S. A. P. Chubb

Prevalence and progression of subclinical hypothyroidism in women with type 2 diabetes: the Fremantle Diabetes Study.

Objective  To assess the prevalence and progression of subclinical hypothyroidism in women with type 2 diabetes.

Prevalence and predictors of osteopenia and osteoporosis in adults with Type 1 diabetes

Aims  To determine the prevalence and biochemical/hormonal determinants of osteopenia and osteoporosis in adults with Type 1 diabetes.

Bone mineral density and its determinants in diabetes: the Fremantle Diabetes Study

Aims/hypothesisWe assessed the effects of type 1 and type 2 diabetes on bone density and metabolism.Materials and methodsWe analysed bone mineral density (BMD) measured at the hip, spine and forearm using dual energy X-ray absorptiometry in 34 patients with type 1 and 194 patients with type 2 diabetes. Patients were from the community-based Fremantle Diabetes Study, and findings for them were compared with those from normal age- and sex-matched control subjects from the local community. Biochemical and hormonal markers of bone metabolism were measured in a subset of 70 patients.ResultsAfter adjusting for age and BMI, there was a lower BMD at total hip (p<0.001) and femoral neck (p=0.012) in type 1 men vs control subjects, but type 1 women and matched controls had similar BMD at each site. There was a higher BMD at total hip (p=0.006), femoral neck (p=0.026) and forearm (p<0.001) in type 2 women vs control subjects, but diabetes status was not associated with BMD in type 2 men after adjustment for age and BMI. Serum oestradiol, BMI, C-terminal telopeptide of collagen type 1 and male sex were consistently and independently associated with BMD at forearm, hip and femoral neck and explained 61, 55 and 50% of the total variance in BMD, respectively, at these sites. Spine BMD was independently associated with BMI and ln(oestradiol).Conclusions/interpretationMen with type 1 diabetes may be at increased risk of osteoporosis, while type 2 women appear to be protected even after adjusting for BMI. Low serum oestradiol concentrations may predispose to diabetes-associated osteoporosis regardless of sex.

Chronic hepatitis C infection and sex hormone levels: effect of disease severity and recombinant interferon‐α therapy

Background: We aimed to investigate the associations between androgen status and markers of liver disease severity and to determine the effect of interferon‐α (IFN‐α) treatment on sex hormone levels in the context of hepatitis C infection.

Higher free thyroxine levels are associated with frailty in older men: the Health In Men Study

Objective  Frailty is common in the elderly and predisposes to ill‐health. Some symptoms of frailty overlap those of thyroid dysfunction, but it is unclear whether differences in thyroid status influence risk of frailty. We evaluated associations between thyroid status and frailty in older men.

Continuing Disparities in Cardiovascular Risk Factors and Complications Between Aboriginal and Anglo-Celt Australians With Type 2 Diabetes The Fremantle Diabetes Study

OBJECTIVE To determine whether disparities in the nature and management of type 2 diabetes persist between Aboriginal and the majority Anglo-Celt patients in an urban Australian community. RESEARCH DESIGN AND METHODS Baseline data from the observational Fremantle Diabetes Study collected from 1993 to 1996 (phase I) and from 2008 to 2011 (phase II) were analyzed. Patients characterized as Aboriginal or Anglo-Celt by self-report and supporting data underwent comprehensive assessment, including questionnaires, examination, and biochemical testing in a single laboratory. Generalized linear modeling with age/sex adjustment was used to examine differences in changes in variables in the two groups between phases I and II. RESULTS The indigenous participants were younger at entry and at diabetes diagnosis than the Anglo-Celt participants in both phases. They were also less likely to be educated beyond primary level and were more likely to be smokers. HbA1c decreased in both groups over time (Aboriginal median 9.6% [interquartile range 7.8–10.7%] to 8.4% [6.6–10.6%] vs. Anglo-Celt median 7.1% [6.2–8.4%] to 6.7% [6.2–7.5%]), but the gap persisted (P = 0.65 for difference between phases I and II by ethnic group). Aboriginal patients were more likely to have microvascular disease in both phases. The prevalence of peripheral arterial disease (ankle-brachial index ≤0.90 or lower-extremity amputation) increased in Aboriginal but decreased in Anglo-Celt participants (15.8–29.7 vs. 30.7–21.5%; P = 0.055). CONCLUSIONS Diabetes management has improved for Aboriginal and Anglo-Celt Australian patients, but disparities in cardiovascular risk factors and complications persist.

