Evaluation of continuous glucose monitoring‐derived person‐specific HbA1c in the presence and absence of complications in type 1 diabetes

Abstract

Aim: To evaluate the accuracy of a novel kinetic model at predicting HbA1c in a realworld setting and to understand and explore the role of diabetes complications in altering the glucose-HbA1c relationship and the mechanisms involved.Materials and Methods: Deidentified HbA1c and continuous glucose monitoring values were collected from 93 individuals with type 1 diabetes. Person-specific kinetic variables were used, including red blood cell (RBC) glucose uptake and lifespan, to characterize the relationship between glucose levels and HbA1c. The resulting calculated HbA1c (cHbA1c) was compared with glucose management indicator (GMI) for prospective agreement with laboratory HbA1c. Results:The cohort (42 men and 51 women) had a median age (IQR) of 61 (43, 72) years and a diabetes duration of 21 (10, 33) years. A total of 24 459 days of continuous glucose monitoring (CGM) data were available and 357 laboratory HbA1c were used to assess the average glucose-HbA1c relationship. cHbA1c had a superior correlation with laboratory HbA1c compared with GMI with a mean absolute deviation of 1.7 and 6.7 mmol/ mol, r 2 = 0.85 and 0.44, respectively. The fraction within 10% of absolute relative deviation from laboratory HbA1c was 93% for cHbA1c and 63% for GMI. Macrovascular disease had no effect on the model's accuracy, whereas microvascular complications resulted in a trend towards higher HbA1c, secondary to increased RBC glucose uptake.Conclusions: cHbA1c, which takes into account RBC glucose uptake and lifespan, accurately reflects laboratory HbA1c in a real-world setting and can aid in the management of individuals with diabetes.

Risk factors for penile prosthesis infection: An umbrella review and meta-analysis

“…No statistically significant difference in implantation outcomes between the groups with and without diabetes has been found. We believe this is due to significant improvement in diabetes management and increased patient awareness of the dangers of diabetes mellitus and the importance of prevention and self-management strategies [ 4 ]. On the other hand, individuals with diabetes who fail to adequately control their condition remain at risk of infection.…”

“…Moreover, normal HbA1c ranges depend on various factors, e.g. race, gender and age [ 4 ]. This could be explained by the fact that different publications describe different thresholds for HbA1c levels.…”

“…The resulting groups with and without infection after implantation numbered 163 and 2,380 patients respectively. Given that some sources reported fasting blood glucose measurements, we used the model proposed by Xu Y et al [ 4 ] to convert fasting glucose levels to HbA1c levels, thereby increasing the amount of data for meta-analysis. The difference in mean HbA1c levels was 1.20 (95% CI 0.09–2.31) I [ 2 ] = 84%, (p-values = 0.005).…”

“…Patients with long-term DM are at an increased risk of erectile dysfunction, and penile implant surgery for such patients is associated with higher infection rates [ 3 ] because of leucocytes dysfunction and microangiopathy [ 1 ]. On the other hand, prevention strategies and monitoring of patients with DM are constantly improving [ 4 ], so we hope that the risks of DM-associated infection will decline. Because of the importance of diabetes as a risk factor for both erectile dysfunction and prosthetic infection, we focused on the impact of diabetes and associated glycated hemoglobin (HbA1c) levels on infection risk after implantation.…”