Methods Two representative cross-sectional surveys of all nurses providing community-based care, and patients with diabetes they consult, were conducted in 2006–8 and 2016. All participants completed a self-administered questionnaire on biographical details and a telephone interview on their provision of diabetes care. Results Significantly more nurses discussed serum glucose and medications with patients, planned follow-up and scheduled practice nurse appointments in 2016 compared with 2006–8, and fewer specialist diabetologist appointments were made (12% versus 2%). Fewer nurses in 2016 than in 2006–8 felt valued (62% versus 75%) and supported (78% versus 89%) when managing patients (p-values = 0.0004). Nurses diabetes education was associated with recommended practice and feeling valued. Significantly more patients were prescribed metformin (81%) and insulin (46%) in 2016 compared with 58% and 30% in 2006–8. Despite this, HbA1c levels remained unchanged. Conclusions Prescribed glycaemic-related medications increased, and more nurses engaged with patients about glycaemic control and medications in 2016 compared with 2006–8. Nurses undertaking diabetes education was strongly associated with best management practices and nurses feeling valued.

Background: This study aimed to estimate the prevalence of diabetes and prediabetes in adults in Kuwait. Methods: The Kuwait Diabetes Epidemiology Program was a nationally representative, cross-sectional study of diabetes and obesity in Kuwait conducted between 2011 and 2014. The survey sampled 4937 adults in Kuwait aged 20 years or more and recorded participants&rsquo, demographics, behaviours, medical history, physical measurements and blood biochemical measurements. Prediabetes was defined as fasting plasma glucose between 6.1 and 6.9 mmol/L or HbA1c between 6 and 6.4% (42&ndash, 47 mmol/mol). Diabetes was defined as self-reported history with prescribed glucose-lowering medication or FPG &ge, 7mmol/L or HbA1c level &ge, 6.5% (&ge, 48 mmol/mol). Results: The overall adjusted prevalence of diabetes was 19.1%. The overall adjusted prevalence of prediabetes was 13.5%. Diabetes prevalence was 5.4%, 14.2%, 38.7% and 64.8% in adults aged 20&ndash, 29, 30&ndash, 44, 45&ndash, 59 and 60 years or more, respectively. Diabetes prevalence was 22.4% in men and 14.4% in women. Prediabetes prevalence was 14.8% in men and 11.5% in women. In Kuwaitis, diabetes and prediabetes prevalence was 21.8% and 11.1%, respectively, while prevalence in non-Kuwaitis was 18.2% for diabetes and 14.3% for prediabetes. Conclusion: These findings illustrate the severe public health challenge posed by diabetes in Kuwait.

Aims To correlate patient‘s average HbA1c scores to the modality of insulin therapy utilised to identify whether there is a statistically significant difference in the average HbA1c levels of patients who initially received multiple dose insulin (MDI) and then were commenced on continuous subcutaneous insulin infusions (CSCI). This information would then be used to deliver realistic counselling for patients changing from MDI to CSCI based on real data from our trust. Methods Within this service evaluation, average HbA1c scores were calculated for all paediatric patients who were initially taking multiple dose insulin therapy and then subsequently commenced subcutaneous insulin infusions. The average HbA1c scores were reviewed at 1 year prior to CSCI and then 1 year and 2 years after the change in modality of insulin delivery. The service evaluation was conducted in 2017 and then again in 2019. Results In 2017, a mean difference of in HbA1c of 2.03 (95% confidence interval 1.17–2.88) was seen with a significant difference of 0.033. This concludes that there was no significant difference between the average HbA1c of patients on MDI and their average HbA1c values when on CSCI a year later. When repeated in 2019, there was an average improvement in HbA1c levels of 48% and at 24 months an average of 53% improvement. Conclusion This data is utilised to demonstrate to staff and patients how CSCI alone is no guarantee for normalising poorly controlled HbA1C levels. We must continue to take a holistic approach to the counselling and management of our type 1 diabetes paediatric patients.

Fracture is defined by the loss of bone or cartilage continuity, either total or partial. Diabetes mellitus (DM) is a group of metabolic diseases characterized by hyperglycaemia resulting from defects in insulin secretion, insulin action, or both. HbA1c could be used as a diagnostic tool and determines the glycaemic control of DM patients. This study aimed to investigate the correlation between serum HbA1c levels and the healing process of postoperative fractures in DM patients. This was an observational study with a retrospective cohort design. The study population was DM patients who were admitted to the Department of Emergency, Dr. Wahidin Sudirohusodo General Hospital, Makassar due to long bone fracture within the period of September 2019-February 2020. The bone fractures healing was evaluated based on the radiographic union scale in tibial fractures (RUST) scores. The results are analysed using the Chi-square test. A total of 70DM patients who underwent fracture reduction surgery were involved in this study. Out of 35 patients with controlled DM (HbA1c 7%), and there were 13 (37.1%) patients and 22 (62.9%) patients with good and delayed union, respectively. The Chi-square test showed a significant relationship (p= 0.008). It can be concluded that the increase in HbA1c levels was related to the obstacles in bone fractures healing. Moreover, an infection contributes to the healing status of bone fractures.

الملخص: أهداف البحث: فقدان الوزن هو عنصر أساسي في علاج النوع الثاني من السكري. يمكن تحقيق هذه النتيجة عن طريق تكميم المعدة بالمنظار. تهدف هذه الدراسة لتحديد فاعلية تكميم المعدة بالمنظار لإنقاص الوزن، وتقييم تأثيرها للتحكم على النوع الثاني من السكري عن طريق قياس السكر التراكمي ومؤشر كتلة الجسم قبل الجراحة وخلال العام الأول بعد تكميم المعدة بالمنظار. طرق البحث: أجريت هذه الدراسة بأثر رجعي على ٣٤٠ مريضا أعمارهم ≥ ١٥ عاما، مصابون بالنوع الثاني من السكري ومؤشر كتلة الجسم ≥ ٣٥ كجم/م٢. خضع هؤلاء المرضى لعملية تكميم المعدة بالمنظار في مستشفى الملك فهد بالمدينة المنورة بالمملكة العربية السعودية بين ١ يناير٢٠١٥ و٣١ يوليو ٢٠١٩. تم قياس السكر التراكمي ومؤشر كتلة الجسم قبل الجراحة وثم بعد الجراحة في أقل من شهر واحد، ١-٣، ٤-٦، ٧-٩، ١٠-١٢ شهرا وبعد عام واحد. النتائج: انخفض المتوسط لمؤشر كتلة الجسم بشكل مستمر من ٤٩.٢٧ كجم/م٢ قبل العملية إلى ٣٢.٧٢ كجم/م٢ بعد ١٠-١٢ شهرا من تكميم المعدة بالمنظار. كان هناك انخفاض ملحوظ في متوسط السكر التراكمي من ٨.٣٨٪ إلى٦.٤٣٪ في عام واحد. وصل ٧٥٪ من المرضى إلى المستوى المطلوب للسكر التراكمي ٦.٥٪ أو أقل في عام واحد. أظهر ٢٥٪ المتبقيين من المرضى تحسنا في السكر التراكمي ولكن أقل من المستوى المطلوب. الاستنتاجات: تدعم هذه الدراسة النتيجة الإيجابية لعملية تكميم المعدة بالمنظار على كلا من فقدان الوزن وحالة السكري. هناك انخفاض كبير في كلا من مؤشر كتلة الجسم (حتى العام الأول) ومستويات السكر التراكمي بعد الجراحة. Abstract: Objectives: Weight loss is a key component in the management of type 2 diabetes mellitus (T2DM). This outcome can be potentially achieved by laparoscopic sleeve gastrectomy (LSG). This study aims to determine the efficacy of LSG in reducing weight and to evaluate its impact on controlling T2DM by measuring HbA1c and body mass index (BMI) preoperatively and during the first year following the procedure. Methods: This retrospective study was carried out on 340 patients aged ≥15 years who had T2DM and a BMI of ≥ 35 kg/m2. These patients had LSG at King Fahad Hospital Almadinah Almunawwarah KSA between January 2015 and July 2019. Their HbA1c and BMI were measured preoperatively and then postoperatively at less than one month, 1–3, 4–6, 7–9, and 10–12 months as well as after one year. Results: Average BMI dropped consistently from a preoperative BMI of 49.27 kg/m2 to 32.72 kg/m2 at 10–12 months following LSG. A reduction in HbA1c from 8.38% to 6.43% was observed over one year (p = 0.0001). Seventy-five percent of the patients achieved the HbA1c target of 6.5% or less within one year. The remaining 25% of the patients showed improvement in their HbA1c but did not reach the target level. Conclusion: This study endorses a positive impact of LSG on both weight loss and diabetic status. There was a significant reduction of both BMI (up to the first year) and HbA1c levels postoperatively.

