Outcomes Associated With Insulin Therapy Disruption After Hospital Discharge Among Patients with Type 2 Diabetes Mellitus who Had Used Insulin Before and During Hospitalization

ObjectiveTo evaluate outcomes associated with insulin therapy disruption after hospital discharge in patients with type 2 diabetes mellitus who had used insulin before and during hospitalization.MethodsIn this observational, retrospective analysis of medical records obtained from a coordinated health system in the United States, patients with type 2 diabetes mellitus who had used insulin 30 days before and during hospitalization were included. Clinical and cost outcomes were compared between patients who continued insulin therapy and those who had disrupted insulin therapy after hospital discharge.ResultsIn total, 2160 records were analyzed (851 patients with continued insulin therapy and 1309 patients with disrupted insulin therapy). Mean baseline glycated hemoglobin A_1c levels were 8.56% and 7.73% in patients who continued insulin therapy and patients who disrupted insulin therapy, respectively (P <.001), suggesting that patients who discontinued insulin therapy had better glycemic control at baseline. Continued insulin therapy was associated with an expected greater reduction in glycated hemoglobin A_1c (P <.001); similar hypoglycemia rates; lower risks of all-cause hospital readmission, diabetesrelated readmission, and all-cause emergency department visits; and improved survival. Continued insulin therapy was associated with $3432 lower total medical service costs than disrupted therapy over the 6-month postdischarge period.ConclusionEnsuring adherence to insulin therapy in patients who require insulin therapy after hospitalization should be a priority for postdischarge patient care programs. However, the clinical implications of this study are limited by the fact that it could not be determined whether all patients required insulin therapy after hospital discharge. (Endocr Pract. 2012;18:651-659)     

血清γ-谷氨酰转肽酶水平与老年2型糖尿病患者并发急性冠脉综合征的相关性分析

目的:探讨血清γ-谷氨酰转肽酶(GGT)水平与老年2型糖尿病患者并发急性冠脉综合征的相关性。方法:选取2015年10月至2016年10月哈尔滨市第一医院收治的老年患者238例,根据病情分为单纯2型糖尿病组81例(DM组),单纯急性冠脉综合征组78例(ACS组),2型糖尿病患者合并急性冠脉综合征79例(DA组);选取同期来我院体检健康者83例作为对照组(NC组)。比较各组一般情况和血清学指标。结果:(1)DA组BMI大于NC组、DM组和ACS组,血清GGT、糖化血红蛋白(HbA1C)、低密度脂蛋白胆固醇(LDL-C)水平显著高于NC组、DM组和ACS组,血清总胆固醇(TC)、甘油三酯(TG)水平均高于NC组,高密度脂蛋白胆固醇(HDL-C)水平低于NC组(P0.05)。(2)血清GGT水平与TG、LDC-C水平呈正相关(p0.05)。结论:血清GGT水平升高是老年2型糖尿病患者并发急性冠脉综合征的独立危险因素,及时监测老年2型糖尿病患者GGT水平对预测急性冠脉综合征的发生具有重要意义。     

HbA1c和FPG水平与2型糖尿病患者视网膜病变的相关性分析

目的：探讨糖化血红蛋（HbA1c）、空腹血糖（FPG）与2型糖尿病患者视网膜病变（DR）的相关性。方法：对我院2010年1月-2012年12月住院或门诊的336例2型糖尿病（T2DM）患者进行眼底检查或眼底血管荧光素造影检测,按有无视网膜病变分为视网膜病变（DR）组和无视网膜病变（NDR）组,并对HbA1c、FBG水平进行检测。结果：DR组较NDR组HbA1c水平高,差异有统计学意义（P〈0．05）,HbA1c水平和DR分期呈正相关（I=0．526,P〈0．001）,而DR组和NDR组FPG水平差异无无统计学意义（P〉0．05）。结论：可将HbA1c作为2型糖尿病患者视网膜病变发生和发展的监测指标之一。     

