Developing and Validating an Equation to Predict Hemoglobin A1c in Type 2 Diabetic Patients at Phanatnikhom Hospital
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Published:
Feb 10, 2019
Keywords:
plasma blood glucose Hemoglobin A1c diabetes mellitus glycemic control
Main Article Content
Abstract
Objective: To develop and validate an equation to predict hemoglobin A1c in type 2 diabetic patients. Methods: The study was a cross-sectional study in outpatients in diabetes care service at Phanatnikhom Hospital. Those who met the inclusion criteria were assigned into 2 groups by systematic random sampling. Every fourth patient was allocated into the equation validating group and the others were in equation developing group. The data collected from medical records and history taking of participants included age, body mass index, number of medicines (no.DRUG), duration of diabetes mellitus and laboratory data such as, fasting plasma glucose (FPG) and HbA1c. Stepwise multiple regression analysis (MRA) was performed to develop predicting equation and test its predictive power. Results: 197 recruited participants were allocated into 148 in equation developing group and 49 in validating group. The analysis showed that FPG and no.DRUG were statistically significant predictors of HbA1c (R2 = 0.405; P<0.001). The HbA1c predicting equation was HbA1c = 3.896 + 0.020(FPG) + 0.278(no.DRUG). The validation found 0.8% of the mean prediction error of HbA1c and the typical prediction error of 10.35%. Correlation of the predicted HbA1c value and that from laboratory test was quite high (r=0.75). Conclusion: FPG and no.DRUG were important predictors of HbA1c in type 2 diabetic patients. Validation test showed that the precision of equation is good and the equation is helpful in predicting glycemic control among patients with diabetes in hospitals where HbA1c testings are infrequently done.
Article Details
Section
Research Articles
ผลการวิจัยและความคิดเห็นที่ปรากฏในบทความถือเป็นความคิดเห็นและอยู่ในความรับผิดชอบของผู้นิพนธ์ มิใช่ความเห็นหรือความรับผิดชอบของกองบรรณาธิการ หรือคณะเภสัชศาสตร์ มหาวิทยาลัยสงขลานครินทร์ ทั้งนี้ไม่รวมความผิดพลาดอันเกิดจากการพิมพ์ บทความที่ได้รับการเผยแพร่โดยวารสารเภสัชกรรมไทยถือเป็นสิทธิ์ของวารสารฯ
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33. Bruce DG, Davis WA, Davis TME. Glycemic control in older subjects with type 2 diabetes mellitus in the fremantle diabetes study. J Am Geriatr Soc. 2000;48:1449-53.
34. Khattab M, Khader YS, Al-Khawaldeh A, Ajlouni K. Factors associated with poor glycemic control among patients with type 2 diabetes. J Diabetes Complications. 2010;24:84-9.
35. Verma M, Paneri S, Badi P, Raman PG. Effect of increasing duration of diabetes mellitus type 2 on glycated hemoglobin and insulin sensitivity. Indian J Clin Biochem. 2006;21:142-6.
36. Goud M, Nayal B, Devi S, Sathisha TG, Shivas hanker S, Devaki RN. Relation of calculated HbA1c with fasting plasma glucose and duration of diabetes. Int J Appl Biol Pharm. 2011;2:58-61.
37. Intensive blood-glucose control with sulphonyl ureas or insulin compared with conventional treat ment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837-53.
38. College of Sports Science and Technology. BMI [online]. 2017 [cited Aug 30, 2017]. Available from: ss.mahidol.ac.th/th2/index.php?option=com_k2&view=item&layout=item&id=2&Itemid=136.
2. American Diabetes Association. Standards of medical care in diabetes. Diabetes care. 2018; 41: S1-159.
3. Diabetes Association of Thailand, Endocrine Society of Thailand, Department of Medical Services, National Health Security Office. Clinical practice guideline for diabetes. Bangkok: Romyen Media; 2017: 1-210.
