Tuchinda C

Increasing Prevalence of Type 2 Diabetes Mellitus in Thai Children and Adolescents Associated with Increasing Prevalence of Obesity

Type 2 diabetes mellitus (DM) is being diagnosed more frequently in children and adolescents. Thailand has a low incidence of childhood DM. This study reviewed patients with DM in the Division of Pediatric Endocrinology, Faculty of Medicine, Siriraj Hospital compared to our previous study. The results demonstrate that type 2 DM in Thai children and adolescents has increased from 5% during 1986-1995 to 17.9% during 1996-1999. Mean age was 11.6 years. Mean BMI was 27.8 kg/m2. Fifty-six percent were diagnosed on routine examination. The period of increase in type 2 DM is associated with an increase of obesity prevalence from 5.8% in 1990 to 13.3% in 1996. This result emphasizes the importance of encouraging daily physical activity and healthy diet in our populations and also alerts our pediatricians and endocrinologists to the possibilities of type 2 DM in these age groups.

Diagnostic Significance of pH, Lactic Acid Dehydrogenase, Lactate and Glucose in Pleural Fluid

The pH, lactic acid dehydrogenase, lactate and glucose of pleural fluid simultaneous with serum lactic acid dehydrogenase, blood lactate and glucose were determined in 105 pediatric patients. The patients were classified into groups according to the diagnosis. The pleural fluid of empyema cases was found to have the lowest pH with a mean value of 6.83 (p less than 0.0075). The malignant pleural fluid has a relatively low pH with a mean value of 7.32. The lactic acid dehydrogenase in pleural fluid of empyema cases has the highest mean of 1,470.68 (p less than 0.05). The lactic acid dehydrogenase was found increased in malignancy, tuberculosis and parapneumonic effusion cases. Lactate level was found extremely high in empyema cases with a mean value of 13.68. It was also found extremely high in malignancy, tuberculosis and parapneumonic effusion cases. The glucose level was markedly decreased in empyema cases. There exists correlation of pleural fluid lactate to pH, lactic acid dehydrogenase and glucose, as well as that of pH to lactic acid dehydrogenase.

IGF-1 Generation Test inNon-Growth Hormone-DeficientShort Children

This article is also accessible online at: http://BioMedNet.com/karger There has been controversy about the results of growth hormone (GH) therapy in short children who are nonGH-deficient which may be due to the underlying causes of the short stature. GH insensitivity syndrome (GHIS) and GH bioinactive disorder may be causes. Previous studies reported in the literature suggest that the IGF-1 generation test may be useful in diagnosing GHIS. However, the appropriate dosage and duration of the test are still a matter of debate. Our group performed the IGF-1 generation test in a small group of non-GH-deficient short children to identify whether there is any GHIS in the Thai population, or other causes such as GH bioinactive disorder. We also wished to see whether the test can predict a growth response in this group of patients. The inclusion criteria for the study included: (1) height 12 SD below normal for age and (2) height velocity below the 25th percentile for age. The study group included 12 children, 8 males and 4 females. All were clinically prepubertal with a bone age of !11 years. Thyroid function was normal. None had any significant systemic illness and there were no obvious dysmorphic features. Their peak GH response from either the insulin stimulation test or the L-dopa-propanolol test were 110 ng/ml. The IGF-1 generation test was performed in these 12 children with a synthetic GH given at a dosage of 0.1 IU/kg/ day subcutaneously for 7 days. Blood samples for serum IGF-1 and IGFBP-3 were taken without fasting at the basal level, and again 8–16 h after the seventh injection (fig. 1). The results in 12 of the children showed that 7 had low basal IGF-1 levels for their age, with low normal IGFBP3. After treatment with GH injections for 7 days, 6 children with low and low-normal basal IGF-1 levels showed a dramatic increase of IGF-1 levels, up to 130–609%. One child who also had low basal IGF-1 at 5.7 ng/ml showed no response when she was tested for GHIS. The Fig. 1. Preand post-IGF-1 level after IGF-1 generation test in NGHD and GHD. There is significant difference in pre-IGF-1 level with p ! 0.05 between groups. ) = GHD; [ = NGHD with 1100% increased IGF-1 after generation test; o = NGHD with !100% increased IGF-1 after generation test. ▲ ▲ ▲ ▲

