The Appalachian region of the United States has a high prevalence of diabetes, placing residents with diabetes at risk for physical, psychological, social, and financial burdens. To compound the issue, primary care providers often do not adhere to the guidelines established by the American Diabetes Association (ADA) regarding the recommended frequency of testing hemoglobin A1C in patients with diabetes. Lewin's planned change theory guided the project. The purpose of this project was to measure the knowledge of the primary care providers before and after an educational intervention covering the ADA guidelines for A1C monitoring and testing and to assess compliance with the guideline. The 12 volunteer participants were medical doctors, physician assistants and family nurse practitioners who served as primary care providers for a rural health clinic. Results of the educational presentation and the pre- and posttests indicated that providers improved in their knowledge of the ADA guidelines for prevention and management of diabetes. Providers identified 9 reasons that patients were not compliant with follow-up for A1C monitoring, including lack of provider knowledge of the guidelines, distance to travel to the clinic, delayed lab results, forgetting to keep appointments, bad weather, no transportation, lost orders for labs, fear that the A1C will be elevated, and fear of having more medications added to their treatment plan. This project has the potential to promote positive social change by raising awareness among providers of the need for regular monitoring of hemoglobin A1C and following the ADA guidelines for the treatment and management of diabetes. In so doing, the project may reduce the complications of diabetes for patients in the community.

O Diabetes mellitus gestacional (DMG) é uma séria condição que afeta muitas gestantes e traz muitos riscos tanto para a gestante, como para o feto. A recomendação é que se faça o rastreamento com teste oral de tolerância à glicose (TOTG) entre 24 e 28 semanas de gestação. O objetivo desse estudo é determinar a utilidade do teste de hemoglobina glicada (A1c) como teste diagnóstico de DMG, comparado com os critérios baseados na medida de glicemia. Métodos: este é um estudo de acurácia de teste diagnóstico. Nós avaliamos o metabolismo dos carboidratos através dos testes de TOTG e A1c em mulheres grávidas brasileiras atendidas nas visitas de pré-natal do Hospital de Clínicas de Porto Alegre (HCPA). Além dos testes de TOTG e A1c, foi analisada a história clínica das pacientes. O DMG foi definido de acordo com critério da American Diabetes Association (ADA) - um ou mais pontos alterados, glicemia de jejum, 1h ou 2h com concentrações de glicose plasmática ≥5.1, 10.0, ou 8.5 mmol/L, respectivamente-, ou de acordo com os critérios da Organização Mundial da Saúde (OMS) - glicemia de jejum ou 2h com concentrações de glicose plasmática ≥7.0mmol/L ou ≥7.8mmol/L, respectivamente. Presença de anemia, hemoglobinas variantes e doença renal crônica foram excluídas. Para avaliar o desempenho do teste de A1c foi utilizada a curva ROC (receiver operating characteristic curve). Resultados: um total de 262 mulheres grávidas (média de idade de 30 anos, média de idade gestacional de 26 semanas) foram avaliadas e 82 (31,3%) tiveram diagnóstico positivo (40 pelo critério da ADA e 42 pelo critério da OMS). Baseado na análise da curva ROC, considerando os critérios da ADA e OMS juntos e o TOTG como teste de referência, o ponto de corte para obter o melhor equilíbrio entre sensibilidade e especificidade (diagonal 100% a 100%) foi o valor de A1c de 31mmol/mol (5,3%). A sensibilidade e especificidade para este ponto de corte foi de 69,9% e 65,9%, respectivamente. Os pontos