Incidence and prevalence of cardiometabolic diseases, have increased in the last four decades, to epidemic proportions worldwide. Despite a significant decline in the morbidity and mortality related, to cardiovascular diseases in industrialized nations, diabetes related deaths are on the rise. Patients with type-2 diabetes, suffer from a greater risk of vascular disease, often in association with dyslipidaemia. Majority of clinics, use fasting glucose or impaired glucose tolerance, to determine the progress of prediabetic state to that of diabetes.
In view of the fact, that glycated haemoglobin A1c (HbA1c), represents three months average value of the glycemic load, it is used as the gold standard, to monitor the success or otherwise of the interventions, as well as progress or regression of the disease. Hypothyroidism causes many cardiometabolic abnormalities, as well as clinical symptoms, including insulin resistance, hypertension and dyslipidaemia, known features of type-2 diabetes. In this case report, we have presented our preliminary findings on, forty long-term diabetic subjects, less than 70 years of age and under regular supervised medical management.
We have screened these patients, for vascular dysfunction using thermal imaging, to obtain risk scores for diabetes, hypertension and dyslipidaemia. Our study shows, that at clinically significant value of HbA1c (> 6.5), the observed values correlate well, with diabetes risk index. However, in some individuals with HbA1c greater than 9, the risk index is less than 3, indicating a moderate risk. In these patients, HbA1c seems to be independent of the state of diabetes condition, which is usually directly associated with HbA1c levels in type-2 diabetes. Results of these studies raise some very important questions on the role of glycemic load on treating diabetic patients with co-morbidities. What are the underlying mechanisms that promote vascular complications in diabetic patients with high levels of HbA1c? In the case of diabetic patients with comorbidities, is HbA1C sufficient for treatment? Further studies with a larger cohort, will provide answers to these very important questions related to the role of glycated proteins and lipids in the pathophysiology of endocrine disorders.
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