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Showing posts with label hba1c. Show all posts
Showing posts with label hba1c. Show all posts

Study Links Mothers’ Weight and Blood-Sugar Levels to Health of Newborns

Pregnant women with weight and blood-sugar levels even slightly above average may pose a risk to their pregnancies and the health of their newborns, a study suggests.

The 2008 Hyperglycemia and Adverse Pregnancy Outcome study showed a possible link between mothers with elevated blood sugar — but below the level of gestational diabetes — and increased birth weight and elevated insulin in newborns.

The new review of data from the HAPO study shows that blood-sugar levels and weight even just above average can boost newborns’ birth weights and insulin levels, and lower blood sugar. Having a larger-than-average baby can lead to infant injuries during delivery and more, risky Caesarean births.

“My recommendation would be that every pregnant mother should have a chance to have dietary advice. It would pay off in the long run,” says Dr. Boyd Metzger, the principle investigator of the study and a professor of medicine-endocrinology at Northwestern University Feinberg School of Medicine. However, many insurance plans don’t cover prenatal dietician visits, he says.

Women who are slightly overweight with moderately elevated blood-sugar levels pose a higher risk than pregnant women who are obese with normal blood sugar, or those who have gestational diabetes (when blood-sugar levels rise to a certain point) and a normal weight, the study says. It included 23,316 women from nine countries and was published in April’s Diabetes Care.

Babies born to mothers that are both obese and have gestational diabetes weigh an average of 340 grams, or about three-quarters of a pound, more than those born to mothers with normal weight and blood sugar, according to the study.

Mothers who are overweight — but not obese — with above-normal blood sugar had babies weighing an average of 214 grams, or half a pound, more. Babies of mothers of normal weight who have gestational diabetes weigh an average of 164 grams — just under a third of a pound — more. And obese mothers with normal glucose level have babies that weigh an average of 174 grams more.

Earlier studies have linked gestational diabetes and other ailments in mothers to health problems later on in the lives of their children, as WSJ reported last year.

There is a potential link between mothers with higher blood-sugar levels and weight, and obesity and diabetes in the children, perhaps as early as childhood, Metzger tells the Health Blog.  But “the unsettled question is whether these milder levels of higher glucose or weight [in the mother] carry that risk,” says Metzger.

Study Links Mothers’ Weight and Blood-Sugar Levels to Health of Newborns

Pregnant women with weight and blood-sugar levels even slightly above average may pose a risk to their pregnancies and the health of their newborns, a study suggests.

The 2008 Hyperglycemia and Adverse Pregnancy Outcome study showed a possible link between mothers with elevated blood sugar — but below the level of gestational diabetes — and increased birth weight and elevated insulin in newborns.

The new review of data from the HAPO study shows that blood-sugar levels and weight even just above average can boost newborns’ birth weights and insulin levels, and lower blood sugar. Having a larger-than-average baby can lead to infant injuries during delivery and more, risky Caesarean births.

“My recommendation would be that every pregnant mother should have a chance to have dietary advice. It would pay off in the long run,” says Dr. Boyd Metzger, the principle investigator of the study and a professor of medicine-endocrinology at Northwestern University Feinberg School of Medicine. However, many insurance plans don’t cover prenatal dietician visits, he says.

Women who are slightly overweight with moderately elevated blood-sugar levels pose a higher risk than pregnant women who are obese with normal blood sugar, or those who have gestational diabetes (when blood-sugar levels rise to a certain point) and a normal weight, the study says. It included 23,316 women from nine countries and was published in April’s Diabetes Care.

Babies born to mothers that are both obese and have gestational diabetes weigh an average of 340 grams, or about three-quarters of a pound, more than those born to mothers with normal weight and blood sugar, according to the study.

Mothers who are overweight — but not obese — with above-normal blood sugar had babies weighing an average of 214 grams, or half a pound, more. Babies of mothers of normal weight who have gestational diabetes weigh an average of 164 grams — just under a third of a pound — more. And obese mothers with normal glucose level have babies that weigh an average of 174 grams more.

Earlier studies have linked gestational diabetes and other ailments in mothers to health problems later on in the lives of their children, as WSJ reported last year.

There is a potential link between mothers with higher blood-sugar levels and weight, and obesity and diabetes in the children, perhaps as early as childhood, Metzger tells the Health Blog.  But “the unsettled question is whether these milder levels of higher glucose or weight [in the mother] carry that risk,” says Metzger.

