OBJECTIVE

To determine the pupillary parameters of adult patients with type 2 diabetes mellitus (DM) using the Reflex PLR© mobile application and to correlate these parameters with glycosylated hemoglobin (HbA1C) levels.

This was a single-center, prospective, observational, cross-sectional study conducted at Ospital ng Makati from June to August 2024. Study participants were patients with type 2 DM without diabetic retinopathy and non-diabetics who served as the control group. Participants underwent blood chemistry testing and pupillometry using the Reflex PLR© mobile app. The study outcomes were maximum and minimum pupillary diameters, amplitude, and latency.

There were 44 study participants: 26 non-diabetics and 18 diabetic patients. The two groups had similar pupillary baseline diameters (p = 0.72; p = 0.30), maximum pupillary diameters (p = 0.82; p = 0.89), minimum pupillary diameters (p = 0.85; p = 0.89), pupillary amplitudes (p = 0.88; p = 0.55), and pupillary latencies (p = 0.53; p = 0.47) for the right and left eyes, respectively. The relationship between pupillary parameters and HbA1C levels showed no significant variations in baseline diameter (p = 0.21; p = 0.45), maximum diameter (p = 0.65 for the right eye; p = 0.46 for the left eye), minimum diameter (p = 0.77; p = 0.46), amplitude (p = 0.89; p = 0.83), and latency (p = 0.31; p = 0.22).

The study did not demonstrate any significant correlation between pupillary parameters and HbA1C levels. Pupillary changes in diabetes may have been more dependent on factors such as disease duration and the presence of complications rather than glycemic control alone.

Objectives: The study aimed to identify whether pre-operative glycosylated hemoglobin level (HbA1c) and fasting blood sugar (FBS) can be used as markers for the development of acute kidney injury (AKI) in the immediate post-operative period of type 2 diabetic patients after elective abdominal surgery.

Methods: This retrospective cohort pilot study included seventy-four diabetic patients who underwent elective abdominal surgery from 2015 to 2018. HbA1c and FBS, demographic data, comorbidities, type and indication of surgery, and treatment history were correlated with the development of AKI using logistic regression analysis.

Results: In this cohort, 12% of subjects developed AKI. Univariate and multivariate logistic regression analysis, however, showed that neither HbA1c and FBS nor other studied factors were predictive for the occurrence of AKI (OR 2.55, p= 0.26 and OR 0.64, p= 0.72 respectively).

Conclusion: Pre-operative HbA1c and one-time FBS values in diabetic patients undergoing elective abdominal surgery procedures were not statistically predictive of AKI in the present data. However, the observed trend towards the risk of AKI among the elevated HbA1c subset of patients should drive further studies with a greater sample size and of a prospective nature looking at other metabolic factors contributing to AKI.

hemoglobin (HbA(1c)) is a key biomarker for the monitoring of glycemic balance in patients with diabetes. The aim of this study was to evaluate the performance of a new system, the Tosoh HLC-723 G11 analyzer (Tosoh Corporation, Japan), compared to that of two routine diagnostic testing systems, Tosoh G8 (Tosoh Corporation) and Capillarys 2 Flex Piercing (Sebia, France).METHODS: Tosoh G11 was evaluated for precision, linearity, and carry-over, according to the Clinical and Laboratory Standard Institute's guidelines. Test results from clinical samples were compared between Tosoh G11 and the routine testing systems, Tosoh G8 and Capillarys 2 Flex Piercing.RESULTS: With respect to the precision of Tosoh G11, the test results for low- and high-concentration controls showed a coefficient of variation of less than 1.1%. Furthermore, the new device exhibited good linearity for HbA(1c) values ranging from 3.4% to 18.8%, and carry-over was not observed. HbA(1c) results for Tosoh G11 (N=143) correlated well with those for Tosoh G8 (r=0.9971) and Capillarys 2 Flex Piercing (r=0.9918).CONCLUSIONS: Tosoh G11 demonstrated reliable analytical performance with good precision and linearity, and no carry-over results. In addition, its results were comparable to those of the existing instruments. Thus, the results of this evaluation suggest that Tosoh G11 is suitable for the routine diagnostic testing of HbA(1c) levels in clinical chemistry laboratories.]]>
Chemistry, Clinical ; Diagnostic Tests, Routine ; Hemoglobin A, Glycosylated ; Humans

