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[Diabetes mellitus-Definition, classification, diagnosis, screening and prevention (Update 2019)].
Harreiter, J, Roden, M
Wiener klinische Wochenschrift. 2019;(Suppl 1):6-15
Abstract
Diabetes mellitus comprises a group of heterogeneous disorders, which have an increase in blood glucose concentrations in common. The current classification for diabetes mellitus is presented and the main features of type 1 and type 2 diabetes are compared. Furthermore, the criteria for the correct biochemical diagnosis during fasting and oral glucose tolerance tests as well as the use of hemoglobin A1c (HbA1c) are summarized. The increasing prevalence of diabetes requires targeted screening for detecting diabetes and prediabetes in risk groups. This forms the basis for the early initiation of measures to prevent the onset of diabetes in these risk groups and to delay the progression of diabetes.
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2.
Caution is Needed in Interpreting Hemoglobin A1c Levels in the Muslim Bedouin Population of Southern Israel.
Treister-Goltzman, Y, Peleg, R
The Israel Medical Association journal : IMAJ. 2019;(8):546-551
Abstract
The Bedouins living in southern Israel are a Muslim-Arab population that is transitioning from a nomadic lifestyle to life in permanent settlements. The population has unique characteristics that could affect hemoglobin A1c (HbA1c) measurements. The objective of this study was to describe the socio-demographic and unique morbidity characteristics of this community and their effect on HbA1c measurements. Consanguinity, especially among cousins in the Bedouin population, results in a high prevalence of autosomal recessive genetic diseases such as thalassemia (underestimate of HbA1c), hemoglobinopathies (underestimate and overestimate), Gilbert's disease, and glucose-6-phosphate dehydrogenase deficiency, an X-linked disorder, which can cause hyperbilirubinemia with an overestimate of HbA1c. Furthermore, nutritional deficiencies, autosomal recessive diseases, high birth rates, parasitic infections, and poverty can all cause high rates of anemia (iron and vitamin B12 deficiencies) that can raise HbA1c levels. Congenital dyserythropoietic anemia is found among Bedouin tribes in the Negev region and can lead to an underestimation of HbA1c levels. Pregnancy can also affect HbA1c levels. Medical teams working in the Bedouin community and in other Muslim populations with similar morbidity characteristics throughout the world should identify patients with medical conditions that can affect HbA1c measurements and be aware of possible measurement alternatives such as fructosamine and glycated albumin.
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3.
The effectiveness of theory- and model-based lifestyle interventions on HbA1c among patients with type 2 diabetes: a systematic review and meta-analysis.
Doshmangir, P, Jahangiry, L, Farhangi, MA, Doshmangir, L, Faraji, L
Public health. 2018;:133-141
Abstract
OBJECTIVES The prevalence of type 2 diabetes is rising rapidly around the world. A number of systematic reviews have provided evidence for the effectiveness of lifestyle interventions on diabetic patients. The effectiveness of theory- and model-based education-lifestyle interventions for diabetic patients are unclear. The systematic review and meta-analysis aimed to evaluate and quantify the impact of theory-based lifestyle interventions on type 2 diabetes. STUDY DESIGN A literature search of authentic electronic resources including PubMed, Scopus, and Cochrane collaboration was performed to identify published papers between January 2002 and July 2016. METHODS The PICOs (participants, intervention, comparison, and outcomes) elements were used for the selection of studies to meet the inclusion and exclusion criteria. Mean differences and standard deviations of hemoglobin A1c (HbA1c [mmol/mol]) level in baseline and follow-up measures of studies in intervention and control groups were considered for data synthesis. A random-effects model was used for estimating pooled effect sizes. To investigate the source of heterogeneity, predefined subgroup analyses were performed using trial duration, baseline HbA1c (mmol/mol) level, and the age of participants. Meta-regression was performed to examine the contribution of trial duration, baseline HbA1c (mmol/mol) level, the age of participants, and mean differences of HbA1c (mmol/mol) level. The significant level was considered P < 0.05. RESULTS Eighteen studies with 2384 participants met the inclusion criteria. The pooled main outcomes by random-effects model showed significant improvements in HbA1c (mmol/mol) -5.35% (95% confidence interval = -6.3, -4.40; P < 0.001) with the evidence of heterogeneity across studies. CONCLUSION The findings of this meta-analysis suggest that theory- and model-based lifestyle interventions have positive effects on HbA1c (mmol/mol) indices in patients with type 2 diabetes. Health education theories have been applied as a useful tool for lifestyle change among people with type 2 diabetes.
