Browsing by Subject "HbA1c"

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  • Moller, Grith; Sluik, Diewertje; Ritz, Christian; Mikkilä, Vera; Raitakari, Olli T.; Hutri-Kähönen, Nina; Dragsted, Lars O.; Larsen, Thomas M.; Poppitt, Sally D.; Silvestre, Marta P.; Feskens, Edith J. M.; Brand-Miller, Jennie; Raben, Anne (2017)
    Higher-protein diets have been advocated for body-weight regulation for the past few decades. However, the potential health risks of these diets are still uncertain. We aimed to develop a protein score based on the quantity and source of protein, and to examine the association of the score with glycated haemoglobin (HbA1c) and estimated glomerular filtration rate (eGFR). Analyses were based on three population studies included in the PREVIEW project (PREVention of diabetes through lifestyle Intervention and population studies in Europe and around the World): NQplus, Lifelines, and the Young Finns Study. Cross-sectional data from food-frequency questionnaires (n = 76,777 subjects) were used to develop a protein score consisting of two components: 1) percentage of energy from total protein, and 2) plant to animal protein ratio. An inverse association between protein score and HbA1c (slope -0.02 +/- 0.01 mmol/mol, p <0.001) was seen in Lifelines. We found a positive association between the protein score and eGFR in Lifelines (slope 0.17 +/- 0.02 mL/min/1.73 m(2), p <0.0001). Protein scoring might be a useful tool to assess both the effect of quantity and source of protein on health parameters. Further studies are needed to validate this newly developed protein score.
  • Nazu, Nazma Akter; Wikström, Katja; Lamidi, Marja-Leena; Lindström, Jaana; Tirkkonen, Hilkka; Rautiainen, Päivi; Laatikainen, Tiina (2020)
    Aims: To compare the quality of diabetes care among type 2 diabetes patients with and without mental disorders during six-year follow-up in North Karelia, Finland. Methods: All type 2 diabetes patients (n = 10190) were analysed using the electronic health records data from 2011-12 to 2015-16. The diabetes care was evaluated using the measurement activity and the achievement of the treatment targets for HbA1c and LDL. Results: Monitoring of HbA1c and LDL levels improved among all patient groups, except the dementia patients. The proportion of those achieving the HbA1c target declined and those achieving the LDL target improved in all patient groups. Differences in the changes of achievement of the target HbA1c level among patients with dementia and depression were observed when compared with those having only type 2 diabetes. Conclusions: This study highlights the challenge of glucose level management as the age and comorbidities of the patients related to the care and achievements of the treatment targets. Mental disorders that are likely to affect patients' adherence to medication and other treatments should be taken into account and more support for self-care should be provided to such patients. Improvement in the achievement of LDL target address the progress in the prevention of macrovascular complications. (C) 2020 The Authors. Published by Elsevier B.V.