BackgroundTo evaluate the associations between glycated hemoglobin (HbA1c) at admission and 6-month mortality and outcomes after out-of-hospital cardiac arrest (OHCA) treated by hypothermic targeted temperature management (TTM).MethodsThis single-center retrospective cohort study included adult OHCA survivors who underwent hypothermic TTM from December 2011 to December 2019. High HbA1c at admission was defined as a level higher than 6%. Poor neurological outcomes were defined as cerebral performance category scores of 3–5. The primary outcome was 6-month mortality. The secondary outcome was the 6-month neurological outcome. Descriptive statistics, log-rank tests, and multivariable regression modeling were used for data analysis.ResultsOf the 302 patients included in the final analysis, 102 patients (33.8%) had HbA1c levels higher than 6%. The high HbA1c group had significantly worse 6-month survival (12.7% vs. 37.5%,p p = 0.001) than the non-high HbA1c group. Kaplan-Meier analysis and the log-rank test showed that the survival time was significantly shorter in the patients with HbA1c > 6% than in those with HbA1c ≤6%. In the multivariable logistic regression analysis, HbA1c > 6% was independently associated with 6-month mortality (OR 5.85, 95% CI 2.26–15.12, p ConclusionsThis study showed that HbA1c higher than 6% at admission was associated with increased 6-month mortality and poor outcomes in OHCA survivors treated with hypothermic TTM. Poor long-term glycemic management may have prognostic significance after cardiac arrest.

Objective: The T1D Exchange Clinic Registry figure of HbA1c levels according to age has become a classic picture of how average HbA1c varies from childhood to elderly. To further assess the course of HbA1c across the life span in T1D, we created similar figures stratified by device use and socioeconomic status (SES). Methods: Mean HbA1c was plotted versus age for 21,253 T1D Exchange Clinic Registry participants with an HbA1c measurement between January 1, 2016 and March 31, 2018 according to device use, race/ethnicity, and measures of SES. Results: Across the age range from childhood to elderly, continuous glucose monitoring (CGM) use without an insulin pump had better average HbA1c than pump without CGM; and among CGM users, pump and injection users had similar HbA1c levels. Any device use (pump or CGM) was associated with better HbA1c levels than no device use across the age range. Lower SES and African American race were associated with higher HbA1c across the age range. Across all device use, SES, and race/ethnicity factors, average HbA1c levels were highest in adolescents and young adults. Conclusion: Although the plot of average HbA1c from early childhood to elderly shifts according to device use and SES factors, the shape of the plots remains reasonably constant with highest HbA1c levels in adolescents and young adults. These findings emphasize the importance of targeting adolescence and early adulthood as the ages with the greatest need for improving diabetes management irrespective of device use and SES.

To investigate the seasonal variations of HbA1c values in a semi-arid climate among type 2 diabetic patients throughout 11 years of care.A retrospective cohort study of 2860 patients with 61,187 HbA1c measures. We calculated the averages of HbA1c values of all patients and sub-groups defined by age, gender, BMI, ethnicity, insulin use, smoking status and region of residence, matched to the mean temperature and diurnal range over the 30 and 60 days prior to the HbA1c test date.We found a sinusoidal seasonal pattern with statistically significant HbA1c levels gaps between the spring peak and the autumn trough (F = 18.4, P0.001). The lowest values were in October-November and the highest in March or August with a difference of 0.17-0.31% (2-4 mmol/mol). We found different relations between the mean temperature and HbA1c depending on season, gender, age, ethnicity and smoking habits.The study identified specific subgroups in which the seasonal influence is particularly marked. A possible explanation is that during hot periods people tend to change their diet and decrease their physical activity, effecting indirectly diabetic imbalance. Recognition of the seasonal variations of HbA1c levels in this geographical region could help physicians with diabetes care and HbA1c control.

Background: In diabetic patients high HbA1c is associated with high level of HSCRP and VITD3 deficiency could result in diabetes and high HbA1c level. The aim of this study was to determine the relation of HbA1c, HSCRP and vitamin D3 in healthy individuals who referred to Rasool Akram Hospital. Methods: In this cross sectional study, individuals who referred to our center between 2018 and 2019 for the measurement of HbA1c were classified to three groups based on the level of the HbA1c: Results: In this study, 90 healthy individuals were studied. In subjects with BMI below 25, no significant difference in HSCRP level was seen in group with low and normal HbA1c, but group with high HbA1c has non-significant higher level of HSCRP rather than group with normal HbA1c. In subject with BMI higher than 25, group with high HbA1c and low HbA1c had non-significant higher level of HSCRP than group with normal HbA1c and in the subjects, no significance difference at serum level of vitamin D3 level has been identified between HbA1c groups. Conclusion: As immunomedulatory role of VitD3 is shown in many studies and low VitD3 could predispose people to diabetes independent of obesity, Conflicting results in various studies emerge an idea to mind that considering relation of other factors responsible in glucose metabolism such as insulin level, IGF-1, C-Peptide and VitD3 could be a better overview on vitD3 effect on glucose metabolism

Background: The purpose of this study was to investigate the relationship between self-care management and HbA1c level of the patients with type 2 diabetes in YAZD. Methods: This study was a cross-sectional study. The number of 376 diabetic patients referred to the Diabetes Research Center in Yazd entered the study. The data collection tool was a summary of Diabetes Self Care Activity questionnaire (SDSCA), which was collected through interviews with patients. Data analysis was performed using SPSS software V 16 and kruskalwallis and independent sample t tests. Results: The results showed that of 376 patients, 218 (%58) were women and 158 (%42) were male. The mean age of the participants in the study was 54.5 ± 10.9 years old and the mean duration of the disease was 9.53 ± 8.39 years. The mean HbA1C in the patients was 7.93% ± 1.38%. The mean of BMI was 28.93 ± 6 kg/ m2. The mean of self-care score in the patients under study was 30.53 ± 11.4. There was a significant relationship between the mean of self-care score, BMI, age and HbA1C (P value

Social jetlag (SJL) has been linked to many cardiovascular and metabolic diseases, as it disturbs the circadian rhythm. In this study, we analyzed the impact of SJL on glycemic control. To our knowledge, this was the first study that discussed the issue of SJL, and we explored the prevalence of SJL in the studied population. A case-control study matched by age and gender was conducted among 511 subjects. Control group subjects were diabetic with HbA1c levels of

Giriş ve Amaç: Çalışma, diyabet bakımında ebeveyn izlemenin ergenlerde tedaviye ve metabolik parametrelere uyum üzerindeki etkisini belirlemek amacıyla yapıldı.Gereç ve Yöntem: Çalışma Gaziantep Çocuk Hastanesi Endokrinoloji Polikliniğinde takip edilen 132 Tip 1 diyabetli ergenin yanı sıra ebeveynleri ile yürütüldü. Veriler Ekim 2016 and Mayıs 2017 tarihleri arasında toplandı. Verilerin toplanmasında“ “Kişisel Özellikler İçin Bilgi Formu” ve “Ebeveyn İzleme Ölçeği” kullanıldı. Verilerin istatistiksel analizi için SPSS 21.0 paket yazılımı kullanıldı. Araştırmanın yürütülmesi için etik kurul ve kurum izni alınmıştır.Bulgular: Çalışmaya katılan ergenlerin %65,9'unun erkek, %81,1'inin HbA1c düzeyi ≥7,5, %43,4'ünün açlık glikoz düzeyi ≥ 180 ve Ebeveyn İzleme Ölçeği puan ortalamalarının 108,20± 19.55 olduğu tespit edildi. Kadınların HbA1c değerlerinin erkeklerin HbA1c değerlerinden düşük olduğu belirlenmiştir (p, Purpose: The study was conducted to determine the effect of parental monitoring in diabetes care on compliance to treatment and metabolic parameters in adolescents. Material and Method: The study consisted of adolescents with Type 1 diabetes followed up in Endocrinology Outpatient Clinic of Gaziantep Children's Hospital. 132 diabetic adolescents who met the study inclusion criteria and were followed up in Endocrinology Outpatient Clinic as well as their parents were included in the study. In order to collect the data, “Information Form for Personal Characteristics” and “Parental Monitoring Scale in Diabetes Care of Adolescents with Type 1 diabetes” were used. SPSS 21.0 packaged software was used for statistical analysis of the data. Results: It was found that 65.9% of the adolescents participating in the study were male, 81.1% had poor HbA1c levels of ≥7.5, 43.4% had poor fasting glucose levels of ≥ 180 and above and their mean scores of Parental Monitoring Scale were 108.20±19.55. It was determined that HbA1c values of the women were lower than HbA1c values of the men (p