Higher HbA1c Levels Predict Better Outcomes in Advanced Heart Failure With Diabetes

Patients with advanced heart failure who were also diabetic had better two-year survival if their baseline glycated hemoglobin (HbA1c) levels were >7.3% in a new study [1]. Among the non-diabetic patients with heart failure, HbA1C levels did not predict survival outcomes. The retrospective cohort study is published online March 27, 2012 in the American Journal of Cardiology.

"We're finding that in heart failure [plus diabetes], higher HbA1C levels are associated not with worse outcomes, but with better outcomes," lead investigator Dr Tamara Horwich (University of California, Los Angeles) told heartwire . This suggests that for patients with both diseases, "the focus should not be on lowering the HbA1Clevels to as low as possible," she said, adding that "aiming for a midrange of 7.2% to 8.2% may be very reasonable."

This "adds to a small but growing body of literature demonstrating a complex relationship between levels of glycemic control and survival in patients with advanced, established heart failure," Dr David Aguilar (Baylor College of Medicine, Houston, TX), who was not involved with this research, told heartwire . However, because it was an observational study, residual confounding factors may be contributing to adverse outcomes.

The implications for clinical practice are that "in someone with advanced heart failure who may be having difficulties with hypoglycemia or other adverse effects of diabetic medications, less stringent glycemic control (HbA1C <8%) may be acceptable," he said. On the other hand, "if patients are tolerating the medications without difficulties, current glycemic guidelines should continue to be followed as we await further information from prospective clinical trials."

Very Sick Heart-Failure Patients

In patients with established heart failure, the relationship between HbA1C levels and survival is not clear, the group writes. The Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) program found that as HbA1C levels rose, cardiovascular risk increased. However, in a study of close to 6000 older veterans with heart failure, Aguilar and colleagues reported a U-shaped relationship between HbA1C and survival: optimal survival was seen among patients with "modest" glycemic control--an HbA1C of 7.1% to 7.8%.

Horwich and colleagues performed a retrospective analysis on data from 845 patients with advanced heart failure who had been referred to a cardiomyopathy center for heart transplant or other evaluation from 1999 to 2010. The patients had a mean age of 55 years, and 28% were women.

The team subdivided the cohort into two subgroups, 358 patients with diabetes and 487 patients without diabetes, who were then stratified into quartiles according to baseline HbA1C levels.

The primary end points were death or urgent need for heart transplantation and all-cause mortality at two years. At two years, 181 patients had undergone urgent heart transplantation and 180 patients had died.

Among the patients with diabetes, two-year event-free survival was highest in the two highest quartiles of HbA1C.

Patients With Diabetes: Two-Year Survival Free From Death/Urgent Heart Transplantation

Quartile
HbA1C (%)
2-y survival (%)

1
<6.4
47.9

2
6.5–7.2
41.5

3
7.3–8.5
60.7

4
>8.6
65.3

In the subgroup of patients without diabetes, patients with HbA1C levels of 5.7% to 6.0% had better survival, but this was not statistically significant.

Patients Without Diabetes: Two-Year Survival Free From Death/Urgent Heart Transplantation

Quartile
HbA1c (%)
2-y survival (%)

1
<5.6
50.4

2
5.7–6.0
60.6

3
6.1–6.5
51.1

4
>6.6
49.9

In the total cohort, after adjustment for age, gender, body-mass index, and LVEF, for each unit increase in HbA1C, patients had an 8% decreased risk of death or need for urgent transplantation. In the subgroup of patients with diabetes, for each unit increase in HbA1C, patients had a 15% decreased risk of death or need for urgent transplantation.

Awaiting Further Trials, Individualized Treatment for Now

Low HbA1c levels may reflect an inflammatory state or malnutrition, or some anti-diabetic therapies may be causing the adverse cardiac outcomes, Horwich speculated.

Many, large-scale, phase 3 trials are currently testing the safety and efficacy of diabetic therapies in high-risk patients, including those with heart failure--a group that has often been excluded from glycemia clinical trials--said Aguilar. "Hopefully, we will have more prospective data on the best treatment strategies in this patient population over the next several years. . . . For now, I believe that practicing clinicians should follow published guidelines, which state that target glycemic goals should be individualized."

Adding dapagliflozin to sulfonylurea improved HbA1c in type 2 diabetes

Results of a phase 3 study presented at the International Diabetes Federation 2011 World Diabetes Congress in Dubai, United Arab Emirates, demonstrate that when added to sulfonylurea therapy, dapagliflozin reduced HbA1c at 24 weeks vs. placebo plus sulfonylurea in patients with type 2 diabetes. The reduction was maintained at 48 weeks, according to a press release.