  • Presseau, Justin; Mackintosh, Joan; Hawthorne, Gillian; Francis, Jill J; Johnston, Marie; Grimshaw, Jeremy M; Steen, Nick; Coulthard, Tom; Brown, Heather; Kaner, Eileen; Elovainio, Marko; Sniehotta, Falko F (BioMed Central, 2018)
    Abstract Background National diabetes audits in the UK show room for improvement in the quality of care delivered to people with type 2 diabetes in primary care. Systematic reviews of quality improvement interventions show that such approaches can be effective but there is wide variability between trials and little understanding concerning what explains this variability. A national cohort study of primary care across 99 UK practices identified modifiable predictors of healthcare professionals’ prescribing, advising and foot examination. Our objective was to evaluate the effectiveness of an implementation intervention to improve six guideline-recommended health professional behaviours in managing type 2 diabetes in primary care: prescribing for blood pressure and glycaemic control, providing physical activity and nutrition advice and providing updated diabetes education and foot examination. Methods Two-armed cluster randomised trial involving 44 general practices. Primary outcomes (at 12 months follow-up): from electronic medical records, the proportion of patients receiving additional prescriptions for blood pressure and insulin initiation for glycaemic control and having a foot examination; and from a patient survey of a random sample of 100 patients per practice, reported receipt of updated diabetes education and physical activity and nutrition advice. Results The implementation intervention did not lead to statistically significant improvement on any of the six clinical behaviours. 1,138,105 prescriptions were assessed. Intervention (29% to 37% patients) and control arms (31% to 35%) increased insulin initiation relative to baseline but were not statistically significantly different at follow-up (IRR 1.18, 95%CI 0.95–1.48). Intervention (45% to 53%) and control practices (45% to 50%) increased blood pressure prescription from baseline to follow-up but were not statistically significantly different at follow-up (IRR 1.05, 95%CI 0.96 to 1.16). Intervention (75 to 78%) and control practices (74 to 79%) increased foot examination relative to baseline; control practices increased statistically significantly more (OR 0.84, 95%CI 0.75–0.94). Fewer patients in intervention (33%) than control practices (40%) reported receiving updated diabetes education (OR = 0.74, 95%CI 0.57–0.97). No statistically significant differences were observed in patient reports of having had a discussion about nutrition (intervention = 73%; control = 72%; OR = 0.98, 95%CI 0.59–1.64) or physical activity (intervention = 57%; control = 62%; OR = 0.79, 95%CI 0.56–1.11). Development and delivery of the intervention cost £1191 per practice. Conclusions There was no measurable benefit to practices’ participation in this intervention. Despite widespread use of outreach interventions worldwide, there is a need to better understand which techniques at which intensity are optimally suited to address the multiple clinical behaviours involved in improving care for type 2 diabetes. Trial registration ISRCTN, ISRCTN66498413 . Registered April 4, 2013
  • Matz, Karl; Tuomilehto, Jaakko; Teuschl, Yvonne; Dachenhausen, Alexandra; Brainin, Michael (BioMed Central, 2020)
    Abstract Background Diabetes is an increasingly important risk factor for ischemic stroke and worsens stroke prognosis. Yet a large proportion of stroke patients who are eventually diabetic are undiagnosed. Therefore, it is important to have sensitive assessment of unrecognized hyperglycaemia in stroke patients. Design Secondary outcome analysis of a randomized controlled trial focussing on parameters of glucose metabolism and detection of diabetes and prediabetes in patients with acute ischemic stroke (AIS). Methods A total of 130 consecutively admitted patients with AIS without previously known type 2 diabetes mellitus (T2DM) were screened for diabetes or prediabetes as part of secondary outcome analysis of a randomized controlled trial that tested lifestyle intervention to prevent post-stroke cognitive decline. Patients had the oral glucose tolerance test (OGTT) and glycated hemoglobin (HbA1c) measurements in the second week after stroke onset and after 1 year. The detection rates of diabetes and prediabetes based on the OGTT or HbA1c values were compared. Results By any of the applied tests at the second week after stroke onset 62 of 130 patients (48%) had prediabetes or T2DM. Seventy-five patients had results from both tests available, the OGTT and HbA1c; according to the OGTT 40 (53.3%) patients had normal glucose metabolism, 33 (44%) had prediabetes, two (2.7%) T2DM. In 50 (66.7%) patients the HbA1c results were normal, 24 (32%) in the prediabetic and one (1.3%) in the diabetic range. The detection rate for disorders of glucose metabolism was 10% higher (absolute difference; relative difference 29%) with the OGTT compared with HbA1c. After 1 year the detection rate for prediabetes or T2DM was 7% higher with the OGTT (26% relative difference). The study intervention led to a more favourable evolution of glycemic status after 1 year. Conclusion The OGTT is a more sensitive screening tool than HbA1c for the detection of previously unrecognized glycemic disorders in patients with acute stroke with an at least a 25% relative difference in detection rate. Therefore, an OGTT should be performed in all patients with stroke with no history of diabetes. Trial registration http://clinicaltrials.gov . Unique identifier: NCT01109836.