de corte de 40 mmol/mol (5.8%), 41 mmol⁄mol (5.9%) e 42 mmol⁄mol (6.0%) representaram especificidades de 96,1%, 96,6% e 98,3%, respectivamente. Conclusões: o teste de A1c apresenta baixa sensibilidade e alta especificidade para o diagnóstico de DMG, quando comparado com o critério tradicional. Nossos resultados mostraram que 39% dos casos de DMG foram diagnosticados usando o ponto de corte de A1c≥ 40 mmol/mol (5.8%). O teste de A1c, sozinho ou em combinação com o TOTG, talvez seja bastante útil no diagnóstico de DMG. / BACKGROUND: Gestational diabetes mellitus (GDM) is a potentially serious condition that affects many pregnancies and it carries risk for the mother and neonate. The current recommendation is to perform screening before 24 - 28 weeks of gestation by an oral glucose tolerance test (OGTT). The aim of this study is to determine the usefulness of glycated hemoglobin (A1c) as a diagnostic tool for GDM compared with the traditional criteria based on glycemia measurements. METHODS: This is a study of diagnostic test accuracy. We evaluated the status of carbohydrate metabolism by performing OGTT and A1c in Brazilian pregnant women attending prenatal visits at Hospital de Clínicas de Porto Alegre (HCPA). A1c, OGTT, and clinical history were analyzed. GDM was defined according to the American Diabetes Association (ADA) criteria (one or more fasting, 1-h, or 2-h plasma glucose concentrations ≥5.1, 10.0, or 8.5 mmol/L; respectively) or World Health Organization (WHO) criteria (fasting or 2-h plasma glucose ≥7.0mmol/L or ≥7.8mmol/L, respectively). Presence of anemia, variant hemoglobins and chronic renal disease were excluded. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic performance of A1c. RESULTS: A total of 262 pregnant women (mean age 30 years, mean gestational duration 26 weeks) were enrolled and 82 (31.3%) were diagnosed with diabetes (40 by ADA criteria and 42 by WHO criteria). Based on ROC curve analysis, and considering OGTT as the reference criterion, the cut-off point obtained by the point with the best equilibrium between sensitivity and specificity (100%-to-100% diagonal) was A1c value of 31 mmol⁄mol (5.3%). The sensitivity and specificity for this cut-off 27 point were 69.9 % and 65.9 %, respectively. The cut-off points of A1c of 40 mmol/mol (5.8%), 41 mmol⁄mol (5.9%) and 42 mmol⁄mol (6.0%) presented specificities of 96,1%, 96,6% and 98,3%, respectively. CONCLUSIONS: A1c test presented low sensitivity and very high specificity for GDM diagnosis when compared with traditional criteria. Our results show that 39% of GDM cases would be diagnosed by using the cut-off point A1c≥ 40 mmol/mol (5.8%) alone. A1c test, alone or in combination with OGTT, may be a very useful diagnostic tool in GDM.

O Diabetes mellitus gestacional (DMG) é uma séria condição que afeta muitas gestantes e traz muitos riscos tanto para a gestante, como para o feto. A recomendação é que se faça o rastreamento com teste oral de tolerância à glicose (TOTG) entre 24 e 28 semanas de gestação. O objetivo desse estudo é determinar a utilidade do teste de hemoglobina glicada (A1c) como teste diagnóstico de DMG, comparado com os critérios baseados na medida de glicemia. Métodos: este é um estudo de acurácia de teste diagnóstico. Nós avaliamos o metabolismo dos carboidratos através dos testes de TOTG e A1c em mulheres grávidas brasileiras atendidas nas visitas de pré-natal do Hospital de Clínicas de Porto Alegre (HCPA). Além dos testes de TOTG e A1c, foi analisada a história clínica das pacientes. O DMG foi definido de acordo com critério da American Diabetes Association (ADA) - um ou mais pontos alterados, glicemia de jejum, 1h ou 2h com concentrações de glicose plasmática ≥5.1, 10.0, ou 8.5 