A View Beyond HbA1c: Role of Continuous Glucose Monitoring

Chehregosha, Haleh; Khamseh, Mohammad E.; Malek, Mojtaba; Hosseinpanah, Farhad; Ismail‐Beigi, Faramarz

doi:10.1007/s13300-019-0619-1

Cited by 169 publications

(133 citation statements)

References 57 publications

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“…More recently, an exploratory analysis of DRCR.net Protocol T, in which participants were randomized to receive bevacizumab, ranibizumab, or aflibercept, similarly found the magnitude of vision improvement after anti-VEGF treatment to be associated with HbA1c levels [20]. One possible explanation for the discrepancy between studies is that patients with similar HbA1c levels can have marked differences in their daily glucose profiles, with variable frequency and duration of glucose excursions [22,23]. Transient hyperglycemic spikes can be a HbA1cindependent risk factor for diabetes-related complications, due to transient episodes of oxidative stress [24].…”

Section: Association Of Systemic Factors With Visual Outcome Aftermentioning

confidence: 99%

Systemic Factors Associated with Treatment Response in Diabetic Macular Edema

Wong

Chee

Bhargava

et al. 2020

Journal of Ophthalmology

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Purpose. To identify systemic factors that may influence the response to anti-VEGF therapy in patients with diabetic macular edema (DME). Methods. 35 patients undergoing anti-VEGF injections for centre-involving DME were studied in this prospective observational study. The primary outcome was change in macular thickness one month after treatment, measured using spectral-domain optical coherence tomography (OCT). At baseline, information on various systemic factors was collected including glycosylated hemoglobin (HbA1c), serum VEGF levels, lipid profile and markers of renal function, and blood pressure. Thirty-three of the 35 patients were included in this study. Nonparametric statistical tests were used for the analysis of the data in view of the nonnormal distribution of the outcome variables. Multivariate analysis was performed using logistic regression. Stata 12.1 software was used for the analysis. Main Outcome Measures. Reduction in macular central subfield thickness (on spectral-domain OCT) and change in logMAR visual acuity at one month after injection. Results. Lower HbA1c levels (7% or less) were significantly associated with greater reduction in central macular subfield thickness at one month after injection of bevacizumab or ranibizumab on both univariate analysis (p=0.012) and multivariate analysis (p=0.042). Conclusions. Better glycemic control is associated with a greater reduction in central macular thickness after the first injection of bevacizumab or ranibizumab in diabetic macular edema. Patients with high levels of HbA1c and poor response to anti-VEGF may benefit from strict control of their blood glucose.

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Section: Association Of Systemic Factors With Visual Outcome Aftermentioning

confidence: 99%

Systemic Factors Associated with Treatment Response in Diabetic Macular Edema

Wong

Chee

Bhargava

et al. 2020

Journal of Ophthalmology

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“…However, a persistent glucose-lowering effect over the day is important to ensure sustained improvement of glycaemic control during diabetes therapy. [13][14][15][16] Furthermore, it is also not known whether the difference in pharmacokinetics and enzyme-binding characteristics of the different DPP-4 inhibitors 3 is translated to different effects on glycaemia and islet and incretin hormones over the day. To explore these two questions, we examined the effects of DPP-4 inhibition on glucose and islet and incretin hormones after each meal over a whole day in metformin-treated subjects with T2D, and in this study, we examined three different DPP-4 inhibitors.…”

Section: Introductionmentioning

confidence: 99%

Persistent whole day meal effects of three dipeptidyl peptidase‐4 inhibitors on glycaemia and hormonal responses in metformin‐treated type 2 diabetes

Alsalim

Göransson

Tura

et al. 2019

Diabetes Obesity Metabolism

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Aim Dipeptidyl peptidase‐4 (DPP‐4) inhibition has effects on both fasting and postprandial glucose. However, the extent of this effect over the whole day and whether different DPP‐4 inhibitors have the same effects have not been established. We therefore explored the whole day effects of three different DPP‐4 inhibitors versus placebo on glucose, islet and incretin hormones after ingestion of breakfast, lunch and dinner in subjects with metformin‐treated and well‐controlled type 2 diabetes. Methods The study was single‐centre and crossover designed, involving 24 subjects [12 men, 12 women, mean age 63 years, body mass index 31.0 kg/m2, glycated haemoglobin 44.7 mmol/mol (6.2%)], who underwent four test days in random order. Each whole day test included ingestion of standardized breakfast (525 kcal), lunch (780 kcal) and dinner (560 kcal) after intake of sitagliptin (100 mg) or vildagliptin (50 mg twice), or saxagliptin (5 mg) or placebo. Results Compared with placebo, DPP‐4 inhibition reduced glucose levels, increased beta‐cell function (insulin secretory rate in relation to glucose), suppressed glucagon, increased intact glucagon‐like‐peptide‐1 (GLP‐1) and glucose‐dependent insulinotropic polypeptide (GIP) but suppressed total GLP‐1 and GIP after all three meals. The effects were sustained throughout the daytime period with similar changes after each meal and did not differ between the DPP‐4 inhibitors. Conclusions DPP‐4 inhibition has persistent daytime effects on glucose, islet and incretin hormones with no difference between three different DPP‐4 inhibitors.