  • Matz, Karl; Tuomilehto, Jaakko; Teuschl, Yvonne; Dachenhausen, Alexandra; Brainin, Michael (2020)
    Background Diabetes is an increasingly important risk factor for ischemic stroke and worsens stroke prognosis. Yet a large proportion of stroke patients who are eventually diabetic are undiagnosed. Therefore, it is important to have sensitive assessment of unrecognized hyperglycaemia in stroke patients. Design Secondary outcome analysis of a randomized controlled trial focussing on parameters of glucose metabolism and detection of diabetes and prediabetes in patients with acute ischemic stroke (AIS). Methods A total of 130 consecutively admitted patients with AIS without previously known type 2 diabetes mellitus (T2DM) were screened for diabetes or prediabetes as part of secondary outcome analysis of a randomized controlled trial that tested lifestyle intervention to prevent post-stroke cognitive decline. Patients had the oral glucose tolerance test (OGTT) and glycated hemoglobin (HbA1c) measurements in the second week after stroke onset and after 1 year. The detection rates of diabetes and prediabetes based on the OGTT or HbA1c values were compared. Results By any of the applied tests at the second week after stroke onset 62 of 130 patients (48%) had prediabetes or T2DM. Seventy-five patients had results from both tests available, the OGTT and HbA1c; according to the OGTT 40 (53.3%) patients had normal glucose metabolism, 33 (44%) had prediabetes, two (2.7%) T2DM. In 50 (66.7%) patients the HbA1c results were normal, 24 (32%) in the prediabetic and one (1.3%) in the diabetic range. The detection rate for disorders of glucose metabolism was 10% higher (absolute difference; relative difference 29%) with the OGTT compared with HbA1c. After 1 year the detection rate for prediabetes or T2DM was 7% higher with the OGTT (26% relative difference). The study intervention led to a more favourable evolution of glycemic status after 1 year. Conclusion The OGTT is a more sensitive screening tool than HbA1c for the detection of previously unrecognized glycemic disorders in patients with acute stroke with an at least a 25% relative difference in detection rate. Therefore, an OGTT should be performed in all patients with stroke with no history of diabetes. Trial registration. Unique identifier: NCT01109836.
  • Jalonen, Emmi (Helsingin yliopisto, 2019)
    Tyypin 1 diabetesta esiintyy Suomessa eniten maailmassa. Tärkeimmät estettävissä olevat lisäsairastavuutta aiheuttavat tekijät ovat sairauden mikro- ja makrovaskulaariset komplikaatiot. The Finnish Diabetic Nephropathy Study eli FinnDiane -seurantatutkimus selvittää näiden lisäsairauksien syntymekanismeja, erityisesti munuaissairauden (nefropatia) osalta, joka tunnetaan merkittävänä kuolleisuuden riskitekijänä. Diabeettinen nefropatia lisää huomattavasti sydän- ja verisuonisairastavuutta, mikä on diabetesta sairastavien potilaiden johtava kuolinsyy. Pulssipaine on systolisen ja diastolisen verenpaineen erotus. Se on noninvasiivinen tapa mitata valtimoiden jäykkyyttä, ja esimerkiksi valtimoiden keskiverenpaineeseen verrattuna huomioi paremmin sekä systolisen että diastolisen verenpaineen vaihtelun. Aiemmassa tutkimuksessamme on osoitettu diabetesta sairastavien kiihtyneestä valtimoiden jäykistymisestä johtuva varhaisempi pulssipaineen nousu jo nuoremmalla iällä. Tässä tutkimuksessa halusimme selvittää, ennustaako kohonnut pulssipaine kuolleisuutta tyypin 1 diabetesta sairastavilla henkilöillä. Tutkimusaineisto koostui 4439 FinnDiane-tutkimukseen osallistuneesta aikuispotilaasta, joilla diabetes oli todettu alle 40-vuotiaana ja joiden insuliinihoito oli aloitettu vuoden sisään diagnoosista. Tiedot kerättiin kyselylomakkeella, jota täydennettiin vastaanotolla. Tiedot kuolemasta saatiin Tilastokeskuksen kuolinrekisteristä. Tietoa kerättiin vuosien 1994-2014 välisenä aikana. Seuranta-ajan mediaani oli 14 vuotta. 