Suthee Rattanamongkolgul

Curcumin Extract for Prevention of Type 2 Diabetes

OBJECTIVE To assess the efficacy of curcumin in delaying development of type 2 diabetes mellitus (T2DM) in the prediabetic population. RESEARCH DESIGN AND METHODS This randomized, double-blinded, placebo- controlled trial included subjects (n = 240) with criteria of prediabetes. All subjects were randomly assigned to receive either curcumin or placebo capsules for 9 months. To assess the T2DM progression after curcumin treatments and to determine the number of subjects progressing to T2DM, changes in β-cell functions (homeostasis model assessment [HOMA]-β, C-peptide, and proinsulin/insulin), insulin resistance (HOMA-IR), anti-inflammatory cytokine (adiponectin), and other parameters were monitored at the baseline and at 3-, 6-, and 9-month visits during the course of intervention. RESULTS After 9 months of treatment, 16.4% of subjects in the placebo group were diagnosed with T2DM, whereas none were diagnosed with T2DM in the curcumin-treated group. In addition, the curcumin-treated group showed a better overall function of β-cells, with higher HOMA-β (61.58 vs. 48.72; P < 0.01) and lower C-peptide (1.7 vs. 2.17; P < 0.05). The curcumin-treated group showed a lower level of HOMA-IR (3.22 vs. 4.04; P < 0.001) and higher adiponectin (22.46 vs. 18.45; P < 0.05) when compared with the placebo group. CONCLUSIONS A 9-month curcumin intervention in a prediabetic population significantly lowered the number of prediabetic individuals who eventually developed T2DM. In addition, the curcumin treatment appeared to improve overall function of β-cells, with very minor adverse effects. Therefore, this study demonstrated that the curcumin intervention in a prediabetic population may be beneficial.

Factors affecting soft tissue level around anterior maxillary single‐tooth implants

BACKGROUND Peri-implant soft tissue recession is a major esthetic concern for the anterior implants. The aim of this study was to determine the factors that affected the facial marginal mucosal level and papilla level around single-tooth implants in the anterior maxilla. METHODS Forty single-tooth implants in the anterior maxilla were studied. Variables possibly associated with the soft tissue level were obtained from clinical measurements, study models, peri-apical radiographs, and computerized tomograms. Fishers exact test, analysis of variance, and binary logistic regression analysis were used to determine the influence of each factor on the facial marginal mucosal level and papilla level. RESULTS The majority of the implants (75%) replaced the upper central incisors. The facial mucosal margin of the implant was 0.5+/-0.9 mm more apical than that of the contralateral tooth. Half or more of papilla fill was observed in 89% of the samples. More apical level of the facial mucosal margin at the implant sites was significantly influenced by many factors including a thin peri-implant biotype, a proclined implant fixture angle, more apical level of the facial bone crest, increased distance from the contact point to the bone crest, contact point to the platform, and contact point to implant bone. A thin biotype was the most significant factor in determining the facial marginal mucosal level. Increased distance from the contact point to the bone crest was the only factor significantly associated with less papilla fill. CONCLUSIONS The papilla level around single-tooth implants in the anterior maxilla was mainly influenced by the interproximal bone crest level of the adjacent tooth. Facial marginal mucosal level, on the other hand, was affected by multiple factors including the peri-implant biotype, the facial bone crest level, the implant fixture angle, the interproximal bone crest level, the depth of implant platform, and the level of first bone to implant contact.

Reduction of atherogenic risk in patients with type 2 diabetes by curcuminoid extract: a randomized controlled trial ☆

Curcumin is a phytocompound found in the root of turmeric, a common herbal ingredient in many Asian cuisines. The compound contains anti-inflammatory activity, which is mediated through an up-regulation of adiponectin and reduction of leptin. Consumption of curcumin was shown to prevent some deteriorative conditions caused by inflammation, such as ulcerative colitis, rheumatoid arthritis and esophagitis, and so on. Inflammation-associated cardiovascular conditions such as atherosclerosis are common in diabetes patients. The anti-inflammation effect of curcumin might be beneficial to prevent such condition in these patients. We aim to evaluate an antiatherosclerosis effect of curcumin in diabetes patients. Effects of curcumin on risk factors for atherosclerosis were investigated in a 6-month randomized, double-blinded and placebo-controlled clinical trial that included subjects diagnosed with type 2 diabetes. An atherosclerosis parameter, the pulse wave velocity, and other metabolic parameters in patients treated with placebo and curcumin were compared. Our results showed that curcumin intervention significantly reduced pulse wave velocity, increased level of serum adiponectin and decreased level of leptin. These results are associated with reduced levels of homeostasis model assessment-insulin resistance, triglyceride, uric acid, visceral fat and total body fat. In summary, a 6-month curcumin intervention in type 2 diabetic population lowered the atherogenic risks. In addition, the extract helped to improve relevant metabolic profiles in this high-risk population.