espanolIntroduccion. La diabetes tipo 2 es un problema de salud publica cuyo manejo es muy complejo, reconociendose multiples problemas y limitaciones para un adecuado control de la enfermedad. Objetivo.Determinar el efecto de un programa educativo anadido al tratamiento habitual, en el control de los pacientes con diabetes tipo 2 de la consulta especializada ambulatoria en un hospital nacional peruano. Metodos. Se realizo un estudio longitudinal analitico de tres meses de seguimiento, cincuenta pacientes consecutivos con diabetes tipo 2 no controlada que se atendian en la consulta ambulatoria del servicio de endocrinologia aceptaron participar voluntariamente en las 4 sesiones grupales (5-8 participantes, 1sesion/semana). Se aseguro la disponibilidad de la medicacion antidiabetica, asi como el mantenimiento de las dosis farmacologicas prescritas desde tres meses antes de la intervencion y durante el periodo de seguimiento. Se determinaron los cambios en los niveles de HbA1c, glicemia en ayunas y perfil lipidico, antes y 3 meses despues de la intervencion. Resultados. Del total de pacientes que aceptaron participar, 41 completaron todas las sesiones y sus resultados fueron analizados. La cuarta parte eran varones. Luego de los tres meses de la intervencion educativa, la HbA1c disminuyo -1,7%, la glicemia en ayunas -59mg/dL y el colesterol LDL -23mg/Dl, siendo los cambios significativos en los grupos de mayores de 45 anos y con mas de 5 anos de diagnostico. Conclusiones. El programa de educacion diabetologica, anadido al manejo habitual, tuvo un efecto beneficioso temprano en el control de los pacientes con diabetes tipo 2 en un hospital nacional peruano EnglishIntroduction. Type 2 diabetes is a public health problem whose management is very complex, recognizing multiple problems and limitations for an adequate control of the disease. Objective. To determine the effect of educational program added to the usual treatment, in the control of patients with type 2 diabetes in a peruvian national hospital. Methods. A longitudinal analytical study of three months of follow-up was conducted. Fifty consecutive patients with uncontrolled type 2 diabetes who were treated in the outpatient clinical of the endocrinology service agreed to voluntarily participate in the four sessions in groups of 5-8 participants (1session/week). The availability of antidiabetic medication was assured, as well as the maintenance of the prescribed pharmacological doses from three months before the intervention and during the follow-up period. Changes in HbA1c levels, fasting blood glucose and lipid profile were determined before and 3 months after the intervention. Results. Of the total of patients who agreed to participate, 41 completed all sessions and their results were analyzed. The fourth part were males. After three months of the educational intervention: HbA1c decreased -1,7%, fasting blood glucose -59mg/dL and LDL cholesterol -23mg/dL; being the significant changes in the groups of over 45 years and with more than 5 years of diagnosis. Conclusions. The diabetes educational program added to the usual management had an early beneficial effect in the control of patients with type 2 diabetes in a peruvian national hospital.

OBJECTIVES We hypothesize that men with diabetes mellitus whose inflatable penile prosthesis (IPP) implantation is delayed for unacceptably high hemoglobin A1c (HbA1c) will have durable improvements in their glycemic control after achieving acceptable HbA1c levels for surgery. METHODS Per institutional protocol, an A1c

We assessed the significance of recommendations from the international consensus on continuous glucose monitoring (CGM)-derived metrics in Japanese children and adolescents with type 1 diabetes. Eighty-five patients (age, 13.5 ± 4.7 years) who wore the FreeStyle® Libre for a 28-day period were enrolled in this study. Seventy-three patients were treated with multiple daily injections of insulin and 12 with insulin pump therapy without using a sensor-augmented pump or a predictive low-glucose suspend-function pump. We evaluated the relationship between CGM-derived metrics: time in range (TIR: 70-180 mg/dL), time below range (TBR: 180 mg/dL), and laboratory-measured HbA1c and estimated HbA1c (eA1c) levels calculated from the mean glucose values. The TIR was 50.7 ± 12.2% (23-75%), TBR was 11.8 ± 5.8% (2-27%), and TAR was 37.5 ± 13.5% (9-69%). The TIR was highly correlated with HbA1c level, eA1c level, and TAR, but not with TBR. An HbA1c level of 7.0% corresponded to a TIR of 55.1% (95% CI: 53.7-56.5%), whereas a TIR of 70% corresponded to an HbA1c level of 6.1% (95% CI: 5.9-6.3%). The results of eA1c levels were similar to those observed for HbA1c levels. From these findings, we conclude that low rates of a recommended TIR of 70% may be due to less use of advanced technology and insufficient comprehensive diabetes care. Ethnic characteristics including lifestyle and eating customs may have contributed to the result. CGM-derived targets must be individualized based on ethnic characteristics, insulin treatment and diabetes care, and needs of individuals with diabetes.

In the U.S., Hispanic/Latino populations bear a disproportionate burden of type 2 diabetes (T2D) and its complications. Research suggests that poor air quality may have an influence on progression of T2D. We compared HbA1c levels in Hispanic/Latino (95% Mexican-origin) adults with T2D by exposure to particulate matter HbA1c levels were measured on 101 participants (54±12 years, 65% female, 25% insulin users, 60% uninsured, 40% food insecure). A third (36%) had an HbA1c 9.0%. We matched HbA1c with California Air Resource Board (CARB) air pollution records to create a regression model relating HbA1c to average ambient PM2.5 concentration with participant zip codes 14 days prior to HbA1c measurement. PM2.5 exposure was stratified as “high” or “low,” (> or < 12 µg/m³ annual CARB standard PM2.5 concentration), controlling for other PM2.5-correlated factors (location, year and month fixed effects). Figure 1 shows regression-adjusted mean [95% CI] HbA1c for low (N=85) and high exposure individuals (N=16) and estimated difference between groups (2.2%, p Air pollution exposure should be considered as an independent factor impacting glycemic control in Hispanic/Latino adults with T2D. Disclosure N.M. Glantz: Research Support; Self; Abbott, Eli Lilly and Company. O. Deschenes: None. D. Kerr: Advisory Panel; Self; Novo Nordisk A/S, Sanofi-Aventis. Research Support; Self; Eli Lilly and Company. Stock/Shareholder; Self; Glooko, Inc. Funding Eli Lilly and Company (2017-5864)

This study assessed HbA1c across the lifespan in people with T1D in Austria/Germany, Sweden, and the United States (U.S.) between 2011 and 2017. Data extracted from the DPV, Austria/Germany (n = 25651 in 2011, n = 29442 in 2017); SWEDIABKIDS/NDR, Sweden (n = 44474 in 2011, n = 53690 in 2017); and T1D Exchange, U.S. (n = 16198 in 2011, n= 17087 in 2017) registries were included in the analysis. Mean HbA1c across the lifespan in 2017 and changes in mean HbA1c between 2011 and 2017 overall and by age cohorts were analyzed. In 2017 mean HbA1c for adults ≥45 years converged across registries; HbA1c levels for subjects Disclosure A. Albanese-O’Neill: Consultant; Self; American Diabetes Association. J. Hermann: None. A. Svensson: None. K. Miller: None. K. Raile: None. K. Akesson: None. P. Calhoun: Stock/Shareholder; Self; Dexcom, Inc. K. Eeg-Olofsson: None. D.M. Maahs: Advisory Panel; Self; Eli Lilly and Company, Insulet Corporation, Medtronic, Novo Nordisk A/S. Consultant; Self; Abbott, Sanofi. Research Support; Self; Bigfoot Biomedical, Dexcom, Inc., Roche Diabetes Care, Tandem Diabetes Care. R.W. Holl: None. R. Hanas: Advisory Panel; Self; Abbott, Novo Nordisk A/S. Speaker’s Bureau; Self; Sanofi. Other Relationship; Self; AstraZeneca. Funding German Center for Diabetes Research; The Leona M. and Harry B. Helmsley Charitable Trust (G-2016PG-T1D053)