mmol/L, respectivamente-, ou de acordo com os critérios da Organização Mundial da Saúde (OMS) - glicemia de jejum ou 2h com concentrações de glicose plasmática ≥7.0mmol/L ou ≥7.8mmol/L, respectivamente. Presença de anemia, hemoglobinas variantes e doença renal crônica foram excluídas. Para avaliar o desempenho do teste de A1c foi utilizada a curva ROC (receiver operating characteristic curve). Resultados: um total de 262 mulheres grávidas (média de idade de 30 anos, média de idade gestacional de 26 semanas) foram avaliadas e 82 (31,3%) tiveram diagnóstico positivo (40 pelo critério da ADA e 42 pelo critério da OMS). Baseado na análise da curva ROC, considerando os critérios da ADA e OMS juntos e o TOTG como teste de referência, o ponto de corte para obter o melhor equilíbrio entre sensibilidade e especificidade (diagonal 100% a 100%) foi o valor de A1c de 31mmol/mol (5,3%). A sensibilidade e especificidade para este ponto de corte foi de 69,9% e 65,9%, respectivamente. Os pontos de corte de 40 mmol/mol (5.8%), 41 mmol⁄mol (5.9%) e 42 mmol⁄mol (6.0%) representaram especificidades de 96,1%, 96,6% e 98,3%, respectivamente. Conclusões: o teste de A1c apresenta baixa sensibilidade e alta especificidade para o diagnóstico de DMG, quando comparado com o critério tradicional. Nossos resultados mostraram que 39% dos casos de DMG foram diagnosticados usando o ponto de corte de A1c≥ 40 mmol/mol (5.8%). O teste de A1c, sozinho ou em combinação com o TOTG, talvez seja bastante útil no diagnóstico de DMG. / BACKGROUND: Gestational diabetes mellitus (GDM) is a potentially serious condition that affects many pregnancies and it carries risk for the mother and neonate. The current recommendation is to perform screening before 24 - 28 weeks of gestation by an oral glucose tolerance test (OGTT). The aim of this study is to determine the usefulness of glycated hemoglobin (A1c) as a diagnostic tool for GDM compared with the traditional criteria based on glycemia measurements. METHODS: This is a study of diagnostic test accuracy. We evaluated the status of carbohydrate metabolism by performing OGTT and A1c in Brazilian pregnant women attending prenatal visits at Hospital de Clínicas de Porto Alegre (HCPA). A1c, OGTT, and clinical history were analyzed. GDM was defined according to the American Diabetes Association (ADA) criteria (one or more fasting, 1-h, or 2-h plasma glucose concentrations ≥5.1, 10.0, or 8.5 mmol/L; respectively) or World Health Organization (WHO) criteria (fasting or 2-h plasma glucose ≥7.0mmol/L or ≥7.8mmol/L, respectively). Presence of anemia, variant hemoglobins and chronic renal disease were excluded. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic performance of A1c. RESULTS: A total of 262 pregnant women (mean age 30 years, mean gestational duration 26 weeks) were enrolled and 82 (31.3%) were diagnosed with diabetes (40 by ADA criteria and 42 by WHO criteria). Based on ROC curve analysis, and considering OGTT as the reference criterion, the cut-off point obtained by the point with the best equilibrium between sensitivity and specificity (100%-to-100% diagonal) was A1c value of 31 mmol⁄mol (5.3%). The sensitivity and specificity for this cut-off 27 point were 69.9 % and 65.9 %, respectively. The cut-off points of A1c of 40 mmol/mol (5.8%), 41 mmol⁄mol (5.9%) and 42 mmol⁄mol (6.0%) presented specificities of 96,1%, 96,6% and 98,3%, respectively. CONCLUSIONS: A1c test presented low sensitivity and very high specificity for GDM diagnosis when compared with traditional criteria. Our results show that 39% of GDM cases would be diagnosed by using the cut-off point A1c≥ 40 mmol/mol (5.8%) alone. A1c test, alone or in combination with OGTT, may be a very useful diagnostic tool in GDM.

