ABSTRACT
@#<p>The Asia-Pacific region carries a high disease burden, with over half of the global diabetic population residing in this region. Increasing evidence shows that without targeted intervention, the progression from impaired glucose tolerance (IGT) to type 2 diabetes occurs more frequently in Asians compared with Caucasians. Furthermore, IGT is independently associated with an increased risk of cardiovascular disease, and should be managed as early as possible. Because diabetes is now a major public health issue, strategies aimed at prevention and treatment are urgently required. Lifestyle modification, including weight loss, dietary changes and increased physical activity, play a major role in controlling the disease. Significant evidence also supports the effectiveness of a combination of lifestyle modification and pharmacologic therapy, such as metformin, in delaying the onset of diabetes. Although the importance of lifestyle interventions is well recognized throughout Asia, many countries do not have formal recommendations to guide the diagnosis and management of individuals at risk of progression to diabetes. At a recent regional meeting, experts from the Asian region convened to develop consensus recommendations to guide clinicians in the management of Asian patients with pre-diabetes. These consensus recommendations provide a clear and concise approach to the management of individuals with IGT based on the available evidence and current best clinical practice.</p>
Subject(s)
Humans , Male , Female , Adult , Prediabetic State , AsiaABSTRACT
@#The Asia-Pacific region carries a high disease burden, with over half of the global diabetic population residing in thisregion. Increasing evidence shows that without targeted intervention, the progression from impaired glucose tolerance(IGT) to type 2 diabetes occurs more frequently in Asians compared with Caucasians. Furthermore, IGT is independently associated with an increased risk of cardiovascular disease, and should be managed as early as possible. Because diabetes is now a major public health issue, strategies aimed at prevention and treatment areurgently required. Lifestyle modification, including weight loss, dietary changes and increased physical activity, play a major role in controlling the disease. Significant evidence also supports the effectiveness of a combination of lifestylemodification and pharmacologic therapy, such as metformin, in delaying the onset of diabetes. Although the importanceof lifestyle interventions is well recognized throughout Asia, many countries do not have formal recommendations to guide the diagnosis and management of individuals at risk of progression to diabetes. At a recent regional meeting,experts from the Asian region convened to develop consensus recommendations to guide clinicians in themanagement of Asian patientswith pre-diabetes. These consensus recommendations provide a clear and conciseapproach to the management of individuals with IGT based on the available evidence and current best clinical practice.
Subject(s)
Glucose Intolerance , AsiaABSTRACT
Abstract Prevalence of T3 toxicosis and FT4 toxicosis in Thyrotoxic Patients Natee Munsakul MD Swangjit Suraamornkul MD Petch Rawdaree MD, MSc (Epid), DLSHTM Endocrinology Unit, Department of Medicine, BMA Medical College and Vajira Hospital Objective: To determine the prevalence of T3 toxicosis and FT4 toxicosis in thyrotoxic patients. Study design: Cross - sectional descriptive study. Subjects: Two hundred and ninety five newly diagnosed thyrotoxic patients were studied from January 1999 to September 2000 in BMA Medical College and Vajira Hospital. Methods:All patients were diagnosed by endocrinologists based on thyroid function tests. Age, sex, address, symptoms, signs, duration of symptoms before diagnosis, and thyroid function tests were recorded. The prevalence and correlation factors were analyzed by using SPSS for Windows program. Main outcome measures: Prevalence of T3 toxicosis and FT4 toxicosis, characteristic of the subjects such as age, sex, duration of symptoms before diagnosis. Results: From 295 subjects recruited, 19.3% were male and 80.7% were female. The prevalence of T3 toxicosis and FT4 toxicosis were 2% and 3.4% respectively. The diagnoses were Graves' disease 93.2%, toxic multinodular goiter 3.1%, toxic adenoma 2.7%, thyroiditis 0.3% and molar pregnancy 0.7%. Mean age of T3 toxicosis group, FT4 toxicosis group and the group that increased both T3 and FT4 were 31.4 + 11.4, 41.5 + 16.5, and 39.3 + 13.5 year respectively that were no statistically significant difference (p = 0.38). The duration of symptoms before diagnosis were 3.8 + 4.6, 2.4+2.8, and 2.9+2.8 months respectively that were no statistically significant difference (P= 0.79). Conclusion: The prevalence of T3 toxicosis and FT4 toxicosis in thyrotoxic patients were 2.0% and 3.4% respectively but there were no statistically significant difference. Key words: T3 toxicosis, FT4 toxicosis Vajira Med J 2001 ; 45 : 55 - 60
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Abstract Effectiveness of Surveillance System in Prevention of Hospital Hypoglycemia. Swangjit Sura-amornkul MD, FRCP(T), MSc Petcharaphan Tiyamani BSc Petch Rawdaree MD, FRCP(T), MSc Endocrinology unit, department of medicine, Bangkok Metropolitan Administration Medical College and Vajira Hospital. Objective: To reduce incidence and clinical impact of hospital hypoglycemia in diabetic patients at medicine ward. Study design: A prospective interventional study. Setting: Department of Medicine, Bangkok Metropolitan Administration Medical College and Vajira Hospital. Subjects: 1,233 diabetic patients admitted in department of medicine from January to December 2004. Intervention: The surveillance of hospital hypoglycemia had been implemented from January to December 2004 by multidisciplinary team. Main outcome measures: Comparison the incidence of hospital hypoglycemia before and after surveillance indicated by 1. rate of hospital hypoglycemia per all diabetic patients 2. rate of hospital hypoglycemia per high risk diabetic patients 3. level of clinical