Older people with T2D have a high prevalence of comorbidities, frailty and polypharmacy. We investigated the effects of linagliptin (LINA) 5 mg versus glimepiride (GLIM) 1-4 mg once daily across age groups in the CARdiovascular Outcome Study of LINAgliptin Versus Glimepiride in T2D (CAROLINA®). CAROLINA® recruited adults with relatively early T2D, HbA1c 6.5-8.5%, and elevated CV risk and its primary outcome was CV death, non-fatal myocardial infarction, or non-fatal stroke (3P-MACE), with secondary outcomes including mortality as well as change from baseline in HbA1c, weight and hypoglycemia. Of 6033 patients (median age 64 [range 36-85]), 846 (14.0%) were ≥75 years. During median follow-up of 6.3 years, CV and mortality outcomes rates did not differ between treatment groups overall and across age categories (interaction p-values >0.05). Over time, following some initial dynamics, changes in HbA1c levels were comparable between treatment-groups and across age, but hypoglycemia risk (Fig) and weight were significantly lower with LINA vs. GLIM overall and consistently across age groups. These data demonstrate that results for CV and mortality outcomes were consistent across age subgroups, but LINA has a modest benefit in weight and a significantly lower hypoglycemia burden than GLIM, which are important safety considerations when selecting therapy for the elderly. Disclosure M. Espeland: Other Relationship; Self; Boehringer Ingelheim International GmbH, Ironwood Pharmaceuticals. R.E. Pratley: Other Relationship; Self; AstraZeneca, Eli Lilly and Company, GlaxoSmithKline plc., Glytec, Janssen Scientific Affairs, LLC., Lexicon Pharmaceuticals, Inc., Ligand Pharmaceuticals Incorporated, Merck & Co., Inc., Novo Nordisk Inc., Sanofi. J. Rosenstock: Research Support; Self; AstraZeneca, Bristol-Myers Squibb, Genentech, Inc., GlaxoSmithKline plc., Lexicon Pharmaceuticals, Inc., Oramed Pharmaceuticals, PegBio Co., Ltd., Pfizer Inc., REMD Biotherapeutics. Other Relationship; Self; Applied Therapeutics, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Intarcia Therapeutics, Janssen Pharmaceuticals, Inc., Novo Nordisk Inc., Sanofi. T. Kadowaki: Research Support; Self; Astellas Pharma Inc., Daiichi Sankyo, Mitsubishi Tanabe Pharma Corporation, MSD Corporation, Novartis Pharma K.K., Novo Nordisk Pharma Ltd., Ono Pharmaceutical Co., Ltd., Sanofi, Sumitomo Dainippon Pharma Co., Ltd., Takeda Pharmaceutical Company Limited. Speaker’s Bureau; Self; Abbott, Astellas Pharma Inc., AstraZeneca K.K., Boehringer Ingelheim Pharmaceuticals, Inc., Cosmic Corporation, Daiichi Sankyo, Eli Lilly Japan K.K., FUJIFILM, Kowa Company, Ltd., Kyowa Hakko Kirin Co., Ltd., Medscape Education, Medtronic, Mitsubishi Tanabe Pharma Corporation, MSD Corporation, NIPRO Medical Corporation, Novartis Pharma K.K., Novo Nordisk Pharma Ltd., Ono Pharmaceutical Co., Ltd., Sanofi, Sanwa Kagaku Kenkyusho, Sumitomo Dainippon Pharma Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Terumo Medical Corporation. Other Relationship; Self; Asahi Mutual Life Insurance. Y. Seino: Research Support; Self; ARKRAY, Bayer Yakuhin, Ltd., Boehringer Ingelheim International GmbH, Eli Lilly Japan K.K., Merck Sharp & Dohme Corp., Nippon Boehringer Ingelheim Co. Ltd., Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Terumo Medical Corporation. Speaker’s Bureau; Self; Becton, Dickinson and Company, Eli Lilly Japan K.K., Kao Corporation, Merck Sharp & Dohme Corp., Nippon Boehringer Ingelheim Co. Ltd., Novo Nordisk Inc., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited. B. Zinman: Advisory Panel; Self; Abbott, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novo Nordisk Inc., Sanofi-Aventis. N. Marx: Other Relationship; Self; Amgen, AstraZeneca, Bayer Vital, Boehringer Ingelheim International GmbH, Daiichi Sankyo, Kowa Research Institute, Inc., Medtronic, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Pfizer Inc., Sanofi-Aventis. D.K. McGuire: Consultant; Self; Afimmune, Applied Therapeutics, Merck Sharp & Dohme Corp., Metavant. Other Relationship; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eisai Co., Ltd., Eli Lilly and Company, Esperion Therapeutics, Inc., GlaxoSmithKline plc., Janssen Pharmaceuticals, Inc., Lexicon Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk A/S, Pfizer Inc., Sanofi-Aventis. K.R. Andersen: None. M. Mattheus: None. A. Keller: Employee; Self; Boehringer Ingelheim International GmbH. O. Johansen: Employee; Self; Boehringer Ingelheim International GmbH. Funding Boehringer Ingelheim and Eli Lilly and Company Diabetes Alliance

Objective: To examine the relationships between diabetes care measures and HbA1c levels through analyzing the National Health and Nutrition Examination Survey (NHANES) data between 2007 and 2016. Methods: This cross-sectional study involved subjective and objective data obtained from the CDC NHANES website. Data was then analyzed by STATA14 with ordered logistic regression models, controlling for age, race, gender, health insurance coverage. Subjective data included participants’ answers to the general and diabetes-related questionnaires, and the objective data was their HbA1c levels at the time of the interview/standardized clinical examination. Results: Three of the eight regression analysis models showed statistically significant associations between HbA1c levels and identified diabetes care questions. Conclusion: The levels of HbA1c in people with diabetes were associated with how long ago the participant checked-in with a diabetes specialist, whether having a doctor for diabetes care or not, and how often the participant saw a doctor within a year before the NHANES interview/examination. These findings suggest that connecting with healthcare professionals (Questions 1 - 3) showed significant relationships with HbA1c levels, but the same relationships were not observed between receiving or performing the actual diabetes care measures (Questions 4 - 8) and HbA1c levels. Disclosure C.F. Young: None. H.E. Velasco: None.

CONCLUDE was a randomized, open-label, treat-to-target trial in participants with T2D, who received basal insulin ± oral antihyperglycemic drugs (OADs) and had ≥1 baseline hypoglycemia risk factors, including moderate renal impairment. Participants were randomized to degludec U200 or glargine U300 (± OADs). CONCLUDE demonstrated no significant difference in the overall symptomatic hypoglycemia rate with degludec U200 vs. glargine U300 in the maintenance period (primary endpoint, tested for superiority). However, lower rates of nocturnal symptomatic and severe hypoglycemia in the maintenance period (exploratory secondary endpoints) were observed with degludec U200 vs. glargine U300. The current post-hoc analysis investigated these hypoglycemia endpoints and HbA1c stratified by baseline estimated glomerular filtration rate (eGFR) subgroups ( Disclosure T.R. Pieber: Advisory Panel; Self; ADOCIA, Arecor, AstraZeneca, Eli Lilly and Company, Novo Nordisk A/S, Sanofi. Research Support; Self; AstraZeneca, Novo Nordisk A/S. Speaker’s Bureau; Self; Novo Nordisk A/S, Roche Diagnostics K.K. H.S. Bajaj: Research Support; Self; Amgen, AstraZeneca, Boehringer Ingelheim (Canada) Ltd., Eli Lilly and Company, Kowa Pharmaceuticals America, Inc., Novartis Pharmaceuticals Canada Inc., Novo Nordisk Inc., Sanofi. Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim (Canada) Ltd., Eli Lilly and Company, Janssen Pharmaceuticals, Inc., mdBriefCase, Medscape, Merck Sharp & Dohme Corp., Novo Nordisk Inc. S.R. Heller: Advisory Panel; Self; Eli Lilly and Company, Novo Nordisk A/S, Zealand Pharma A/S. Speaker’s Bureau; Self; AstraZeneca, Novo Nordisk A/S. Other Relationship; Self; MannKind Corporation. T. Jia: Employee; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Novo Nordisk A/S. K. Khunti: Advisory Panel; Self; Amgen, AstraZeneca, Bayer AG, Berlin-Chemie AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Menarini Group, Merck Sharp & Dohme Corp., Napp Pharmaceuticals, Novartis AG, Novo Nordisk A/S, Roche Pharma, Sanofi-Aventis, Servier. Board Member; Self; AstraZeneca, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi-Aventis. Consultant; Self; Amgen, AstraZeneca, Bayer AG, Berlin-Chemie AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Menarini Group, Merck Sharp & Dohme Corp., Napp Pharmaceuticals, Novartis AG, Novo Nordisk A/S, Roche Pharma, Sanofi-Aventis, Servier. Research Support; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Pfizer Inc., Sanofi-Aventis, Servier. Speaker’s Bureau; Self; Amgen, AstraZeneca, Bayer AG, Berlin-Chemie AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Menarini Group, Merck Sharp & Dohme Corp., Napp Pharmaceuticals, Novartis AG, Novo Nordisk A/S, Roche Pharma, Sanofi-Aventis, Servier. D.C. Klonoff: Consultant; Self; Abbott, Ascensia Diabetes Care, Dexcom, Inc., EOFlow, Fractyl Laboratories, Inc., Know Labs, LifeCare, Inc., Novo Nordisk Inc., Roche Diabetes Care. S. Ladelund: Employee; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Novo Nordisk A/S. L.A. Leiter: Advisory Panel; Self; Abbott, Amgen, AstraZeneca, Boehringer Ingelheim (Canada) Ltd., Boehringer Ingelheim International GmbH, Eli Lilly and Company, HLS Therapeutics, Inc., Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk Inc., Sanofi, Servier. Research Support; Self; Amgen, AstraZeneca, Kowa Pharmaceuticals America, Inc., Medicines Company. Speaker’s Bureau; Self; Amgen, AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, HLS Therapeutics, Inc., Janssen Pharmaceuticals, Inc., Medscape, Merck & Co., Inc., Novo Nordisk Inc., Sanofi, Servier. M.V. Hansen: Employee; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Novo Nordisk A/S. Stock/Shareholder; Spouse/Partner; Novo Nordisk A/S. A. Philis-Tsimikas: Advisory Panel; Self; Lilly Diabetes, Medtronic, Novo Nordisk A/S, Sanofi. Employee; Spouse/Partner; Ionis Pharmaceuticals, Inc. Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Dexcom, Inc., Lilly Diabetes, Medtronic, Novo Nordisk A/S, Sanofi. Funding Novo Nordisk A/S

