HbA1c alone is sufficient as a marker of good diabetes control
Chronic hyperglycemia is captured by A1c but not by FPG (even when repeated twice).
Microangiopathic complications (retinopathy) are associated with A1c as strongly as with FPG.
A1c is better related to cardiovascular disease than FPG.
Fasting is not needed for A1c assessment.
No acute perturbations (e.G, stress, diet, exercise, smoking) affect A1c.
A1c has a greater preanalytical stability than blood glucose.
A1c has an analytical variability not inferior to blood glucose.
Standardization of A1c assay is not inferior to blood glucose assay.
Biological variability of A1C is lower than FPG and 2-h OGTT PG.
Individual susceptibility to protein glycation might be caught by A1c.
A1c can be used concomitantly for diagnosing and initiating diabetes monitoring
Natural history of T2DM in Asia
******************************************
Diabetes is a global epidemic which is out of control, but worse in Asian countries.
It is a huge and growing problem and costs to the society are high and escalating.
Five countries from Asia figure in the top 10 and account for most cases of diabetes globally.
Asian countries share similar risk factors.
There is an association between economic growth and diabetes.
Rapid urbanization and modernization obesogenic environment i.E. Physical inactivity, psychosocial stress and abundance of food
Asians are prone to developing diabetes at a lower level of obesity.
Diabetes has the potential to negatively impact economy and may bankrupt healthcare systems.
Cost effective interventions in healthy living and diet decrease the burden of diabetes and save on healthcare costs and lost productivity.
There has been a dramatic rise in the number of diabetic population in Korea: economic growth, greater exposure to risk factors (lifestyle and diet), demographic changes (childhood obesity, aging population).
Hypertriglyceridemia: The most difficult lipid disorder to evaluate and treat
-----------------------------------------------------------------------------------------------------
Hypertriglyceridemia is the most difficult lipid disorder to evaluate and treat. Hypertriglyceridemic disorder in adults is not a single gene. We do not know if TGs by themselves are an atherogenic risk or is it because of the company they keep.
The intra-individual biological variability (diurnal and monthly) of lipids make it more difficult to define hypertriglyceridemia.
TGs are inversely associated with HDL-C, if high HDL-C levels, almost always TGs are low.
Dietary treatment of severe hypertriglyceridemia: <5%, no alcohol, discontinue all TG-lowering drugs, monitor TG q 3 days until levels are below 1000, then restart treatment.
Fibrates do not reduce the CHD events in high risk patient groups. What impact hypertriglyceridemia has on CHD outcomes is not yet clear.
Lower fasting TG to less than 500 mg/dL; this will reduce the risk of pancreatitis.
Follow the current guideline recommendations to lower LDL-C.
The real value of Apo-B is in patients who do not have raised LDL-C (<100 mg/dL). In such patients it can be very informative and should be taken as an indicator of CVD risk.
Plasma apoB and the other cholesterol indexes are complementary rather than competitive indexes of atherosclerotic risk (Am J Cardiol. 2003 May 15;91(10):1173).
Baseline TGs are determinants of the response to bezafibrate (BIP trial).
Omega-3 fatty acids are beneficial in reducing CV risk (JELIS; Lancet 2007), especially in patients with high TG and low HDL-C (Atherosclerosis. 2008).
If fasting TG is >200 mg/dL and HDL-C <35 mg/dL, consider a fibrate or omega-3 fatty acid.