Association between serum uric acid level and microalbuminuria to chronic vascular complications in Thai patients with type 2 diabetes

AIMS To investigate an association between serum uric acid/microalbuminuria and chronic micro/macro-vascular complications in type 2 diabetic patients. METHODS This cross-sectional study enrolled 608 patients with type 2 diabetes. All subjects were examined and basic information on health of the subjects was recorded for inclusion criteria. Several chemical parameters (fasting plasma glucose, triglyceride, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, uric acid, and microalbuminuria), and related chronic vascular complications were measured and recorded in data forms. RESULTS Logistic regressions were used to analyse odds ratios between uric acid/microalbuminuria levels and several chronic vascular complications. Prevalence of chronic vascular complications in T2DM patients, namely coronary arterial disease, cerebrovascular disease, diabetic nephropathy, diabetic retinopathy, and diabetic peripheral neuropathy was significantly correlated with increase of uric acid level [2.29 (1.01-5.2), 16.01 (4.74-54.09), 9.99 (4.4-22.8), 4.43 (1.3-15.1), 4.37 (1.5-12.9)], and of microalbuminuria level [7.0 (3.6-13.8), 3.2 (1.2-8.7), NA, 14.7 (5.1-42.7), 7.2 (2.9-17.7)]. CONCLUSION Both elevated uric acid and microalbuminuria levels were significantly associated with diabetic chronic micro/macro-vascular complications. Monitoring of uric acid and microalbuminuria levels provides a predictive value for a presence of chronic micro/macro-vascular complications in patients with type 2 diabetes.

Association of serum high-sensitivity C-reactive protein with metabolic control and diabetic chronic vascular complications in patients with type 2 diabetes.

AIMS To determine an association between hs-CRP and metabolic control/diabetic chronic vascular complications (DCVCCxs) in the patients with type 2 diabetes (DM). In addition, the possibility of using hs-CRP levels to predict risk of DCVCCxs will also be validated. METHODS This cohort study randomly enrolled 608 patients with DM during the 2007-2008 study period. We also recorded basic laboratory findings at baseline and at one year, to include fasting plasma glucose, HbA1c, triglyceride, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and hs-CRP. RESULTS Logistic regressions of odds ratios between hs-CRP and DCVCCxs (coronary arterial disease, cerebrovascular disease, diabetic nephropathy, diabetic retinopathy, and diabetic peripheral neuropathy) showed significant correlations, except for cerebrovascular disease, as follows 0.2 (0.11-0.38), 0.09 (0.01-0.77), 0.06 (0.02-0.16), 0.31 (0.12-0.82), and 0.17 (0.07-0.43), respectively. Linear regression for changes in hs-CRP were significantly correlated with HbA1c (r=0.38), fasting plasma glucose (r=0.40), triglyceride (r=0.20), low-density lipoprotein cholesterol (r=0.12), and high-density lipoprotein cholesterol (r=-0.12). No correlation was found for total cholesterol (r=0.06). Based on receiver operating characteristic (ROC) analysis, the cut-off points for hs-CRP levels for prediction of DCVCCxs were 2.89, 2.25, 2.10, 2.25, and 2.82mg/L, for coronary arterial disease, cerebrovascular disease, diabetic nephropathy, diabetic retinopathy, and diabetic peripheral neuropathy, respectively. CONCLUSIONS Our data showed that DCVCCxs were associated with hs-CRP in patients with DM. The cut-off point for hs-CRP can be used to predict association with DCVCCxs. Well-controlled metabolic components in diabetic patients, especially HbA1c, fasting plasma glucose, and triglyceride may reduce the level of hs-CRP.

The impact of the quality of care and other factors on progression of chronic kidney disease in Thai patients with Type 2 Diabetes Mellitus: A nationwide cohort study

Objective The present study investigates the impact of quality of care (QoC) and other factors on chronic kidney disease (CKD) stage progression among Type 2 Diabetes Mellitus (T2DM) patients. Methods This study employed a retrospective cohort from a nationwide Diabetes and Hypertension study involving 595 Thai hospitals. T2DM patients who were observed at least 2 times in the 3 years follow-up (between 2011–2013) were included in our study. Ordinal logistic mixed effect regression modeling was used to investigate the association between the QoC and other factors with CKD stage progression. Results After adjusting for covariates, we found that the achievement of the HbA1c clinical targets (≤7%) was the only QoC indicator protective against the CKD stage progression (adjusted OR = 0.76; 95%CI = 0.59–0.98; p<0.05). In terms of other covariates, age, occupation, type of health insurance, region of residence, HDL-C, triglyceride, hypertension and insulin sensitizer were also strongly associated with CKD stage progression. Conclusions This cohort study demonstrates the achievement of the HbA1c clinical target (≤7%) is the only QoC indicator protective against progression of CKD stage. Neither of the other clinical targets (BP and LDL-C) nor any process of care targets could be shown to be associated with CKD stage progression. Therefore, close monitoring of blood sugar control is important to slow CKD progression, but long-term prospective cohorts are needed to gain better insights into the impact of QoC indicators on CKD progression.

National survey: evaluation of cardiovascular risk factors in Thai patients with type 2 diabetes and chronic kidney disease after the development of cardiovascular disease.

