Diabetes & Metabolism Journal

Original Articles

Clinical Care/Education
Improvement of Glycosylated Hemoglobin in Patients with Type 2 Diabetes Mellitus under Insulin Treatment by Reimbursement for Self-Monitoring of Blood Glucose: Young Shin Song, Bo Kyung Koo, Sang Wan Kim, Ka Hee Yi, Kichul Shin, Min Kyong Moon; Diabetes Metab J. 2018;42(1):28-42. Published online September 28, 2017; DOI: https://doi.org/10.4093/dmj.2018.42.1.28

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Background

In Korea, the costs associated with self-monitoring of blood glucose (SMBG) for patients with type 2 diabetes mellitus (T2DM) under insulin treatment have been reimbursed since November 2015. We investigated whether this new reimbursement program for SMBG has improved the glycemic control in the beneficiaries of this policy.

Methods

Among all adult T2DM patients with ≥3 months of reimbursement (n=854), subjects without any changes in anti-hyperglycemic agents during the study period were selected. The improvement of glycosylated hemoglobin (HbA1c) was defined as an absolute reduction in HbA1c ≥0.6% or an HbA1c level at follow-up <7%.

Results

HbA1c levels significantly decreased from 8.5%±1.3% to 8.2%±1.2% during the follow-up (P<0.001) in all the study subjects (n=409). Among them, 35.5% (n=145) showed a significant improvement in HbA1c. Subjects covered under the Medical Aid system showed a higher prevalence of improvement in HbA1c than those with medical insurance (52.2% vs. 33.3%, respectively, P=0.012). In the improvement group, the baseline HbA1c (P<0.001), fasting C-peptide (P=0.016), and daily dose of insulin/body weight (P=0.024) showed significant negative correlations with the degree of HbA1c change. Multivariate analysis showed that subjects in the Medical Aid system were about 2.5-fold more likely to improve in HbA1c compared to those with medical insurance (odds ratio, 2.459; 95% confidence interval, 1.138 to 5.314; P=0.022).

Conclusion

The reimbursement for SMBG resulted in a significant improvement in HbA1c in T2DM subjects using insulin, which was more prominent in subjects with poor glucose control at baseline or covered under the Medical Aid system.

Citations

Citations to this article as recorded by

Immunogenicity and Efficacy of Insulin Glargine Biosimilar Ezelin versus Originator Insulin Glargine in Patients with Type 2 Diabetes
Tri Juli Edi Tarigan, Adisti Dwijayanti, Susie Setyowati, Melva Louisa
Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy.2021; Volume 14: 107. CrossRef
Insulin Glargine U100 Utilization in Patients with Type 2 Diabetes in an Italian Real-World Setting: A Retrospective Study
Luca Degli Esposti, Valentina Perrone, Stefania Saragoni, Valerio Blini, Stefano Buda, Rosella D’avella, Gina Gasperini, Fabio Lena, Francesca Fanelli, Luca Gazzi, Francesco Giorgino
Journal of Diabetes Research.2019; 2019: 1. CrossRef
Self-Monitoring of Blood Glucose in Patients with Insulin-Treated Type 2 Diabetes Mellitus
Kyung-Soo Kim
Diabetes & Metabolism Journal.2018; 42(1): 26. CrossRef

Clinical Care/Education
Physician-Directed Diabetes Education without a Medication Change and Associated Patient Outcomes: Hun-Sung Kim, Hyunah Kim, Hae-Kyung Yang, Eun Young Lee, Yoo Jin Jeong, Tong Min Kim, So Jung Yang, Seo Yeon Baik, Seung-Hwan Lee, Jae Hyoung Cho, In Young Choi, Hyeon Woo Yim, Bong-Yun Cha; Diabetes Metab J. 2017;41(3):187-194. Published online May 12, 2017; DOI: https://doi.org/10.4093/dmj.2017.41.3.187

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Background

When patients with diabetes mellitus (DM) are first referred to a hospital from primary health care clinics, physicians have to decide whether to administer an oral hypoglycemic agent (OHA) immediately or postpone a medication change in favor of diabetes education regarding diet or exercise. The aim of this study was to determine the effect of diabetes education alone (without alterations in diabetes medication) on blood glucose levels.

Methods

The study was conducted between January 2009 and December 2013 and included patients with DM. The glycosylated hemoglobin (HbA1c) levels were evaluated at the first visit and after 3 months. During the first medical examination, a designated doctor also conducted a diabetes education session that mainly covered dietary management.

Results

Patients were divided into those who received no diabetic medications (n=66) and those who received an OHA (n=124). Education resulted in a marked decrease in HbA1c levels in the OHA group among patients who had DM for <1 year (from 7.0%±1.3% to 6.6%±0.9%, P=0.0092) and for 1 to 5 years (from 7.5%±1.8% to 6.9%±1.1%, P=0.0091). Those with DM >10 years showed a slightly lower HbA1c target achievement rate of <6.5% (odds ratio, 0.089; P=0.0024).

Conclusion

For patients who had DM for more than 5 years, higher doses or changes in medication were more effective than intensive active education. Therefore, individualized and customized education are needed for these patients. For patients with a shorter duration of DM, it may be more effective to provide initial intensive education for diabetes before prescribing medicines, such as OHAs.

