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  • 1
    Online Resource
    Online Resource
    2439-PUB: Ethnic Differences in Plasma Glucose on Emergency Admission to Hospital in People with No Prior Diagnosis of Diabetes
    American Diabetes Association ; 2019
    In:  Diabetes Vol. 68, No. Supplement_1 ( 2019-06-01)
    Details
    In: Diabetes, American Diabetes Association, Vol. 68, No. Supplement_1 ( 2019-06-01)
    Abstract: Objective: Glucose is measured on hospital admission as an emergency as elevated glucose is associated with an eight-fold risk of dying in hospital. This study reports on admission plasma glucose by ethnicity in people without prior diabetes. Research Design and Methods: A clinical audit CARMS-12031 of electronic patient records for 113,097 admissions to hospital over 1 year from April 2014 to March 2015 identified 43,201 emergency admissions with glucose unavailable for 11,274 (26%). Of 5,867 admissions with prior diabetes coding, 5,523 (94%) had glucose recorded. First attendances were analyzed for emergency admissions with no record of diabetes. Results: Of these 18,965 people admitted, 75% were White Europeans WE who were older than South Asians SA 12%, unknown/other ethnic groups U 9%, and Afro-Caribbeans AC 4%. 1,003 people admitted as an emergency had glucose in ‘diabetes range’ (≥11.1mmol/L) and 3,042 in ‘at risk’ range (7.8 to 11.0mmol/L). More SA 8% had glucose in diabetes range than WE 5% and also than U 5%; there were significantly more WE 17% in ‘at risk’ range than U 14% or AC 11%. Higher glucose was observed in SA and U men than women, p = 0.005 and p = 0.018, respectively. Conclusions: Protocols should target people requiring additional HbA1c testingto diagnose undiagnosed diabetes on hospital admission especially younger SA and AC individuals, and outline appropriate clinical intervention. Disclosure S. Ghosh: Advisory Panel; Self; Abbott. Other Relationship; Self; Mylan. R. Susarla: None. R.A. Round: None. P. Nightingale: None. J.A. Williams: None. I.M. Stratton: Consultant; Self; Novo Nordisk A/S. Research Support; Self; Bayer AG, Boehringer Ingelheim International GmbH. G. Gkoutos: None. J. Webber: None. W. Hanif: Advisory Panel; Self; Boehringer Ingelheim International GmbH. Consultant; Self; Novo Nordisk A/S. Research Support; Self; AstraZeneca, Janssen Diagnostics, Sanofi. Speaker's Bureau; Self; AstraZeneca, Novartis AG, Novo Nordisk A/S. G. Roberts: None. S.E. Manley: None.
    Type of Medium: Online Resource
    ISSN: 0012-1797 , 1939-327X
    URL: Article
    DOI: 10.2337/db19-2439-PUB
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2019
    detail.hit.zdb_id: 1501252-9
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  • 2
    Online Resource
    Online Resource
    1312-P: Admission Plasma Glucose and HbA1c in Emergency Hospital Admissions by Ethnicity
    American Diabetes Association ; 2019
    In:  Diabetes Vol. 68, No. Supplement_1 ( 2019-06-01)
    Details
    In: Diabetes, American Diabetes Association, Vol. 68, No. Supplement_1 ( 2019-06-01)
    Abstract: Introduction: As HbA1c is now widely used for the diagnosis of diabetes with WHO cut-off ≥ 48 mmol/mol/6.5%, it is debatable whether the value should vary by ethnicity. Aim: This study compares plasma glucose and HbA1c in white European WE, South Asian SA, unknown/other U and Afro-Caribbean AC people admitted as an emergency. Methods: Electronic patient records were interrogated over 1 year (2014/5) for a clinical audit, CARMS-12031R. Glucose was measured on wards with meters/gas machines or the laboratory along with HbA1c on Tosoh G8 HPLC analysers if haemoglobin normal. Results: There were 30,664 people of whom 22,045 (72%) had glucose recorded and 2,083 (7%) HbA1c. 1,904 (6%) had both glycaemic markers and were aged 64 (50-78) years, median (IQ range); 839 (44%) female; 560 (29%) prior diabetes diagnosis; 1,405 (74%) WE, 296 (16%) SA, 112 (6%) U and 91 (5%) AC. Glucose was 7.4 (5.8-10.6), 8.6 (6.2-12.3), 8.1 (5.9-10.7), 7.0 (5.9-11.6) mmol/L and HbA1c 42 (37-55), 50 (41-70), 42 (38-60), 46 (39-70) mmol/mol/6.0 (5.5-7.2), 6.7 (5.9-8.6), 6.0 (5.6-7.6), 6.4 (5.7-8.6)%, respectively. HbA1c was higher relative to glucose in SA and AC compared to WE and U, p & lt;0.001. Conclusions: Haematological differences related to red blood cell turnover may account for the variance; this should be recognised by those involved in producing protocols/guidelines for diagnosis. More research is required on using HbA1c to confirm undiagnosed diabetes in admissions. Disclosure S.E. Manley: None. R. Susarla: None. R.A. Round: None. P. Nightingale: None. J.A. Williams: None. I.M. Stratton: Consultant; Self; Novo Nordisk A/S. Research Support; Self; Bayer AG, Boehringer Ingelheim International GmbH. J. Webber: None. G. Gkoutos: None. W. Hanif: Advisory Panel; Self; Boehringer Ingelheim International GmbH. Consultant; Self; Novo Nordisk A/S. Research Support; Self; AstraZeneca, Janssen Diagnostics, Sanofi. Speaker's Bureau; Self; AstraZeneca, Novartis AG, Novo Nordisk A/S. G. Roberts: None. S. Ghosh: Advisory Panel; Self; Abbott. Other Relationship; Self; Mylan.