4. Bonora E, Calcaterra F, Lombardi S, Bonfante N, Formentini G, Bonadonna RC, et al. Plasma glucose levels throughout the day and HbA1c interrelationships in type 2 diabetes: implications for treatment and monitoring of metabolic control. Diabetes care. 2001;24:2023-9.
5. Charoenhirunyingyos W, Nitiyanant W, Thabsang P, Sriussadaporn S, Vannasaeng S. Blood glucose patterns in type 2 diabetic patients with optimal fasting plasma glucose but high HbA1c. J Med Assoc Thai. 2011;94:278-85.
6. Ketema EB, Kibret KT. Correlation of fasting and postprandial plasma glucose with HbA1c in assessing glycemic control; systematic review and meta-analysis. Arch Public Health. 2015;73:1-9.
7. Pichayapaiboon S. Area under the curve of glucose: an accurate indicator of glucose control in type 2 diabetic patients [dissertation]. Bangkok: Chulalong korn University; 2011.
8. Saiedullah M, Begum S, Shermin S, Rahman M, Khan M. Relationship of glycosylated hemoglobin with fasting and postprandial plasma glucose in nondiabetic, pre-diabetic and newly diagnosed diabetic subjects. Bangladesh Med J 2011;40:37-8.
9. Shrestha L, Jha B, Yadav B, Sharma S. Correlation between fasting blood glucose, postprandial blood glucose and glycated hemoglobin in non-insulin treated type 2 diabetic subjects. Sunsari Technical College Journal 2012;1:18-21.
10. Ketsuwan T. Correlation between HbA1c and blood levels in patients with type 2 diabetes mellitus. [master thesis]. Bangkok: Chulalongkorn University; 2016.
11. Mekvanich N. The relationship between fasting plasma glucose and hemoglobin A1c for creating average plasma glucose chart in diabetic patients of Pranangklao Hospital. Journal of the Medical Technologist Association of Thailand 2557; 42: 75-89.
12. Praditthakorn V. Developing and validating an equation to predict blood glucose level in diabetic patients at Police General Hospital. [master thesis]. Bangkok: Chulalongkorn University; 2011.
13. Nitin S. HbA1c and factors other than diabetes mellitus affecting it. Singapore Med J 2010; 51: 616 -22.
14. Phillips PJ. HbA1c and monitoring glycaemia. Aust Fam Physician. 2012;41:37-9.
15. Hinzmann R, Schlaeger C, Tran CT. What do we need beyond hemoglobin A1c to get the complete picture of glycemia in people with diabetes? Int J Med Sci. 2012;9:665-81.
16. Chew BH, Ghazali SS, Ismail M, Haniff J, Bujang MA. Age >/= 60 years was an independent risk factor for diabetes-related complications despite good control of cardiovascular risk factors in patients with type 2 diabetes mellitus. Exp Gerontol 2013;48:485-91.
17. Ewenighi C, Dimkpa U, Adejumo B, Onyeanusi J, Nnatuanya I, Simon U, et al. The effect of age, gender, level of adiposity and diabetes duration on glycated hemoglobin reduction after anti-diabetic therapy in type-2 diabetic patients. Journal of Diabetes Mellitus 2012;2:245-50.
18. Juarez DT, Sentell T, Tokumaru S, Goo R, Davis JW, Mau MM. Factors associated with poor glycemic control or wide glycemic variability among diabetes patients in Hawaii, 2006-2009. Prev Chro nic Dis. 2012;9:1-10.
19. Roush G, Salonga A, Bajaj N. A longitudinal study of sociodemographic predictors of hemoglobin A1c. Conn Med. 2011;75:325-8.
20. Sanal TS, Nair NS, Adhikari P. Factors associated with poor control of type 2 diabetes mellitus: A systematic review and meta-analysis. Journal of Diabetology. 2011;2:1-10.