Background: We used DISCOVER, a 3-year observational study of people with T2D, to assess the effects of second-line metformin combination therapies on weight, HbA1c level and risk of hypoglycemia. Methods: Adjusted changes from baseline in weight and HbA1c level at 6, 12, 24 and 36 months were assessed using linear mixed models. An interval censored analysis was used to assess the risk of hypoglycemia. Results: At baseline, 7613 patients from 37 countries received second-line therapy with metformin and a dipeptidyl peptidase-4 inhibitor (DPP-4i; 48.3%), a glucagon-like peptide-1 receptor agonist (GLP-1 RA; 2.4%), a sodium-glucose co-transporter 2 inhibitor (SGLT2i; 8.3%) or a sulfonylurea (SU; 40.9%). When used in combination with metformin, GLP-1 RAs, SGLT2is and DPP-4is were associated with greater weight loss than SUs at all time points (Figure). Beyond 12 months, changes in HbA1c from baseline were similar for all combinations. Patients prescribed metformin and an SU had a greater occurrence of hypoglycemia over 3 years (11.9%) compared with the other combinations (3.9-6.4%). Conclusions: A high proportion of patients received metformin and a DPP-4i or an SU as a second-line therapy. All combinations showed a similar reduction in HbA1c. However, combinations of metformin and an SU were associated with the highest risk of hypoglycemia and the lowest weight reduction. Disclosure K. Khunti: Advisory Panel; Self; Amgen, AstraZeneca, Bayer AG, Berlin-Chemie AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Menarini Group, Merck Sharp & Dohme Corp., Napp Pharmaceuticals, Novartis AG, Novo Nordisk A/S, Roche Pharma, Sanofi-Aventis, Servier. Board Member; Self; AstraZeneca, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi-Aventis. Consultant; Self; Amgen, AstraZeneca, Bayer AG, Berlin-Chemie AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Menarini Group, Merck Sharp & Dohme Corp., Napp Pharmaceuticals, Novartis AG, Novo Nordisk A/S, Roche Pharma, Sanofi-Aventis, Servier. Research Support; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Pfizer Inc., Sanofi-Aventis, Servier. Speaker’s Bureau; Self; Amgen, AstraZeneca, Bayer AG, Berlin-Chemie AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Menarini Group, Merck Sharp & Dohme Corp., Napp Pharmaceuticals, Novartis AG, Novo Nordisk A/S, Roche Pharma, Sanofi-Aventis, Servier. B. Charbonnel: Advisory Panel; Self; Merck Sharp & Dohme Corp., Mundipharma International, Novo Nordisk A/S, Sanofi. Speaker’s Bureau; Self; AstraZeneca. A. Cooper: Employee; Self; AstraZeneca. M.B. Gomes: None. L. Ji: None. P. Leigh: Employee; Self; AstraZeneca. Employee; Spouse/Partner; Merck Sharp & Dohme Corp. A. Nicolucci: Consultant; Self; AstraZeneca. W. Rathmann: Advisory Panel; Self; AstraZeneca. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc. Research Support; Self; Novo Nordisk Inc. Speaker’s Bureau; Self; Eli Lilly and Company, Novo Nordisk Inc. M.V. Shestakova: None. A. Siddiqui: None. F. Tang: Research Support; Self; AstraZeneca. H. Watada: Advisory Panel; Self; Abbott, Ajinomoto, Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Fuji Film, Janssen Pharmaceuticals, Inc., Kowa Company, Ltd., Kyowa Hakko Kirin Co., Ltd., Mitsubishi Tanabe Pharma Corporation, Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Sanofi-Aventis, Takeda Pharmaceutical Company Limited, Terumo Medical Corporation. Research Support; Self; Astellas Pharma Inc., Bayer Yakuhin, Ltd., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo, Eli Lilly Japan K.K., Kissei Pharmaceutical Co., Ltd., Kowa Company, Ltd., Kyowa Hakko Kirin Co., Ltd., Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Novartis Pharma K.K., Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Otsuka Pharmaceutical Co., Ltd., Pfizer Japan Inc., Sanofi-Aventis, Sanwa Kagaku Kenkyusho, Shionogi & Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited, Yakult. Speaker’s Bureau; Self; Astellas Pharma Inc., AstraZeneca, Bayer Yakuhin, Ltd., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo, Eli Lilly Japan K.K., Kissei Pharmaceutical Co., Ltd., Kowa Company, Ltd., Kyowa Hakko Kirin Co., Ltd., Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Sanofi-Aventis, Sanwa Kagaku Kenkyusho, Sumitomo Dainippon Pharma Co., Ltd., Takeda Pharmaceutical Company Limited. H. Chen: None. Funding AstraZeneca

Introduction: While glucose remains the major determining factor of HbA1C, other conditions like hemolytic anemia, iron/vitamin B 12 deficiency anemia have also been shown to affect HbA1C. Material and Methods: A prospective study was carried out in a tertiary care center, Kasturba hospital, India over a period of two years, that included patients in the age group of 18 to 70 years with anemia and no proven diabetes. We excluded all patients with diabetes, other forms of anemia, major organ dysfunction, hemoglobin Anemia was treated with iron and/or cobalamin. Hemoglobin was measured every month till normal values were attained. HbA1C was measured at the beginning and at the end of completion of 3 months of treatment. For comparing pre and post therapy HbA1C levels, paired t-testwas used. A p value of Results: We found a significant decrease in HbA1C levels among 70% of the iron deficient group, 72% of the B12 deficiency group and 83% of the dual deficiency group with the treatment of anemia. In our study, as many as 27 (38%) patients were labeled as prediabetic without considering their anemic status. Conclusion: From the observations made in this study, it is evident that HbA1C could be influenced by the anemic state of an individual. Hence, it is advisable to treat patients with anemia before defining their diabetic status. Larger studies are required to know the degree of impact of anemia on HbA1C. Disclosure V. Pendela: None. S. Venugopal: None. P. Kudaravalli: None.

Background: Many studies have estimated the prevalence of type 2 diabetes in suburban regions of India, such as Ahmedabad, Gujarat. However, there are few studies that examine the progression of HbA1C levels in patients diagnosed with diabetes over multiple visits to healthcare facilities. Objective: The primary aims of this study were to assess the efficacy of patient treatment at a diabetes care center in Gujarat, India and determine factors that may affect the progression of HbA1C levels over multiple visits. Methods: A total of 2,037 individuals aged ≥25 years (mean age 53.7 years) were included in this retrospective study. All individuals were previously diagnosed with diabetes and received treatment at the Dia Care Advanced Diabetes Care Center in Ahmedabad. Patient data was acquired from the clinic’s HealthPlix EMR. Results: Of those meeting inclusion criteria, males constituted 69.1%. The average BMI of all subjects was 29.7 kg/m2. Of all 2,037 subjects, only 22.0% (n=442) patients were tested for HbA1C levels multiple times. On average, these subjects underwent blood tests for HbA1C values 3.3 times in a one-year period and HbA1C levels dropped by 0.51 mg/dl (95% CI 0.70-0.31). There was a substantial correlation between the number of clinic visits and the decrease in HbA1C values (R = 0.71). Over the course of one year, 22.6% (19.9-25.1) of subjects who returned to the clinic saw a drop in HbA1C to levels not indicative of diabetes (≤6.5 mg/dl). A significant correlation was observed between RBS measurements and HbA1C levels. Notably, there was also a slight negative correlation between BMI and the number of clinic visits (R = 0.74). Conclusion: Results from this study reinforce the conventional wisdom that frequent visits to one’s physician help achieve glycemic control. More importantly, these results also reflect the success of suburban clinics such as Dia Care and call for physicians to stress the importance of clinic visits and address improvement in metabolic status regularly. Disclosure S. Shah: None. B.D. Saboo: None. S. Shah: None. D. Hasnani: None. V. Chavda: None. J. Kesavadev: Speaker’s Bureau; Self; Biocon, Novo Nordisk Inc., Sanofi-Aventis. H.B. Shah: None. K.J. Patel: None.

Previous research has demonstrated an association between genetic variation in the CTRB1/2 gene and response to incretin therapies. We aimed to evaluate the role of CTRB1/2 rs7202877 (T>G) polymorphism in glycemic response to liraglutide among Greek people with T2D. 116 adults with T2D (51% female, mean BMI 35.4±6.4 kg/m2, mean age 68.3±10.9 years), who had been on treatment with liraglutide for at least 6 months were genotyped for the rs7202877 polymorphism, using real-time PCR. Responders met at least one of the following criteria: i) achievement of good glycemic control defined as HbA1c level of Disclosure A. Kyriakidou: None. A.V. Kyriazou: Research Support; Self; Novo Nordisk A/S. T. Koufakis: None. Y. Vasilopoulos: None. I. Avramidis: None. S. Baltagiannis: None. E. Manthou: None. D.G. Goulis: None. P. Zebekakis: None. K. Kotsa: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Sanofi-Aventis, Takeda Pharmaceutical Company Limited. Speaker’s Bureau; Self; Menarini Group. Other Relationship; Self; Novo Nordisk Inc. Funding Novo Nordisk (91220)

Aim: To assess the awareness of dietary constituents, perception of diet in those with diabetes. Methods: A cross-sectional, objective, qualitative questionnaire-based assessment was performed among outpatient diabetes patients who visited tertiary diabetes care centers in Metropolitan cities of India. The questionnaire was answered by diabetes patients in a simple ’Yes’ or ’No’ format about awareness of various foods. The questions were about diet, quantity that could be consumed, and myths about various food products consumed routinely. Patients’ perception of diet was categorized into ’correct’ and ’incorrect’ depending on their response to each question in a 10-point questionnaire. A score of ’1’ was given for each ’correct’ answer and ’0’ for an ’incorrect’ answer. Maximum score one can get is 10/10 and a minimum of 0/10. Results: Total 2295 patients with diabetes were assessed. Patients included were in age range 9 to 90 years with median age of 55 years. Males, females were 62% and 38% respectively. A mean score of 3.8 and median score of 4 was achieved. 2.2% patients achieved maximum correct answer score of 9/10 and 5.9% patients had minimum score 0/10. 44.8% patients scored 6. Socioeconomic status, education, HbA1c levels, occupation, Insulin use, duration of diabetes were the factors that contributed to better level of awareness about diet (p Conclusion: This study gives valuable insights into the lack of awareness about daily food products and the factors associated with the diet perceptions in diabetic patients. This facilitates health care providers to work on areas that could facilitate improving awareness about dietary practices in those with diabetes. Disclosure R.S. Erukulapati: None. M. Rm: None. K. Dash: None. S. Das: None. H. Reddy: None. V. S: None. A. Punjani: None. S. Yalamanchili: None. S. Tippisetty: None. V.K. Kolukula: None. S.G. Krishna: None.