    Type of Medium: Online Resource
    ISSN: 0012-1797 , 1939-327X
    URL: Article
    DOI: 10.2337/db19-1312-P
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2019
    detail.hit.zdb_id: 1501252-9
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  • 3
    Online Resource
    Online Resource
    133-LB: Relationship of HbA1c and Glucose by Ethnicity in UK Biobank
    American Diabetes Association ; 2022
    In:  Diabetes Vol. 71, No. Supplement_1 ( 2022-06-01)
    Details
    In: Diabetes, American Diabetes Association, Vol. 71, No. Supplement_1 ( 2022-06-01)
    Abstract: The UK Biobank recruited 502,481 people aged 40 to 70 years who were invited to participate by post so not necessarily representative of the general population. The 405,363 participants with random glucose, HbA1c and the necessary demographic/clinical data were aged 56.5 (8.09) years, mean SD, with 54% female, and ethnicity 95.0% White W, 1.9 South Asian SA, 1.3% Black B, 0.9% Other O, 0.6% Mixed Background MB, and 0.3% Chinese C. Glucose was measured by hexokinase and HbA1c by BioRad VARIANT II TURBO analysers, reference range 20-42 mmol/mol in a dedicated central laboratory. Cohen's D statistic was used to compare glucose/HbA1c by ethnicity versus the largest group W. Mean glucose ranged from 5.04 to 5.41 mmol/L with HbA1c40.7 mmol/mol for SAversus36.0 for W (D=0.78 medium effect M) , B 39.3 (D=0.51 M) , O 38.4 (D=0.37 small S) , C 37.1 (D=0.17 very small V) & MB 36.6 (D=0.09 V) , all p values & lt;0.001. There were large differences by ethnicity in linear regression slopes for the glucose/HbA1c relationship when compared to W with correlation coefficient comparison Z-statistics for SA 16.74, B 8.69, O 10.94, C 8.96, all p & lt;0.001, except for MB 2.56, p=0.01. Such ethnic differences in HbA1c have been reported previously and questions raised as whether different cut-offs should be used for diagnosis of diabetes. However, more information on the prevalence of microvascular complications and differences in haematological profiles is required for such modifications. Disclosure J. A. Williams: None. S. E. Manley: n / a. A. Karwath: None. R. A. Round: None. I. M. Stratton: None. S. Ghosh: Other Relationship; Boehringer Ingelheim International GmbH, Eli Lilly and Company, Novo Nordisk. S. Mostafa: None. G. Roberts: None. J. Webber: None. G. Gkoutos: None. Funding Medical Research Council (MR/S003991/1) , MRC HDR UK (HDRUK/CFC/01) , NIHR Birmingham ECMC, NIHR Birmingham SRMRC, Nanocommons H2020-EU (731032) , MAESTRIA (965286)
    Type of Medium: Online Resource
    ISSN: 0012-1797
    URL: Article
    DOI: 10.2337/db22-133-LB
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2022
    detail.hit.zdb_id: 1501252-9
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  • 4
    Online Resource
    Online Resource
    Gestational Diabetes Mellitus: NICE for the U.S.? A Comparison of the American Diabetes Association and the American College of Obstetricians and Gynecologists Guidelines With the U.K. National Institute for Health and Clinical Excellence Guidelines
    American Diabetes Association ; 2010
    In:  Diabetes Care Vol. 33, No. 3 ( 2010-03-01), p. e46-e47
    Details
    In: Diabetes Care, American Diabetes Association, Vol. 33, No. 3 ( 2010-03-01), p. e46-e47
    Type of Medium: Online Resource
    ISSN: 0149-5992 , 1935-5548
    URL: Article
    DOI: 10.2337/dc09-2234
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2010
    detail.hit.zdb_id: 1490520-6
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  • 5
    Online Resource
    Online Resource
    973-P: By How Much Does Red Blood Cell Status Affect the Accuracy of HbA1c?