BACKGROUND: Insulin therapy is the treatment of choice in type 2 diabetes mellitus (T2DM) patients who are not achieving glycemic goals despite triple oral hypoglycemic agent (OHA) combination therapy. However, there is still no additional treatment option for patients who cannot afford insulin therapy or who have various clinical limitations. The purpose of this study was to evaluate the clinical efficacy and safety of four OHA combination therapy in poorly controlled T2DM patients who could not afford insulin therapy. METHODS: Forty-seven T2DM patients were enrolled according to the following criteria: 1) glycosylated hemoglobin [HbA1c] > 8.5%, 2) ongoing treatment with 3 OHA combination therapy (metformin, sulfonylurea, dipeptidyl peptidase-4 inhibitor), or 3) combined limitations for applying insulin therapy. Patients were given the fourth OHA (pioglitazone) in addition to their previous treatment for 12 months. We evaluated changes in HbA1c, body weight, hypoglycemic events, and side effects. RESULTS: At study completion, mean HbA1c and fasting plasma glucose were significantly reduced from 9.6% to 8.04% and from 198.4 mg/dL to 161.5 mg/dL, respectively (P < 0.001). Mean body weight was significantly increased from 66.7 kg to 69.3 kg. Hypoglycemia and side effects were observed 18 times and only 3 cases showed abnormal liver function tests or edema. In addition, subjects with higher initial HbA1c levels and HOMA-beta showed an independent association with a greater reduction in HbA1c. CONCLUSION: The 4 OHA combination therapy is effective and safe when insulin is not feasible.
Blood Glucose ; Body Weight ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Drug Therapy ; Edema ; Fasting ; Hemoglobin A, Glycosylated ; Humans ; Hypoglycemia ; Hypoglycemic Agents ; Insulin ; Liver Function Tests ; Treatment Outcome

BACKGROUND: Diabetic patients are known to have unusually high mean intraocular pressure (IOP); attributable to autonomic dysfunction and genetic factors. A recent study reported that diabetic complications occur in not only diabetes but also prediabetes. We performed this study to analyze the relationship between glycated hemoglobin A1c (HbA1c) levels and IOP in non-diabetics using electronic medical records at the health screening center of Soon Chun Hyang University Seoul Hospital.METHODS: We considered 16,643 individuals who visited the health screening center of Soon Chun Hyang University Seoul Hospital between November 2015 and September 2017. In total, 3,029 subjects were included in the study. Exclusion criteria included a history of hypertension, diabetes, stroke, cardiovascular disease, hepatitis (A-C), cancer, other disease, fasting blood glucose of 126 mg/dL or higher, HbA1c of 6.5% or higher, and individuals whose binocular IOP could not be measured. We categorized subjects into two groups; those with HbA1c less than or equal to 5.6%, and those with HbA1c greater than 5.6% and less than 6.5%. The mean IOP of each group was compared by gender.RESULTS: After adjusting for factors affecting IOP, analysis of variance was performed to analyze the relationship between HbA1c and IOP. There was no statistically significant difference between the HbA1c groups in males. However, there was a significant difference in IOP between females in the the higher and lower HbA1c groups.CONCLUSION: There was a statistically significant relationship between mean IOP and HbA1c in females without diabetes. Further research is needed with prospective and extensive data collection.
Blood Glucose ; Data Collection ; Diabetes Complications ; Diabetes Mellitus ; Electronic Health Records ; Fasting ; Female ; Health Promotion ; Hemoglobin A, Glycosylated ; Hepatitis ; Humans ; Hypertension ; Intraocular Pressure ; Male ; Mass Screening ; Myocardial Infarction ; Prediabetic State ; Prospective Studies ; Seoul ; Telescopes

BACKGROUND: The purpose of this study was to investigate the relationship between sleep patterns and health in Korea, using data from the Korea National Health and Nutrition Examination Survey 2016–2017.METHODS: In total, 12,646 individuals were divided into those who sleep more than 5 hours and less than 5 hours per day during the week. In addition, 512 people who slept less than 5 hours a day on weekdays were further classified into those sleeping on average less than 5 hours a day and those sleeping more than 5 hours a day on weekends.RESULTS: People who slept on average for more than 5 hours on weekdays were taller, had lower body mass index, and lower fasting blood sugar and glycated hemoglobin levels than those who slept less than 5 hours on weekdays. In addition, the percentage of people with osteoporosis, cervical cancer, and depression was lower in the group that slept on average 5 hours or more on weekdays than in the group that slept less than 5 hours on weekdays. Among those who slept on average less than 5 hours a day on weekdays, individuals who slept more than 5 hours a day on weekends were taller and had lower fasting blood glucose and glycated hemoglobin than those who slept less than 5 hours a day on weekends. The prevalence of patients with angina, arthritis, osteoporosis, colon cancer, and depression was higher in the group who slept less than 5 hours a day on weekends.CONCLUSION: There are differences in height, body mass index, fasting blood sugar level and glycated hemoglobin level and in the prevalence of angina, arthritis, osteoporosis, colon cancer, and depression according to weekday and weekend sleep times.
Adult ; Arthritis ; Blood Glucose ; Body Height ; Body Mass Index ; Colonic Neoplasms ; Depression ; Fasting ; Hemoglobin A, Glycosylated ; Humans ; Korea ; Nutrition Surveys ; Osteoporosis ; Prevalence ; Uterine Cervical Neoplasms