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4.
Plant-based Diet for HbA1c Reduction in Type 2 Diabetes Mellitus: an Evidence-based Case Report.
Utami, DB, Findyartini, A
Acta medica Indonesiana. 2018;(3):260-267
Abstract
BACKGROUND diabetes has become a major public health concern with an estimated 180 million cases worldwide. Nutritional changes are one of the key aspects in the management of type 2 diabetes mellitus. Previous studies have suggested an association between vegetarian diets and improvements in glycemic control in type 2 diabetes mellitus, however the relationship is not well established. The aim of this report is to perform a critical appraisal to analyze whether plant-based diet reduces the HbA1c level compared to conventional diet. METHODS a comprehensive computer-based literature search was performed on June 20, 2016 using PubMed, Ovid, EBSCO, and the Cochrane Library. All abstracts and titles from the initial search results were screened, reviewed, and appraised using critical appraisal worksheets by Center of Evidence-Based Medicine, University of Oxford. RESULTS one systematic review and two RCTs met the inclusion criteria and were considered eligible for this case report. In patients with type 2 diabetes mellitus, HbA1c significantly yielded greater reduction in the plant-based group compared to conventional diet group after 22 weeks of follow up. Similarly, there was a statistically greater reduction in HbA1c level in the plant-based group after 72 weeks. Furthermore, consumption of plant-based diet was associated with a significant reduction in HbA1c. CONCLUSION in patients with type 2 diabetes mellitus, HbA1c reduction was greater in patients with plant-based diet compared to patients with conventional diet. Further research should be conducted with larger sample size and longer follow-up period.
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5.
The glycaemic sixer [glycaemic hexad].
Kalra, S
JPMA. The Journal of the Pakistan Medical Association. 2018;(10):1541-1542
Abstract
This opinion piece describes a cricket-based analogy, the Glycaemic Sixer, for diabetes care. The hexad lists six glycaemic parameters which must be targeted to achieve optimal cardiovascular outcomes. All six parameters, i.e., fasting glucose, post prandial glucose, glycosylated haemoglobin, avoidance of hypoglycaemia, avoidance of nocturnal hypoglycaemia, and minimization of glycaemic variability, are associated with cardiovascular outcomes. Hence, equal attention must be paid to all these while planning strategies and choosing drugs for diabetes management. The Glycaemic Sixer promotes safety along with efficacy, and supports institution of individualized, patient centred care, using evidence-based therapeutic agents.
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6.
Beyond self-monitored plasma glucose and HbA1c: the role of non-traditional glycaemic markers in gestational diabetes mellitus.
Mendes, N, Tavares Ribeiro, R, Serrano, F
Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology. 2018;(6):762-769
Abstract
Strict glycaemic management is the cornerstone of metabolic control in gestational diabetes mellitus (GDM). Current monitoring standards involve self-monitoring plasma glucose (SMBG) and haemoglobin A1c (HbA1c). However, both have important limitations. SMBG only reflects instantaneous blood glucose and the inconvenience of self-collecting blood frequently results in poor compliance. HbA1c provides information on blood glucose levels from the previous 2 to 3 months and it is influenced by iron-deficient states, common during pregnancy. There is an urgent need for new shorter-term glycaemic markers, as glycated albumin, fructosamine or 1,5-anhydroglucitol. Glycated albumin seems especially interesting as it provides information on blood glucose levels over the foregoing 2-3 weeks and it is not influenced by iron deficiency or the dilutional anaemia of pregnancy. Fructosamine has a precise and inexpensive measurement and it is not affected by haemoglobin characteristics. This review further discusses the potential value of these non-traditional indicators of glycaemic control in patients with GDM, outlining their possible future applications.
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7.
Impact of Genetic Determinants of HbA1c on Type 2 Diabetes Risk and Diagnosis.