Citations

Citations to this article as recorded by

Management Status of Patients with Type 2 Diabetes Mellitus at General Hospitals in Korea: A 5-Year Follow-Up Study
Jin Hee Jung, Jung Hwa Lee, Hyang Mi Jang, Young Na, Hee Sun Choi, Yeon Hee Lee, Yang Gyo Kang, Na Rae Kim, Jeong Rim Lee, Bok Rye Song, Kang Hee Sim
The Journal of Korean Diabetes.2022; 23(1): 64. CrossRef
Effect of Voluntary Participation on Mobile Health Care in Diabetes Management: Randomized Controlled Open-Label Trial
Da Young Lee, Seung-Hyun Yoo, Kyong Pil Min, Cheol-Young Park
JMIR mHealth and uHealth.2020; 8(9): e19153. CrossRef
Developing a multi-center clinical data mart of ACEI and ARB for real-world evidence (RWE)
Hun-Sung Kim, Sue Hyun Lee, Tong Min Kim, Ju Han Kim
Clinical Hypertension.2018;[Epub] CrossRef

Clinical Care/Education
Diabetes Camp as Continuing Education for Diabetes Self-Management in Middle-Aged and Elderly People with Type 2 Diabetes Mellitus: So Young Park, Sun Young Kim, Hye Mi Lee, Kyu Yeon Hur, Jae Hyeon Kim, Moon-Kyu Lee, Kang-Hee Sim, Sang-Man Jin; Diabetes Metab J. 2017;41(2):99-112. Published online March 3, 2017; DOI: https://doi.org/10.4093/dmj.2017.41.2.99

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Background

Despite the established benefits of diabetes camps for the continuing education of children with type 1 diabetes mellitus, little is known about the long-term metabolic benefits of diabetes camps for middle-aged and elderly people with type 2 diabetes mellitus (T2DM), especially in terms of glycosylated hemoglobin (HbA1c) variability.

Methods

The 1-year mean and variability of HbA1c before and after the diabetes camp was compared between the participants of the diabetes camp (n=57; median age 65 years [range, 50 to 86 years]; median diabetes duration 14 years [range, 1 to 48 years]). Additional case-control analysis compared the metabolic outcomes of the participants of the diabetes camp and their propensity score-matched controls who underwent conventional diabetes education (n=93).

Results

The levels of HbA1c during the first year after the diabetes camp were comparable to those of the matched controls (P=0.341). In an analysis of all participants of the diabetes camp, the 1-year mean±standard deviation (SD) of HbA1c decreased (P=0.010 and P=0.041) after the diabetes camp, whereas the adjusted SD and coefficient of variance (CV) of HbA1c did not decrease. The adjusted SD and CV significantly decreased after the diabetes camp in participants whose 1-year mean HbA1c was ≥6.5% before the diabetes camp (n=40) and those with a duration of diabetes less than 15 years (n=32).

Conclusion

The 1-year mean and SD of HbA1c decreased after the diabetes camp, with significant reduction in the adjusted SD and CV in those with higher baseline HbA1c and a shorter duration of diabetes.

Citations

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Camp-style lifestyle modification program (CAMP) for diabetes prevention among rural women with prior GDM: study protocol for a three-arm cluster hybrid type 2 randomized controlled trial
Yao Chen, Qinyi Zhong, Wencong Lv, Qing Long, Man Ping Wang, Jyu-Lin Chen, James Allen Willey, Robin Whittemore, Jia Guo
BMC Public Health.2024;[Epub] CrossRef
Older adults’ experiences of being at a senior summer camp—A phenomenographic study
Veronika Wallroth, Kjerstin Larsson, Agneta Schröder
Qualitative Social Work.2022; 21(5): 956. CrossRef
Pushing for miracles, pulling away from risk: An ethnographic analysis of the force dynamics at Senior Summer Camps in Sweden
Gabriella Nilsson, Lisa Ekstam, Janicke Andersson
Journal of Aging Studies.2018; 47: 96. CrossRef

Clinical Care/Education
Practical Focus on American Diabetes Association/European Association for the Study of Diabetes Consensus Algorithm in Patients with Type 2 Diabetes Mellitus: Timely Insulin Initiation and Titration (Iran-AFECT): Mohammad Ebrahim Khamseh, Gholamreza Yousefzadeh, Zahra Banazadeh, Sahar Ghareh; Diabetes Metab J. 2017;41(1):31-37. Published online October 25, 2016; DOI: https://doi.org/10.4093/dmj.2017.41.1.31

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Abstract PDF PubReader: Background
The aim of this study was to evaluate the safety and effectiveness of insulin glargine in a large population from a variety of clinical care in Iranian people with type 2 diabetes mellitus (T2DM) and to measure the percentage of patients achieving glycosylated hemoglobin (HbA1c) <7% by the end of 24 weeks of treatment in routine clinical practice.
Methods
This study was a 24 week, observational study of patients with T2DM, for whom the physician had decided to initiate or to switch to insulin glargine. The safety and efficacy of glargine were assessed at baseline and at week 24.
Results
Seven hundred and twenty-five people with T2DM (63% female) including both insulin naïve and prior insulin users were recruited in this study. The mean age of the participants was 54.2±11.2 years, and the mean HbA1c level was 8.88%±0.93% at baseline. By the end of the study, 27% of the entire participants reached to HbA1c target of less than 7% and 52% had HbA1c ≤7.5%. No serious adverse event was reported in this study. Furthermore, overall hypoglycemia did not increase in prior insulin users and the entire cohort. In addition, body weight did not change in participants while lipid profile improved significantly.
Conclusion
Treatment with insulin glargine could improve glycemic control without increasing the risk of hypoglycemic events in people with T2DM. In addition, a significant clinical improvement was observed in lipid profile.