妊娠糖尿病患者血清HbA1c与CRP水平的相关性分析

目的:为明确妊娠期糖尿病(gestational diabetes mellitus,GDM)患者血清糖化血红蛋白(glycosylated hemoglobin,Hb A1c)与C反应蛋白(C-reactive protein,CRP)的关系,本研究检测了GDM患者血糖、血清Hb A1c与CRP水平,并对Hb A1c与CRP的相关性进行了分析。方法:以68例2015年4月至2017年4月于我院诊治的GDM孕妇为研究对象,所有患者均符合《妇产科学》中关于GDM的诊断标准,另选取68例正常孕妇为对照组。采用葡萄糖氧化酶法检测血糖水平(空腹血糖及餐后2 h血糖水平),采用免疫凝集法检测和比较两组血清糖化血红蛋白(HbA1c)水平,采用免疫透射比浊法检测血清C反应蛋白(CRP)水平,并分析HbA1c与CRP的相关性。结果:GDM组患者空腹血糖(fasting plasma glucose,FPG)、2 h血糖(plasma glucose,PG)、血清HbA1c和CRP水平均显著高于正常组(P0.05),GDM患者血清Hb A1c和CRP水平呈显著正相关关系(r=0.654,P0.05)。结论:GDM患者血清HbAlC和CRP水平相较于正常孕妇有显著提高,且二者呈显著的正相关关系,二者联合检测可能作为GDM早期诊断的筛查的重要参考指标。     

Effect of sitagliptin on blood glucose control in patients with type 2 diabetes mellitus who are treatment naive or poorly responsive to existing antidiabetic drugs: the JAMP study

Background

To investigate the ameliorating effect of sitagliptin, a dipeptidyl peptidase-4 inhibitor, on blood glucose control in patients with type 2 diabetes mellitus who were previously untreated with or who have a poor responsive to existing antidiabetic drugs.

Methods

Sitagliptin (50 mg/day) was added on to the pre-existing therapy for type 2 diabetes and changes in the glycated hemoglobin (HbA1c) level after 3 months of treatment were compared with the baseline and performed exploratory analysis.

Results

HbA1c levels were significantly decreased after 1 month of treatment compared to baseline, with a mean change in HbA1c level from baseline of ?0.73% (range, ?0.80 to ?0.67) in the entire study population at 3 months. Patients who received a medium dose of glimepiride showed the least improvement in HbA1c levels. The percentage of patients who achieved an HbA1c level of <7.0% significantly increased after 1 month of treatment, reaching 53.1% at 3 months. The percentage of patients who achieved a fasting blood glucose level of <130 mg/dL significantly increased after 1 month of treatment, reaching 50.9% at 3 months.

Conclusions

Sitagliptin improved the HbA1c level and rate of achieving the target control levels in patients with type 2 diabetes mellitus who were previously untreated with, or poorly responsive to, existing antidiabetic drugs. Thus, sitagliptin is expected to be useful in this patient group. However, the additional administration of sitagliptin in patients treated with medium-dose glimepiride only slightly improved blood glucose control when corrected for baseline HbA1c level.

     

血清HCY、MMP-9、NT-proBNP水平与老年2型糖尿病大血管病变的相关性研究

目的:探讨血清同型半胱氨酸(HCY)、金属蛋白酶9(MMP-9)、N-端B型钠利尿肽(NT-pro BNP)变化与老年2型糖尿病大血管病变的关系。方法:选取我院2014年5月至2016年5月收治的老年2型糖尿病患者50例,依据大血管病变发生情况将其分为合并大血管病变组(A组,n=25)和未合并大血管病变组(B组,n=25),另选取同期来我院进行体检的健康人员50例作为对照组,比较三组的一般临床资料、血清HCY、MMP-9、NT-pro BNP水平。结果:A组患者的收缩压、舒张压、空腹血糖(FBG)、餐后2h血糖(2h BG)水平均显著高于B组(P0.05),高密度脂蛋白胆固醇(HDL-C)水平显著低于B组(P0.05),但三组患者的性别、年龄、体质量指数(BMI)、糖化血红蛋白(Hb A1c)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)水平比较差异均无统计学意义(P0.05)。A组、B组患者的BMI、收缩压、舒张压、FBG、2h BG、Hb A1c、TG、TG、LDL-C水平均显著高于对照组(P0.05),LDL-C水平均显著低于对照组(P0.05),但三组人员的性别、年龄比较差异均无统计学意义(P0.05)。A组患者的血清HCY、MMP-9、NT-pro BNP水平均显著高于B组(P0.05);A组、B组患者的HCY、MMP-9、NT-pro BNP水平均显著高于对照组(P0.05)。结论:血清HCY、MMP-9、NT-pro BNP水平与老年2型糖尿病的大血管病变显著相关。     

