Chatchalit Rattarasarn

Postprandial plasma glucose: a good index of glycemic control in type 2 diabetic patients having near-normal fasting glucose levels.

To investigate the effect of postprandial plasma glucose (PG) concentrations on HbA1c levels in type 2 diabetic patients, we evaluated the relationship between HbA1c levels and postprandial PG concentrations after a meal tolerance test in 35 type 2 diabetic patients who had fasting PG concentrations persistently < 7.8 mmol/l and stable HbA1c levels. Two-hour postprandial PG concentrations were found to be more strongly correlated (r = 0.51) with HbA1c levels than 1-h postprandial PG (r = 0.35) and fasting PG (r = 0.46) concentrations. Patients whose HbA1c levels were high (HbA1c > or = 7%) had significantly higher 2-h postprandial PG concentrations and areas under the glucose curve than those whose HbA1c levels were lower (8.12+/-1.10 (SD) vs 6.70+/-2.22 mmol l(-1), P = 0.004 and 17.43+/-1.92 vs 15.58+/-3.26 mmol h(-1) l(-1), P = 0.02, respectively). Although fasting PG concentrations of patients with higher HbA1c levels were slightly higher, they did not differ significantly from those with lower HbA1c levels (6.21+/-0.89 vs 5.73+/-0.68 mmol l(-1)). Age, duration of diabetes, body mass index, serum C-peptide, both fasting and postprandial, did not differ between these two groups. This study suggests that postprandial hyperglycemia, particularly 2-h postprandial PG concentrations, is associated with high HbA1c levels in type 2 diabetic patients whose fasting PG levels were within normal or near-normal levels.

Regional Abdominal Fat Distribution in Lean and Obese Thai Type 2 Diabetic Women: Relationships With Insulin Sensitivity and Cardiovascular Risk Factors

To determine the relationships of body fat distribution and insulin sensitivity and cardiovascular risk factors in lean and obese Thai type 2 diabetic women, 9 lean and 11 obese subjects, with respective mean age 41.7 +/- 6.3 (SD) and 48.0 +/- 8.5 years, and mean body mass index (BMI) 23.5 +/- 1.8 and 30.3 +/- 3.7 kg/m2, were studied. The amount of total body fat (TBF) and total abdominal fat (AF) were measured by dual-energy x-ray absorptiometer, whereas subcutaneous (SAF) and visceral abdominal fat areas (VAF) were measured by computerized tomography (CT) of the abdomen at the L4-L5 level. Insulin sensitivity was determined by euglycemic hyperinsulinemic clamp. Cardiovascular risk factors, which included fasting and post-glucose challenged plasma glucose and insulin, systolic (SBP) and diastolic blood pressure (DBP), lipid profile, fibrinogen, and uric acid, were also determined. VAF was inversely correlated with insulin sensitivity as determined by glucose infusion rate (GIR) during the clamp, in both lean (r=-0.8821; P=.009) and obese subjects (r=-0.582; P=.078) independent of percent TBF. SAF and TBF were not correlated with GIR. With regards to cardiovascular risk factors, VAF was correlated with SBP (r=0.5279; P=.024) and DBP (r=0.6492; P=.004), fasting insulin (r=0.7256; P=.001) and uric acid (r=0.4963; P=.036) after adjustment for percent TBF. In contrast, TBF was correlated with fasting insulin (r=0.517; P=.023), area under the curve (AUC) of insulin (r=0.625; P=.004), triglyceride (TG) (r=0.668; P=.002), and uric acid (r=0.49; P=.033). GIR was not correlated with any of cardiovascular risk factors independent of VAF. In conclusion, VAF was a strong determinant of insulin sensitivity and several cardiovascular risk factors in both lean and obese Thai type 2 diabetic women.

Relationships of body fat distribution, insulin sensitivity and cardiovascular risk factors in lean, healthy non-diabetic Thai men and women

In order to study the relationships of body fat distribution, insulin sensitivity and cardiovascular risk factors in lean, healthy non-diabetic Thai men and women, 32 healthy, non-diabetic subjects, 16 men and 16 women, with respective mean age 28.4+/-6.6 (S.D.) and 32.8+/-8.9 years, mean BMI 21.0+/-2.8 and 21.2+/-3.7 kg/m(2), were measured for total body fat and abdominal fat by dual energy X-ray absorptiometry (DEXA), anthropometry and insulin sensitivity by euglycemic hyperinsulinemic clamp. Cardiovascular risk factors included fasting and post-glucose challenge plasma glucose and insulin, blood pressure, lipid profile, fibrinogen and uric acid. For similar age and BMI, men had a lower amount and percent of total body fat, but had a higher proportion of abdominal/total body fat than women. In men, insulin sensitivity, as determined by glucose infusion rate during euglycemic hyperinsulinemic clamp, was inversely correlated with total body fat, abdominal fat, BMI and waist circumference, whereas only total body fat, but not abdominal fat, BW and hip circumference were inversely correlated with insulin sensitivity in women. No cardiovascular risk factors, except area under the curve (AUC), of plasma insulin in women correlated with insulin sensitivity when adjusted for total body fat. After age adjustment, total body fat was better correlated with fasting and AUC of plasma glucose and insulin in men and with systolic blood pressure as well as triglyceride levels in women. Only HDL-C in men was better correlated with abdominal fat. In conclusion, there were sex-differences in body fat distribution and its relationship with insulin sensitivity and cardiovascular risk factors in lean, healthy non-diabetic Thai subjects. Total body fat was a major determinant of insulin sensitivity in both men and women, abdominal fat may play a role in men only. Body fat, not insulin sensitivity, was associated with cardiovascular risk factors in these lean subjects.