21. Shamshirgaran SM, Mamaghanian A, Aliasgarza deh A, Aiminisani N, Iranparvar-Alamdari M, Ataie J. Age differences in diabetes-related complications and glycemic control. BMC Endocr Disord. 2017; 17: 25.
22. Thorpe SR, Baynes JW. Role of the maillard reac tion in diabetes mellitus and diseases of aging. Drugs Aging. 1996; 9: 69-77.
23. Abdullah A, Peeters A, Courten M, Stoelwinder J. The magnitude of association between overweight and obesity and the risk of diabetes: A meta-analysis of prospective cohort studies. Diabetes Res Clin Pract. 2010; 89: 309-19.
24. Chung JO, Cho DH, Chung DJ, Chung MY. Associations among body mass index, insulin resistance, and pancreatic beta-cell function in Korean patients with new-onset type 2 diabetes. Korean J Intern Med. 2012; 27: 66-71.
25. Garca-Estevez DA, Araujo-Vilar D, Saavedra-Gon zalez A, Fiestras-Janeiro G, Cabezas-Cerrato J. Analysis of the relationship between body mass index, insulin resistance, and beta-cell function: a cross-sectional study using the minimal model. Metabolism. 2004;53:1462-6.
26. Matthaei S, Stumvoll M, Kellerer M, Haring HU. Pathophysiology and pharmacological treatment of insulin resistance. Endocr Rev. 2000;21:585-618.
27. Intarapiroj T, Pueakpong P. Adipose tissue hormones: Leptin, Adiponectin and Resistin. Thai Bulletin of Pharmaceutical Sciences 2011;6:1-18.
28. Benoit SR, Fleming R, Philis-Tsimikas A, Ji M. Predictors of glycemic control among patients with Type 2 diabetes: A longitudinal study. BMC Public Health. 2005;5:1-9.
29. de Pablos-Velasco P, Parhofer KG, Bradley C, Eschwege E, Gonder-Frederick L, Maheux P, et al. Current level of glycaemic control and its associated factors in patients with type 2 diabetes across Europe: data from the PANORAMA study. Clin Endocrinol. 2014;80:47-56.
30. Donnelly LA, Morris AD, Evans JM. Adherence to insulin and its association with glycaemic control in patients with type 2 diabetes. QJM. 2007;100:345-50.
31. Willey CJ, Andrade SE, Cohen J, Fuller JC, Gurwitz JH. Polypharmacy with oral antidiabetic agents: an indicator of poor glycemic control. Am J Manag Care. 2006;12:435-40.
32. Badedi M, Solan Y, Darraj H, Sabai A, Mahfouz M, Alamodi S, et al. Factors associated with long-term control of type 2 diabetes mellitus. J Diabetes Res. 2016:19.
33. Bruce DG, Davis WA, Davis TME. Glycemic control in older subjects with type 2 diabetes mellitus in the fremantle diabetes study. J Am Geriatr Soc. 2000;48:1449-53.
34. Khattab M, Khader YS, Al-Khawaldeh A, Ajlouni K. Factors associated with poor glycemic control among patients with type 2 diabetes. J Diabetes Complications. 2010;24:84-9.
35. Verma M, Paneri S, Badi P, Raman PG. Effect of increasing duration of diabetes mellitus type 2 on glycated hemoglobin and insulin sensitivity. Indian J Clin Biochem. 2006;21:142-6.
36. Goud M, Nayal B, Devi S, Sathisha TG, Shivas hanker S, Devaki RN. Relation of calculated HbA1c with fasting plasma glucose and duration of diabetes. Int J Appl Biol Pharm. 2011;2:58-61.
37. Intensive blood-glucose control with sulphonyl ureas or insulin compared with conventional treat ment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837-53.
38. College of Sports Science and Technology. BMI [online]. 2017 [cited Aug 30, 2017]. Available from: ss.mahidol.ac.th/th2/index.php?option=com_k2&view=item&layout=item&id=2&Itemid=136.