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“…The relationship between glycemic control and hypertension can be explained by several possible mechanisms. First, function deficits of pancreatic beta cells, as well as insulin resistance could be indicated by the expression, of HbA1c [9,10]. It was well-recognized that insulin resistance was the common pathophysiological basis for the development of both type 2 diabetes and hypertension [28].…”

Section: Discussionmentioning

confidence: 99%

“…Insulin resistance, hyperinsulinemia, and the excitatory effects of hyperglycemia itself may be the underlying mechanisms of hypertension [8]. HbA1c, as a stable indicator of long-term glycemia, can precisely reflect the stability of glycemic control within nearly 8-12 weeks and was also correlated with defects of pancreatic β-cell function, as well as the degree of insulin resistance [9,10]. Other evidence has increasingly demonstrated that not only patients with a higher risk of developing diabetes but also those with cardiovascular diseases could be identified by HbA1c level [11,12].…”

Section: Introductionmentioning

confidence: 99%

Elevated glycosylated hemoglobin levels and their interactive effects on hypertension risk in nondiabetic Chinese population: a cross-sectional survey

Song

wei

Zhao

et al. 2020

Preprint

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Background: Abnormal glucose metabolism has been suggested to be involved in the development of hypertension. This study investigated the effect of the association and potential interaction of glycosylated hemoglobin (HbA1c) and other factors on the risk of hypertension among Chinese nondiabetic adults. Methods : As a cross-sectional survey, the current work deployed a questionnaire survey, anthropometric tests, and biochemical measures for each of the eligible participants. The HbA1c levels were quantified and grouped by quartiles. Correlations between HbA1c and hypertension, isolated systolic hypertension (ISH), and isolated diastolic hypertension (IDH) risk in nondiabetics were investigated by univariate and multivariate logistic analyses. For evaluating the interactive effects, the parameters of relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index (SI) were calculated, respectively. Results : In the current study, 1,462 nondiabetic subjects were enrolled. In total, the prevalence rates of hypertension, ISH and IDH were 22.4%, 9.6% and 4.5%, respectively. When HbA1c levels were grouped by quartile, it was revealed that the prevalence rates of hypertension and ISH were substantially elevated across groups (Pfor trend<0.001). In the multivariable logistic regression analyses, in comparison with the first quartile of HbA1c, the normalized OR for hypertension risk was 1.90 (95% CI: 1.28-2.80) for the highest quartile. Also, the risk of ISH was significantly increased with HbA1c level in the highest quartile relative to in the bottom quartile (OR: 2.23,95% CI:1.47-3.71). However, no significant relationship between the HbA1c level and IDH risk was observed (OR: 1.78, 95% CI: 0.82-3.84). Eventually, it was demonstrated from the interactive effect analysis that HbA1c significantly interacted with abdominal obesity(RERI: 1.48, 95% CI: 0.38-2.58; AP: 0.37, 95% CI: 0.14-0.60 and SI: 1.96, 95% CI: 1.06-3.62) and family history of hypertension(AP: 0.37, 95% CI: 0.05-0.70) in influencing the risk of hypertension in nondiabetic participants.Conclusion: Higher HbA1c levels were associated with an increased risk of hypertension and ISH, but not IDH among Chinese nondiabetic adults. Moreover, the risk of hypertension was also aggravated by the upregulated HbA1c in a synergistic manner alongside abdominal obesity and family history of hypertension.

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A View Beyond HbA1c: Role of Continuous Glucose Monitoring

Cited by 169 publications

References 57 publications

Systemic Factors Associated with Treatment Response in Diabetic Macular Edema

Systemic Factors Associated with Treatment Response in Diabetic Macular Edema

Persistent whole day meal effects of three dipeptidyl peptidase‐4 inhibitors on glycaemia and hormonal responses in metformin‐treated type 2 diabetes

Elevated glycosylated hemoglobin levels and their interactive effects on hypertension risk in nondiabetic Chinese population: a cross-sectional survey

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