Thesis advisor: Samuel Richardson / HbA1c levels are the most frequently used test for diagnosis and prognosis of diabetes mellitus. Recent studies have shown the biases this test has in particular cohorts, that was not noted when it was originally accepted by the American Diabetes Association in 2008. This study examined how these biases affect HbA1c’s ability as a predictor for complications that arise due to diabetes in specific cohorts, those of ethnicity, age, weight, and other patient attributes, compared to other established diabetes prognosis tests. We discovered that both glucose and HbA1c share similar biases as predictors for particular cohorts (the high glucose, high BMI, Asian, African, and Hispanic descent cohorts), HbA1c works better as a predictor when it is combined with the results of a glucose test and more characteristics of the patient compared to a HbA1c test alone with fewer variables, and glucose and HbA1c are better predictors for different diseases, respectively, that may arise due to diabetes mellitus. / Thesis (BA) — Boston College, 2020. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: Departmental Honors. / Discipline: Economics.

Aims: The intravenous application of the chlorite-based drug solution WF10 is known to improve wound healing in patients with diabetic foot syndrome. In this retrospective study, we addressed the question, which effects are caused by this drug in patients with diabetic foot ulcers on the hemoglobin A1c value. Methods: Patients received five consecutive daily infusions of WF10. Three patients received a second cycle of WF10, and one patient a third cycle. Results: On a group of twelve patients with diabetic foot syndrome, WF10 gradually reduced the HbA1c values from a high-risk range (9.1 ± 1.6% (76 ± 13 mmol/mol)) into a low-risk range in all patients but one. These values remain low over at least 8 to 12 weeks after the administration of WF10. This drug improved also considerably wound healing processes in eleven patients. Conclusions: The chlorite component of WF10 is known to inactivate efficiently free cytotoxic hemoglobin forms that might accumulate in peripheral blood after hemolysis and induces the removal of predamaged red blood cells from circulation. By these mechanisms WF10 diminished toxic effects of hemolysis, improved microcirculation and glucose consumption in affected tissues, and prevented, thus, below knee amputation.

Bakgrund: Antalet personer med diabetes i världen ökar ständigt. Dåliga levnadsvanor ökar risken för diabeteskomplikationer. Vården har ett ansvar att stärka patientens motivation och förmåga till egenvård.  Syfte: Undersöka effekten av MI som behandlingsmetod för att hjälpa diabetespatienter till förbättrad egenvård.    Metod: Litteraturstudie. Artikelsökningar gjordes i de medicinska databaserna Pubmed, Cinahl och Scopus. I studien inkluderades 10 originalartiklar varav fem var av medelkvalitet och fem av hög kvalitet. Dessa delades in i två grupper vilka var effekt på HbA1c och blodfetter samt effekt på egenvård.    Resultat: Utifrån inkluderade studier kunde ingen signifikant effekt påvisas i HbA1c och blodfetter eller gällande kost, fysisk aktivitet eller medicinsk följsamhet. Däremot sågs positiv effekt vid mätningar av upplevd kompetens, kunskap och egenkontroll. En studie visade positiv effekt på HbA1c av MI i kombination med KBT.  De effekter som kunde påvisas avtog kort tid efter behandlingssessionerna upphört. Studiernas utformning och mätmetoder ifrågasattes.    Slutsats: I nuläget finns få studier inom området därför är det för tidigt att rekommendera MI som metod inom diabetesvården. Mer forskning behövs om MI med tydligare fokus på personalens relation med patienten och personalens MI-färdigheter om man syftar till att mäta effekten av MI-samtalet. / Background: The number of people with diabetes in the world is constantly increasing. Bad food habits increase the risk of diabetes complications. Healthcare has a responsibility to enhance the patient's motivation and ability for self-care. Objective: Investigate the impact of MI as a treatment to help patients with diabetes to better self-care. Method: Literature review. The search for articles were made in the medical databases Pubmed , Cinahl and Scopus. The study included 10 original articles of which five were medium and five high quality. These were divided into two groups, effect on HbA1c and blood lipids and effect on self-care. Results: Based on the included studies, no significant effect is demonstrated in HbA1c and blood lipids or current diet, physical activity or medical adherence. There was however a positive effect in measurements of perceived competence, knowledge and self-control. One study demonstrates a positive effect on HbA1c of MI in combination with CBT. The effects found subsided shortly after the treatment sessions ended. Study design and measurement methods were questioned. Conclusion: Few studies exist in the field, therefore, it is too early to yet recommend the MI-method in diabetes care. More research is needed on MI with a clearer focus on the interviewers relationship with the patient and the MI skills of the interviewers if one aims to measure the effect of the MI-sessions.

