Glimepiride in type 2 diabetes mellitus Thai patients.

This study aimed to confirm the efficacy of glimepiride given once daily in the treatment of Thai type 2 diabetic patients and to find out the optimum dosage for Thai patients. The patients were enrolled at the diabetic clinics of 5 hospitals (Rajavithi, Chulalongkorn, Pramongkutklao, Siriraj and Theptarin Hospitals). All patients started glimepiride 1 mg once daily and escalated to 2, 3, 4 and until 6 mg every 4 weeks if fasting plasma glucose (FPG) exceeded 140 mg/dL. Subjects were 60 females and 29 males with an average age of 52.2 +/- 10.0 years. Mean BMI was 25.5 +/- 3.8 kg/m2. Fifty seven patients (64.0%) were drug naïve and thirty two patients (36.0%) had been previously treated with oral hypoglycemic agents. Seventy three per cent of the drug naïve and 37 per cent of the previously treated patients could be controlled with 1-2 mg of glimepiride once daily. At the twelfth week of treatment, mean fasting plasma glucose decreased from 224.6 to 156.6 mg/dL (30% reduction) and mean HbA1c decreased from 10.0 to 7.5 per cent (25% reduction). At the end of the study 49.4 per cent of the patients had HbA1c < 7.0 per cent, 21.3 per cent had HbA1c 7.0-8.0 per cent and 29.3 per cent had HbA1c > 8.0 per cent. Adverse events that were probably or possibly related to the drug were reported in 5 patients (5.6%). Three of them were hypoglycemia and two patients had skin rash. All hypoglycemic episodes were mild. Glimepiride was indicated to be safe. There were no clinically significant changes in clinical laboratory values, physical examinations and vital signs. In conclusion, glimepiride was efficacious and safe in type 2 diabetes Thai patients and 1-2 mg of glimepiride appeared to be a sufficient dose for most newly diagnosed type 2 diabetic patients.

A controlled clinical trial of multidisciplinary team approach in the general medical wards of Chulalongkorn Hospital.

The benefits and acceptability of a strengthened physician-nurse collaboration and a multidisciplinary team approach are demonstrated in the medical wards of a Thai acute-care hospital (Chulalongkorn University Hospital). The strengthened physician-nurse collaboration should be introduced or strengthened in all medical wards. Because of the lack of appropriately trained personnel, concentrating resources into a small unit or ward may be the appropriate measure at present if a multidisciplinary team approach is to be integrated into the medical ward of acute-care hospitals in South East Asia.

Disability among Thai elderly living in Klong Toey slum.

Forty three per cent of the elderly in Klong Toey slum had BAI score less than 20. One point six per cent were moderately severe or severely disabled and needed special care. Around one-third of them caused by stroke. Locomotion, reaching and stretching, dexterity, continence and seeing are common significant types of disability among this population study. Perceived health status, age and working status are independent factors related to disability level. The Barthel ADL index is suitable for using as a tool for a disability survey among Thai elderly. The ODS questionnaire may be applied after considerable modification of the questions concerning behavior and intelligence dimensions.

Pregnancy in Sheehan's syndrome.

This is the first report of pregnancy in a patient with Sheehan's syndrome in Thailand. Resumption of menstruation and pregnancy following massive postpartum hemorrhage although rare, can occur if there is selective hypopituitarism with normal gonadotropin level and are not against the diagnosis. Since the maternal and fetal mortality is far more common in unrecognized cases, therefore, early diagnosis is crucial. Physicians should consider this syndrome every patient who has a history of postpartum hemorrhage and symptoms and signs of hypopituitarism.