Macrosomia in non-gestational diabetes pregnancy: Glucose tolerance test characteristics and feto-maternal complications in tropical Asia Pacific Australia

Objective: To look into the glucose tolerance test characteristics and determine complications in non-gestational diabetes pregnant subjects. Methods: From 2006 to 2009 all non-gestational diabetes mellitus (non-GDM) pregnant women who delivered macrosomia at the North Australia's Townsville Hospital were retrospectively reviewed by extracting data from clinical record. Glucose tolerance tests results were analysed in the light of an earlier diagnosis of non-GDM. Results: Ninety-one non-GDM mothers with macrosomia were studied and compared with 41 normoglycemic subjects without macrosomia. Of the subjects with non-GDM macrosomia, 45 (49.4%) had normal 50 g glucose challenge test (GCT) without further testing, another 8 (8.8%) had abnormal GCT but normal 75 g oral glucose tolerance test (OGTT). A total of 4 (4.4%) subjects had normal GCT and OGTT. Interestingly, 14 out of 16 (87.5%) subjects who were tested with OGTT owing to past history of macrosomia had normal results but delivered macrosomic babies. Only 12 subjects had both GCT and OGTT, the rest of the cohort had either of the two tests. Subjects with non-GDM macrosomia had higher frequency of neonatal hypoglycaemia 34% as compared to 10% in non-macrosomic babies (P=0.003). Other feto-maternal complications were similar in both groups. Conclusions: No significant pattern of glucose tolerance characteristics was identified in non-GDM mothers with macrosomic babies. In spite of being normoglycemic significant neonatal hypoglycaemia was recorded in non-GDM macrosomic babies. Further prospective studies on a larger population are needed to verify our findings.

Prevalence of hyponatremia in acute medical admissions in tropical Asia Pacific Australia

OBJECTIVE@#To determine prevalence of hyponatremia in acute medical admissions in Northern Australasia.@*METHODS@#We studied 469 consecutive acute medical admissions to a hospital in Australia's Far North Queensland during the colder months of June and July 2012. Prevalence of hyponatremia and its relationship with gender, age, diagnosis and prognosis in acute medical admissions were investigated.@*RESULTS@#On admission, hyponatremia (plasma sodium <136 mmol/L) was present in 39.4% of patients, with mild (130-135 mmol/L), moderate (126-129 mmol/L) and severe (<126 mmol/L) hyponatremia being present in 25.2%, 10.7% and 3.6% respectively. Overall, adding together admission hyponatremia with that developing during admission, 45.2% of patients were affected with 11.5% moderate hyponatremia cases and 4.1% severe ones. Hypokalemia and hyperkalemia were present in 17.0% and 18.1%, respectively. Overall, 275/469 patients (58.6%) presented with an electrolyte abnormality. There were significant correlations of hyponatremia with age but not with gender and in-hospital mortality. Prevalence of hyponatremia was high across all diagnostic categories.@*CONCLUSIONS@#The prevalence of hyponatremia appears to be high in the tropical North Australian population, being the highest prevalence reported amongst acute hospital admissions. The previously reported correlations with age and mortality do appear to hold good for this population with a high prevalence of electrolyte disorders. Further prospective analysis on a larger population in the area is needed to confirm our findings.

Diabetes epidemic in the Asia Pacific region: has hemoglobin A1C finally earned its place as a diagnostic tool?

Two-third of the world's population lives in the Asia Pacific region where prevalence of diabetes has reached epidemic proportion. With China and India being the most populous nations on the globe, it is believed that over 150 million diabetes reside in the region with more than 95% being of type 2 diabetes mellitus (T2DM). Furthermore, other Pacific islands in the region have high rates of T2DM including Tonga, Fiji, French Polynesia, and Nauru. The latter has the highest prevalence of T2DM per population in the world. Over the past two decades, in Australia and New Zealand, the prevalence of T2DM has more than doubled, mainly amongst the Aboriginal and Torres Strait Islander and Maori peoples respectively. With the increasing prevalence of diabetes in the Asia Pacific region coupled with the limited number of resources, use of a reliable and effective mode of diagnosis for T2DM is warranted. Yet to date, only New Zealand has adopted the American Diabetes Association recommendation of using hemoglobin A1C in the diagnosis of the disease. The aim of this review is to discuss the clinical usefulness of hemoglobin A1C and highlight its diagnostic role in the Asia Pacific region where T2DM is increasingly encountered.

Macrosomia in non-gestational diabetes pregnancy: glucose tolerance test characteristics and feto-maternal complications in tropical Asia Pacific Australia