The Association of Serum Cystatin C with Glycosylated Hemoglobin in Korean Adults: Eun Hee Sim, Hye Won Lee, Hyun Ju Choi, Dong Wook Jeong, Seok Man Son, Yang Ho Kang; Diabetes Metab J. 2016;40(1):62-69. Published online November 27, 2015; DOI: https://doi.org/10.4093/dmj.2016.40.1.62

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Background

Cystatin C has been known to be associated not only with early renal impairment but also with the incidence of diabetic conditions (prediabetes plus diabetes). However, it is not clear whether cystatin C levels are associated with the prevalence of diabetic conditions in Asian populations. We evaluated this association using glycosylated hemoglobin (HbA1c) levels as the definition of diabetes in Korean adults.

Methods

We analyzed data from 1,559 Korean adults (937 men and 622 women) with available serum cystatin C and HbA1c values.

Results

The serum cystatin C levels in subjects with prediabetes and diabetes were significantly increased (0.91±0.14 mg/L in prediabetes and 0.91±0.17 mg/L in diabetes vs. 0.88±0.13 mg/L in patients with normal glucose levels, P=0.001). At increasing cystatin C levels, the prevalence of subjects with prediabetes (30.2% vs. 14.6%, P<0.001) and those with diabetes (10.6% vs. 8.0%, P<0.001) significantly increased in the group with the highest cystatin C levels. The group with the highest cystatin C levels had a significantly increased odds ratio (OR) for the presence of diabetic conditions compared to the group with the lowest values in total subjects (OR, 2.35; 95% confidence interval [CI], 1.54 to 3.58; P<0.001) and in women (OR, 4.13; 95% CI, 1.97 to 8.65; P<0.001), though there was no significant increase after adjusting for multiple variables.

Conclusions

Higher levels of serum cystatin C are associated with an increased prevalence of diabetic conditions in Korean adults. Our findings may extend the positive association of cystatin C with diabetes incidence to an Asian population.

Citations

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Prognostic significance of serum cystatin C in acute brainstem infarctions patients
H. Li, B. Zhang, Z. Huang, H. Wu, B. Qin, L. Zhou, Z. Lu, F. Qin
Revue Neurologique.2024; 180(7): 642. CrossRef
Cardiovascular risk assessment in prediabetic patients in a hypertensive population: The role of cystatin C
Rafael Garcia-Carretero, Luis Vigil-Medina, Inmaculada Mora-Jimenez, Cristina Soguero-Ruiz, Rebeca Goya-Esteban, Javier Ramos-Lopez, Oscar Barquero-Perez
Diabetes & Metabolic Syndrome: Clinical Research & Reviews.2018; 12(5): 625. CrossRef
Characteristics of Dapagliflozin Responders: A Longitudinal, Prospective, Nationwide Dapagliflozin Surveillance Study in Korea
Eugene Han, Ari Kim, Sung Jae Lee, Je-Yon Kim, Jae Hyeon Kim, Woo Je Lee, Byung-Wan Lee
Diabetes Therapy.2018; 9(4): 1689. CrossRef
Cystatin C as a Predictor for Diabetes according to Glycosylated Hemoglobin Levels in Korean Patients
Eon Ju Jeon, Ji Hyun Lee
Diabetes & Metabolism Journal.2016; 40(1): 32. CrossRef
Prevalence of Reduced Kidney Function by Estimated Glomerular Filtration Rate Using an Equation Based on Creatinine and Cystatin C in Metabolic Syndrome and Its Components in Korean Adults
Yang Ho Kang, Dong Wook Jeong, Seok Man Son
Endocrinology and Metabolism.2016; 31(3): 446. CrossRef
Letter: The Association of Serum Cystatin C with Glycosylated Hemoglobin in Korean Adults (Diabetes Metab J 2016;40:62-9)
Kyung-Soo Kim
Diabetes & Metabolism Journal.2016; 40(2): 171. CrossRef
Response: The Association of Serum Cystatin C with Glycosylated Hemoglobin in Korean Adults (Diabetes Metab J 2016;40:62-9)
Yang Ho Kang
Diabetes & Metabolism Journal.2016; 40(2): 173. CrossRef

Obesity and Metabolic Syndrome
The Usefulness of the Glycosylated Hemoglobin Level for the Diagnosis of Gestational Diabetes Mellitus in the Korean Population: Ah Jeong Ryu, Hyuk Jin Moon, Joo Ok Na, Yeo Joo Kim, Sang Jin Kim, Sang Il Mo, Jeong Ran Byun; Diabetes Metab J. 2015;39(6):507-511. Published online November 23, 2015; DOI: https://doi.org/10.4093/dmj.2015.39.6.507

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Background

An oral glucose tolerance test (OGTT) is the current method used for screening and diagnosis of gestational diabetes mellitus (GDM). OGTT is a relatively complicated procedure and is expensive. Thus, new strategies that do not require fasting or more than a single blood draw may improve the diagnosis of GDM and increase the rate of GDM testing. We investigated the utility of monitoring glycosylated hemoglobin (HbA1c) levels for the diagnosis of GDM.