贝那鲁肽与利拉鲁肽对2型糖尿病患者长期结局影响的对比研究

摘要 目的：对比分析贝那鲁肽与利拉鲁肽对2型糖尿病患者长期结局的影响，为二甲双胍和磺脲类药物治疗后血糖不能达标的患者应用胰高糖素样肽-1（GLP-1） 受体激动剂提供临床依据。方法：选取2018年3月～2019年3月在我院就诊的使用二甲双胍或者二甲双胍联合磺脲类药物血糖未达标的2型糖尿病患者150例作为研究对象，随机分为观察组和对照组，每组各75例。观察组使用贝那鲁肽注射液治疗，对照组使用利拉鲁肽注射液治疗，所有患者均连续治疗24周。比较两组患者治疗前后空腹血糖（FPG）、餐后2 h血糖（2hPG）、糖化血红蛋白（HbA1c）、收缩期血管峰值血流( PSV)、血管内膜中层厚度(IMT) 、肌酐（Scr）和尿素氮（BUN）水平，两年内的不良事件发生率、心血管相关死亡率和全因死亡率。结果：两组患者之间治疗前、后FPG、2hPG、HbA1c、PSV、IMT、Scr和BUN水平无统计学差异（P>0.05）, 观察组的不良事件总发生率（8.00%）较对照组（20.00%）明显降低（P<0.05），两组患者心血管相关死亡率和全因死亡率相比，差异无统计学意义（P>0.05）。结论：在使用二甲双胍或者二甲双胍联合磺脲类药物血糖未达标的2型糖尿病患者中，与利拉鲁肽相比，贝那鲁肽在降低血糖、改善下肢血管功能、肾功能和死亡率方面无明显差异，但不良事件发生率更低。     

Frequent Monitoring of Blood Glucose Levels via a Remote Patient Monitoring System Helps Improve Glycemic Control

ObjectiveThis study aimed to evaluate the effectiveness of the Vivovitals diabetes platform in improving glycemic control and reducing hemoglobin A1c (HbA1c) levels in patients with uncontrolled type 2 diabetes mellitus by providing more accessible and direct patient care under the monitoring and oversight of their physician.MethodsThis 12-week, prospective, pragmatic, single-center, double-arm study assessed the impact of the Vivovitals diabetes platform on glycemic control in 78 adults aged ≥18 years with HbA1c levels of ≥7.5% (58 mmol/mol) at baseline. The participants were randomized into 2 groups. The control group received usual clinical care, whereas the intervention group was provided with a smartphone-linked telehealth application, a preconfigured glucometer, and access to a glycemic reading diary. The blood glucose levels of the intervention group were transmitted to the providers daily. Patients whose blood glucose level was <70 mg/dL or >180mg/dL were contacted, and modifications were made to their diet and medication. The 2 groups were compared at the baseline and at 12 weeks using nonparametric tests, with P <.05 considered statistically significant.ResultsOver 12 weeks, the average HbA1c level in the control group reduced by 0.474% (P = .533; 95% CI, −0.425 to −0.523), whereas the average HbA1c level in the intervention group reduced by 1.70% (P = .002; 95% CI, −1.02 to −2.39). The estimated treatment difference was expressed using Cohen d, which yielded 0.62. After 12 weeks, the HbA1c values between the control and intervention groups were statistically significant (P = .001).ConclusionThe use of the Vivovitals platform may help to improve glycemic control among individuals with type 2 diabetes mellitus.     

Disparities in Utilization and Outcomes With Continuous Subcutaneous Insulin Infusion in Young Adults With Type 1 Diabetes

ObjectiveTo evaluate which factors determine utilization patterns and outcomes of continuous subcutaneous insulin infusion (CSII) in young adults with type 1 diabetes.MethodsUtilizing the Optum deidentified electronic health record data set between 2008 to 2018 to perform a retrospective cohort study, we identified 2104 subjects with type 1 diabetes aged 18 to 30 years. We evaluated the effect of race on determining CSII utilization, HbA1c (%), and hospital admission for diabetic ketoacidosis (DKA). Crude and adjusted estimates were computed using logistic regression and linear mixed models.ResultsThere was low CSII utilization among individuals who were Black, Hispanic, male, and those with governmental insurance. These groups also demonstrated higher HbA1c levels. Subjects who were Black, Hispanic, and those with governmental insurance had higher odds of DKA. Even when commercially insured, Black and Hispanic subjects demonstrated higher HbA1c levels, and Black individuals had higher odds of DKA.ConclusionIn a large electronic health record database in the U.S., there was low CSII utilization overall, particularly in Black and Hispanic minorities, despite CSII showing superior HbA1c control without an increase in DKA events.     