Patients assigned to dapagliflozin (Bristol-Myers Squibb; AstraZeneca) plus glimepiride also experienced maintained reductions in fasting plasma glucose, postprandial glucose and total body weight.  

Results are from a 24-week extension trial of a 24-week, phase 3, multicenter, randomized, parallel-group, double blind, placebo-controlled study initially presented at the 46th European Association for the Study of Diabetes Annual Meeting in Stockholm, Sweden, in September 2010.

Patients with type 2 diabetes and HbA1c levels between 7% and 10% were randomly assigned to either dapagliflozin 2.5 mg (n=154), 5 mg (n=142) or 10 mg (n=151) per day or placebo (n=145) plus glimepiride 4 mg per day. At 24 weeks, the primary endpoint was mean change in HbA1c; the 24-week extension was conducted to assess the safety, efficacy and tolerability of dapagliflozin plus glimepiride during the 48-week period. The extension was completed by 519 patients.

After 48 weeks, mean improvements in HbA1c were -0.37% for the 2.5-mg arm (95% CI, -0.6 to -0.14); -0.53% for the 5-mg arm (95% CI, -0.75 to -0.3) and -0.7% for the 10-mg arm (95% CI, -0.92 to -0.47) compared with placebo. FPG, 2-hour postprandial glucose and body weight were also improved compared with placebo.

The rate of at least one adverse event was as follows: 58.4% for 2.5 mg, 60.7% for 5 mg and 58.9% for 10 mg vs. 55.5% for placebo.

Compared with placebo, hypoglycemic events were more frequent in the dapagliflozin groups (9.7% for 2.5 mg, 10.3% for 5 mg and 11.3% for 10 mg) compared with placebo (6.8%), although no patients discontinued treatment due to hypoglycemia.

According to a press release, events suggestive of genital infections were more common in patients assigned to dapagliflozin vs. placebo. Those events suggestive of urinary tract infections were similar in both groups.

Hemoglobin A1c Testing Method Fails to Identify Kids With Diabetes, Study Shows

In 2009, the American Diabetes Association (ADA) recommended that Hemoglobin A1c be exclusively used for the diagnosis of diabetes in children. The simple test measures longer-term blood sugar levels -- without requiring patients to fast overnight. However, a new U-M study has shown that these tests are not very accurate in children.

"We found that Hemoglobin A1c is not as reliable a test for identifying children with diabetes or children at high risk for diabetes compared with other tests in children," says Joyce M. Lee, M.D., M.P.H., lead author of the study and a pediatric endocrinologist at U-M's C.S. Mott Children's Hospital. "In fact, it failed to diagnose two out of three children participating in the study who truly did have diabetes."

A previous study released earlier this year, also by Lee, found that hemoglobin A1c is not as reliable a test for identifying children with diabetes and pre-diabetes compared with adults. Although tests that require patients to fast are the most accurate tests, they are difficult to obtain in clinical practice, highlighting the need for improved nonfasting testing strategies.

Due in part to high rates of childhood obesity, the Centers for Disease Control estimates that approximately 2.5 million children in the U.S. currently qualify for diabetes screening.

The study, published online ahead of print in the journal Diabetes Care, tested 254 overweight children using both fasting and non-fasting methods. Researchers found that the recommended test, Hemoglobin A1c, missed more cases of pre-diabetes or diabetes compared to other tests.

Participants in the study were defined as having prediabetes or diabetes based on a gold standard test. They were first tested using the Hemoglobin A1C test. After fasting for 12 hours, they returned on a separate day and were tested using a fasting method.

Based on the results, researchers urge that a nonfasting one-hour glucose challenge test, or a random glucose, may be promising methods for identifying children with pre-diabetes or diabetes.

"Other pediatric organizations, like the American Academy of Pediatrics, have not endorsed the use of HbA1c yet. However, there is concern that should they endorse it, more and more providers would use these testing methods, leading to an increase in missed diagnoses in the pediatric population," says Lee.

Researchers intend to use their data to drive future recommendations about screening for diabetes.

"We are currently studying whether the promising non-fasting tests, including the 1-hour glucose challenge test or the random glucose, could be used in combination with clinical characteristics to better identify which children have prediabetes or diabetes," says Lee.

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