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: The aortic knob width (AKW) and the heart rate variability (HRV) were suggested to be related to development of cardiovascular diseases. However, the relationship between them has not been investigated; thus, this study aimed to determine this relationship. METHODS: This study included 587 Koreans aged 18–79 years. Their physical measurements, medical and social histories, blood test findings, and chest radiographs were obtained. The HRV parameters included the standard deviation of the N-N interval (SDNN), root mean square of successive differences (RMSSD), approximate entropy (ApEn), total power (TP), very low frequency (VLF), low frequency (LF), high frequency (HF), and LF/HF ratio, which were measured for 5 minutes. The AKW was measured on chest radiographs by a single reviewer. RESULTS: The AKW was significantly correlated with the HRV parameters, except for the LF/HF ratio. However, RMSSD and ApEn were not significantly related to the AKW in women. After dividing the participants into quartile groups, the AKW was significantly related to the SDNN, RMSSD, TP, VLF, LF, and HF. The HRV parameter values decreased in the higher AKW quartile groups, the HRV parameter values decreased. After adjusting for sex, drinking status, exercise habits, smoking status, waist circumference, and triglyceride, low-density lipoprotein cholesterol, fasting blood sugar, and glycated hemoglobin levels, the AKW showed significant negative associations with the HRV parameters, except for the LF/HF ratio. CONCLUSION: The AKW is significantly associated with the HRV parameters of SDNN, RMSSD, ApEn, TP, VLF, LF, and HF.
Aorta, Thoracic ; Blood Glucose ; Cardiovascular Diseases ; Cholesterol ; Drinking ; Entropy ; Fasting ; Female ; Heart Rate* ; Heart* ; Hematologic Tests ; Hemoglobin A, Glycosylated ; Humans ; Lipoproteins ; Radiography, Thoracic ; Smoke ; Smoking ; Triglycerides ; Waist Circumference

BACKGROUND AND OBJECTIVES: This study was performed to investigate whether stem cell therapy enhances β cell function by meta-analysis with proper consideration of variability of outcome measurements in controlled trial of type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) patients. METHODS: A systematic search was performed from inception to January 2018 in PubMed, EMBASE, and Cochrane databases. β cell function was assessed by stimulated C-peptide, fasting C-peptide, normal glycosylated hemoglobin levels (HbA1C), and exogenous insulin dose patterns. The quality of the studies were assessed by both the Cochrane Collaboration's Risk of Bias (ROB) for Randomized controlled trials and the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) for non-randomized controlled trials. RESULTS: From the selected final 15 articles, total of 16 trials were analyzed. There were 6 T1DM trials (total 153 cases) and 10 T2DM trials (total 457 cases). In T2DM patients, the changes in stimulated C-peptide, HbA1c, and exogenous insulin dose versus baseline showed a favorable pattern with a significant heterogeneity in stem cell therapy. In T1DM, there was no significant difference between control group and stem cell therapy group in three indicators except for HbA1c. Most of the studies were rated as having high risk of bias in the quality assessment. CONCLUSIONS: The stem cell therapy for DM patients is not effective in T1DM but seems to be effective in improving the β cell function in T2DM. However the observed effect should be interpreted with caution due to the significant heterogeneity and high risk of bias within the studies. Further verification through a rigorously designed study is warranted.
Bias (Epidemiology) ; C-Peptide ; Diabetes Mellitus ; Diabetes Mellitus, Type 1 ; Diabetes Mellitus, Type 2 ; Fasting ; Hemoglobin A, Glycosylated ; Humans ; Insulin ; Population Characteristics ; Stem Cells