An Individualized Inpatient Diabetes Education and Hospital Transition Program for Poorly Controlled Hospitalized Patients with Diabetes

ObjectiveTo evaluate predictors of outcomes associated with an inpatient diabetes education and discharge support program for hospitalized patients with poorly controlled diabetes (glycated hemoglobin [HbA1c]>9%).MethodsPatients participated in individualized diabetes education conducted by a certified diabetes educator (CDE) that included an exploration of barriers and goal setting during hospitalization with telephone follow-up and communication with primary providers at discharge. Predictors of HbA1c reduction, successful follow-up, and readmission were analyzed.ResultsThere were 82 subjects, and 48% were insulin naïve. Patients with type 2 diabetes (T2D, n = 58) had a significant decrease in HbAlc at follow-up (-2.8%, P < .0001), while those with type 1 diabetes (T1D, n = 19) did not (+ 0.02%, P = .96). However, after adjustment for other factors, only increasing age, higher baseline HbA1c, earlier education, and initiation of basal insulin were significant predictors of reduction in HbA1c. Higher area level income and empowerment and earlier education were significant predictors of outpatient follow-up within 30 days. While 28% were admitted for severe hyperglycemia, only 1 patient was readmitted with severe hyperglycemia. Successful phone contact was 77% and 57% with and without the support of non-CDE assistants respectively, but all outcomes were similar.ConclusionThe study suggests that an individualized inpatient diabetes education and transition program is associated with a significant reduction in HbA1c that is dependent on baseline HbA1c, older age, initiation of insulin, and earlier enrollment. Additional interventions are needed to ensure better continuity of care. (Endocr Pract. 2014;20:1265-1273)     

Routine enzymes in the monitoring of type 2 diabetes mellitus

We examined the relationships of glucose and HbA1c levels with the routinely screened serum enzyme activities in type 2 diabetes mellitus, and we designed an in vitro study to evaluate the direct effect of glucose levels on enzyme activities. The study was performed on a consecutive series of outpatients with type 2 diabetes who were followed up at Dicle University Medical Faculty Hospital from May 2009 to May 2010 for the first time. Effects of aspartate transaminase, aminotransferase, gamma‐glutamyl transferase (GGT), alkaline phosphatase (ALP), lactate dehydrogenase (LDH) activities, glucose and HbA1c levels and in vitro glucose (492, 287, 184, 131, 82 mg dl⁻¹, respectively) on enzymes were determined. The patients were categorized on the basis of glucose and HbA1c levels and grouped according to a range of values. In patients with high HbA1c levels (>10.1%), ALP, GGT activities and creatine kinase (CK)‐MB/CK (p = 0.008, 0.026, 0.014) ratio were increased significantly when compared with those in the control group. In patients with high glucose levels (>200 mg dl⁻¹), ALP, GGT activities and CK‐MB/CK ratio (p = 0.003, 0.001, 0.001) were increased significantly when compared with those in the control group. Glucose, which was added to serum in different concentrations in vitro, did not directly affect enzyme activities such as ALP, GGT and CK. We concluded that increased glucose levels could damage the liver and the heart muscle cells. Monitoring of blood glucose levels is a more valuable parameter than monitoring HbA1c in the momentary evaluation of diabetes. Copyright © 2011 John Wiley & Sons, Ltd.     

Association between self-care management practices and glycemic control of patients with type 2 diabetes mellitus in Saud Arabia: A cross –sectional study

ObjectiveIn this cross-sectional study, we aimed to determine the association of self-care management practices and glycemic control of type 2 diabetes mellitus in Saudi Arabia.MethodsA total of 352 type 2 diabetes mellitus (T2DM) patients from two public tertiary hospitals in Saudi Arabia participated in this study. All T2DM patients were recruited and interviewed by a researcher between January to April 2018 from the outpatient diabetes clinics. All respondents answered a four-part questionnaire which includes demographics data, Diabetes Self-Management Questionnaire (DSMQ). Linear Regression was performed to assess the significance of predictors and compute the coefficient of determination.ResultsThe mean age of the participants was 51.89 ± 10.94. Of the 352 participants, 52% were obese (BMI: ≥30 kgm²) and 77% of the participants had glycated haemoglobin (HbA1c) over 7%. The analysis showed that subscale of Glucose management was the strongest predictor of Hba1c levels of participants’ followed by physical activity. Gender and marital status emerged as significant predictors for their self-care management practices. Female patients had more self-care management practices than male patients (B 0.20; 95CI 0.10– 0.96 (p = 0.015).ConclusionThis study provides an evidence on the self-care management of T2DM patients in Saudi Arabia. The high self-care management found in the study highlights that the patients are aware of the severity of and possible complications associated with T2DM.     