Der Diabetes mellitus zählt zu den Hauptursachen einer terminalen Niereninsuffizienz. Aufgrund der veränderten Erythropoiese ist die Verwendung des HbA1c für die Beurteilung der Stoffwechseleinstellung bei Diabetikern mit einer chronischen Nierenerkrankung im Stadium 5 nach KDOQI immer noch in Frage gestellt. Die vorliegende Arbeit untersuchte die HbA1c-Variabilität in Abhängigkeit der ESA-Dosis und des ESA-Präparates bei Hämodialysepatienten. Zum Einsatz kamen entweder das klassische Epoetin-Analogon Erythropoietin α oder ein Wirkstoff der neueren Generation Methoxy-Polyethylenglycol-Epoetin beta. Es wurden 102 Hämodialysepatienten, darunter 41 Diabetiker und 61 Nicht-Diabetiker, über einen Zeitraum von neun Monaten beobachtet. Von den Untersuchungsteilnehmern erhielten 48 Patienten Epoetin α und 54 Patienten Methoxy-Polyethylenglycol-Epoetin beta. Unsere Daten konnten zeigen, dass es zu einer Beeinflussung des HbA1c durch die Therapie mit ESA-Präparaten kommt. Das als alternativer Stoffwechselparameter fungierende Fructosamin unterlag keiner derartigen Beeinflussung, korrelierte jedoch nur ungenügend mit den höheren Blutzuckerwerten, sodass seine Anwendbarkeit bei Diabetikern ebenfalls erheblich einschränkt ist. In der Gegenüberstellung der beiden ESA-Präparate erzielten beide Wirkstoffe vergleichbare Ergebnisse bezüglich des Erreichens der Hämoglobin-Zielwerte. Methoxy-Polyethylenglycol-Epoetin beta zeigte im Gegensatz zu Epoetin α eine seltener notwendige Dosisanpassung und längere Applikationsintervalle. Aus der vorliegenden Arbeit geht hervor, dass bei Hämodialysepatienten das HbA1c kritisch und mit Bedacht auf mögliche Einflussfaktoren interpretiert werden sollte. Es ist dennoch derzeit der konstanteste Parameter in der Stoffwechselverlaufskontrolle bei Diabetes mellitus.

Literature review part of this thesis focuses on the diabetes mellitus diagnosis and its negative effects on mental health and social relationships of diagnosed patients in form of diabetes distress. The research part investigates change of diabetes distress measured by Diabetes distress scale (DDS) and glycated haemoglobin HbA1c in the beginning, at the end and 6 months after the end of the group educational course. The group consisted of 66 Czech people diagnosed with type 2 diabetes (mean age 62 years, SD = 9,77; median = 63,5). Increased diabetes distress (DDS value ≥ 2) in the 1st measurement of DDS was reported by 15 people out of 52 (29%). There was a significant decrease in HbA1c from the beginning to the end of the course (χ2 (2) = 22.5; p <0,001) and this low level was maintained even after 6 months after the course. A non-significant reduction in diabetes distress between 1st and 2nd measurement was observed in 45 subjects (W = 509; p = 0,098). A statistically significant reduction in diabetes distress was observed between the 1st and 2nd DDS measurement only in those 23 subjects (χ2 (2) = 9,50; p = 0,002) who also participated in 3rd DDS measurement - further research in this area would be appropriate. In our sample, no significant difference was found between the sexes, DDS and HbA1c,...