O Diabetes mellitus gestacional (DMG) é uma séria condição que afeta muitas gestantes e traz muitos riscos tanto para a gestante, como para o feto. A recomendação é que se faça o rastreamento com teste oral de tolerância à glicose (TOTG) entre 24 e 28 semanas de gestação. O objetivo desse estudo é determinar a utilidade do teste de hemoglobina glicada (A1c) como teste diagnóstico de DMG, comparado com os critérios baseados na medida de glicemia. Métodos: este é um estudo de acurácia de teste diagnóstico. Nós avaliamos o metabolismo dos carboidratos através dos testes de TOTG e A1c em mulheres grávidas brasileiras atendidas nas visitas de pré-natal do Hospital de Clínicas de Porto Alegre (HCPA). Além dos testes de TOTG e A1c, foi analisada a história clínica das pacientes. O DMG foi definido de acordo com critério da American Diabetes Association (ADA) - um ou mais pontos alterados, glicemia de jejum, 1h ou 2h com concentrações de glicose plasmática ≥5.1, 10.0, ou 8.5 mmol/L, respectivamente-, ou de acordo com os critérios da Organização Mundial da Saúde (OMS) - glicemia de jejum ou 2h com concentrações de glicose plasmática ≥7.0mmol/L ou ≥7.8mmol/L, respectivamente. Presença de anemia, hemoglobinas variantes e doença renal crônica foram excluídas. Para avaliar o desempenho do teste de A1c foi utilizada a curva ROC (receiver operating characteristic curve). Resultados: um total de 262 mulheres grávidas (média de idade de 30 anos, média de idade gestacional de 26 semanas) foram avaliadas e 82 (31,3%) tiveram diagnóstico positivo (40 pelo critério da ADA e 42 pelo critério da OMS). Baseado na análise da curva ROC, considerando os critérios da ADA e OMS juntos e o TOTG como teste de referência, o ponto de corte para obter o melhor equilíbrio entre sensibilidade e especificidade (diagonal 100% a 100%) foi o valor de A1c de 31mmol/mol (5,3%). A sensibilidade e especificidade para este ponto de corte foi de 69,9% e 65,9%, respectivamente. Os pontos de corte de 40 mmol/mol (5.8%), 41 mmol⁄mol (5.9%) e 42 mmol⁄mol (6.0%) representaram especificidades de 96,1%, 96,6% e 98,3%, respectivamente. Conclusões: o teste de A1c apresenta baixa sensibilidade e alta especificidade para o diagnóstico de DMG, quando comparado com o critério tradicional. Nossos resultados mostraram que 39% dos casos de DMG foram diagnosticados usando o ponto de corte de A1c≥ 40 mmol/mol (5.8%). O teste de A1c, sozinho ou em combinação com o TOTG, talvez seja bastante útil no diagnóstico de DMG. / BACKGROUND: Gestational diabetes mellitus (GDM) is a potentially serious condition that affects many pregnancies and it carries risk for the mother and neonate. The current recommendation is to perform screening before 24 - 28 weeks of gestation by an oral glucose tolerance test (OGTT). The aim of this study is to determine the usefulness of glycated hemoglobin (A1c) as a diagnostic tool for GDM compared with the traditional criteria based on glycemia measurements. METHODS: This is a study of diagnostic test accuracy. We evaluated the status of carbohydrate metabolism by performing OGTT and A1c in Brazilian pregnant women attending prenatal visits at Hospital de Clínicas de Porto Alegre (HCPA). A1c, OGTT, and clinical history were analyzed. GDM was defined according to the American Diabetes Association (ADA) criteria (one or more fasting, 1-h, or 2-h plasma glucose concentrations ≥5.1, 10.0, or 8.5 mmol/L; respectively) or World Health Organization (WHO) criteria (fasting or 2-h plasma glucose ≥7.0mmol/L or ≥7.8mmol/L, respectively). Presence of anemia, variant hemoglobins and chronic renal disease were excluded. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic performance of A1c. RESULTS: A total of 262 pregnant women (mean age 30 years, mean gestational duration 26 weeks) were enrolled and 82 (31.3%) were diagnosed with diabetes (40 by ADA criteria and 42 by WHO criteria). Based on ROC curve analysis, and considering OGTT as the reference criterion, the cut-off point obtained by the point with the best equilibrium between sensitivity and specificity (100%-to-100% diagonal) was A1c value of 31 mmol⁄mol (5.3%). The sensitivity and specificity for this cut-off 27 point were 69.9 % and 65.9 %, respectively. The cut-off points of A1c of 40 mmol/mol (5.8%), 41 mmol⁄mol (5.9%) and 42 mmol⁄mol (6.0%) presented specificities of 96,1%, 96,6% and 98,3%, respectively. CONCLUSIONS: A1c test presented low sensitivity and very high specificity for GDM diagnosis when compared with traditional criteria. Our results show that 39% of GDM cases would be diagnosed by using the cut-off point A1c≥ 40 mmol/mol (5.8%) alone. A1c test, alone or in combination with OGTT, may be a very useful diagnostic tool in GDM.