Growth Hormone Therapy Update in Thailand

There were 841 children in Thailand with growth hormone deficiency (GHD) from January 1992 to 1996. Idiopathic isolated GHD was the major diagnosis. Only 40.19% received recombinant DNA human growth hormone (rhGH) treatment. Also reported here is a 1–2 year study of rhGH therapy in 30 GH-deficient children (21 males, 9 females), aged (mean ± SD) 10.41 ± 3.16 years, and bone age 7.37 ± 3.34 years. The height velocity 1 and 2 years posttreatment were 8.17 ± 1.9 and 7.36 ± 2.8 cm/year respectively, which were statistically significant compared to pretreatment values of 3.91 ± 1.09 cm/year. Improved height SDS was observed at the end of each treatment period. Thyroid function and glycosylated hemoglobin tests were normal during the treatment period. There were no reports of side effects.

HLA Class II Polymorphism in Thai Insulin-dependent Diabetes Mellitus

Fifty-seven Thai IDDM patients were studied for HLA class I by LCT and HLA class II by LCT and PCR-RFLP. It was found that DRB1*0301, DR3, DQB1*0201, DRB3*0202, DQA1*0501 and DQ2 were significantly increased with R.R. = 10.0, 6.6, 4.2, 3.7, 3.5 and 3.2 and Pc < 0.005, 0.001, 0.01, 0.005, 0.01 and 0.005, respectively. In contrast, DQA1*0101, DRB3*0301, DR5 and DQ1 were significantly decreased with R.R. = 0.2, 0.2, 0.3 and 0.5 and Pc < 0.01, 0.05, 0.01 and 0.05, respectively. The primary factor for IDDM susceptibility is probably DRB1. The homozygous Asp57/Asp57 DQB1 genotype appears to determine resistance to IDDM while Arg52-DQA1, non-Asp57-DQB1 haplotype confers susceptibility to IDDM. The common haplotypes in Thai IDDM cases were DRB1*0301, DRB3*0202, DQA1*0501, DQB1*0201, DPB1*0401 and DRB1*0405, DQA1*0301, DQB1*0402 (or 0401 or 0302), DPB1*0401 (or 0301 or 1501). The less common haplotypes were DRB1*0406, DQA1*0301, DPB1*0302, DPB1*0501 and DRB1*1202, DRB1*0301, DQA1*0601, DQB1*0301, DPB1*0501. DR3 was increased in both gender groups with early onset (< 10 years) regardless of a family history of DM. However, DR3/DR4 genotype was increased only in female patients with a family history of DM and early onset. In conclusion, DRB1, DRB3, DQA1 and DQB1, but not DPB1 are involved in the occurrence of IDDM. The cooperation of HLA class II and X-chromosome may contribute to the development of IDDM in addition to other factors such as other genetic (chromosomes 11, 19, 14, 7), immunologic and environmental factors which require further study.

Diabetic education, special consideration of oriental patients

The important of patient education program in the management of diabetes has been widely recognized. We studied to find out in general what the patients and their parents know about diabetes and their self-care by using a questionnaire. Then, the diabetic education was given by one-to-one basis to every patient. Thirty four insulin-dependent diabetes mellitus attended the diabetic the clinic at Siriraj Hospital, Bangkok age ranged from 4 to 22 years with peak age at 11 to 15 years. Male to female ratio was l:i. Majority came from low socioeconomic families. 23.5 percent were from separated families, one patient lived with neither her mother nor father. Only one patient had home glucose monitoring. Fourteen cases (41.2%) had been hospitalized with diabetic ketoacidosis (DKA) over the past year, however, there was no statistically significant difference between admission with DKA and low socioeconomic status. In addition to insulin, there were 8 patients taking herbs to cure diabetes. Only 6 patients were able to follow their meal plan and only one case ever used the food exchange list. Most patients accepted being diabetic and attended the clinic regularly mainly to get financial supports.The situation in our country is different from that in the western countries as the patients are low in literacy and socioeconomic status. A well-planned educational programme is essential to cater to the need to the oriental patients