<p><b>OBJECTIVE</b>To look into the glucose tolerance test characteristics and determine complications in non-gestational diabetes pregnant subjects.</p><p><b>METHODS</b>From 2006 to 2009 all non-gestational diabetes mellitus (non-GDM) pregnant women who delivered macrosomia at the North Australia's Townsville Hospital were retrospectively reviewed by extracting data from clinical record. Glucose tolerance tests results were analysed in the light of an earlier diagnosis of non-GDM.</p><p><b>RESULTS</b>Ninety-one non-GDM mothers with macrosomia were studied and compared with 41 normoglycemic subjects without macrosomia. Of the subjects with non-GDM macrosomia, 45 (49.4%) had normal 50 g glucose challenge test (GCT) without further testing, another 8 (8.8%) had abnormal GCT but normal 75 g oral glucose tolerance test (OGTT). A total of 4 (4.4%) subjects had normal GCT and OGTT. Interestingly, 14 out of 16 (87.5%) subjects who were tested with OGTT owing to past history of macrosomia had normal results but delivered macrosomic babies. Only 12 subjects had both GCT and OGTT, the rest of the cohort had either of the two tests. Subjects with non-GDM macrosomia had higher frequency of neonatal hypoglycaemia 34% as compared to 10% in non-macrosomic babies (P=0.003). Other feto-maternal complications were similar in both groups.</p><p><b>CONCLUSIONS</b>No significant pattern of glucose tolerance characteristics was identified in non-GDM mothers with macrosomic babies. In spite of being normoglycemic significant neonatal hypoglycaemia was recorded in non-GDM macrosomic babies. Further prospective studies on a larger population are needed to verify our findings.</p>

Apolipoprotein B/apolipoprotein A-I ratio in relation to various definitions of metabolic syndrome among Saudi patients with type 2 diabetes mellitus

To assess if the apolipoprotein Apo B/Apo A-I ratio in Saudi patients with type 2 diabetes mellitus T2DM is associated with metabolic syndrome MetS. This cross-sectional study was conducted on 250 patients with T2DM, above 40 years of age, at King Abdulaziz University Hospital Diabetes Center in Riyadh, Saudi Arabia, between January and December 2006. Metabolic syndrome was defined, and compared according to 3 criteria, namely, National Cholesterol Education Program Adult Treatment Panel III, International Diabetes Federation, and World Health Organization. In the 250 patients studied, all 3 definitions demonstrated significant increase in the Apo B/Apo A-I ratio, in Saudi type 2 diabetics with the MetS. There was a strong positive correlation between the Apo B/Apo A-I ratio and triglycerides, low-density lipoprotein cholesterol, and total cholesterol r=0.43-0.54, p<0.0001, and a weak, yet significant, correlation r=0.14-0.21, p<0.05 with waist circumference, waist-hip ratio, fasting glucose, and hemoglobin A1c, however, not with body mass index r=0.01, p=0.88. In contrast, the ratio showed strong negative correlation with high-density lipoprotein cholesterol r = -0.7, p < 0.0001. Apolipoprotein B/apolipoprotein A-I ratio is significantly associated with MetS in Saudi patients with T2DM, similar to observations made in other ethnic groups

Hirsutism in Saudi females of reproductive age: a hospital-based study

Hirsutism among women of fertile age is commonly seen in clinical practice, but the pattern of the disease in Saudi Arabs has not been studied. The aim of the study was to determine the clinical, biochemical and etiologic features of hirsutism in Saudi females. 101 Saudi Arab women presenting with hirsutism at King Khalid University Hospital, Riyadh, Saudi Arabia, from 1 January 2000 to 31 December 2005 were prospectively assessed using the recently approved diagnostic guidelines for hyperandrogenic women with hirsutism. Polycystic ovary syndrome [PCOS] was the cause of hirsutism in 83 patients [82%] followed by idiopathic hirsutism [IH] in 11 patients [11%]. Others causes of hirsutism included late onset congenital adrenal hyperplasia in 4 patients [4%], microprolactinoma in 2 [2%] and Cushing's syndrome in 1 [1%] patient. Age at presentation of PCOS was 24.5_6.6 years [mean +/- SD] and 51% of the subjects were obese. Furthermore, 74 [89%] of patients with PCOS had an oligo/anovulatory cycle while the remaining 9 patients [11%] maintained normal regular menstrual cycle. Luteinizing hormone and total testosterone were significantly higher in patients with PCOS than in those with IH [P<.05]. The present data show PCOS to be the commonest cause of hirsutism in our clinical practice and PCOS is prominent amongst young obese females. However, further studies on a larger scale are needed to verify our findings

Treatment of Graves' hyperthyroidism - prognostic factors for outcome

To determine whether clinical and biochemical features of Graves' disease at presentation predict response to medical and radioiodine treatment. We carried out a retrospective 10-year study of 194 consecutive Saudi subjects with Graves' disease who were treated with antithyroid drugs, radioiodine therapy, or both, between January 1995 and December 2004 at King Khalid University Hospital, Riyadh, Saudi Arabia. At diagnosis, the mean age was 32 +/- 0.9 years. Only 26% of patients had successful outcome after a course of antithyroid medication. None of the clinical or biochemical factors were associated with a favorable outcome of antithyroid treatment. One dose of radioiodine [13-15 mCi [481-555 MBq]] cured hyperthyroidism in 83% of patients. Presence of ophthalmopathy at presentation was shown to be a significant contributing factor to failure to respond to a single dose of radioiodine [odds ratio, 6.4; 95% CI, 1.51-24.4; p<0.01]. Failure of radioiodine treatment was also associated with higher serum free T3 concentration at presentation [p=0.003]. In patients with Graves' hyperthyroidism, radioiodine treatment is associated with higher success rate than antithyroid drugs. A dose of 13-15 mCi [481-555 MBq] seems to be practical and effective, and should be considered as first line therapy. Patients with high free T3 concentration and, those with ophthalmopathy at presentation were more likely to fail radioiodine treatment. A higher dose of radioiodine may be advisable in such patients