The aim of the present study was to evaluate the achievement in controlling the risk factors of cardiovascular diseases (CVD) in Thai patients with type 2 diabetes (T2DM) and chronic kidney disease (CKD).

Movement Disorders in Non-Wilsonian Hepatic Cirrhotic Patients: The Subgroup Analysis of Various Phenotypes and Associated Risk Factors

Objective The aim of this subgroup analysis was to identify the risk factors associated with the development of various movement disorder phenotypes. Methods Eighty-three non-Wilsonian cirrhotic patients with abnormal movements were allocated into the following groups: intention tremor, bradykinesia, Parkinsonism, and abnormal ocular movements. These movement types were considered the primary outcomes as there was a sufficient sample size. Researchers took into consideration the gender, etiologies of cirrhosis, cirrhosis-related complications, hepatic encephalopathy, medical illness, and some neurological deficits as potential factors associated with these movement disorders. Results The male gender (p = 0.002) and alcoholic cirrhosis (p = 0.005) were significant factors for the prevalence of intention tremors. In bradykinesia, hepatic encephalopathy was highly statistically significant (p < 0.001), and females more commonly developed bradykinesia (p = 0.04). The Parkinsonism features in this study were confounded by hyperlipidemia (p = 0.04) and motor or sensory deficits (p = 0.02). Jerky pursuits and a horizontal nystagmus were detected. Jerky pursuits were significantly related to hepatic encephalopathy (p = 0.003) and bradykinesia, but there were no factors associated with the prevalence of nystagmus other than an intention tremor. Conclusions The association of alcoholic cirrhosis with the development of intention tremor indicates that the persistent cerebellar malfunction in cirrhotic patients is due to alcohol toxicity. The slowness of finger tapping and jerky pursuit eye movements are significantly associated with hepatic encephalopathy. Thus, further studies are needed to evaluate the diagnostic value of these two signs for an early detection of mild hepatic encephalopathy.

Movement Disorders in Non-Wilsonian Cirrhotic Patients: A Report of the Prevalence and Risk Factors from a Study Done in a Medical School in an Agricultural-Based Community

Objective Parkinsonism and other movement disorders have previously been reported in the acquired hepatocerebral degeneration associated with portosystemic shunting. However, there is no study to date about their prevalence as has been noted in general practice. Methods One hundred and forty-three patients with hepatic cirrhosis from the gastroenterology clinic and internal medicine wards were enrolled. Liver data included the diagnoses, etiologies, assessments of complications, and treatments for cirrhosis. Hepatic encephalopathy was classified with regard to the West Haven criteria for semi-quantitative grading for mental status. Neurological examination results and abnormal involuntary movements were recorded as primary outcomes. Neuro-radiology was used for the detection of severe brain lesions. Results Alcoholism was the most common cause of liver cirrhosis. Eighty-three patients (58%) presented with movement disorders. Asterixis was found in one of the cases. The most common movement disorder seen was an intentional tremor at 37.1%, which was followed by bradykinesia, Parkinsonism, and postural tremors at 29.4%, 10.5%, and 6.3%, respectively. The prevalence of movement disorders simultaneously increased with a high Child-Turcotte-Pugh score. The hepatic encephalopathy was grade 1 and 2. With the inclusion of age-range adjustments, we found that alcoholic cirrhosis and hepatic encephalopathy are statistically significant factors [p < 0.05, odds ratio (OR) = 6.41, 95% confidence interval (CI) 1.38–29.71 and p < 0.001, OR = 13.65, 95% CI 4.71–39.54] for the development of movement disorders in non-Wilsonian cirrhotic patients. Conclusions Intentional tremor is a common abnormal movement. Alcoholic cirrhosis and hepatic encephalopathy are significant risk factors in the development of movement disorders in non-Wilsonian cirrhotic patients.

Association between underage pregnancy and perception on occupational risk and protective behaviours among factory workers

Objectives Underage pregnancy is associated with lower socioeconomic status and poorer birth outcome. Teenage pregnant workers may also have less experience in occupational safety. This study was aimed to investigate the possible association between underage pregnancy in employees and perception on occupational risk. Methods A cross-sectional survey was conducted to collect data from pregnant factory workers visiting antenatal care clinic and post-partum ward in general and community hospitals at a north-east province of Thailand. Results Pregnant employees who were underage pregnancy (less than 20 compared to 21–30 year of age) were found to be associated with higher perception on physical risk (OR, 3.01; 95% CI,1.44 to 6.31); chemical risk (OR,1.54; 95% CI,0.68 to 3.49); biological risk (OR,7.16; 95% CI,1.66 to 30.8) ergonomic risk (OR,2.79; 95% CI,1.27 to 6.09) and mental risk (OR, 1.48; 95% CI,0.62 to 3.51). The underage pregnancy was not associated with protective behaviour (OR,1.041; 95% CI, 0.52 to 2.10). Conclusions underage pregnancy in employees have higher perception on physical, biological and ergonomic occupational risk but not for protective behaviour.