BACKGROUND: We aimed to retrospectively analyze the efficacy of 10 mg dapagliflozin (DAPA), which is a sodium-glucose cotransporter-2 inhibitor, in Korean patients with type 2 diabetes who visited a primary diabetes clinic. METHODS: In total, 83 patients with type 2 diabetes, who received treatment with DAPA for the first time in a primary diabetes clinic between January 2015 and October 2015, were included in the study. The effect of DAPA in lowering glycosylated hemoglobin (HbA1c) levels was evaluated via chart review at 6 months follow-up. The patients were categorized into five groups according to add-on to or switched from other glucose-lowering agents: add-on to metformin (MET, n=10), add-on to MET+dipeptidyl peptidase 4 inhibitor (DPP4i, n=12), switched from sulfonylurea (SU, n=13), switched from DPP4i (n=11), and switched from thiazolidinedione (TZD, n=37). All the participants had already used MET for their regimen. RESULTS: Treatment with DAPA reduced HbA1c level by 1.2%±0.8%. Moreover, a significant decrease was observed in all subgroups: add-on to MET, −1.2%±0.7%; add-on to MET+DPP4i, −1.4%±0.8%; switched from SU, −1.4%±0.7%; switched from DPP4i, −0.5%±0.7%; and switched from TZD, −1.2%±0.9% (P<0.01). A significant decrease in body weight (−3.1±2.6 kg, P<0.001) was observed after DAPA administration. Estimated glomerular filtration rate and urine microalbumin were significantly decreased after 6 months of treatment with DAPA (−4.0±13.5 mL/min/1.73 m2, P=0.03; −23.6±45.9 mg/L, P<0.001). CONCLUSION: Treatment with DAPA, whether added to or switched from other glucose-lowering agents, significantly decreased HbA1c levels in Korean patients with type 2 diabetes who visited a single primary diabetes clinic. DAPA can be considered as an optimal second-line treatment for patients with type 2 diabetes, as supported by real-world evidence studies.
Body Weight ; Diabetes Mellitus, Type 2 ; Dipeptidyl-Peptidase IV Inhibitors ; Follow-Up Studies ; Glomerular Filtration Rate ; Hemoglobin A, Glycosylated ; Humans ; Korea ; Metformin ; Primary Health Care ; Retrospective Studies

BACKGROUND: Glycosylated hemoglobin (HbA1c) has been recommended as a diagnostic test for prediabetes and diabetes. Here, we evaluated the level of agreement between diagnoses based on fasting plasma glucose (FPG) versus HbA1c levels and determined optimal HbA1c cutoff values for these diseases in youth and young adults. METHODS: The study included 7,332 subjects (n=4,129, aged 10 to 19 years in youth group; and n=3,203 aged 20 to 29 years in young adult group) from the 2011 to 2016 Korea National Health and Nutrition Examination Survey. Prediabetes and diabetes were defined as 100 to 125 mg/dL (impaired fasting glucose [IFG]) and ≥126 mg/dL for FPG (diabetes mellitus [DM] by FPG [DMFPG]), and 5.7% to 6.4% and ≥6.5% for HbA1c, respectively. RESULTS: In the youth group, 32.5% with IFG had an HbA1c level of 5.7% to 6.4%, and 72.2% with DMFPG had an HbA1c ≥6.5%. In the young adult group, 27.5% with IFG had an HbA1c level of 5.7% to 6.4%, and 66.6% with DMFPG had an HbA1c ≥6.5%. Kappa coefficients for agreement between the FPG and HbA1c results were 0.12 for the youth group and 0.19 for the young adult group. In receiver operating characteristic curve analysis, the optimal HbA1c cutoff for IFG and DMFPG were 5.6% and 5.9% in youths and 5.5% and 5.8% in young adults, respectively. CONCLUSION: Usefulness of HbA1c for diagnosis of IFG and DMFPG in Koreans aged <30 years remains to be determined due to discrepancies between the results of glucose- and HbA1c-based tests. Additional testing might be warranted at lower HbA1c levels to detect IFG and DMFPG in this age group.
Adolescent ; Blood Glucose ; Diabetes Mellitus ; Diagnosis ; Diagnostic Tests, Routine ; Fasting ; Glucose ; Hemoglobin A, Glycosylated ; Humans ; Korea ; Nutrition Surveys ; Plasma ; Prediabetic State ; ROC Curve ; Young Adult