Causes of death, incidence and risk factors of cardiovascular diseases in Thai type 2 diabetic patients: a 5-year follow-up study

There appear to be ethnic disparities in frequencies of diabetic complications in type 2 diabetic patients and such data from Asian countries are relatively few and limited. Thai type 2 diabetic patients who attended the diabetic clinic at Prince of Songkla University hospital during January-December 1997 and had no history of coronary heart disease (CHD) and stroke were studied to determine cause of death and to establish the incidence of and risk factors for cardiovascular disease (CVD). All patients were followed to death or to the end of year 2001. End-points included death from any cause, fatal and nonfatal CHD, fatal and nonfatal stroke and lower-extremity amputation. There were 229 patients who were followed for 4.2+/0.7 (S.D.) years (range: 0.6-5.0) with total follow-up period 958.2 patient-years. Twenty-nine patients died during follow-up; the total mortality rate was 30.3 (95%CI 20.2-43.4)/1000 patient-years. Of these, 9(9.4/1000 patient-years; 95%CI 4.3-17.8) died from sepsis, 7(7.3/1000 patient-years; 95%CI 2.9-15.0) from CVD, 5(5.2/1000 patient-years; 95%CI 2.7-12.2) from end-stage renal disease, 3(3.1/1000 patient-years; 95%CI 0.6-9.2) from malignancy and 1(1.0/1000 patient-years; 95%CI 0.03-5.8) from peripheral vascular disease. The incidences of fatal and nonfatal CHD as well as fatal and nonfatal stroke were 21.4(95%CI 13.0-33.0)/1000 and 12.8(95%CI 6.6-22.4)/1000 patient-years, respectively whereas the incidence of lower-extremity amputation was 4.3(95%CI 1.2-10.9)/1000 patient-years. Age, the presence of proteinuria and serum HDL-C < or = 0.9 mmol/l were independent risk factors of CHD with the respective Hazard ratios 1.09(95%CI: 1.02-1.17; P=0.016), 4.41(95%CI: 1.18-16.45; P=0.027) and 3.91(95%CI: 1.20-12.80; P=0.024). In conclusion, sepsis and CVD were the major causes of death accounting for approximately 50% of total mortality in Thai type 2 diabetic patients. Age, the presence of proteinuria and low HDL-C were independent risk factors for the development of CHD. The mortality from and the incidence of CHD in Thai type 2 diabetic patients are lower than those reported from Caucasian populations but the incidence of stroke appears to be higher. These findings need to be confirmed by a large-scale population-based study.

GAD Antibodies in IDDM in Thailand

alter mesna therapy (Abstract). Clin Chcm 3 3:913, 1087 11. Hinberg I, Poon R: Hffect of eaptopril on reagent strip tests for urine ketones (Letter). Clin Chcm 33:981, 1987 12. tiraham P, Naidoo D: False-positive Ketostix in a diabetic on antihypertensive therapy (Letter), Clin Chcm 33:1490, 1987 13. Csako G: Causes, consequences, and recognition of false-positive reactions for ketones (Letter). Clin Chcm 36:1388-1389, 1990 14. Poon R, Hinberg 1: One-step elimination of interference of free-sulfhydryl-containing drugs with Chemstrip ketone readings (Letter). Clin Chcm 36:1527-1528, 1990 15. Csako Ci, Benson CC, Elin RJ: False-positive ketone reactions in CAP surveys (Letter). Clin Chcm 39:915-917, 1993 16. Williamson J, Davidson DF, Boag DE: Contamination of a specimen with N-acetylcysteine infusion: a cause of spurious ketonemia and hyperglycaemia (Letter). Ann Clin Biochcm 26:207-208, 1989 17. Foster DW, McGarry JD: The metabolic derangements and treatment of diabetic ketoacidosis (Review). N EnglJ Mcd 309: 159-169, 1983 18. Clements RS: Ketoacidosis (Review). Southern McdJ 69:217-221, 1976 19. Utnpierrrez GE, Watts NB, Phillips LS: Clinical utility of /3-hydroxybutyrate determined by reflectance meter in the management of diabetic ketoacidosis (Letter). Diabetes Care 18:137-138, 1995