老年2型糖尿病患者血清BGP、ghrelin、YKL-40水平与胰岛素抵抗及认知功能损害的关系研究

摘要 目的：研究老年2型糖尿病（T2DM）患者血清骨钙素（BGP）、生长激素释放多肽（ghrelin）及人软骨糖蛋白-39（YKL-40）水平与胰岛素抵抗及认知功能损害的关系。方法：选择2018年1月～2019年12月我院收治的老年T2DM患者100例记作病变组,选择同期于我院进行体检的老年健康志愿者100例作为对照组。比较两组血清BGP、ghrelin及YKL-40水平,血糖、血脂、胰岛素抵抗相关指标及简易智力状态检查量表（MMSE）评分情况,并分析各指标的相关性。结果：病变组血清BGP、ghrelin水平低于对照组,而YKL-40水平高于对照组（P＜0.05）。病变组空腹血糖（FPG）、糖化血红蛋白（HbA1c）水平及胰岛素抵抗指数（HOMA-IR）均高于对照组,而空腹胰岛素（FINS）水平低于对照组（P＜0.05）。病变组除语言、延迟记忆评分与对照组对比差异无统计学意义（P＞0.05）,其他各项MMSE评分均低于对照组（P＜0.05）。经Pearson相关性分析可得：老年T2DM患者血清BGP、ghrelin水平和FPG、HbA1c、HOMA-IR均呈负相关,与FINS及MMSE评分均呈正相关（P＜0.05）;而血清YKL-40水平和FPG、HbA1c、HOMA-IR均呈正相关,与FINS及MMSE评分均呈负相关（P＜0.05）。结论：老年T2DM患者的血清BGP、ghrelin存在明显低表达,而血清YKL-40水平呈明显高表达,且上述血清学指标水平均与胰岛素抵抗和认知功能损害密切相关。     

Assessment of hematologic indices and their correlation to hemoglobin A1c among Bosnian children with type 1 diabetes mellitus and their healthy peers

BackgroundAltered levels of many hematological parameters have been directly associated with diabetes in adults, while studies on children with type 1 diabetes mellitus are lacking. The aim of this study was to determine hematological indices in diabetic Bosnian children in comparison to healthy controls as well as to correlate their levels to blood glucose and hemoglobin A1c.Methods100 healthy and 100 children with type 1 diabetes mellitus (age 1-18) were included in this study. Complete blood count, hemoglobin A1c, and glucose were tested. Results were analysed by IBM SPSS Statistics version 23.ResultsSignificant differences (p<0.05) between healthy and diabetic children were found in relation to HbA1c, glucose, mean platelet volume, the number of white blood cells and erythrocytes, hematocrit, hemoglobin and MCH values. No gender differences or significant age differences were seen for hemoglobin, hematocrit, and MCV, while platelets, MPV, and MCH differed by age only in healthy children. When diabetic children were classified according to HbA1c levels, significant differences were seen for erythrocyte count and hematocrit value (p=0.013 and 0.019, respectively). The number of erythrocytes and white blood cells correlated significantly with HbA1c (p=0.037 and 0.027, respectively).ConclusionsLower levels of erythrocytes, hematocrit, and hemoglobin in diabetic compared to healthy children indicate possible development of anemia, while higher MCV, MCH, and MPV values indicate an alteration in erythrocyte morphology. Hematological indices could be a useful inexpensive tool in the diagnosis and follow up of type 1 diabetes in children.     

Association Between a Low-Carbohydrate Diet,Glycemic Control,and Quality of Life in Australian Adults Living With Type 1 Diabetes: A Pilot Study