Methods

The data from 992 pregnant women with estimated gestational ages ranging from 24 to 28 weeks were retrospectively reviewed. There were 367 women with plasma glucose levels ≥140 mg/dL 1 hour after a 50-g OGTT. GDM was diagnosed according to the Carpenter-Coustan criteria for a 3-hour 100 g OGTT. A HbA1c assessment was performed at the same time.

Results

We enrolled 343 women in this study, and there were 109 women with GDM. The area under the curve the receiver operating characteristic curve for HbA1c detection of GDM was 0.852 (95% confidence interval, 0.808 to 0.897). A HbA1c cutoff value ≥5.35% had maximal points on the Youden index (0.581). The sensitivity was 87.2% and the specificity was 70.9% for diagnosing GDM. A threshold value ≥5.35% indicated that 163 patients had GDM and that 68 (41.7%) were false positive. The positive predictive value was 58.3% at this threshold value.

Conclusion

Despite substantial progress in methodology, HbA1c values cannot replace OGTT for the diagnosis of GDM.

Citations

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Predelivery HbA1c levels and their relationship with adverse perinatal outcomes in women with normal 75-g OGTT
Xiaoxia Tang, Jin Wei, Zifeng Jiang, Shaohua Wu
Archives of Gynecology and Obstetrics.2023; 310(1): 293. CrossRef
The diagnostic value of glycosylated hemoglobin for gestational diabetes mellitus in Asian populations: A systematic review and meta‐analysis
Jiani Zhang, Fan Zhou, Tingting Xu, Jinfeng Xu, Yaqian Li, Li Lin, Qi Cao, Xiaodong Wang
Journal of Obstetrics and Gynaecology Research.2022; 48(4): 902. CrossRef
The role of first-trimester HbA1c in the early detection of gestational diabetes
Mehrnaz Valadan, Zeinab Bahramnezhad, Fatemeh Golshahi, Elham Feizabad
BMC Pregnancy and Childbirth.2022;[Epub] CrossRef
Glycaemic Variability and Risk Factors of Pregnant Women with and without Gestational Diabetes Mellitus Measured by Continuous Glucose Monitoring
Martina Gáborová, Viera Doničová, Ivana Bačová, Mária Pallayová, Martin Bona, Igor Peregrim, Soňa Grešová, Judita Štimmelová, Barbora Dzugasová, Lenka Šalamonová Blichová, Viliam Donič
International Journal of Environmental Research and Public Health.2021; 18(7): 3402. CrossRef
A Review on Research Progress in the Application of Glycosylated Hemoglobin and Glycated Albumin in the Screening and Monitoring of Gestational Diabetes
Xinyan Liu, Na Wu, Abdulrahman Al-Mureish
International Journal of General Medicine.2021; Volume 14: 1155. CrossRef
Evaluation of the Combination of HbA1C with Hematocrit for Early Screening of Gestational Diabetes Mellitus
Ali Reza Norouzi, Mahsa Siavashi, Fatemeh Norouzi, Maryam Talayeh, Somayyeh Noei Teymoordash
Journal of Obstetrics, Gynecology and Cancer Research.2021; 6(4): 217. CrossRef
The accuracy of haemoglobin A1c as a screening and diagnostic test for gestational diabetes: a systematic review and meta-analysis of test accuracy studies
Chiamaka Esther Amaefule, Archana Sasitharan, Princee Kalra, Stamatina Iliodromoti, Mohammed S.B. Huda, Ewelina Rogozinska, Javier Zamora, Shakila Thangaratinam
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Downregulation of microRNA-873 attenuates insulin resistance and myocardial injury in rats with gestational diabetes mellitus by upregulating IGFBP2
Na Han, Hai-Yan Fang, Jie-Xuan Jiang, Qian Xu
American Journal of Physiology-Endocrinology and Metabolism.2020; 318(5): E723. CrossRef
Reliability of glycosylated hemoglobin in the diagnosis of gestational diabetes mellitus
Duria A. Rayis, Abdel B. A. Ahmed, Manal E. Sharif, Amir ElSouli, Ishag Adam
Journal of Clinical Laboratory Analysis.2020;[Epub] CrossRef
Mid‐trimester glycosylated hemoglobin levels (HbA1c) and its correlation with oral glucose tolerance test (World Health Organization 1999)
Devanshi Dubey, Shipra Kunwar, Uma Gupta
Journal of Obstetrics and Gynaecology Research.2019; 45(4): 817. CrossRef
The utility of HbA1c combined with haematocrit for early screening of gestational diabetes mellitus
Kui Wu, Yan Cheng, Tingting Li, Ziwen Ma, Junxiu Liu, Qingying Zhang, Haidong Cheng
Diabetology & Metabolic Syndrome.2018;[Epub] CrossRef
The Cutoff Value of HbA1c in Predicting Diabetes and Impaired Fasting Glucose
Seyoung Kwon, Youngak Na
The Korean Journal of Clinical Laboratory Science.2017; 49(2): 114. CrossRef
Diagnosing gestational diabetes mellitus: implications of recent changes in diagnostic criteria and role of glycated haemoglobin (HbA1c)
Fahmy W Hanna, Christopher J Duff, Ann Shelley-Hitchen, Ellen Hodgson, Anthony A Fryer
Clinical Medicine.2017; 17(2): 108. CrossRef
Utility of Glycated Haemoglobin in Gestational Diabetes Mellitus: Present and Future
Rajesh Rajput, Deepak Jain
EMJ Diabetes.2016; : 84. CrossRef