CGM use is associated with lower HbA1c in people with T1D. We hypothesize early CGM initiation will improve longer term HbA1c. Youth with newly diagnosed T1D from July 2018 to May 2019 (pilot cohort, n=65), were offered CGM initiation in the 1st month of T1D diagnosis with 62 initiating CGM. We compared HbA1c outcomes in this pilot cohort with those diagnosed in 2014-2016 (control cohort, n=272) with follow-up duration restricted to 15 months. HbA1c trajectories were visualized using locally estimated scatter plot smoothing (Figure 1) and compared using a generalized mixed effects regression model adjusted for baseline characteristics (HbA1c at onset, age, sex, race and insurance type). Mean HbA1c at diagnosis was higher in the pilot cohort (12.0% vs. 10.7%). Over the first 15 months of T1D, CGM was initiated in 95% of the pilot cohort (78.5% within 30 days), whereas 56% initiated in the control cohort (1.8% within 30 days). Adjusting for baseline characteristics, mean HbA1c levels were 0.5% lower (95%CI: -1.0, -0.1) in the pilot cohort at 3 months and 1.7% lower (95% CI: -2.6, -0.8) at 6 months compared to the control cohort. Differences beyond 6 months were also in the expected direction and statistically significant at the 0.05 level. Early initiation of CGM in the new onset period was associated with lower HbA1c compared to historic controls. These data suggest that early CGM initiation should be considered a part of standard new onset T1D care. Disclosure P. Prahalad: None. V. Ding: None. A. Addala: None. C. New: None. B.P. Conrad: None. A. Chmielewski: None. E. Geels: None. J. Leverenz: None. A. Martinez-Singh: None. P. Sagan: None. J. Senaldi: None. A. Freeman: None. D. Scheinker: None. K.K. Hood: Research Support; Self; Dexcom, Inc. Speaker’s Bureau; Self; LifeScan, Inc., MedIQ. M. Desai: None. D.M. Maahs: Advisory Panel; Self; Eli Lilly and Company, Insulet Corporation, Medtronic, Novo Nordisk A/S. Consultant; Self; Abbott, Sanofi. Research Support; Self; Bigfoot Biomedical, Dexcom, Inc., Roche Diabetes Care, Tandem Diabetes Care.

DCCT/EDIC participants have been followed for an average of 32 years (N=1,054; mean age 60±7 years; duration T1DM 38±5 years). To evaluate cognitive function in T1DM, mental efficiency and memory were assessed five times during the study. Standardized z-scores were calculated relative to the DCCT baseline evaluation and averaged to obtain three summary domain scores (immediate recall, delayed recall, mental efficiency). Generalized linear mixed models were used. In 2018, mean HbA1c levels were 7.9±0.9% and 46% of participants had experienced ≥1 hypoglycemic coma/seizure. Adjusted for age, sex, and education, cognition declined over time (p Disclosure A.M. Jacobson: None. C.M. Ryan: None. B.H. Braffett: None. R. Gubitosi-Klug: None. G.M. Lorenzi: None. J.A. Luchsinger: Consultant; Self; vTv Therapeutics. V.R. Trapani: None. I. Bebu: None. N. Chaytor: Consultant; Self; Eli Lilly and Company. S.M. Hitt: None. K. Farrell: Stock/Shareholder; Spouse/Partner; Dexcom, Inc., Tandem Diabetes Care. J.M. Lachin: Board Member; Self; Tolerion, Inc. Funding National Institute of Diabetes and Digestive and Kidney Diseases

Glycemic control varies among different cohorts of pregnant women with diabetes. Most studies examining differences between groups using continuous glucose monitoring (CGM) data were performed with older CGM systems worn for 2-7 days. We examined differences in glycemic control and glycemic variability (GV) between pregnant women (n=32) with T1D (n=20), T2D (n=3), or GDM (n=9) in the 2nd and 3rd trimesters using the Dexcom G6 CGM system, worn for 10 days as part of a pregnancy CGM accuracy trial. Pair-wise comparisons were made between groups and group heterogeneity testing was performed. No adjustments were made for multiple comparisons analyses. Most women required insulin therapy (26/32, 81%). The baseline HbA1C levels were similar between groups (Table). The glucose management indicator (GMI) was numerically similar to HbA1C for the T1D and GDM cohorts. Time spent >140 mg/dL (p=0.009) was highest and time in range (63-140 mg/dL) was lowest (p=0.001) in women with T1D compared to the other groups. The coefficient of variation (CV) and mean amplitude of glycemic excursions (MAGE) were highest in the T1D group, lowest in the GDM group, and intermediate in the T2D group (p Disclosure S. Polsky: None. C.J. Levy: Consultant; Self; Dexcom, Inc. Employee; Spouse/Partner; Allergan plc. Research Support; Self; Abbott, Dexcom, Inc., Insulet Corporation. X. Zhang: Employee; Self; Dexcom, Inc. S. Shah: Employee; Self; Dexcom, Inc. G. Haroush: None. K. Nelson: None. G. O’Malley: Research Support; Self; Abbott, Dexcom, Inc. S.J. Ogyaadu: None. S.J. Brackett: None. C. Levister: None. K.N. Castorino: Research Support; Self; Abbott, Dexcom, Inc., Medtronic, Mylan, Novo Nordisk Inc. Funding Dexcom, Inc.

Background: There is a large variation in mean HbA1c levels even between high-income countries, with a decrease over time in HbA1c in some countries but an increase in others. Sweden has experienced a steady decrease in HbA1c over the past 10 years. The aim of this study was to illustrate how changes in HbA1c during the first two years after diagnosis in children and adolescents is related to calendar year for diagnosis of type 1 diabetes from 2010 to 2017. Methods:The Swedish SWEDIABKIDS registry collects data every ~3 months and has > 95% coverage up to age 18 years. We plotted all available HbA1c data vs. diabetes duration, presented as separate Loess curves per 2 consecutive year groups. Results: In total, 5,102 patients contributed with 51,550 HbA1c values over 8 years. HbA1c at onset has slightly increased from 93.9 to 95.0 mmol/mol (10.7 to 10.8 %) between 2010 and 2017. The HbA1c nadir (lowest level during first year) is around 4 months, and has become lower over the years. Early HbA1c tracking is apparent and is established with a difference between the groups from 1 year’s diabetes duration. Conclusions: Intensification of early diabetes treatment, resulting in a lower HbA1c nadir at 4 months and lower HbA1c from 1 year onwards is related to HbA1c two years after diagnosis. Thus, a modifiable factor for a long-term improvement in metabolic control has been identified. Disclosure R. Hanas: Advisory Panel; Self; Abbott, Novo Nordisk A/S. Speaker’s Bureau; Self; Sanofi. Other Relationship; Self; AstraZeneca. I.I. Steineck: None. J. Anderzén: None. K. Eeg-Olofsson: None. J. Ekelund: Employee; Spouse/Partner; AstraZeneca. S. Gudbjörnsdottir: None. L. Hanberger: None. J. Nåtman: None. A. Pundziute Lyckå: None. A. Svensson: None. S. Särnblad: Advisory Panel; Self; Novo Nordisk A/S. Other Relationship; Self; Novo Nordisk A/S. K. Akesson: None.

Objective To evaluate the efficacy and safety of thrice daily Biphasic Human Insulin 30 (BHI 30) versus the traditional twice-daily regimen in type 2 diabetes mellitus (T2DM) patients. It’s a cross over single clinical study. Twenty-two diabetic patients who were already using BHI 30 in twice or thrice daily regimens with or without metformin were included. At the 1st interval; patients continued on their usual insulin regimen as twice or thrice daily injections with adjustment of insulin doses guided by their glucose readings. On the 2nd interval; patients were switched to the other regimen with the same total daily insulin dose redistributed. Results There was a significant decrease in HbA1c level (p 0.05. On the other hand, patients had lower average blood glucose readings (mg/dl) when they were on thrice daily insulin injections (161.4 ± 62.7) compared to twice daily regimen (166.0 ± 69.5), p

Aims/hypothesisThe aim of this work was to determine how weight patterns together with blood glucose, BP and lipids vary at diagnosis of diabetes by age, sex and ethnicity.MethodsUsing the UK Clinical Practice Research Datalink, we identified people with type 2 diabetes (n = 187,601) diagnosed in 1998–2015 and compared their weights, HbA1c, BP and lipid levels at diagnosis with age-matched people without diabetes (n = 906,182), by sex and ethnic group.ResultsYounger age at diagnosis was associated with greater adjusted mean difference (95% CI) in weight between those with vs without type 2 diabetes: 18.7 (18.3, 19.1) kg at age 20–39 years and 5.3 (5.0, 5.5) kg at age ≥ 80 years. Weight differentials were maximal in white women, and were around double in white people compared with South Asian and black people. Despite lower absolute values, BP differences were also greater at younger age of diabetes onset: 7 (6, 7) mmHg at age 20–39 years vs −0.5 (−0.9, −0.2) at age ≥ 80 years. BP differences were greatest in white people, and especially in women. Triacylglycerol level differences were greatest in younger men. Finally, HbA1clevels were also higher with younger onset diabetes, particularly in black people.Conclusions/interpretationAt diagnosis of type 2 diabetes, when compared with people without diabetes, weight and BP differentials were greater in younger vs older people, in women vs men and in white vs South Asian and black people. These differences were observed even though South Asian and black people tend to develop diabetes a decade earlier with either similar or greater dysglycaemia. These striking patterns may have implications for management and prevention.