impacts of hospital hypoglycemia. Results: Incidence of hospital hypoglycemia per all diabetic patients reduced after the surveillance of hospital hypoglycemia by multidisciplinary team from 5.01% to 4.28%. As well as incidence of hospital hypoglycemia per high risk diabetic patients decreased from 19.08% to 11.74% with relative risk reduction 38.5% after the surveillance. Less severity of clinical impacts of hospital hypoglycemia also demonstrated. Conclusion: This study is a part of hospital accreditation process, clinical risk management. Hospital hypoglycemia in diabetic patients is the priority watch list of incident reports. The surveillance of hospital hypoglycemia by multidisciplinary team decreased rate of hospital hypoglycemia and severity of clinical impact. Key words: hospital hypoglycemia, diabetes, root cause analysis, clinical risk, surveillance, multidisciplinary Vajira Med J 2005 ; 49 : 59 - 67
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Abstract "Diabesity": The 21st Century Epidemic Swangjit Sura-amornkul MD, FRCP(T), MSc (clinical investigation) Endocrinology unit, Department of Medicine, BMA Medical College and Vajira Hospital. Diabetes and obesity are twin interrelated epidemics which threaten to engulf the world's healthcare systems over the next two decades. The prevalences of both are increasing at an alarming rate with up to 400 million people likely to develop diabetes, largely type 2, in the next 15 to 20 years unless action is taken. Indeed, much of this increase in diabetes prevalence is directly attributable to the epidemic of obesity. Both diabetes and obesity are associated with significant mortality and morbidity from macrovascular disease such as heart attack, stroke and peripheral vascular disease. In addition, diabetes carries the extra burden from the specific microvascular complications of retinopathy, nephropathy and neuropathy. The costs of these conditions, both personal and economic, are enormous. Vajira Med J 2008 ; 52 : 77 - 82
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Abstract Prevalence of Thyroid Antibodies in Hyperthyroid patients treated at BMA Medical College and Vajira Hospital Suvimol Rimdusid MT* Swangjit Sura-amornkul MD, MSc** Prapun Rimdusid MD*** * Radioimmunoassay (RIA) laboratory, Division of Nuclear Medicine, Department of Radiology, BMA Medical College and Vajira Hospital ** Department of Medicine, BMA Medical College and Vajira Hospital ** Medical Department, Trang-ruampat Hospital Objectives: To study the prevalence of abnormally high thyroid peroxidase (TPO) antibody and thyroglobulin antibody in hyperthyroid patients and to evaluate the association of these antibodies with other clinical characteristics of hyperthyroid patients. Study design: Descriptive study. Subjects: 133 hyperthyroid patients with high T3 , total T4 , free T4 and low thyroid stimulating hormone (TSH), who underwent laboratory investigations at RIA laboratory, Division of Nuclear Medicine, Department of Radiology, BMA Medical College and Vajira Hospital during September 2004 and February 2005 were enrolled. Methods: Demographic data, thyroid hormone level and thyroid antibodies level of the patients were collected from hospital and laboratory records. Main outcome measures: TPO antibody level and thyroglobulin antibody level. Results: Mean age of the patients was 39.0 ± 13.8 years old. Female to male ratio was 3.4:1. The etiologies of hyperthyroidism were: Graves' disease (101 cases), toxic multinodular goiter (21 cases), and others (11 cases). Median value of free T4 was high at 4.2 (0.8-6.0) ng/dL while median TSH level was low at 0.012 (0-6.9) IU/mL. Abnormally high level of TPO and thyroglobulin antibody were detected in 80.5% and 67.7% of hyperthyroid patients, respectively. In patients with Graves' disease, high TPO antibody level was found in 85.1%. There was statistically significant association between Graves' disease and TPO antibody, but not with thyroglobulin antibody. No association between thyroid antibodies and age, gender were observed. Conclusion: The prevalence of abnormally high TPO antibody and thyroglobulin antibody in hyperthyroid patients, especially in Graves' disease, were high. There was statistically significant association between Graves' disease and TPO antibody. Vajira Med J 2008 ; 52 : 159 - 165
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Abstract Prevalence and Association between Androgen Deficiency and Metabolic Syndrome in Aging Thai Male with Type 2 Diabetes Mellitus Swangjit Sura-amornkul MD, FRCP (T),MSc (Chinical Investigation) Thantip Jongboonyanupap MD, FRCP (T) Petch Rawdaree MD, FRCP (T),MSc Endocrinology unit, Department of Medicine, BMA Medical College and Vajira Hospital. Objective: To determine the prevalence and association between androgen deficiency (AD) and metabolic syndrome in aging Thai male with type 2 diabetes mellitus. Study design: Cross-sectional study. Subjects: 246 males aged ≥ 55 years old with type 2 diabetes who attended Diabetic Clinic, Department of Medicine, BMA Medical College and Vajira Hospital from June 2007 to October 2008. Methods: Waist circumference and blood pressure were measured. Blood was drawn for fasting plasma glucose, glycated hemoglobin (),lipid and total testosterone levels in all participants. Main outcome measures: total testosterone level, metabolic syndrome according to American Heart Association (AHA) criteria. Results: Prevalence of androgen deficiency (AD) in aging Thai male with type 2 diabetes was 35.8%. The total testosterone level of type 2 diabetes aging male with and without AD was 2.55 ± 0.74 and 4.95 ± 1.44 ng/ml respectively. Body weight, body mass index (BMI) and waist circumference were significantly negatively correlated with total testosterone levels. Prevalence of metabolic syndrome in type 2 diabetes aging male with and without AD was not significantly different (87.5% vs 83.5%). Conclusion: AD was frequently found in aging Thai male with type 2 diabetes. However, there was no association between AD and metabolic syndrome in this group. Vajira Med J 2009 ; 53 : 33 - 39