Glutamic acid decarboxylase antibodies in non-insulin-dependent diabetes patients with secondary sulfonylurea failure in Thailand

The objective of this study was to determine the frequency of glutamic acid decarboxylase antibody (GAD-Ab) in Thai non-insulin-dependent diabetes (NIDDM) patients who had secondary sulfonylurea failure. Sera were collected from 40 NIDDM patients, who had history of secondary failure to treatment with sulfonylurea, for analysis of fasting c-peptide and GAD-Ab. Both c-peptide and GAD-Ab were measured using radioimmunoassay method. Of 40 patients, ten (25.0%) were positive for GAD-Ab with a mean level of 59.9 U/ml (median 58.5, range 3.4-127). Patients with (GAD-Ab (+) had a significantly lower fasting c-peptide levels than those with GAD-Ab(-) albeit shorter duration of diabetes (0.21 +/- 0.19 (S.D.) versus 0.52 +/- 0.33 nmol/l; P = 0.003). Duration of treatment with sulfonylurea in patients with GAD-Ab (+) was also shorter (4.6 +/- 3.5 versus 10.4 +/- 5.5 years; P = 0.001). Age at onset of diabetes did not differ between these two groups. Among 40% of patients who had insulin deficiency (fasting c-peptide level < 0.33 nmol/1), GAD-Ab was present in half and these GAD-Ab(+) patients had significantly shorter duration of sulfonylurea treatment (3.3 +/- 2.3 versus 10.0 +/- 7.9 years; P = 0.018). In conclusion, the frequency of GAD-Ab in Thai NIDDM patients with secondary sulfonylurea failure in this study was 25%. Almost all GAD-Ab(+) patients had insulin deficiency and most had been initially treated with sulfonylurea for a few years before depending on insulin. This group of patients represents a slowly progressive type I or latent autoimmune diabetes in adult diabetic population.

Comparison of autoantibodies to IA-2 and GAD65 in the rapid- and the slow-onset, adult Type 1 diabetes in Thailand

The population of Crete is of great interest because in previous epidemiological studies a very low coronary heart disease (CHD) prevalence, incidence and mortality rates have been reported [1]. Nevertheless, the morbidity and mortality rates for a rural population were assessed using data from the medical records-based information system [2] of the Cretan network of Primary Health Care (PHC) Centres. General practitioners working at the Archanes Regional Surgery have treated many people with diabetes mellitus (DM) and the initial observation on the standardized mortality rate from CHD was found to be higher in comparison with other PHC Centres within the Cretan Network. These ®ndings prompted us to study the prevalence of DM in this well-de®ned population in order to examine its contribution to the increase in CHD. This letter seeks to establish the current prevalence of known diabetes in this rural area of Crete. The study was conducted in the area of Archanes Municipality. The study population consisted of 4282 permanent inhabitants of whom 727 were aged > 65 years. The diagnosis of diabetes was documented retrospectively by analysing all the computerized medical records of patients seen by doctors at the Regional Surgery since 1996. The records were reviewed in December 1999 and subjects with DM were identi®ed. The 1985 WHO diagnostic criteria were used in the study [3], and the new criteria [4] are well known in this locality. Subjects with a veri®ed history of diabetes were classi®ed as known diabetic. Diabetes was also de®ned by the new diagnostic criteria. Only patients alive at the time of the collection of data were included. The medical records of patients with DM were reviewed at a second stage and information concerning weight, height, hypertension and coronary artery disease was obtained. Hypertension was de®ned as systolic blood pressure > 140 mmHg or diastolic blood pressure > 90 mmHg under basal conditions on three or more occasions. A diagnosis of coronary artery disease was considered when evidence from thallium scintiscan was available in the health chart of the patients with DM. Scintiscan is a standard practice for all people with symptoms and signs indicating CHD in the Archanes Regional Surgery. Body mass index (BMI) was calculated as the measured weight in kg divided by the height in metres squared (kg/m). Two hundred and ninety-six patients with DM were identi®ed and represent a prevalence of 6.9%. One hundred and sixty-one were female. The differences between males and females in the different age categories were not statistically signi®cant (P > 0.05). DM was more frequent in patients aged > 65 years (215 subjects, prevalence 29.6%) (Table 1). Only two males and one female were found with IDDM. The prevalence of DM, after age and sex standardization with that for the European population, was estimated at 5.2%. Seventy-three (54.1%) of males and 100 (62.1%) of females with DM were overweight (BMI > 25 kg/m). The difference between males and females was statistically signi®cant in all age groups (P < 0.01). In 213 patients with DM (72% of the total number), the diagnosis of hypertension was con®rmed, 129 of them female (P < 0.001). A diagnosis of coronary artery disease was reported in 65 patients with DM (22%), 38 of them males (P < 0.05). Twentyeight male patients with DM and 25 females were diagnosed as having both hypertension and coronary artery disease.