PURPOSE: Methylglyoxal (MGO) and MGO related advance end product (AGE) are thought to contribute to the development of diabetes and its complications. The present study was intended to determine plasma MGO and sRAGE levels in T2DM patients and to assess the relationship between MGO and other parameters, such as sRAGE and oxidative markers. METHODS: The study was carried out in 100 control and T2DM subjects. Methylglyoxal, sRAGE, HbA1c, and other markers were measured by using a standard protocol and the relationship between variables was analyzed using Spearman’s correlation analysis. RESULTS: Plasma MGO levels in patients with T2DM (221.1 ± 9.50 ng/mL) were significantly higher than in control subjects (121.1 ± 6.52 ng/mL, P 10%), the sRAGE level was 6.2 ± 0.42 ng/mL and was not statistically significant as compared to control healthy group (> 0.05). Moreover, we have not found any correlation between MGO and other markers (p > 0.05). CONCLUSIONS: The findings of the present study showed that increased plasma MGO level is significantly associated with the HbA1c levels in T2DM patients. Moreover, the study shows that plasma sRAGE level is significantly augmented at increased level of glycation (HbA1c > 10%) in T2DM patients.

Purpose This study examines the relationship between timing of initiation on a glucagon-like peptide-1 receptor agonist (GLP-1 RA) and glycosylated hemoglobin (HbA1c) values. Methods The IBM MarketScan databases were used to identify adults with type 2 diabetes mellitus (T2DM) who initiated GLP-1 RA therapy and had multiple recorded HbA1c results. Time to GLP-1 RA initiation was proxied by the number of classes of glucose-lowering agents prescribed in the 2 years before GLP-1 RA initiation, with fewer glucose-lowering agents indicating initiation of a GLP-1 RA earlier in disease progression. Paired t tests examined differences in HbA1c values from preperiod to 2-year postperiod. Multivariable analyses examined the relationship between time to GLP-1 RA initiation and postperiod HbA1c values. Findings Initiation on a GLP-1 RA was associated with a 0.6% reduction in HbA1c values over 2 years (P Implications Results indicate that although initiation on a GLP-1 RA is generally associated with reduced HbA1c levels, there may be additional clinical benefits associated with earlier initiation of a GLP-1 RA.

Background. The aim of our study was to estimate the association of lipid fractions and skin autofluorescence (AF), measured with experimental sample of fiber optic spectrometer FOS-1, in patients with diabetes mellitus (DM). Methods. We included in the study 44 type 1 DM patients (median age 29.5 (24.0; 36.0) and 23 type 2 DM patients, median age 58.0 (47.0; 61.0). Blood lipids and glycosylated hemoglobin (HbA1c) were analyzed. Skin AF was measured with fluorescence–reflection spectrometer FOS-1 at a wavelength of 460 nm with excitation of 365 nm. Ratio of fluorescent signal to signal of reflection in excitation region was used as measured parameter to reduce the effect of skin pigmentation. The measurements were carried out at 5 points on the skin area of forearms. Results. Type 1 DM group was divided to 13 dyslipidemic and 31 normolipidemic patients, subgroups were comparable by age, DM duration and HbA1c level. AF level in dyslipidemic and normolipidemic patients was 0.95 (0.82; 1.16) arb. units and 0.86 (0.79; 0.91) arb. units respectively, p=0.016. In type 1 DM group we found significant positive correlation between skin AF and total cholesterol level (R=0.45, р

This study investigated the clinical characteristics and associated risk factors of prediabetes in the southwestern region of Korea. A total of 323 subjects from 13 prediabetes studies were included in the data analysis. Subjects with prediabetes were divided into the following subtypes: (1) normal glucose tolerance (NGT) with HbA1c 5.7%&ndash, 6.4%, (2) isolated impaired fasting glucose (I-IFG), (3) isolated impaired glucose tolerance (I-IGT), and (4) combined I-IFG and I-IGT (C-IFG/IGT). Clinical and biochemical variables were compared among subtypes, and multivariate logistic regression analysis was used to identify risk factors for prediabetes subtypes. The overall proportion of subjects with NGT, I-IFG, I-IGT and C-IFG/IGT was 8.4%, 20.7%, 33.1% and 37.8%, respectively. In men, C-IFG/IGT was the most common subtype, while in women, I-IGT was the most common. The parameters related to dysglycemia, atherosclerosis and liver dysfunction were higher in subjects in the C-IFG/IGT subtype than in other subtypes. Multiple linear regression analysis revealed independent risk factors for increased FPG, 2h-PPG and HbA1c levels. This study identified the clinical features and independent risk factors for prediabetes subtypes.

To evaluate whether pregnancy glycated hemoglobin (HbA1c) levels of ≤6% and maternal race impacts neonatal hypoglycemia and birthweight, and whether diabetes and beta blocker use during pregnancy additively impacts neonatal outcomes.Retrospective chart review of 4769 infants born at ≥34 weeks; 21 482 glucose measurements were assessed. Predefined groups were infants born to mothers without documented pregnancy conditions (group N), prenatal exposure of beta blockers (group B), diabetes (group D), or both (group DB).In group N, both in Caucasian (Caucasian, n = 1756; β = 2.6, P .001) and African American (n = 1872; β = 2.2, P = .002) race, there was a direct relationship between pregnancy HbA1c levels and birthweight. HbA1c (aOR 1.8; 95% CI [1.3-2.5]) levels, maternal race, prematurity, cesarean delivery, and birth weight predicted hypoglycemia. Each 0.1% increase in HbA1c levels between 4.8 and 6 increased the odds of neonatal hypoglycemia by 6.4% in African American (β 0.62, SE 0.22, P = .01) and by 12.0% in Caucasian (β 1.13, SE 0.23 P .001) population. The odds of neonatal hypoglycemia were 1.7 (group B), 2.1 (group D), and 3.1 (group DB) times higher compared with group N.Pregnancy HbA1c levels between 4.8% and 6.0% considered acceptable during pregnancy impacts neonatal hypoglycemia and birthweight especially in Caucasian race. A third trimester HbA1c5.2 is a potential risk factor for neonatal hypoglycemia, especially in preterm infants. Although we report new findings on the relationship between maternal HbA1c levels and neonatal outcomes, a prospective study is required to validate our findings and determine "optimal" HbA1C levels during pregnancy.

Introduction The Roche Cobas c513 (c513) is a dedicated stand-alone high throughput HbA1c analyzer. We evaluated the performance and the difference in turnaround times (TAT) of the c513 against our Cobas 8000 c502 (c502). Methods We assessed the linearity and precision of the c513, and its agreement (Deming regression and Bland–Altman analysis) with the c502 assay. We compared TAT for these analyzers for a single run of 50 samples and for all samples run over 2 comparable time periods. Results The c513 assay was linear from 4.4–18.3% HbA1c. Interassay precision (CV%) was 1.2 and 0.8 at HbA1c levels of 5.7 and 10.5%, respectively. The c513 assay showed excellent concordance with the c502 assay (r = 0.997) with no significant difference between methods by Bland–Altman analysis (mean difference = 0.021% HbA1c, P = 0.1422). The c513 took 17 min to analyze 50 samples, compared to 40 min on the c502. Over comparable 2-month periods, 90% of samples requiring HbA1c tests only were completed under 25 min (c513) vs 30–35 min (c502). For tubes sharing complete blood count (CBC) testing with HbA1c, the 90th percentile TAT was 35–40 min (c513) compared to 45–50 min (c502). Conclusion The c513 assay performs well with excellent correlation to the c502 assay. The improved TAT of the c513 is suitable when there are demands for rapid HbA1c results and it may forestall requests for point-of-care testing. It is also attractive to sites with heavy workloads with a claimed throughput of 400 tests / h.