    American Diabetes Association ; 2022
    In:  Diabetes Vol. 71, No. Supplement_1 ( 2022-06-01)
    Details
    In: Diabetes, American Diabetes Association, Vol. 71, No. Supplement_1 ( 2022-06-01)
    Abstract: Medical conditions can affect haematological factors altering relationship between HbA1c and glucose. Patients were recruited at hospital over 3 visits (*1/**2 & 3 only) comprising 20 with diabetes and in Fig 1 with liver disease (LD) & hepatitis C (HC) on ribavirin*, on dapsone*, with macrocytosis, and in Fig 2 LD & HC off ribavirin**, LD with nonalcoholic steatohepatitis and cirrhosis, rheumatoid arthritis, renal disease on erythropoietin (EPO) , renal disease off EPO and with microcytosis. Glucose and full blood count were measured with HbA1c on Tosoh G8 analysers, ref range 20-42mmol/mol. In Fig 1 HbA1c was more depressed relative to glucose than Fig 2, both p & lt;0.001, with a combination of lower red blood cell (rbc) count & higher mean cell volume. The macrocytic nature of rbc implies faster turnover and less contact of haemoglobin with circulating glucose. Disclosure A. Karwath: None. J.A. Williams: None. R.A. Round: None. G. Gkoutos: None. G. Roberts: None. J. Webber: None. Funding Medical Research Council (MR/S003991/1) , MRC HDR UK (HDRUK/CFC/01) , NIHR Birmingham ECMC, NIHR Birmingham SRMRC, Nanocommons H2020-EU (731032) , MAESTRIA (Grant agreement ID 965286)
    Type of Medium: Online Resource
    ISSN: 0012-1797
    URL: Article
    DOI: 10.2337/db22-973-P
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2022
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  • 6
    Online Resource
    Online Resource
    Improved glycemic control with insulin aspart: a multicenter randomized double-blind crossover trial in type 1 diabetic patients. UK Insulin Aspart Study Group.
    American Diabetes Association ; 1998
    In:  Diabetes Care Vol. 21, No. 11 ( 1998-11-01), p. 1904-1909
    Details
    In: Diabetes Care, American Diabetes Association, Vol. 21, No. 11 ( 1998-11-01), p. 1904-1909
    Abstract: OBJECTIVE: To compare glycemic control obtained with the new rapid-acting insulin analog insulin aspart with that obtained with unmodified human insulin using algorithm-driven dosage adjustment. RESEARCH DESIGN AND METHODS: This was a multicenter randomized double-blind crossover study of 90 male subjects with type 1 diabetes. Insulin aspart or soluble human insulin was administered before meals, and NPH insulin was administered at bedtime as basal therapy. Each 4-week study period ended with a 24-h inpatient serum insulin and plasma glucose profile. RESULTS: The 24-h plasma glucose control obtained with insulin aspart, as assessed by excursions of blood glucose outside a predefined normal range (4.0-7.0 mmo/l), was superior (22% reduction in excursion, P & lt; 0.01). Fructosamine levels remained unchanged with insulin aspart, with daytime glycemic control superior but nighttime glycemic control inferior. Eight-point home blood glucose profiles confirmed that insulin aspart significantly improved postprandial blood glucose control after lunch and dinner (P & lt; 0.05) without deterioration of preprandial blood glucose control. Hypoglycemic episodes requiring third-party intervention were significantly fewer with insulin aspart than with human insulin (20 vs. 44 events, P & lt; 0.002). Insulin aspart was well tolerated. CONCLUSIONS: In comparison with human insulin, insulin aspart can improve postprandial glycemic control as assessed by a reduction in hyper- and hypoglycemic excursions in people with type 1 diabetes. For its full potential to be realized, it will need to provide better control of nighttime hyperglycemia.
    Type of Medium: Online Resource
    ISSN: 0149-5992 , 1935-5548
    URL: Article
    DOI: 10.2337/diacare.21.11.1904
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 1998
    detail.hit.zdb_id: 1490520-6
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