713 kuoli seuranta-aikana. Jaoimme potilaat pulssipaineen suhteen neljänneksiin, joita vertailimme Coxin regressio –menetelmää käyttäen. Kolmen matalimman neljänneksen välillä ei saatu merkittävää eroa kuolleisuudessa, mutta korkeimman pulssipaineen neljänneksessä kuolleisuus oli 1,4-kertainen edellisiin verrattuna. Lisäksi analysoimme aineistoa pulssipaineen mediaanin suhteen kahtia jaettuna. Korkeampi pulssipaine liittyi yhdenmukaisesti suurempaan kuolleisuuteen. Muita pulssipaineeseen liittyvän kuolleisuuden riskitekijöitä olivat nefropatia, miessukupuoli ja huono glukoositasapaino.
  • Tuomaala, Anna-Kaisa; Hero, Matti; Tuomisto, Martti T.; Lähteenmäki, Maria; Miettinen, Päivi J.; Laine, Tiina; Wehkalampi, Karoliina; Kiiveri, Sanne; Ahonen, Pekka; Ojaniemi, Marja; Kaunisto, Kari; Tossavainen, Päivi; Lapatto, Risto; Sarkola, Taisto; Pulkkinen, Mari-Anne (2021)
    A multicenter randomized controlled pilot trial investigated whether motivational interviewing (MI) by diabetes physicians improves glycemic control and variability in the context of follow-up for adolescent patients with poorly controlled type 1 diabetes. Patients (n = 47) aged 12 to 15.9 years who showed poor glycemic control (HbA1c >75 mmol/mol/9.0%) were randomized to standard education (SE) only or MI+SE, with study physicians randomized to employ MI+SE (N = 24 patients) or SE only (N = 23). For one year of follow-up, the main outcome measurements were obtained at three-month visits (HbA1c) or six-monthly: time in range (TIR) and glycemic variability (CV). Mean adjusted 12-month change in HbA1c was similar between the MI+SE and SE-only group (-3.6 vs. -1.0 mmol/mol), and no inter-group differences were visible in the mean adjusted 12-month change in TIR (-0.8 vs. 2.6%; P = 0.53) or CV (-0.5 vs. -6.2; P = 0.26). However, the order of entering the study correlated significantly with the 12-month change in HbA1c in the MI+SE group (r = -0.5; P = 0.006) and not in the SE-only group (r = 0.2; P = 0.4). No link was evident between MI and changes in quality of life. The authors conclude that MI's short-term use by diabetes physicians managing adolescents with poorly controlled type 1 diabetes was not superior to SE alone; however, improved skills in applying the MI method at the outpatient clinic may produce greater benefits in glycemic control.
  • Juusola, Matilda; Parkkola, Anna; Härkönen, Taina; Siljander, Heli; Ilonen, Jorma; Åkerblom, Hans; Knip, Mikael (Helsingfors universitet, 2015)
    RESEARCH DESIGN AND METHODS We set out to define the relationship between autoantibodies against zinc transporter 8 (ZnT8) and other diabetes-associated autoantibodies, HLA DR-DQ alleles and metabolic status in Finnish children with newly diagnosed type 1 diabetes (n=723). Metabolic status was monitored by plasma glucose and pH at diagnosis, and through a 2-year follow-up of C-peptide concentrations, daily insulin dose and GHb levels. RESULTS ZnT8A-positivity was detected in 530 children (73%). Positivity for ZnT8A was associated with older age (median 8.9 vs. 8.2 years, P=0.002) and more frequent ketoacidosis (24% vs. 15%; P=0.013). Children carrying the HLA DR3 allele were less often ZnT8A-positive (66% vs. 77%, P=0.002) than others. ZnT8A-positive children had lower serum C-peptide concentrations (P=0.008) and higher insulin doses (P=0.012) over time than their ZnT8A-negative peers. CONCLUSIONS Positivity for ZnT8A at diagnosis seems to reflect a more aggressive disease process both before and after diagnosis.