The role of surgical intervention in patients with diabetic gastroparesis is unclear. We report a case of a 37-year-old man with a history of recurrent episodes of vomiting and long-standing type 2 diabetes mellitus. Esophagogastroduodenoscopy did not reveal any findings of reflux esophagitis or obstructive lesions. A gastric emptying time scan showed prolonged gastric emptying half-time (344 minutes) indicating delayed gastric emptying. Laboratory tests revealed elevated fasting serum glucose and glycosylated hemoglobin (HbA1c, 12.9%) and normal fasting C-peptide and insulin levels. We performed Roux-en-Y reconstruction after subtotal gastrectomy to treat gastroparesis and improve glycemic control, and the patient showed complete resolution of gastrointestinal symptoms postoperatively. Barium swallow test and gastric emptying time scan performed at follow-up revealed regular progression of barium and normal gastric emptying. Three months postoperatively, his fasting serum glucose level was within normal limits without the administration of insulin or oral antidiabetic drugs with a reduced HbA1c level (6.9%). Long-limb Roux-en-Y reconstruction after subtotal gastrectomy may be useful to treat severe diabetic gastroparesis by improving gastric emptying and glycemic control.
Adult ; Barium ; Blood Glucose ; C-Peptide ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Endoscopy, Digestive System ; Esophagitis, Peptic ; Fasting ; Follow-Up Studies ; Gastrectomy ; Gastric Emptying ; Gastroparesis ; Hemoglobin A, Glycosylated ; Humans ; Hypoglycemic Agents ; Insulin ; Vomiting

BACKGROUND: Continuous metabolic syndrome (MS) severity scores that can track metabolic risk in individuals over time have been developed for Western populations. The present study aimed to develop gender- and age-specific equations for MS severity scores in Korean adults. METHODS: Using data from the Korea National Health and Nutrition Examination Surveys (KNHANES) IV (2010–2012) and VI (2013–2015), we performed a confirmatory factor analysis of single MS factor that allowed for differential loadings across groups to generate gender- and age-specific, continuous MS severity scores. Then, we validated this equation in a different dataset of Korean adults. RESULTS: In confirmatory analysis, waist circumference had the highest factor loading, indicating that waist circumference had the strongest correlation with MS among Korean adults. Lower factor loadings (< 0.4) among Korean adults aged 40–59 years were noted for systolic blood pressure and fasting glucose. MS severity score values were significantly correlated with metabolic parameters, including high-sensitivity C-reactive-protein, glycated hemoglobin, and homeostasis model assessment of insulin resistance. Furthermore, MS severity scores well predicted traditional MS according to receiver operating characteristic analysis in a validation dataset (KNHANES VII). In a longitudinal cohort dataset, participants diagnosed with Adult Treatment Program III (ATP-III) MS after an initial assessment had progressively higher baseline MS severity scores in relationship to their time until ATP-III MS diagnosis. CONCLUSION: The new MS severity score equations for Korean adults proposed in this study provide a clinically-accessible continuous measure of MS for potential use in identifying adults at higher risk for MS-related diseases and following changes within individuals over time.
Adult ; Blood Pressure ; Cohort Studies ; Dataset ; Diagnosis ; Epidemiology ; Fasting ; Glucose ; Hemoglobin A, Glycosylated ; Homeostasis ; Humans ; Insulin Resistance ; Korea ; Nutrition Surveys ; Obesity ; ROC Curve ; Waist Circumference

OBJECTIVE: Fatty liver is associated with insulin resistance-related diseases, such as dyslipidemia, obesity, and type 2 diabetes. The aim of this study was to evaluate the association of dyslipidemia with fatty liver and assess the differences in these associations according to the degree of hepatic steatosis. METHODS: A total of 2,462 subjects (1,679 men and 783 women) who underwent a comprehensive health check-up (including abdominal computed tomography) from January 2010 to December 2013 were enrolled at Samsung Changwon Hospital Healthcare Center. The liver attenuation index (LAI), defined as the difference between mean hepatic and splenic attenuation, was used to assess the degree of hepatic steatosis. An LAI below 5 Hounsfield units was defined as fatty liver. RESULTS: We found that 32.2% of the study subjects had fatty liver. Serum low-density lipoprotein cholesterol (LDL-C) and triglyceride (TG), and fasting blood glucose concentrations and glycated hemoglobin (HbA1c percentage) were significant greater in the fatty liver group compared with the non-fatty liver group, while serum high-density lipoprotein cholesterol (HDL-C) was significantly lower in the fatty liver group. Subjects with fatty liver had 1.7-fold greater risk of dyslipidemia than those without fatty liver after adjusting for age, sex, body mass index (BMI), and HbA1c. When individuals with fatty liver were analyzed by tertiles of LAI values, LDL-C, TG, fasting glucose, BMI, and HbA1c concentrations increased while HDL-C decreased with decreasing LAI tertiles. Compared with LAI tertile 3, the risk for dyslipidemia significantly increased with adjusted odds ratios of 1.42, and 1.81 in tertiles 2 and 1, respectively. CONCLUSION: Fatty liver was significantly associated with dyslipidemia and this association varied according to the degree of hepatic steatosis.
Blood Glucose ; Body Mass Index ; Cholesterol ; Delivery of Health Care ; Dyslipidemias ; Fasting ; Fatty Liver ; Glucose ; Gyeongsangnam-do ; Hemoglobin A, Glycosylated ; Humans ; Insulin ; Korea ; Lipoproteins ; Liver ; Male ; Obesity ; Odds Ratio ; Tomography, Spiral Computed ; Triglycerides