Reference intervals for common laboratory tests in Melanesian children

Pediatric reference intervals for biochemical tests are often derived from studies in Western countries and may not be applicable to the developing world. No such intervals exist for Melanesian populations. The aim of this study was to provide specific reference intervals for children from Papua New Guinea (PNG). We assayed plasma from 327 healthy Melanesian children living in Madang Province for common biochemical and hematological analytes. We used well-validated commercially available assay methodology. Compared with reference intervals from children from Western countries and/or African children, there were substantial differences in hemoglobin, soluble transferrin receptor, ferritin, calcium, phosphate, and C-reactive protein. Differences in the upper limits of reference intervals for bilirubin and alanine aminotransferase were also observed. Available reference intervals from Western and African countries may be inappropriate in PNG and other Melanesian countries. This has implications for clinical care and safety monitoring in pharmaceutical intervention trials and vaccine studies.

Antiplatelet therapy, Helicobacter pylori infection and complicated peptic ulcer disease in diabetes: the Fremantle Diabetes Study.

Aims  To assess whether, based on its relationship with complications of peptic ulcer disease (PUD), directed Helicobacter pylori serological screening is justified in diabetic patients prior to commencement of antiplatelet therapy.

Subclinical hypothyroidism and mortality in women with type 2 diabetes

© 2006 Blackwell Publishing Ltd, Clinical Endocrinology , 64 , 474–477 predicts long-term efficacy of somatostatin analogue therapy (SSA) in acromegaly. 1 Among 33 patients who had octreotide suppression testing and were subsequently treated with SSA therapy, 15 achieved long-term remission defined by GH < 5 mU/l ranging from 3 to 66 months. They observed that a nadir GH < 10 mU/l following octreotide 50 μ g demonstrated 100% sensitivity but poor specificity (56%) for remission (GH < 5 mU/l) at 3–16 months of depot treatment. These results suggest that the octreotide test dose could potentially identify most patients who will achieve long-term remission from growth hormone excess; however, over 40% of those with adequate test-dose suppression still will not have achieved remission in the longer term. The authors conclude that the nadir GH after a test dose of octreotide 50 μ g is a useful predictor of potential disease remission using SSA as primary or adjunctive therapy. Our own published results are not so clear cut. 2 We acknowledge the challenges of predicting and achieving long-term remission from acromegaly. We evaluated the usefulness of acute responses to an octreotide test dose for prediction of the longer-term response (3 years) to treatment with the drug in 23 patients with acromegaly. The majority were treated with primary trans-sphenoidal pituitary surgery and were receiving at least 600 μ g octreotide or 20 mg octreotide LAR for at least 3 years. In contrast to the Gilbert series, we found that that the test dose was much less useful for prediction of long-term remission from acromegaly. Sixteen of our patients had a test-day nadir GH of 10 mU/l or less and of these 50% achieved GH < 5 mU/l at follow-up. Of the remaining seven patients who had GH suppression > 10 mU/l, only three had achieved GH < 5 mU/l at follow-up but all three had required external pituitary irradiation in the interim. We concluded that in patients on optimal long-term doses of octreotide for acromegaly, absence of a nadir GH < 10 mU/l 8 h after a test dose was associated with failure to achieve GH levels associated with a normal life expectancy (5 mU/l or less) unless adjunctive external pituitary irradiation was given. In our opinion, as well as testing tolerability of the drug, an octreotide test dose may help in determining which patients should be offered, at an early stage after surgery that has failed to achieve ‘safe’ GH levels, either external pituitary irradiation or GH receptor antagonist therapy.

Metabolic memory and all‐cause death in community‐based patients with type 2 diabetes:The Fremantle Diabetes Study

To validate the findings, in a usual care setting, of glycaemic intervention trials, which have shown that tight control in patients with recently diagnosed type 2 diabetes protects against death during post‐study monitoring, but that it may be deleterious in long‐duration diabetes with vascular complications.