Bakgrund: Diabetes mellitus typ 2 (DMT2) är en snabbt växande sjukdom i dagens samhälle. Vid diabetes är egenvård viktigt och ett stort ansvar ligger på individen. Att ha en hälsosam livsstil kan göra mycket för att minska risken för komplikationer och för att skapa balans i sitt dagliga liv. Empowerment vid diabetes kan vara viktigt för att känna sig trygg och för att känna kontroll över sin sjukdom. Syfte: Att beskriva empowerment och egenvårdsförmåga hos personer med diabetes mellitus typ 2. Metod: Examensarbetet genomfördes som en litteraturöversikt och baserades på 12 vetenskapliga studier med kvantitativ ansats. Dataanalys genomfördes enligt Fribergs trestegsmodell. Resultat: Ett positivt samband kunde ses mellan empowerment och egenvårds-förmåga hos personer med DMT2. Kunskap och utbildning har visats vara viktigt för att skapa trygghet. Hög känsla av empowerment och god egenvårdsförmåga har visat sig ha en reducerande effekt på HbA1c-värdet. Slutsats: Utbildning i empowerment kan tillämpas för att främja personer med DMT2 egenvårdsförmåga. Det är betydelsefullt att vårdpersonal har god kunskap kring empowerment för att kunna ge råd och stöd till personer med diabetes, och för att kunna skapa en god vårdrelation.

Peripheral artery disease (PAD) affects 8 to 10 million Americans, and the incidence of PAD is expected to increase as the population ages. A high percentage of the PAD is undiagnosed prior to the onset of a serious cardiovascular event; therefore, the inability to screen and diagnose for PAD in the early stages could hinder efforts to decrease adverse consequences of cardiovascular disease. Individuals with PAD have a 3 to 5 times increased risk of cardiovascular disease (CVD) mortality when compared to people without PAD. Guided by the Stetler model, the purpose of this project was to evaluate the relationship between level of PAD, as measured by skin perfusion pressure, and HbA1c using secondary data obtained from charts of patients within the clinic setting. Data included patient gender, age, degree of PAD, and HbA1c. A Pearson's correlation investigated the relationship between the patients' HbA1c and level of PAD. There was a significant relationship between HbA1c and LT PAD (r = .21, p =.009). There was no relation in RT PAD (r =.01, n = 149, p = .90). There was a significant relationship between HbA1c and age (r = .34, p = .00). Ultimately, the goal of this study was to improve PAD recognition, encourage early intervention, and facilitate effective preventive methods. Critical limb ischemia might be delayed or prevented if it is identified earlier by screening methodologies. Early identification and treatment of PAD can improve the quality of life and care for individuals suffering with PAD.

<p><strong>Målsättning</strong><strong></strong></p><p>Att utreda skillnader i tillgänglighet till insulinpump mellan olika patientgrupper samt vad som orsakar ett byte till insulinpump.</p><p><strong>Metod</strong><strong></strong></p><p>Data från 7224 individer med typ 1 diabetes vid tio olika vårdenheter analyserades för att utreda effekterna av njurfunktion, kön, långtidsblodsocker, insulindos, diabetesduration samt ålder. Jämförelsen mellan patientgrupper utfördes med logistisk regression som en tvärsnittsstudie och Cox-regression för att utreda vad som föregått ett byte till pump.</p><p><strong>Resultat</strong><strong></strong></p><p>Genom logistisk regression erhölls en bild av hur skillnader mellan patienter som använder insulinpump och patienter som inte gör det ser ut i dagsläget. Cox-regressionen tar med ett tidsperspektiv och ger på så sätt svar på vad som föregått ett byte till insulinpump. Dessa analyser gav liknande resultat gällande variabler konstanta över tiden. Kvinnor använder pump i större utsträckning än män och andelen pumpanvändare skiljer sig åt vid olika vårdenheter. I dagsläget visar sig hög ålder sänka sannolikheten att använda insulinpump, vilket bekräftas vid den tidsberoende studien som visade hur sannolikheten att byta till pump är avsevärt lägre vid hög ålder. Långtidsblodsockret har också tydlig effekt på sannolikheten att gå över till pump där ett högt långtidsblodsocker medför hög sannolikhet att byta till insulinpump.</p><p><strong>Slutsatser</strong><strong></strong></p><p>I dagsläget finns det skillnader i andelen insulinpumpanvändare mellan olika patientgrupper och skillnader finns även i de olika gruppernas benägenhet att byta från andra insulinbehandlingar till insulinpump. Beroende av patienters njurfunktion, kön, långtidsblodsocker, insulindos, diabetesduration och ålder har dessa olika sannolikheter att byta till insulinpump.<strong></strong></p>

