The preservation of insulin sensitivity in obese women without diabetes.

OBJECTIVE: To assess insulin sensitivity, pancreatic beta-cell function, and compare circulating levels of adiponectin and ghrelin in obese women with and without diabetes. MATERIAL AND METHOD: Ninety-nine obese women with a body mass index (BMI) > or = 25 kg/m2 and age at least 40 years without previous history of diabetes participated in this study. Oral glucose tolerance test was performed in all subjects. Serum for insulin, adiponectin, and ghrelin were obtained at baseline. Data were expressed as mean +/- SEM. RESULTS: Oral glucose tolerance test revealed 66 non-diabetic (ND) and 33 diabetic (D) subjects. Despite a similar degree of obesity, women without diabetes had near normal insulin sensitivity (ND, 105.7 +/- 6.4%; D, 62.3 +/- 5.9%; p < 0.001) and beta cell function (ND, 95.4 +/- 3.0%; D, 79.0 ++/- 6.1%; p < 0.001) as assessed by the HOMA model. Non-diabetic subjects had higher serum adiponectin levels despite similar BMI (ND, 8.3 +/- 0.4 mg/ml; D, 6.3 +/- 0.4 mg/ml; p < 0.01). Obese subjects with diabetes had lower serum ghrelin levels than obese non-diabetic subjects (ND, 1027.2 +/- 32.0 pg/ml; D, 875.1 +/- 34. 6 pg/ml; p < 0.05). CONCLUSION: Obese women without diabetes have less pancreatic beta cell dysfunction and higher insulin sensitivity than obese women with diabetes. Higher circulating adiponectin may play protective roles in obese non-diabetic subjects, but the significance of higher ghrelin level should be further explored.

The relation between parameters from homeostasis model assessment and glycemic control in type 2 diabetes.

OBJECTIVE: To determine the association of insulin sensitivity and pancreatic beta-cell function parameters assessed by the homeostasis model assessment (HOMA) and glycemic control, and their potential utilization in the clinical care of patients with type 2 diabetes mellitus. MATERIAL AND METHOD: The HOMA indices were assessed in 204 (62 males, 142 females) type 2 diabetic outpatients aged 60.7 +/- 10.9 years. All patients were non-insulin treated for their diabetes. The correlation between variables including logarithmically transformed HOMA-%S and HOMA-%B, body mass index (BMI) and duration of diabetes to glycemic control were assessed The value of the disposition index (HOMA-%SxHOMA-%B) that best discriminated patients with good glycemic control (HbA1C < 7%) from those without (HbA1C > or = 7%) was determined. RESULTS: Both log (HOMA-%S) and log (HOMA-%B) were inversely related to HbA1C with comparable degrees of association (beta = -0.62, p < 0.001 and beta = -0.61, p < 0.001, respectively). The log-transformed disposition index of at least 3.57 had a sensitivity of 74.2% and a specificity of 67.6% in classifying patients as having HbA1C < 7%. The result suggested that in order to achieve acceptable glycemic control, oral hypoglycemic agents should be adjusted to maximize the likelihood of the log-transformed disposition index reaching 3.57. CONCLUSIONS: Glycemic control in diabetic patients partially depends on both insulin sensitivity and pancreatic beta-cell function. Assessing both parameters with the HOMA model is likely to result in a more rational approach for achieving better glycemic control in type 2 diabetic patients.

The development and validation of a diabetes risk score for high-risk Thai adults.

OBJECTIVE: To develop a simple risk score to identify high-risk individuals for diabetes screening in Thailand. MATERIAL AND METHOD: The authors analyzed data from 75-g oral glucose tolerance tests performed in 159 males and 270 females, aged 48.4 +/- 10.9 years. RESULTS: The independent variables associated with diabetes included age (p < 0.001), BMI (p < 0.01) and known history of hypertension (HHT) (p < 0.01). The risk equation was Y = 3 age + 5 BMI + 50 HHT. At the cut-off Y value of 240, the sensitivity and specificity for having diabetes were 96.8% and 24.0%, respectively. The positive predictive value was 17.8% and the negative predictive value was 97.8%. Using the equation in a validation group comprising 1617 subjects, it was found that 560 (34.6%) diabetes screenings could be saved while 28 subjects (12.8%) with diabetes would be missed. CONCLUSION: The authors have developed a simple risk scoring method that should be helpful in decreasing the number of unnecessary screening and optimizing the costs associated with diabetes screening.

Thailand diabetes registry project: prevalence of hypertension, treatment and control of blood pressure in hypertensive adults with type 2 diabetes.

OBJECTIVE: To determine the prevalence of hypertension, patterns of antihypertensive treatment and level of blood pressure control in adult Thai type 2 diabetic patients who attended diabetes clinics in university and tertiary-care hospitals. MATERIAL AND METHOD: A cross-sectional, multi-center, hospital-based diabetes registry of 8884 adults 18 years old and older was carried out from diabetes clinics of 11 tertiary centers. Demographic data, including use of antihypertensive drugs and blood samples were collected and analyzed for prevalence, associated factors, patterns of antihypertensive therapy and level of blood pressure control. RESULTS: The prevalence of hypertension in adult Thai type 2 diabetic patients was 78.4 (6965)%. Antihypertensive drugs were prescribed in 84.4 (5878)% of all hypertensive patients. The achievement of blood pressure control (less than 130/80 mmHg) w as 13.85%. Thepercentage of patients receiving 1, 2, 3, 4, and 5 drugs were 45 (2645)%, 33.4 (1963)%, 16.8 (987)%, 4.4 (259)%, and 0.4 (24)% respectively. Angiotensin-converting enzyme inhibitors were the most commonly prescribed antihypertensive agents (54.6%), followed by diuretics (43.8%), and calcium channel blockers (34.6%). CONCLUSION: Blood pressure control in hypertensive adults with type 2 diabetes was suboptimal. Strategies to improve awareness and adequacy of blood pressure control in these subjects should be seriously considered.

Prevalence of thyroid antibodies in Thai patients with chronic idiopathic urticaria.

One hundred Thai patients with chronic idiopathic urticaria (CIU) were studied to determine the prevalence of thyroid antibodies in comparison to 100 age- and sex-matched healthy volunteers. It was found that 21 patients (21%) with CIU were positive for thyroid antibodies. Among normal volunteers, only nine cases (9%) had elevated titers of thyroid antibodies. The frequency of thyroid antibodies in the chronic urticaria group was significantly more common than the control group (chi-square = 4.75, p=0.03). Among 21 patients with CIU who were positive for thyroid antibodies, 9 cases were negative for thyroid antibodies when repeating the tests after 3 months. Only 12 patients still had persistent elevation of antibodies after 3 months and thyroid function test was performed in these 12 patients. It was found that 9 cases had autoimmune thyroiditis with euthyroidism. One case had subclinical hyperthyroidism. One case had autoimmune hyperthyroidism, One case had subclinical hypothyroidism.