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Elevated White Blood Cell Count is Associated with Higher Hemoglobin A1C in Diabetic Patients from Bangladesh
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Abstract [+]
Background
Diabetes mellitus (DM) is associated with altered white blood cell (WBC) and glycated hemoglobin dysfunction.
Aim
In this study, we were aimed to compare the status of hemoglobin, glycated hemoglobin and WBC level between diabetic and nondiabetic patient’s group.
Methods
This study was conducted in the medicine department of Women’s Medical College and Hospital, Sylhet, Bangladesh. The number of participants was 142. All the patients enrolled were informed verbally about the study and written consent was taken from each patient. Ethical permission was obtained from the institute. All of the tests were performed according to the procedure adopted in the hospital for routine uses. Among the participants, 71 (male 47, female 24) were diagnosed as type-2 diabetics (T2DM) and the other was non-diabetes (male 32 and female 39).
Results
During this study, diabetic patients showed increased hemoglobin (Hb) and WBC level in diabetic blood than non-diabetic one. It has been supported by the study that, HbA1c is remarkably greater than that of New Delhi metallo-β-lactamase 1 (NDM-1) patients. So, our assumptions could be concluded as; diabetes mellitus is an inflammatory condition itself, which may play role in increased HbA1c and WBC count.
Conclusion
Therefore, elevated WBC count is independently associated with worsening of glucose metabolism and HbA1c may ameliorate the chronic low-grade inflammation such as type-2 diabetics (T2DM).
Keywords
Diabetes; Blood parameters; White blood cell (WBC); Glycated hemoglobin; Hemoglobin.
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Current Perspectives for Oral Hypoglycemic Agents with Clinical Evidence of Larger Studies
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Abstract [+]
Current reports for oral hypoglycemic agents (OHAs) are described. As to the association of dipeptidyl peptidase-4 inhibitors (DPP-4i) and bullous pemphigoid (BP), odds ratio (OR) was vildagliptin 5.08, linagliptin 2.87, sitagliptin 1.29 (not significant). Regarding the comparative study between SGLT2i and DPP-4i, SGLT2i group showed lower hazard ratio (HR) as MACE 0.76, myocardial infarction 0.82, cardiovascular death 0.60, heart failure 0.43, all-cause mortality 0.60. Semaglutide showed reduced OR for cardiovascular death than exenatide 0.47, dulaglutide 0.46, albiglutide 0.45, lixisenatide 0.43. SGLT2i showed reduction risk of HR for MACE 0.90, hospitalization for heart failure (HHF)/cardiovascular death 0.78, renal outcomes 0.62.
Keywords
Oral hypoglycemic agents (OHAs); Sodium glucose cotransporter-2 inhibitor (SGLT-2i); Semaglutide; Bullous pemphigoid (BP); Hospitalization for heart failure (HHF); Major adverse cardiovascular event (MACE).
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Type 2 Diabetes Mellitus with Diabetic Gastroparesis and Occasional Liver Dysfunction Treated by Low Carbohydrate Diet
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Abstract [+]
Diabetes mellitus (DM) has wider neurological complications. They include upper gastrointestinal (GI) symptoms, impaired motility, impaired gastric emptying (GE) and diabetic gastroparesis (DG), which are usually found. The patient was a 64-year-old man with type 2 diabetes (T2D) for 22-years. The patient weighed 74 kg with body mass index (BMI) 23.6 kg/m2, hemoglobin A1C (HbA1c) 9.2%, ankle brachial index (ABI) 1.19/1.23, AST 25 U/L(7-38), ALT 23 U/L(4-44), GGT 48 U/L(<86), Chest X-P normal, and electrocardiogram (ECG) negative. When the patient was treated with low carbohydrate diet (LCD), a significant reduction in body weight and HbA1c was observed. Abdominal computerized tomography (CT) revealed multiple gall stone, dilated common bile duct and impaired GE, indicating DG. For endoscopic examination, much food residue was found in the stomach due to DG after 13 hours fasting. Treatment for DG was initiated by mosapride citrate hydrate. During clinical progress, occasional liver dysfunction was observed twice associated with elevation of AST 196 U/L, GGT 373 U/L and without symptoms, indicating cholestasis-type dysfunction. Some possible triggers may be involved in these episodes, such as gall stone, enlarged volume of stomach due to DG, overeating, overdrinking, and other factors. This impressive report will hopefully become a reference for developing diabetic practice and research. Keywords Type 2 diabetes (T2D); Diabetic gastroparesis (DG); Gastric emptying (GE); Functional dyspepsia (FD); Low carbohydrate diet (LCD).
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Skin Autofluorescence a Non-Invasive Biomarker of Ages and Its Association to Metabolic Parameters in a Greek Diabetic Population
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Abstract [+]
Objectives
This cross-sectional study aims to evaluate the association between advanced glycation end-products (AGEs) accumulation, assessed by skin autofluorescence (SAF) measured using the AGE Reader, and the prevalence of several metabolic variables in a diabetic population.