Class of 2016 Abstract / Objectives: The purpose of this study is to determine whether there is a correlation between diabetes control and beverage consumption. We hypothesize that diabetes control (as measured by A1C) is inversely related to consumption of sugary sweetened beverages (SSB) in patients with type 2 diabetes. Methods: This study will be a retrospective chart review evaluating the relationship between intake of sugary sweetened beverages and hemoglobin A1C values (HgA1C). Individuals will be eligible for inclusion in the study if they are current patients at El Rio Community Health Center with type 2 diabetes and were 18 years of age or older at the time of the study. Exclusion criteria are as follows: not seen by a clinical pharmacist for diabetes within the last year (Jan 2015 – Feb 2016), no beverage consumption information available in electronic chart and/or no A1C value listed in the patient’s profile. The anticipated study population will be comprised of 330 patients. The data will be analyzed using a t-test to determine the relationship between A1C and beverage consumption. Results: 150 patients were identified from the patient pool as meeting inclusion criteria. The mean fluid ounces of SSB consumption in the low SSB intake group and high SSB intake group were 7.2 (SD=2.441) and 30.269 (SD=21.197) respectively. The mean A1C in the low SSB intake group was 8.35 (SD=2.038) and in the high SSB intake group was 8.799 (SD=1.852). There was no statistically significant difference between the mean A1C in the low SSB intake group and the high SSB intake group (p=0.2451). Conclusions: The mean A1C between high SSB intake and low SSB intake appears similar.

Managing medical care for patients with diabetes mellitus requires a comprehensive approach that includes empowering the patient to be an active participant in the management of their disease as lifestyle management, in addition to medical therapy, is a crucial component in the care of the diabetic patient. The objective of this project was to determine if implementing diabetic care cards in a family medicine residency clinic would increase patient engagement with their care in the form of knowledge concerning A1C values and subjectively feeling in control of their diabetes. The initial phase of the project involved providing diabetic patients a brief anonymous survey concerning their A1C and asking if they felt in control of their diabetes; these surveys were collected for several months. The next phase consisted of an educational lecture during formal resident physician didactic time where diabetic guidelines were discussed, diabetic care cards were introduced, and the resident physicians were encouraged to utilize the cards with their diabetic patients. After several months of implementation of the diabetic care cards in the clinic, the same anonymous survey was repeated with diabetic patients. A total of 93 anonymous patient surveys were collected prior to formal resident physician education concerning diabetic care cards and a total of 40 anonymous surveys were collected after formal resident physician education. The data from the pre and post educational surveys were then reviewed and compared and data was analyzed. Overall, A1C values did not significantly differ between the pre- and post-survey groups. Although there was a slightly higher percentage of patients who reported knowing their A1C level after the diabetic card implementation, this was not statistically significant and there was not a statistically significant difference in the percentage of patients that felt in control of their diabetes between survey groups. It was found that higher A1c values were associated with patients feeling less in control of their diabetes. A limitation of this study was realized with the methodology; it is not known if every patient who completed a survey also directly encountered the diabetic care card. The study yielded some valuable insight into patient perspective of diabetes control. It was found that an A1C less than or equal to 7%, which is the A1C goal for most diabetic patients, did not necessarily correlate with diabetic patients feeling in control of their diabetes. It was felt that this indicated that there is room for improvement in patient education concerning A1C goal. It also revealed a need for further investigation of the factors that influence whether a patient feels they are in control of their diabetes.