Sarnowski, C, Hivert, MF
Current diabetes reports. 2018;(8):52
Abstract
PURPOSE OF REVIEW Glycated hemoglobin (A1c) is used to diagnose type 2 diabetes and monitor glycemic control. Specific genetic variants interfere with A1c and effects/frequencies of some variants vary by ancestry. In this review, we summarize findings from large trans-ethnic meta-analyses of genome-wide association studies (GWAS) of A1c and describe some variants influencing erythrocyte biology and interfering with A1c. RECENT FINDINGS Recent GWAS meta-analyses have revealed 60 loci associated with A1c in multi-ethnic populations. The main A1c genetic driver in African Americans is rs1050828 (G6PD). Some identified loci are located in/near genes known as monogenic causes of erythrocytic disorders (ANK1, SPTA1) or iron disorders (TMPRSS6, HFE). Uncommon genetic variants (not revealed by GWAS) that are known to cause hemoglobinopathies may also influence A1C levels, partly by interfering with laboratory assays. Specific genetic variants that have a large impact on A1c levels may influence clinical practice, especially in individuals of African descent. Efforts to reveal novel A1c loci should focus on increasing representation of GWAS in non-European ancestries, and on using better genome-wide coverage of uncommon variants that are specific to each population.
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8.
[Remission is possible. Every patient with type 2 diabetes should have the right to reverse his diabetes!].
Scholl, J
MMW Fortschritte der Medizin. 2018;(18):60-65
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9.
Diagnosing diabetes mellitus in patients with porphyria cutanea tarda.
Christiansen, AL, Bygum, A, Hother-Nielsen, O, Rasmussen, LM
International journal of dermatology. 2018;(7):763-769
Abstract
The prevalence of diabetes mellitus is increased in patients with porphyria cutanea tarda. Different tests are available for diagnosing and screening for type II diabetes mellitus, however choosing the most suitable test is challenging. The pitfalls in the different tests along with the interfering comorbidities and treatments concerning patients with porphyria cutanea tarda complicate diagnosing these patients with diabetes mellitus. HbA1c, fasting glucose, or oral glucose tolerance are the current available tests, with HbA1c as first choice. Measuring HbA1c requires no fasting, however HbA1c can be false low if the patient is treated with phlebotomy or has liver cirrhosis or chronic hepatitis. Instead fasting glucose and oral glucose tolerance tests can be used if the patient is not acutely ill. If either of the tests give a result in the diagnostic range, the test should be repeated if the patient has no clinical symptoms of diabetes. Diagnosing diabetes mellitus is important for the purpose of early intervention, and this review provides the knowledge needed to diagnose this special patient group properly.
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10.
To what extent does cinnamon administration improve the glycemic and lipid profiles?
Santos, HO, da Silva, GAR
Clinical nutrition ESPEN. 2018;:1-9
Abstract
BACKGROUND & AIMS Cinnamon is a condiment used in cooking and by some in large quantities as a supplement with purported hypoglycemic and lipid-lowering potential. The current literature review aims to discuss the evidence of cinnamon administration regarding its hypoglycemic and lipid-lowering effects, summarizing clinical recommendations. METHODS Electronic databases including PubMed, Cochrane library, Science Direct and Web of Science were searched with the scientific name of the plant as well as the common name. The search for articles was based on following keywords: "cinnamon diabetes", "cinnamon diabetes type 2", "cinnamon and diabetes type 2", "Cinnamomum aromaticum", "Cinnamomum cassia", "Cinnamomum verum", "Cinnamomum zeylanicum". We carried out inclusion criteria between 2003 and 2018 focusing on human studies. RESULTS Concerning glycemic profile, in individuals with type II diabetes mellitus the fasting blood glucose reduced from 12.9 to 52.2 mg/dL and HbA1c from 0.27 to 0.83%, whereas serum insulin decreased in few studies. Research papers ranged from 6 to 17 weeks in duration. The lipid lowering potential, in turn, is most controversial compared to anti-hyperglycemic potential. Also cinnamon administration has been claimed to reduce fat mass and raise serum antioxidants, but the studies used inaccurate methods. Two species are most investigated, C. cassia/aromaticum, and C.zeylanicum/verum. CONCLUSIONS About 1-6 g of these cinnamon species mainly in powder seems to be an adjunct drug treatment for type 2 diabetes mellitus and other conditions of glycemic impairment. However, more controlled clinical trials are needed.