Review

The Optimal Cutoff Value of Glycated Hemoglobin for Detection of Diabetic Retinopathy: Jung Min Kim, Dong-Jun Kim; Diabetes Metab J. 2015;39(1):16-26. Published online February 16, 2015; DOI: https://doi.org/10.4093/dmj.2015.39.1.16

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With standardization of measurement of glycated hemoglobin (A1C), the International Expert Committee Report in 2009 and the American Diabetes Association in 2010 recommended incorporating A1C ≥6.5% into the previous diagnostic criteria using fasting plasma glucose and/or 2-hour plasma glucose. Whereas the association of A1C with cardiovascular diseases and other diabetic microvascular complications was linear without evidence of a distinct threshold, several studies suggested a threshold value for A1C in diabetic retinopathy (DR). In studies about the optimal cutoff value for A1C in DR, the A1C values range from 5.2% to 7.8%. There are several possible reasons why these values for DR differ so widely (differences in the definition and/or methods for DR, variation in statistical methods, differences in study population, differences in exclusion criteria, and difference in methods for measuring A1C). With these wide variations in the study method, drawing a conclusive cutoff value for A1C in DR is impossible. In published studies, the cutoff values for moderate or severe DR were higher than those for any or mild DR (6.4% to 7.0% vs. 5.5% to 6.5%).

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What Difference Does a Diagnosis Make?
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Jae Yong Park, Je Hyung Hwang, Min Ji Kang, Ha Eun Sim, Jae Suk Kim, Kyung Soo Ko
Retina.2021; 41(7): 1487. CrossRef
Simple diagnosis of HbA1c using the dual-plasmonic platform integrated with LSPR and SERS
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Original Articles

Effectiveness of 3-Day Continuous Glucose Monitoring for Improving Glucose Control in Type 2 Diabetic Patients in Clinical Practice: Soo Kyoung Kim, Hye Jeong Kim, Taehun Kim, Kyu Yeon Hur, Sun Wook Kim, Moon-Kyu Lee, Yong-Ki Min, Kwang-Won Kim, Jae Hoon Chung, Jae Hyeon Kim; Diabetes Metab J. 2014;38(6):449-455. Published online December 15, 2014; DOI: https://doi.org/10.4093/dmj.2014.38.6.449

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Background

The aim of this study was to investigate whether adjusting diabetic treatment regimens according to the information obtained from a continuous glucose monitoring system (CGMS) might lead to improved glycemic control in patients with type 2 diabetes.

Methods

We reviewed the medical charts of 172 patients who used the CGMS for 1 year starting in December 2008 and the records of 1,500 patients who visited their regular outpatient clinics during December 2008. Of these patients, a total of 65 CGMS patients and 301 regular outpatients (control group) were enrolled in the study after propensity score matching. There were no differences in baseline glycated hemoglobin (HbA1c), age, and duration of diabetes between the CGMS and the control groups after propensity score matching. The changes in the HbA1c levels from baseline to 6 months were calculated.

Results

The CGMS group showed a significant improvement in the HbA1c level compared to the control group at 3 months (7.9%±1.6% vs. 7.4%±1.2%, P=0.001) and at 6 months (7.4%±1.2% vs. 7.9%±1.6%, P=0.010). There were significant differences in the treatment modality changes between the CGMS group and the control group.

Conclusion

Using a 3-day CGMS was advantageous for improving glucose control in patients with type 2 diabetes and may help these patients to optimize glycemic control in clinical practice.