<p> </p><p>The aim of the study was auditing medical records examine postoperative blood glucose levels after undergoing CABG surgery. Furthermore the aim was to determine if the ward staff abides the local guidelines frame of reference concerning each ward, regarding blood glucose measurements and blood glucose levels. The study included 70 patients undergoing CABG surgery at the cardiothoracic surgery, Uppsala University Hospital. The study was conducted by retrospective medical record auditing. Studied factors were postoperative blood glucose levels, number of registered blood glucose measurements, a current diagnosis of DM and preoperative HbA_1c. Mean level of blood glucose levels stayed continuously above the local guidelines frame of reference for both TIVA/TIMA and the care ward throughout the continuity of patient care. The number of registered blood glucose measurements per postoperative day at TIVA/TIMA where within the local guidelines. The result showed that the local guidelines frame of reference concerning the ward were not reached. A difference could be seen between patients with DM and patients without DM regarding the previously mentioned factors. Preoperative elevated levels of HbA_1c could have influenced the number of postoperative blood glucose measurements. Recommendations will therefore be too audit the current local guideline that concerns the treatment, therapy goals and the number of blood glucose measurements. Establishing criterions regarding termination of blood glucose measurements and the transfer day between TIVA/TIMA and the care ward are recommended.</p><p> </p>

Background: For people with type 1 diabetes, there is no alternative to treatment with insulin. The major side effect of insulin is severe hypoglycaemia (SH), when the patient needs help or even becomes unconscious. Material: We have studied a geographic population of yearly 130-140 unselected type 1 diabetes patients aged 1-18 years during 1992-1999. They were intensively treated with 87-96% on 4-7 daily insulin doses, combined with active self-control, psychosocial support and problem-based education from onset. Average HbA1c was 6.5 with Mono-S standard (1.15% beow DCCT level). Methods: We evaluated use of a prospective patient questionnaire for continuous long-term registration of treatment and outcome data and analysed HbA1c, SH and other variables. Over years, 95-100% response rate was achieved. We used also temporary questionnaries. Results: We found SH with unconsciousness reported from on average 11% of patients yearly, SH without unconsciousness but needing assistance from on average 36% yearly and weak associations to HbA1c, such as reletive risk of SH 1.24 for yearly mean HbA1c &lt;7.0% compared to ≥7.0% There was a seasonal variation in HbA1c (p=0.023) and incidence of SH. The strongest predictor for SH was SH during the previous year (r=9.38, p&lt;0.0001). The impact from SH showed great variation, and 20-30% of events led to practical disturbancies for parents and/or other people. Hospital visits took place only at 5% and hospitalisations at 3% of events. Social activities for patients were cancelled after 10% of events. Increased worry for patients was reported after 8% of events, bad sleep after 7%. We estimated the average socio-economic cost for SH at EURO 239 per event of SH with unconsciousness, and EURO 63 per event of SH without unconsciousness but needing assistance. Mass-distributed self-study material (brochures and videos) aimed at the prevention of SH without compromising metabolic control reached high dissemination and was widely appreciated by patients. The material copy cost was only EURO 7 per patient. It also seems to have contributed to a decrease in SH with unconsciousness from yearly 13% of patients before to 9% after intervention (3-years average), but controlled studies are needed. Conclusions: We conclude that SH remains a very serious problem of multifactorial aethiology. It causes considerable discomfort and costs. Systematic patient education mgiht reduce the incidence. Interventions using mass-distribution of high quality self-study material such as videos and brochures seem to have a potential to be cost-effective. There is a great patient/consumer interest in high quality- and advanced information/education materials.