The use of telehealth in healthcare has grown in recent years; however, little is known about the effectiveness of this delivery method in the management of Type 2 diabetes mellitus (T2DM). Guided by the chronic care model and telehealth in chronic disease model, the purpose of this systematic literature review was to explore evidence related to lowering hemoglobin A1c levels and managing T2DM using telehealth in the outpatient setting. The practice-focused questions explored telehealth interventions used in T2DM management and their effectiveness. The Joanna Briggs Institute (JBI) method for conducting systematic literature reviews was the process, and data were compiled using the PRISMA evidence-based minimum set for reporting. Eighteen studies met the inclusion criteria for this project. Data were extracted, analyzed, and synthesized using JBI tools for data extraction and critical appraisal. Article appraisals revealed numerous telehealth interventions for management of T2DM including telephone, Internet-based, clinical video, remote monitoring, and smart phones/applications. Overall, telehealth interventions showed statistically significant improvement in the hemoglobin A1c levels of participants compared to traditional outpatient care. Success of the interventions is associated with components of evidenced-based diabetes management such as education, self-management, support, and feedback loop. The implications of this project for positive social change include the integration of telehealth interventions in the outpatient setting to manage T2DM with enhanced access to care, reduction in health disparities, and improved health outcomes for society.

Daug pasaulinių organizacijų, kurios stengiasi pagerinti cukrinio diabeto diagnostiką ir sergančių pacientų glikemijos kontrolę, nes nepakankama ir vėlyva diagnostika skatina komplikacijų atsiradimą ir progresavimą. Šio darbo tikslas išanalizuoti cukriniu diabetu sergančių pacientų metodologinių ypatumų įtaką glikozilinto hemoglobino rezultatams. Išmatavus analitę HbA1c, 100 pacientų sergančių cukriniu diabetu, trimis skirtingos standartizacijos analizinėmis sistemomis Roche-Hitachi 917, Bayer-Advia1650 ir Dade Behring-Dimension RxL, gauta koreliacija su trijų mėnesių gliukozės koncentracijos vidurkiu. Lyginant HbA1c rezultatus, referentiniu metodu Roche-Hitachi 917 analizine sistema, standartizuota Tarptautinės klinikinės chemijos ir laboratorinės medicinos federacijos (IFCC) ir Diabeto kontrolės ir komplikacijų tyrimų (DCCT), gautas skirtumas. Bayer-Advia1650 analizinė sistema, kurios HbA1c metodas standartizuotas Nacionalinės glikohemoglobino standartizacijos programos (NGSP), lyginant su mūsų referentinio metodo rezultatais, kai IFCC standartizacija r = 1.017 [0.883 iki 1.188]; y = 3.068 [1.894 iki 4.142]; n = 52; p = 0.0000001, o kai standartizacija DCCT r = 1.132 [1.060 iki 1.209]; y = 0.282 [-0.476 iki 0.990]; n = 53; p = 0.001. Dade Behring-Dimension RxL analizinės sistemos metodas standartizuotas pagal Diabeto kontrolės ir komplikacijų tyrimus (DCCT) palyginus su IFCC standartizuotu metodu rezultatais: r = 0.886 [0.767 iki 1.021]; y = 2.422 [1.630 iki 3.413]; n = 52... [toliau žr. visą tekstą] / There are many organisations trying to improve Diabetes Mellitus diagnostics, enhance glycaemia management of diabetes patients, because insufficient and late diagnosis increases formation, and complications progress. The purpose of this work was evolution of influence, of different methodological approaches to of glycated hemoglobin results. Samples of 100 patients with Diabetes Mellitus was analyzed for glucose and HbA1c. There was shown correlation between average concentration glucose‘s during three months coefficient. HbA1c was analyzed using three analytical systems of Roche-Hitachi 917, Bayer-Advia1650 and Dade Behring-Dimension RxL standardized according different standardization recommendations: International Federation of Clinical Chemistry and Laboratory Medicine (IFCC), Diabetes Control and Complications Trial (DCCT), National Glycohemoglobin Standardization Program (NGSP). Roche-Hitachi 917 results standardized according IFCC recommendations were chosen as reference. Correlation and differences between analytical systems were as follows. Roche-Hitachi 917 (IFCC) – Bayer-Advia1650 (NGSP): r = 1.017 [0.883 to 1.188]; y = 3.068 [1.894 to 4.142]; n = 52; p = 0.0000001. Roche-Hitachi 917 (DCCT) – Bayer-Advia1650 (NGSP): r = 1.132 [1.060 to 1.209]; y = 0.282 [-0.476 to 0.990]; n = 53; p = 0.001. Roche-Hitachi 917 (IFCC) – Dade Behring-Dimension RxL (DCCT): 0.886 [0.767 to 1.021]; y = 2.422 [1.630 to 3.413]; n = 52; p = 0.0000001. Roche-Hitachi 917 (DCCT) – Dade... [to full text]