PURPOSE: To evaluate the morphological changes of meibomian glands and dry eye syndrome in patients with type II diabetes. METHODS: The medical records of 72 diabetic patients referred to the ophthalmology clinic for the evaluation of diabetic retinopathy, who had dry eye symptoms, were retrospectively reviewed. RESULTS: A total of 72 patients, with an age of 56.3 ± 13.3 years, were analyzed. The group with diabetic retinopathy (52 patients) had a significantly lower tear film break-up time (p = 0.046), lower Schirmer's test value (p = 0.005), and higher percentage of upper (p = 0.036) and lower (p = 0.017) meibomian gland area losses than the group without diabetic retinopathy (20 patients). According to multilinear regression analyses considering sex, age, and diabetes-related characteristics, the Schirmer's test value was significantly lower with increasing stage of diabetic retinopathy (β = −1.180, p = 0.016). The percentage of upper meibomian gland area loss was significantly increased with increasing age (β = 0.605, p < 0.001), glycosylated hemoglobin (β = 1.881, p = 0.011), and stage of diabetic retinopathy (β = 4.458, p = 0.001). The percentage of lower meibomian gland loss area was significantly increased with increasing age (β = 0.443, p = 0.001) and stage of diabetic retinopathy (β = 4.879, p = 0.001). CONCLUSIONS: In patients with type 2 diabetes, the more severe the diabetic retinopathy, the more likely the meibomian gland loss will occur, so careful and appropriate treatment should be conducted.
Diabetic Retinopathy ; Dry Eye Syndromes ; Hemoglobin A, Glycosylated ; Humans ; Medical Records ; Meibomian Glands ; Ophthalmology ; Retrospective Studies ; Tears

BACKGROUND: We assessed the frequency and severity of hypoglycemia in type 2 diabetes mellitus patients treated with sulfonylurea monotherapy or sulfonylurea+metformin. METHODS: We conducted a retrospective, observational, cross-sectional study in 2011 and 2012 including patients with type 2 diabetes mellitus aged ≥30 years who were treated with ≥6 months of sulfonylurea monotherapy or sulfonylurea+metformin at 20 university-affiliated hospitals in Korea. At enrollment, glycated hemoglobin (HbA1c) was assessed; participants completed self-reported questionnaires describing hypoglycemia incidents over the past 6 months. A review of medical records up to 12 months before enrollment provided data on demographics, disease history, comorbidities, laboratory results, and drug usage. RESULTS: Of 726 enrolled patients, 719 were included (55.6% male); 31.7% and 68.3% were on sulfonylurea monotherapy and sulfonylurea+metformin, respectively. Mean±standard deviation age was 65.9±10.0 years; mean HbA1c level was 7.0%±1.0%; 77.8% of patients had hypertension (89.4% used antihypertensive medication); 60.5% had lipid disorders (72.5% used lipid-lowering medication); and 52.0% had one or more micro- or macrovascular diseases. Among patients with A1c measurement (n=717), 56.4% achieved therapeutic goals (HbA1c <7.0%); 42.4% (305/719) experienced hypoglycemia within 6 months of enrollment; and 38.8%, 12.9%, 12.7%, and 3.9% of patients experienced mild, moderate, severe, and very severe hypoglycemia symptoms, respectively. Several reported hypoglycemia frequency as 1–2 times over the last 6 months. The mean number of very severe hypoglycemia episodes was 3.5±5.5. CONCLUSION: Among type 2 diabetes mellitus patients treated with sulfonylurea-based regimens, glycemic levels were relatively well controlled but hypoglycemia remained a prevalent side effect.
Comorbidity ; Cross-Sectional Studies ; Demography ; Diabetes Mellitus, Type 2 ; Hemoglobin A, Glycosylated ; Humans ; Hypertension ; Hypoglycemia ; Korea ; Medical Records ; Metformin ; Retrospective Studies