BACKGROUND: We investigated the predictive markers for the therapeutic efficacy and the best combination of sodium-glucose co-transporter 2 (SGLT2) inhibitors (empagliflozin, dapagliflozin, and ipragliflozin) therapy in patients with type 2 diabetes mellitus (T2DM). METHODS: A total of 804 patients with T2DM who had taken SGLT2 inhibitor as monotherapy or an add-on therapy were analyzed. Multivariate regression analyses were performed to identify the predictors of SGLT2 inhibitor response including the classes of baseline anti-diabetic medications. RESULTS: After adjusting for age, sex, baseline body mass index (BMI), diabetes duration, duration of SGLT2 inhibitor use, initial glycosylated hemoglobin (HbA1c) level, estimated glomerular filtration rate (eGFR), and other anti-diabetic agent usage, multivariate analysis revealed that shorter diabetes duration, higher initial HbA1c and eGFR were associated with better glycemic response. However, baseline BMI was inversely correlated with glycemic status; lean subjects with well-controlled diabetes and obese subjects with inadequately controlled diabetes received more benefit from SGLT2 inhibitor treatment. In addition, dipeptidyl peptidase 4 (DPP4) inhibitor use was related to a greater reduction in HbA1c in patients with higher baseline HbA1c ≥7%. Sulfonylurea users experienced a larger change from baseline HbA1c but the significance was lost after adjustment for covariates and metformin and thiazolidinedione use did not affect the glycemic outcome. CONCLUSION: A better response to SGLT2 inhibitors is expected in Korean T2DM patients who have higher baseline HbA1c and eGFR with a shorter diabetes duration. Moreover, the add-on of an SGLT2 inhibitor to a DPP4 inhibitor is likely to show the greatest glycemic response.
Blood Glucose ; Body Mass Index ; Diabetes Mellitus, Type 2 ; Dipeptidyl Peptidase 4 ; Glomerular Filtration Rate ; Hemoglobin A, Glycosylated ; Humans ; Metformin ; Multivariate Analysis

PURPOSE: To investigate the risk factors of diabetic nephropathy in patients with diabetic retinopathy requiring panretinal photocoagulation (PRP) and the visual prognosis. METHODS: A retrospective review of electronic medical records was conducted at Seoul St. Mary's Hospital, comprising 103 patients with type 2 diabetes mellitus and diabetic retinopathy who underwent PRP from 1996 to 2005. Patients with type 1 diabetes mellitus, non-diabetic renal disease, non-diabetic retinal disease, visually significant ocular disease, high-risk proliferative diabetic retinopathy, and advanced diabetic retinopathy were excluded. The patients were divided into three groups: no nephropathy (group 1, n = 45), microalbuminuria (group 2, n = 16), and advanced nephropathy (group 3, n = 42). Duration of diagnosis of retinopathy and nephropathy, glycosylated hemoglobin, visual acuity, complications, and treatment history were investigated. RESULTS: The mean glycosylated hemoglobin of group 3 (8.4 ± 1.2) was higher than that of group 1 (7.7 ± 1.0) or group 2 (7.7 ± 1.0) (p = 0.04). Mean interval from PRP to diagnosis of nephropathy was 8.8 ± 6.0 years in group 2 and 8.7 ± 4.9 years in group 3. The significant decrease in visual acuity in group 3 (28 eyes, 35.9%) was significantly higher than that in group 1 (15 eyes, 18.1%, p = 0.01) or group 2 (6 eyes, 20.7%, p = 0.03). Only vitreous hemorrhage showed a significantly higher incidence in groups 2 and 3 than in group 1 (p = 0.02). Multivariate regression analysis revealed that female sex and lower glycosylated hemoglobin were significantly associated with a protective effect on development of nephropathy. CONCLUSIONS: In the clinical setting, many patients with PRP-requiring diabetic retinopathy develop nephropathy an average of 8 to 9 years after PRP. Male sex and higher glycosylated hemoglobin could be risk factors of nephropathy.
Diabetes Mellitus, Type 1 ; Diabetes Mellitus, Type 2 ; Diabetic Nephropathies ; Diabetic Retinopathy ; Diagnosis ; Electronic Health Records ; Female ; Hemoglobin A, Glycosylated ; Humans ; Incidence ; Light Coagulation ; Male ; Prognosis ; Retinal Diseases ; Retrospective Studies ; Risk Factors ; Seoul ; Visual Acuity ; Vitreous Hemorrhage