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Biological and Clinical Impacts of Glucose Metabolism in Pancreatic Ductal Adenocarcinoma
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Professional continuous glucose monitoring in patients with diabetes mellitus: A systematic review and meta‐analysis
Sergio Di Molfetta, Irene Caruso, Angelo Cignarelli, Annalisa Natalicchio, Sebastio Perrini, Luigi Laviola, Francesco Giorgino
Diabetes, Obesity and Metabolism.2023; 25(5): 1301. CrossRef
American Association of Clinical Endocrinology Clinical Practice Guideline: The Use of Advanced Technology in the Management of Persons With Diabetes Mellitus
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Clinical and economic benefits of professional CGM among people with type 2 diabetes in the United States: analysis of claims and lab data
Joseph A. Sierra, Mona Shah, Max S. Gill, Zachery Flores, Hiten Chawla, Francine R. Kaufman, Robert Vigersky
Journal of Medical Economics.2018; 21(3): 225. CrossRef
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Assessing the Therapeutic Utility of Professional Continuous Glucose Monitoring in Type 2 Diabetes Across Various Therapies: A Retrospective Evaluation
Jothydev Kesavadev, Robert Vigersky, John Shin, Pradeep Babu Sadasivan Pillai, Arun Shankar, Geethu Sanal, Gopika Krishnan, Sunitha Jothydev
Advances in Therapy.2017; 34(8): 1918. CrossRef
Use of Continuous Glucose Monitoring in Youth-Onset Type 2 Diabetes
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The efficacy and safety of adding either vildagliptin or glimepiride to ongoing metformin therapy in patients with type 2 diabetes mellitus
Gyuri Kim, Sewon Oh, Sang-Man Jin, Kyu Yeon Hur, Jae Hyeon Kim, Moon-Kyu Lee
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So Ra Kim, Yong-ho Lee, Sang-Guk Lee, Sun Hee Lee, Eun Seok Kang, Bong-Soo Cha, Hyun Chul Lee, Jeong-Ho Kim, Byung-Wan Lee
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Journal of Diabetes Science and Technology.2016; 10(3): 790. CrossRef
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Assessment of the Association between Mean Hemoglobin A1c Levels for 5 Years and Coronary Artery Disease by Coronary Angiography in Nondiabetic Patients: Jae-Joon Kim, Ji-Hoon Kang, Ja-Jun Goo, Kyoung-Nyoun Kim, Ja-Young Lee, Mi-kyung Kim, Tae Ik Kim; Diabetes Metab J. 2014;38(1):58-63. Published online February 19, 2014; DOI: https://doi.org/10.4093/dmj.2014.38.1.58

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Background

The effects of glucose on cardiovascular events or mortality in nondiabetic patients has been recently reported. However, since atherosclerosis can be formed over a long period of time, it is necessary to devote several years to unveil the relationship between the two factors. Here, we attempted to find out the relationship between the mean hemoglobin A1c (HbA1c) level and HbA1c variability for 5 years and coronary artery disease (CAD) by using coronary angiography (CAG) to assess nondiabetic patients.

Methods

We reviewed patients who performed CAG who were followed up for at least 5 years after the initial diagnosis. The fasting blood test was performed annually for glucose and HbA1c level. CAD was defined as more than 50% of luminal narrowing. The severity of CAD was divided into two groups depending on whether no vessels were involved or one more vessel were involved (CAD(-) or CAD(+), respectively).

Results

The patients in CAD(+) group had higher mean HbA1c level for 5 years than CAD(-) group (5.71±0.40 vs. 5.86±0.68; P=0.04). Mean HbA1c was a significant predictor for CAD in multiple regression (odds ratio, 2.224; P=0.028). The percentage of patients with CAD was significantly higher in patients with >6.2% of mean HbA1c levels compared to patients with <6.2% of mean HbA1c levels (P<0.019).

Conclusion

When the mean HbA1c levels were above 6.2%, the risk of CAD was higher. Also this study shows that HbA1c level can be one of the predictors for CAD even if the patients do not have diabetes.

Citations

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Prevalence of Diabetes and Prediabetes according to Fasting Plasma Glucose and HbA1c: Ja Young Jeon, Seung-Hyun Ko, Hyuk-Sang Kwon, Nan Hee Kim, Jae Hyeon Kim, Chul Sik Kim, Kee-Ho Song, Jong Chul Won, Soo Lim, Sung Hee Choi, Myoung-jin Jang, Yuna Kim, Kyungwon Oh, Dae Jung Kim, Bong-Yun Cha; Diabetes Metab J. 2013;37(5):349-357. Published online October 17, 2013; DOI: https://doi.org/10.4093/dmj.2013.37.5.349

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Abstract PDF PubReader

Background

Due to the inconvenience of performing oral glucose tolerance tests and day to day variability in glucose level, glycated hemoglobin (HbA1c) has been recommended by the American Diabetes Association as a method to diagnose diabetes. In addition, the Korean Diabetes Association has also recommended the use of HbA1c as a diagnostic test for diabetes. In this study, we evaluated the prevalence of diabetes according to fasting plasma glucose (FPG) level only or the combination of FPG and HbA1c tests.

Methods

Data from the 2011 Korea National Health and Nutrition Examination Survey (KNHANES) were analyzed. Among 5,811 subjects aged 30 years or older, 5,020 were selected after excluding the data of fasting time <8 hours, missing values from fasting glucose or HbA1c level, previous diagnosis of diabetes made by physicians, or current use of antidiabetic medications. Diabetes was defined as FPG ≥126 mg/dL, previous diagnosis of diabetes made by a medical doctor, current use of antidiabetic medications, and/or HbA1c ≥6.5%. Prediabetes was defined as FPG of 100 to 125 mg/dL and/or HbA1c of 5.7% to 6.4%.

