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1.  Low Glycated Hemoglobin and Liver Disease in the U.S. Population 
Diabetes Care  2011;34(12):2548-2550.
OBJECTIVE
To characterize the association of low HbA1c values (<4.0%) with liver enzymes and steatosis.
RESEARCH DESIGN AND METHODS
Cross-sectional study of 12,533 participants without diabetes aged <20 years in the Third National Health and Nutrition Examination Survey (1988–1994). Logistic regression models were adjusted for demographic, lifestyle, and health status variables.
RESULTS
HbA1c values ranged from 3.2 to 15.7%, and 84 participants had HbA1c <4.0% in the population (mean age 44, 52% female, 15% black or Hispanic). We observed J-shaped associations between HbA1c and liver enzymes and hepatic steatosis. In adjusted models, HbA1c <4.0% was strongly associated with elevated alanine aminotransferase (OR 3.62 [95% CI 1.09–12.02]) and aspartate aminotransferase (6.80 [2.99–15.43]).
CONCLUSIONS
Low HbA1c values were associated with liver enzymes and steatosis in the U.S. population. Liver disease may partially explain the association of HbA1c with mortality and other long-term outcomes.
doi:10.2337/dc11-0944
PMCID: PMC3220829  PMID: 21953797
2.  Hemoglobin A1c is a Predictor of Healing Rate In Diabetic Wounds 
Lower-extremity wounds are a major complication of diabetes. Hemoglobin A1c (HbA1c) reflects glycemia over 2–3 months and is the standard measure used to monitor glycemia in diabetic patients, but results from studies have not shown a consistent association of HbA1c with wound healing. We hypothesized that elevated HbA1c would be most associated with poor wound healing. To test this hypothesis we conducted a retrospective cohort study of 183 diabetic individuals treated at the Johns Hopkins Wound Center. Our primary outcome was wound-area healing rate (cm2/day). Calibrated tracings of digital images were used to measure wound area. We estimated coefficients for healing rate using a multiple linear regression model controlling for clustering of wounds within individuals and other common clinic variables. The study population was 45% female and 41% black with mean age of 61 years. Mean HbA1c was 8.0% and there were 2.3 wounds per individual (310 wounds total). Of all measures assessed, only HbA1c was significantly associated with wound-area healing rate. Specifically, for each 1.0% point increase in HbA1c, the daily wound-area healing rate decreased by 0.028 cm2/day (95% CI: 0.003, 0.0054, p=0.027). Our results suggest that glycemia, as assessed by HbA1c, may be an important biomarker in predicting wound healing rate in diabetic patients.
doi:10.1038/jid.2011.176
PMCID: PMC3174328  PMID: 21697890
3.  Cranial Volume, Mild Cognitive Deficits, and Functional Limitations Associated with Diabetes in a Community Sample 
Diabetes is associated with dementia in older adults, but it remains unclear whether nondemented adults with type 2 diabetes show subtle abnormalities across cognition, neuroanatomy, and everyday functioning. Using the Aging, Brain Imaging, and Cognition study sample of 301 community-dwelling, middle-aged and older adults, we conducted a secondary analysis on 28 participants with and 150 participants without diabetes. We analyzed brain magnetic resonance imaging data, cognitive test performance, and informant ratings of personal and instrumental activities of daily living (PADL/IADL). Relative to controls, participants with diabetes had lower brain-to-intracranial volume ratios (69.3 ± 4.5% vs. 71.7 ± 4.6%; p < .02), and performed more poorly on measures of working memory, processing speed, fluency, and crystallized intelligence (all p <.05). Decrements in working memory and processing speed were associated with IADL limitations (p < .01). Nondemented adults with diabetes exhibit neuroanatomic and cognitive abnormalities. Their cognitive deficits correlate with everyday functional limitations.
doi:10.1093/arclin/acp091
PMCID: PMC2809552  PMID: 19942595
Diabetes; Endocrine disorders; Cognition; Neuropsychological testing; MRI; Function; Behavior

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