ObjectiveTo examine if there is an association between a low-carbohydrate diet (LCD), glycemic control, and quality of life (QoL) in Australian adults with type 1 diabetes.MethodsThis single-group, pre-post, mixed methods (quantitative and qualitative) study was conducted in an outpatient tertiary hospital. Eligible participants were those aged ≥18 years, with type 1 diabetes for ≥1 year, and using multiple daily insulin injections. Participants followed a 12-week individualized LCD (<100 g/d). Daily glucose levels were monitored using a continuous glucose monitor. Glycated hemoglobin (HbA1c) and QoL were measured preintervention and postintervention. A post-hoc exploratory regression analysis determined whether changes in carbohydrate intake was associated with changes in HbA1c and QoL. Qualitative data collected postintervention explored participants’ perceptions relating to a LCD, glycemic control, and QoL.ResultsParticipants (n = 22) completed the 12-week LCD intervention. An LCD provided a statistically, significant improvement in HbA1c 0.83% (95% CI 0.32%-1.33%), P = .003 but did not impact QoL: estimated change 1.14 units (95% CI: ?5.34 to 7.61); P = .72. The post-hoc exploratory regression analysis showed that participants with poorer baseline glycemic control were more likely to respond to an LCD resulting in significant reductions in HbA1c. Participant perceptions relating to the study variables were mixed.ConclusionsAn LCD (<100 g/d) is a potentially effective and safe strategy to improve glycemic control without negatively effecting QoL in Australian adults with type 1 diabetes.     

血清Fractalkine、Apelin水平与糖尿病视网膜病变患者血糖、血脂以及病程的关系研究

目的:研究血清Fractalkine(FKN)、爱帕琳肽(Apelin)水平与糖尿病视网膜病变(DR)患者血糖、血脂以及病程的关系。方法:选取我院于2015年1月至2016年12月收治的160例糖尿病患者为研究对象,行眼底荧光造影、裂隙灯显微镜检查,按照检查结果将其区分为非增生型DR组(稳定组,43例)、背景期DR组(背景组,62例)和增殖期DR组(增殖组,55例),另外于同期选取我院40例健康体检者为健康对照组(健康组),测量4组血清FKN、Apelin、空腹血糖(FPG)、餐后2h血糖(2hPG)、糖化血红蛋白(HbA1c)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)和总胆固醇(TC)水平,使用Pearson相关性分析分析血清FKN、Apelin与FPG、2hPG、HbA1c、HDL-C、LDL-C、TG、TC、糖尿病病程的相关性。结果:血清FKN、Apelin水平比较:增殖组背景组稳定组健康组,各组间比较差异具有统计学意义(P0.05);血清FPG、2hPG、HbA1c、LDL-C、TG、TC水平比较:增殖组背景组稳定组健康组,各组间比较差异具有统计学意义(P0.05);血清HDL-C水平比较:健康组稳定组背景组增殖组,各组间比较差异具有统计学意义(P0.05);采用Pearson相关性分析显示,血清FKN水平与FPG、2hPG、HbA1c、LDL-C、TG、TC、糖尿病病程呈正相关性(r=0.321、0.215、0.645、0.154、0.215、0.325、0.578,P0.05),与HDL-C呈负相关性(r=-0.547,P0.05);血清Apelin水平与FPG、2hPG、HbA1c、LDL-C、TG、TC、糖尿病病程呈正相关性(r=0.245、0.574、0.951、0.357、0.357、0.159、0.546,P0.05),与HDL-C呈负相关性(r=-0.459,P0.05);糖尿病病程、HbA1c、LDL-C、HDL-C、FKN和Apelin为DR病程的相关影响因素。结论:糖尿病伴发DR患者血清FKN、Apelin水平随着病程的加重逐渐增加,且这两种因子的水平与患者血糖、血脂代谢关系密切。     

C-Peptide Level in Fasting Plasma and Pooled Urine Predicts HbA1c after Hospitalization in Patients with Type 2 Diabetes Mellitus

In this study, we investigate how measures of insulin secretion and other clinical information affect long-term glycemic control in patients with type 2 diabetes mellitus. Between October 2012 and June 2014, we monitored 202 diabetes patients who were admitted to the hospital of Asahi Life Foundation for glycemic control, as well as for training and education in diabetes management. We measured glycated hemoglobin (HbA1c) six months after discharge to assess disease management. In univariate analysis, fasting plasma C-peptide immunoreactivity (F-CPR) and pooled urine CPR (U-CPR) were significantly associated with HbA1c, in contrast to ΔCPR and C-peptide index (CPI). This association was strongly independent of most other patient variables. In exploratory factor analysis, five underlying factors, namely insulin resistance, aging, sex differences, insulin secretion, and glycemic control, represented patient characteristics. In particular, insulin secretion and resistance strongly influenced F-CPR, while insulin secretion affected U-CPR. In conclusion, the data indicate that among patients with type 2 diabetes mellitus, F-CPR and U-CPR may predict improved glycemic control six months after hospitalization.