Results

When we used FPG only, the prevalence of diabetes and prediabetes were 10.5% (men, 12.6%; women, 8.5%) and 19.3% (men, 23.8%; women, 14.9%), respectively. When HbA1c was included as a diagnostic test, the prevalence of diabetes and prediabetes increased to 12.4% (men, 14.5%; women, 10.4%) and 38.3% (men, 41%; women, 35.7%), respectively. Participants with HbA1c ≥6.5% and fasting glucose level <126 mg/dL were older and had lower estimated glomerular filtration rate.

Conclusion

We concluded that using fasting glucose level only may result in an underestimation of diabetes and prediabetes. HbA1c is an acceptable complementary diagnostic test for diabetes in Korean patients. However, national standardization is needed to order to use HbA1c as a diagnostic method of diabetes and prediabetes.

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Hemoglobin A1c May Be an Inadequate Diagnostic Tool for Diabetes Mellitus in Anemic Subjects: Jung Il Son, Sang Youl Rhee, Jeong-taek Woo, Jin Kyung Hwang, Sang Ouk Chin, Suk Chon, Seungjoon Oh, Sung Woon Kim, Young Seol Kim; Diabetes Metab J. 2013;37(5):343-348. Published online October 17, 2013; DOI: https://doi.org/10.4093/dmj.2013.37.5.343

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Background

Recently, a hemoglobin A1c (HbA1c) level of 6.5% has been determined to be a criterion for diabetes mellitus (DM), and it is a widely used marker for the diagnosis of DM. However, HbA1c may be influenced by a number of factors. Anemia is one of the most prevalent diseases with an influence on HbA1c; however, its effect on HbA1c varies based on the variable pathophysiology of anemia. The aim of this study was to determine the effect of anemia on HbA1c levels.

Methods

Anemic subjects (n=112) and age- and sex-matched controls (n=217) who were drug naive and suspected of having DM were enrolled. The subjects underwent an oral glucose tolerance test and HbA1c simultaneously. We compared mean HbA1c and its sensitivity and specificity for diagnosing DM between each subgroup.

Results

Clinical characteristics were found to be similar between each subgroup. Also, when glucose levels were within the normal range, the difference in mean HbA1c was not significant (P=0.580). However, when plasma glucose levels were above the diagnostic cutoff for prediabetes and DM, the mean HbA1c of the anemic subgroup was modestly higher than in the nonanemic group. The specificity of HbA1c for diagnosis of DM was significantly lower in the anemic subgroup (P<0.05).

Conclusion

These results suggest that the diagnostic significance of HbA1c might be limited in anemic patients.

Citations

Citations to this article as recorded by

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Low Levels of Physical Activity Are Associated with Increased Metabolic Syndrome Risk Factors in Korean Adults: Dong Hoon Lee, Yoon Myung Kim, Yoonsuk Jekal, Sukyung Park, Kyong-Chol Kim, Masayo Naruse, Sun Hyun Kim, Sang-Hwan Kim, Ji-Hye Park, Mi Kyung Lee, Sang Hui Chu, Justin Y. Jeon; Diabetes Metab J. 2013;37(2):132-139. Published online April 16, 2013; DOI: https://doi.org/10.4093/dmj.2013.37.2.132

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Background

Low levels of physical activity (PA) are strongly associated with the development of metabolic syndrome (MetS) and chronic diseases. However, few studies have examined this association in Koreans. The primary purpose of this study was to examine the associations between PA and MetS risks in Korean adults.

Methods

A total of 1,016 Korean adults (494 males and 522 females) participated in this study. PA levels were assessed using the International PA Questionnaire. MetS risk factors were determined using clinically established diagnostic criteria.

Results

Compared with the highest PA group, the group with the lowest level of PA was at greater risk of high triglyceride (TG) in males (odds ratio [OR], 1.87; 95% confidence interval [CI], 1.07 to 3.24) and of hemoglobin A1c ≥5.5% in females (OR, 1.75; 95% CI, 1.00 to 3.04) after adjusting for age and body mass index. Compared with subjects who met the PA guidelines, those who did not meet the guidelines were more likely to have low high density lipoprotein cholesterol in both males (OR, 1.69; 95% CI, 1.11 to 2.58), and females (OR, 1.82; 95% CI, 1.20 to 2.77). Furthermore, those who did not meet the PA guidelines were at increased risk of high TG levels in males (OR, 1.69; 95% CI, 1.23 to 2.86) and abnormal fasting glucose (OR, 1.93; 95% CI, 1.17 to 3.20) and MetS (OR, 2.10; 95% CI, 1.15 to 3.84) in females.

Conclusion

Increased levels of PA are significantly associated with a decreased risk of abnormal MetS components.

Citations

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Impact of HbA1c Criterion on the Detection of Subjects with Increased Risk for Diabetes among Health Check-Up Recipients in Korea: Hong-Kyu Kim, Sung-Jin Bae, Jaeone Choe; Diabetes Metab J. 2012;36(2):151-156. Published online April 17, 2012; DOI: https://doi.org/10.4093/dmj.2012.36.2.151

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Abstract PDF PubReader

Background

We performed the study to examine the impact of hemoglobin A1c (HbA1c) criterion on the screening of increased risk for diabetes among health check-up subjects in Korea.