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Objective: The objective of this study was to characterize the composition of the gut microbiota in type 2 Diabetes Mellitus (T2DM) patients with adequate and inadequate metabolic control, and its relationship with fiber consumption. Results: A total of 26 patients with type 2 diabetes mellitus (T2DM) were enrolled, of which 7 (26.9%) cases had adequate metabolic control (HbA1c < 7%) and 19 (73.1%) inadequate metabolic control (HbA1c ≥ 7%). It was observed that among patients with controlled T2DM, 2 (28.6%) cases presented good intake of fiber and 5 (71.4%) cases a regular intake. In contrast, in patients with uncontrolled T2DM, 13 (68.4%) patients reported a regular intake and 6 (31.6%) a poor intake. In relation to the identification of the gut microbiota, both groups presented a similar characterization. There were differences in the population of bacteria identified in both groups, however, the results were not statistically significant. The most frequently identified bacteria in controlled and uncontrolled T2DM patients were Prevotella (71.4% vs 52.6%), followed by Firmicutes (71.4% vs 42.1%), Proteobacteria (71.4% vs 36.8%) and Bacteroidetes (57.1% vs 37.8%). On the other hand, Fusobacterium, Actinobacteria were not identified in either of the two groups of study. / Revisión por pares

OBJECTIVE: Prolonged elevation of blood glucose levels in Type 2 Diabetes is related to a host of medical complications, most of which are mediated by micro and macro vascular damage. Importantly, diabetes is associated with accelerated cognitive decline and compromised brain health as the cerebral vasculature undergoes negative changes stemming from hyperglycemia. It is hypothesized that participants in the Look Ahead Brain study with higher HbA1c levels will exhibit worse performance on the cognitive measures, specifically on tasks assessing executive function. METHODS: Data on participants from the Look Ahead study who also participated in the Look Ahead Brain ancillary study (n = 113) were analyzed. This included HbA1c levels at year 10 (the year that participants were administered the cognitive assessment), mean HbA1c, and change in HbA1c from baseline to year. In order to assess executive function the results on two cognitive tests, the Modified Stroop Color and Word Test and the Trail Making Test, were analyzed. Then, relationships between HbA1c and performance on each of these cognitive tasks were analyzed using two approaches. First, the cohort was split into two group based on HbA1c (HbA1c ≤ 7% vs HbA1c > 7%). The latter of the two groups represented participants will poorer glycemic control. Second, linear correlations were assessed using the full range of HbA1c values as a continuous variable. RESULTS: There were no significant differences between HbA1c groups and performance on either of the cognitive tests. Interestingly, although not statistically significant, those with higher HbA1c levels performed slightly better on cognitive tasks. Correlation analyses revealed further trends in the direction opposite than expected, such that higher HbA1c levels were associated with better scores on both tests. CONCLUSION: The surprising results of this study are evidence of the fact that a great deal has yet to be learned about the effects of T2DM and cognitive decline. There are many potential future directions for the Look Ahead Brain data, and further analyses might provide clarifications to the results of this study.