Majority of men with type 2 diabetes mellitus (T2DM) have been reported to experience erectile dysfunction (ED) in a lifetime. The aim of our study was to prospectively evaluate the postoperative condition of ED and premature ejaculation (PE) in men who underwent metabolic surgery for the treatment of T2DM. A total of 36 sexually active male individuals with T2DM who were applied for metabolic surgery were given two different questionnaire forms prior to and 6 months after the surgery. Patients filled the International Index of Erectile Function (IIEF) and the Premature Ejaculation Profile (PEP) questionnaires before and 6 months after the surgery. The BMI, fasting blood glucose (FBG), and glycated hemoglobin (HbA1c) concentrations were also measured prior to the surgery and on follow-up points of postoperative first, third, and sixth months. Erectile function (EF) and overall satisfaction domains of the IIEF questionnaire increased significantly after the surgery in the patient groups irrespective of the previous ED severity (p

This study was conducted to test the effectiveness of a particular bitter melon peptide (BMP), with a specific sequence of 19 amino acids (mcIRBP-19), in regulating diabetic patients&rsquo, blood glucose. In order to test the product with the specially processed BMP, a total of 142 diabetic patients were solicited as study subjects, of which 64 were assigned to an experiment group and 78 to a control group. Biochemical data were compared with a paired t-test to verify the significance of changes over different time periods. The clinical results showed that BMP started to improve the subjects&rsquo, glycated hemoglobin (HbA1c) levels at the end of the second month (T2), with mean values being significantly lowered from 7.8 &plusmn, 1.4% (T0) to 7.5 &plusmn, 1.4% (T2) (p = 0.004). The values reduced continuously, eventually reaching 7.4 &plusmn, 1.1% (p = 0.000) at the end of the experiment (T3). HbA1c levels for the control group were 7.5 &plusmn, 1.2% in T0 and 7.5 &plusmn, 1.1% (T3), and not significantly different (p = 0.852) over the same period. This study provides clinical evidence that helps to verify the effectiveness of the new BMP product in regulating diabetic patients&rsquo, blood sugar levels.

It is recommended that children and adolescents with diabetes are seen at paediatric diabetes clinics at least four times a year. This study examined whether an increased involvement of parents in planning the contacts would help them take more responsibility and thus lead to better metabolic control. Methods: Patients with type 1 diabetes at the paediatric outpatient clinic at Lillebaelt Hospital were included in a before-after study. During the intervention, the parents were asked to contact the clinic whenever they needed help or wanted to book a consultation. HbA1c levels 1 year before, at the start of, and 1 year after the intervention were compared, as were the number of consultations and telephone contacts during the year prior to and during the intervention. Results: 139 patients were included in the analyses. The mean HbA1c levels were 1 year before the start of the intervention (HbA1c-1) 61.8 mmol/mol (7.8%), and at the start of the intervention (HbA1c-2) 59.9 mmol/mol (7.6%) (P =.01), and after the end of the intervention (HbA1c-3) 63.1 mmol/mol (7.9%) (HbA1c-2 vs HbA1c-3: P =.0002). During the year prior to the intervention, the mean number of consultations was 5.8, and during the intervention period, the mean was 4.4 (P =.0001); the mean number of telephone calls was 1.8 and 3.8 (P

Introduction: India has a large number of diabetic patients and there is a steep rise in the incidence ofdiabetes in the last decade. Diabetic control is categorized as poor control (HbA1c levels above 7%) andgood control (HbA1c levels below 7%). Critical flicker fusion frequency (CFF) is a non-invasive test, whichcould help early detection of retinal dysfunction and optic neuropathic changes in Type 2 diabetes mellitus(T2DM).Objective: To compare the CFF betweenGroup 1: T2DM (HbA1c 7%).Methodology: Sixty diagnosed T2DM patients were the subjects in this study. Thirty patients had theirHbA1c 7 g%. The patients were recruited from Medicine department, Rajarajeswari MedicalCollege and Hospital. CFF was measured using an in-house built apparatus. CFF values were noted and thenanalyzed.Results and Discussion: The mean CFF in group I and the group II patients were 30.17+ 4.69 Hz and26.32+ 6.70 Hz, respectively. This was highly significant (P = 0.012). The significantly lower CFF in thepoorly controlled group II diabetics can be attributed to poorglycemic control in that group.

(1) Background: Structured nutrition therapy (NT) is essential for the management of type 2 diabetes (T2D), but the optimal delivery during Ramadan fasting remains unclear. The present study aimed to evaluate the effect of structured NT program versus standard care in patients with T2D during Ramadan. (2) Methods: The present study was an 8-week, parallel, non-randomized study with patients&rsquo, preference design involving 64 patients with T2D. The participants were asked to choose their preferred group, i.e., structured NT (Structured Ramadan NT, sRNT) or standard care (SC). The participants in the sRNT group received a Ramadan-focused nutrition plan, including a diabetes-specific formula throughout the study, whereas the patients in the SC group received standard nutrition care. Study outcomes included clinical outcomes and quality of life (QoL). Data was analyzed using two-way repeated-measures ANOVA and linear mixed-effects model. (3) Results: More than half of the participants (n = 38, 63%) chose sRNT as their preferred group. Both groups had comparable baseline characteristics. After 8-weeks of the respective intervention, participants in the sRNT group had lower levels of fasting plasma glucose (&ndash, 0.9 &plusmn, 0.3 mmol/L vs. 0.2 &plusmn, 0.3 mmol/L, p &lt, 0.05), triglycerides (&ndash, 0.21 &plusmn, 0.08 mmol/L vs. 0.20 &plusmn, 0.17 mmol/L, p &lt, 0.05), and self-monitoring glucose at pre-dawn (6.9 mmol/L vs. 7.8 mmol/L, p &lt, 0.05) and pre-bedtime (7.6 mmol/L vs. 8.6 mmol/L, p &lt, 0.05) than participants in the SC group. Although not different between groups, HbA1c levels decreased significantly in the sRNT (&ndash, 0.72 &plusmn, 0.16%, p &lt, 0.001) but not in the SC group (&ndash, 0.35 &plusmn, 0.24%, p = 0.155). QoL and satisfaction scores improved significantly in sRNT group, but not in SC group. (4) Conclusions: The structured NT regimen for Ramadan is a feasible and beneficial program for T2D patients observing Ramadan fasting as it showed an improvement in clinical outcomes and QoL.

Previously, we reported that short-term continuous glucose monitoring (CGM) with the professional iPro2© CGM device is a good clinical indicator of glycated hemoglobin (HbA1c) levels. However, there was no significant correlation between CGM and HbA1c levels when HbA1c levels were >8.0%. To further investigate this issue, we performed a similar study using the FreeStyle Libre Pro©, a newer device that does not require glucose calibration and allows patients to be examined for up to 14 days. Fifty-nine patients (68% women, 32% men) were examined. Twenty-eight and 31 patients presented with type 1 and type 2 diabetes, respectively. Clinically assessed HbA1c levels were compared to blood glucose levels determined by the FreeStyle Libre Pro© for up to 14 days (10.7 ± 3.7 days). We found a significant correlation between HbA1c and CGM levels even when HbA1c levels were >8.0%. Additionally, the correlation between HbA1c and average glucose was identified with the modern CGM and was found to deviate substantially from the new suggested formula. More importantly, we found a more robust correlation between HbA1c and CGM levels in patients with type 2 diabetes. Overestimation or underestimation of blood glucose levels through CGM might increase the risks of inappropriate clinical treatment of diabetes patients. Our results indicate the need for proper CGM data interpretation individualized for each patient to better assist the determination of customized treatments for patients.

Digital technologies are gaining an important role in the management of patients with diabetes. We assessed clinical outcomes and user satisfaction of incorporating a digital diabetes care system in diabetes clinics of a developing country. The system integrated a wireless blood glucose monitor that communicates data to any smartphone utilizing a patented acoustic data transfer method, a mobile-app, and cloud-based software that stores, analyzes, and presents data. Five hospital endocrinology clinics in Vietnam sequentially recruited all patients willing to join the study, providing they had a smartphone and access to internet connectivity. Face-to-face visits were conducted at baseline and at 12 weeks, with monthly digital visits scheduled in the interim and additional digital visits performed as needed. HbA1c levels were measured at baseline and at 12 weeks (&plusmn, 20 days). The study included 300 patients of whom 279 completed the evaluation. Average glucose levels declined from 170.4 &plusmn, 64.6 mg/dL in the first 2 weeks to 150.8 &plusmn, 53.2 mg/dL in the last 2 weeks (n = 221, p &lt, 0.001). HbA1c levels at baseline and 12 weeks declined from 8.3% &plusmn, 1.9% to 7.6% &plusmn, 1.3% (n = 126, 0.001). The digital solution was broadly accepted by both patients and healthcare professionals and improved glycemic outcomes. The durability, scalability, and cost-effectiveness of this approach merits further study.

In organ or non-organ-specific autoimmune disorders, human ovary is usually the target of the autoimmune attack. We aimed to demonstrate the correlation between ovarian reserve and DM1, based on the view that women with type-1 diabetes mellitus (DM1) will have lower AMH levels secondary to poor glycemic control and autoimmune attacks. Ovarian functions of 42 patients diagnosed with DM1 who use insulin and 65 healthy volunteers were analyzed. Basal hormone and AMH levels were measured during the follicular phase. Fasting and postprandial blood glucose concentrations, HbA1c and C-peptide levels were evaluated. The mean antral follicle count (AFC) was significantly lower in DM1 patients than in healthy controls (

Background: International guidelines recommend psychosocial care for children and adolescents with type 1 diabetes. Objective: To assess psychological care in children and adolescents with type 1 diabetes in a real-world setting and to evaluate associations with metabolic outcome. Methods: Delivery of psychological care, HbA1c, and rates of severe hypoglycemia and diabetic ketoacidosis (DKA) in children and adolescents with type 1 diabetes from 199 diabetes care centers participating in the German diabetes survey (DPV) were analyzed. Results: Overall, 12 326 out of 31 861 children with type 1 diabetes were supported by short-term or continued psychological care (CPC). Children with psychological care had higher HbA1c (8.0% vs 7.7%, P