  • Brännback, Emilia (Helsingin yliopisto, 2020)
    Considering that dogs originate from wolves, who are carnivores, one may speculate whether high amounts of carbohydrates are beneficial to dogs’ health. The aim of this master’s thesis was to compare two different type of diets regarding glucose markers in dogs. Fasting blood samples were taken before and after a diet intervention for the analysis of blood glycosylated hemoglobin (HbA1c), glucose, insulin and glucagon concentrations to compare the differences between dogs fed a high-carbohydrate diet (dry food diet) and a diet containing no dietary carbohydrates (raw food diet). Also bodyweight was evaluated before and after the trial. This master’s thesis was part of a larger study that investigated associations between diet and atopic dermatitis in Staffordshire bull terrier dogs at the University of Helsinki. The dietary intervention lasted for 50-188 days (median 136 days). The high-carbohydrate diet contained: 42% carbohydrates, 23% proteins and 34% fats of total metabolic energy dry matter. Two different low-carbohydrate diets were used. One was a pork-chicken-lamb diet, which contained: 0%: carbohydrates, 25% proteins and 75% fats of total metabolic energy dry matter, and the other was a beef-turkey-salmon, which contained: 0% carbohydrates, 30% proteins and 70% fats of total metabolic energy dry matter. Water was allowed ad libitum. The results showed that feeding a carbohydrate-rich dry food to pet dogs for 4,5 months increased the percentage of HbA1c. In contrast, a raw food diet with low carbohydrate content did not affect the percentage of HbA1c. Both blood glucose and glucagon concentrations decreased within the raw food diet group; while they were not affected in the dry food diet group. No statistical changes in insulin concentrations were found. Based on the results of this study it can be concluded that a high-carbohydrate diet, and a low-carbohydrate, respectively, have different effects on glucose metabolism in dogs. More research is needed to understand how this affects the dog’s health.
  • Turck, Dominique; EFSA NDA Panel (2017)
    Following an application from Loc Troi group, submitted for authorisation of a health claim pursuant to Article 13(5) of Regulation (EC) No1924/2006 via the Competent Authority of the Netherlands, the EFSA Panelon Dietetic Products, Nutrition and Allergies (NDA) was asked to deliver an opinion on the scientific substantiation of a health claim related to Vibigaba (germinated brown rice) and maintenance of long-term normal blood glucose concentration. The scope of the application was proposed to fall under a health claim based on newly developed scientific evidence. The food proposed by the applicant as the subject of the health claim is Vibigaba. The Panelconsiders that the germinated brown rice Vibigaba is sufficiently characterised. The claimed effect proposed by the applicant is contribution to the maintenance of normal glycated haemoglobin level'. The Panelconsiders that maintenance of long-term normal blood glucose concentration is a beneficial physiological effect. The Panelnotes that the applicant did not perform a comprehensive literature search to identify human intervention studies which could be pertinent to the claim. The applicant did not reply to a specific request from EFSA to provide this information. The applicant identified one human intervention study as being pertinent to the claim. The Panelnotes the important methodological limitations of the study (e.g. statistical methods used for data analysis not appropriate for the study design) and that the information provided on the design and conduct of the study is insufficient for a complete scientific evaluation. The Panelconsiders that no conclusions can be drawn from this study for the scientific substantiation of the claim. The Panelconcludes that a cause and effect relationship has not been established between the consumption of Vibigaba (germinated brown rice) and maintenance of long-term normal blood glucose concentration.