Methods
The measurement of SAF has become a non-invasive method of assessing the accumulation of AGEs as a marker of the long-term impact of glycemic and oxidative stress in humans. In contrast to blood glucose and to hemoglobin A1C (HbA1c), which reflect a short period of glucose levels, the AGE is a marker of the metabolic legacy effect and reflect a long period of glucose levels. AGEs play a pivotal role in the development and progression of diabetic complications. SAF has been validated as a simple, non-invasive method for assessment of AGEs accumulation in the body.
Results
In this study 100 diabetic patients were participated. We non-invasively measured SAF, in all the participants using the AGE Reader (DiagnOptics Technologies BV, Groningen, The Netherlands). We also measured the body mass index (BMI), the blood pressure and the patients underwent arterial duplex sonogram (Doppler examination) in the legs at the level of the ankle and calculated the ankle-branchial index (ABI), which is an important index for diagnosing peripheral artery disease, which is a severe complication of diabetes. The SAF was positive correlated with age, duration of diabetes and systolic blood pressure (BP) and was negative correlated with ABI.
Conclusion
The measurement of SAF has become a non-invasive and reliable method of assessing the accumulation of AGEs in humans. In contrast to blood glucose and to HbA1c, which reflect a short period of glucose levels, the AGEs reflect a long period of glucose levels, correlate with certain metabolic parameters and with peripheral artery disease.
Keywords
Diabetes mellitus (DM); Advanced glycation end-products (AGEs); Skin autofluorescence (SAF); Empirical findings.
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Coronavirus Disease-2019, Diabetes and Dialysis in Southern Italy: The Second Wave Follow-up
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Coronavirus Disease-2019, Diabetes and Dialysis: An Internal Medicine Conundrum Proposal for a Suitable and Easy-to-Handle Prevention Protocol
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Abstract [+]
Background
Frail populations burdened with chronic diseases can get more severe forms of coronavirus disease-2019 (COVID-19) and have a higher mortality rate.
Aim
To test the efficacy of a severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) containment protocol in patients with endstage renal disease (ESRD) diabetes mellitus (DM) requiring dialysis, who are a typical example of the above category.
Methods
The protocol included: (i) daily telephone COVID-19 related triage for patients and their general practitioners (GPs); (ii) social distancing; (iii) environment sanitization, including ambulances, transfer vans, medical equipment, patient/health personnel clothing, and individual protection devices; (iv) adoption of quota systems for patients allowed to the dialysis room, and increased time lags among dialysis shifts. Eight hundred twenty-five (825) patients on dialysis (315 with and 510 without DM), and 381 healthcare providers (HCPs) were monitored continuously from the start of the pandemic until the end of the lockdown.
Results
No HCPs were infected, while only two patients on dialysis were positive for SARS-CoV-2: one with DM, who died in intensive care, and one without DM, who recovered at home. The adopted contagion containment protocol proved to be effective for both HCPs and patients.
Conclusion
Therefore, we propose it as a useful model for any internal medicine or ESRD specialized units dealing with patients on dialysisoriented with or without DM.
Keywords
COVID-19, Dialysis, Diabetes, Prevention, Contagion.
Coronavirus Disease-2019, Diabetes and Dialysis in Southern Italy: The Second Wave Follow-up
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Abstract [+]
Background
After the official coronavirus (severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)) pandemic declaration by the World Health Organization (WHO), Italy had the second-largest number of confirmed cases, after China. The Italian government introduced progressive infection-mitigation measurements, thus dramatically reducing social interactions and preventing virus spread. During the summer, infection containment measures progressively loosened until, due to an unjustified interpretation of some permissions and the excessive utilization of public transportation at school reopening, the contagion rate progressively increased until causing a severe challenge for our National Health Service (NHS) again.
Aim
To assess the efficiency of our previously described protocol in 18 Campania region-located Nefrocenter Consortium dialysis centers (DCs) as further adapted to new knowledge under the new ubiquitous contagion conditions and to identify SARS-CoV-2-infection mortality rate and risk factors.
Methods
381 HCP members underwent regular monitoring on April 1 and November 13, 2020. Dialysis patients did so too during that period according to the expected shifting prevalence over time (mean±SD:853±30 per month; range 825 to 873) vs (11.8% in April, and 14.8% in November vs. a pre-coronavirus disease-2019 (COVID-19) 12.0% rate in January).
Results
More patients got infected in November (10.19%) than in April (0,24%), and 22 patients of the 89 from the SARS-CoV-2 November positive subjects required hospitalization for moderate-severe symptoms (24.72%), with death unavoidably coming in 19 (86.36% of hospitalized and 21.35% of infected patients) compared to the only one recorded in April (0.12%). The pandemic’s two periods
showed a strong association between mortality rate and often co-existing comorbidities, primarily represented by arterial hypertension, type 2 diabetes mellitus (T2DM), and chronic kidney disease (CKD).
Conclusion
The previously efficient contagion containment measures adopted by our DCs were not enough in November to fight the global infection risk pending on the whole Italian social community around. The author, discuss possible reasons and put forward further suggestions for the best handling of any future infection waves.
Keywords
COVID-19; Dialysis; Diabetes; Prevention; Contagion; COVID second round.
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