Methods

We retrospectively analyzed clinical and laboratory data of 37,754 Korean adults (age, 20 to 89 years; 41% women) which were measured during regular health check-ups. After excluding subjects with previously diagnosed diabetes mellitus (n=1,812) and with overt anemia (n=318), 35,624 subjects (21,201 men and 14,423 women) were included in the analysis.

Results

Among the 35,624 subjects, 11,316 (31.8%) subjects were categorized as increased risk for diabetes (IRD) by fasting plasma glucose (FPG) criteria, 6,531 (18.1%) subjects by HbA1c criteria, and 13,556 (38.1%) subjects by combined criteria. Therefore, although HbA1c criteria alone identifies 42% [(11,316-6,531)/11,316] fewer subjects with IRD than does FPG criteria, about 20% [(13,556-11,316)/11,316] more subjects could be detected by including new HbA1c criteria in addition to FPG criteria. Among the 13,556 subjects with IRD, 7,025 (51.8%) met FPG criteria only, 2,240 (16.5%) met HbA1c criteria only, and 4,291 (31.7%) met both criteria. Among subjects with impaired fasting glucose, 65% were normal, 32% were IRD, and 3% were diabetes by HbA1c criterion. In receiver operating characteristic curve analysis, cutoff point of HbA1c with optimal sensitivity and specificity for identifying IRD was 5.4%.

Conclusion

Although HbA1c criteria alone identifies fewer subjects with IRD than does FPG criteria, about 20% more could be detected by addition of HbA1c criteria. Further studies are needed to define optimal cutoff point of HbA1c and to establish screening and management guidelines for IRD.

Citations

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Does reviewing fasting plasma glucose results patterns before glycosylated hemoglobin testing in type-2 diabetic patients lead to better testing decision?
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Seyoung Kwon, Youngak Na
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Risk of progression to diabetes from prediabetes defined by HbA1c or fasting plasma glucose criteria in Koreans
Chul-Hee Kim, Hong-Kyu Kim, Eun-Hee Kim, Sung-Jin Bae, Jaewon Choe, Joong-Yeol Park
Diabetes Research and Clinical Practice.2016; 118: 105. CrossRef
Comparison of the clinical characteristics of diabetes mellitus diagnosed using fasting plasma glucose and haemoglobin A1c: The 2011 Korea National Health and Nutrition Examination Survey
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Diabetes Research and Clinical Practice.2016; 113: 23. CrossRef
Association of prediabetes, defined by fasting glucose, HbA1c only, or combined criteria, with the risk of cardiovascular disease in Koreans
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Fasting plasma glucose concentrations for specified HbA1c goals in Korean populations: data from the Fifth Korea National Health and Nutrition Examination Survey (KNHANES V-2, 2011)
Sangmo Hong, Jun Goo Kang, Chul Sik Kim, Seong Jin Lee, Chang Beom Lee, Sung-Hee Ihm
Diabetology & Metabolic Syndrome.2016;[Epub] CrossRef
Impact of hemoglobin A1c‐based criterion on diagnosis of prediabetes: The Korea National Health and Nutrition Examination Survey 2011
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Letter: Impact of HbA1c Criterion on the Detection of Subjects with Increased Risk for Diabetes among Health Check-Up Recipients in Korea (Diabetes Metab J 2012;36:151-6)
Sung Hee Choi
Diabetes & Metabolism Journal.2012; 36(3): 251. CrossRef

Role of HbA1c in the Screening of Diabetes Mellitus in a Korean Rural Community: Jae Hyun Kim, Gun Woo Kim, Mi Young Lee, Jang Yel Shin, Young Goo Shin, Sang Baek Koh, Choon Hee Chung; Diabetes Metab J. 2012;36(1):37-42. Published online February 17, 2012; DOI: https://doi.org/10.4093/dmj.2012.36.1.37

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44 Download
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Abstract PDF PubReader

Background

Recently, the measurement of glycated hemoglobin (HbA1c) was recommended as an alternative to fasting plasma glucose or oral glucose tolerance tests for diagnosing diabetes mellitus (DM). In this study, we analyzed HbA1c levels for diabetes mellitus screening in a Korean rural population.

Methods

We analyzed data from 10,111 subjects from a Korean Rural Genomic Cohort study and generated a receiver operating characteristic curve to determine an appropriate HbA1c cutoff value for diabetes.

Results

The mean age of the subjects was 56.3±8.1 years. Fasting plasma glucose and 2-hour plasma glucose after 75 g oral glucose tolerance tests were 97.5±25.6 and 138.3±67.1 mg/dL, respectively. The mean HbA1c level of the subjects was 5.7±0.9%. There were 8,809 non-DM patients (87.1%) and 1,302 DM patients (12.9%). A positive relationship between HbA1c and plasma glucose levels and between HbA1c and 2-hour plasma glucose levels after oral glucose tolerance tests was found in a scatter plot of the data. Using Youden's index, the proper cutoff level of HbA1c for diabetes mellitus screening was 5.95% (sensitivity, 77%; specificity, 89.4%).

Conclusion

Our results suggest that the optimal HbA1c level for DM screening is 5.95%.

Citations

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