Night-shift work is associated with poorer glycaemic control in patients with type 2 diabetes.

The circadian system plays a role in regulating metabolism. Night-shift work, a form of circadian misalignment, is associated with increased type 2 diabetes risk. This study aimed to determine if night-shift workers with type 2 diabetes experience poorer glycaemic control than non-shift workers. Patients with type 2 diabetes (104 unemployed, 85 day workers and 60 night-shift workers) participated. Sleep duration, sleep quality, morningness-eveningness preference, depressive symptoms and dietary intake were assessed using standardized questionnaires. Haemoglobin A1c levels were measured. Night-shift workers had significantly higher haemoglobin A1c levels compared with others, while there were no differences between day workers and unemployed participants (median 7.86% versus 7.24% versus 7.09%, respectively). Additionally, night-shift workers were younger, had a higher body mass index, and consumed more daily calories than others. Among night-shift workers, there were no significant differences in haemoglobin A1c levels between those performing rotating versus non-rotating shifts (P = 0.856), or those with clockwise versus counterclockwise shift rotation (P = 0.833). After adjusting for age, body mass index, insulin use, sleep duration, morningness-eveningness preference and percentage of daily intake from carbohydrates, night-shift work, compared with day work, was associated with significantly higher haemoglobin A1c (B = 0.059, P = 0.044), while there were no differences between unemployed participants and day workers (B = 0.016, P = 0.572). In summary, night-shift work is associated with poorer glycaemic control in patients with type 2 diabetes.

Effects of a simple home-based exercise program on fall prevention in older adults: A 12-month primary care setting, randomized controlled trial.

AIM: To investigate the effects of a simple home-based exercise program on falls, physical functioning, fear of falling and quality of life in a primary care setting. METHODS: Participants (n = 439), aged ≥65 years with mild-to-moderate balance dysfunction were randomly assigned to an exercise (n = 219) or control (n = 220) group. The program consisted of five combined exercises, which progressed in difficulty, and a walking plan. Controls received fall prevention education. Physical functioning and other outcomes were measured at 3- and 6-month follow-up visits. Falls were monitored with fall diaries and phone interviews at 3, 6, 9, and 12 months respectively. RESULTS: The 12 months of the home-based exercise program showed the incidence of falls was 0.30 falls per person year in the exercise group, compared with 0.40 in the control group. The estimated incidence rate ratio was 0.75 (95% CI 0.55-1.04), which was not statistically significant. The fear of falling (measured by the Thai fall efficacy scale) was significantly lower in the exercise than control group (24.7 vs 27.0, P = 0.003). Also, the trend of program adherence increased in the exercise group. (29.6% to 56.8%). CONCLUSIONS: This simple home-based exercise program showed a reduction in fear of falling and a positive trend towards exercise adherence. Further studies should focus on factors associated with exercise adherence, the benefits of increased home visits and should follow participants longer in order to evaluate the effects of the program. Geriatr Gerontol Int 2017; 17: 2157-2163.

Identification of Potential Leverage Points for Self-Management Support Intervention in Thais with Type 2 Diabetes.

Background: Although social-ecological models and multi-level interventions have been recommended for implementing the holistic self-management support for patients with type 2 diabetes, they are complex, costly, and need long-term effort. A more realistic approach would be to identify and implement a single or limited leverage point(s) that is most effective and feasible to create change. Objective: To assess the independent relationships of the social-environmental supports with self-management behaviors in Thai patients with type 2 diabetes. Material and Method: A cross-sectional survey was conducted among 1,000 type 2 diabetic patients from 64 healthcare facilities throughout Bangkok. A set of structured questionnaires were used to collect data related to social-environmental supports, and self-management behaviors. The predictor-outcome relationships were presented by beta (ß) coefficients (95% confidence limits). Results: Personal support was significantly associated with the overall self-management, dietary, physical activity, and medication taking behaviors. Neighborhood support was significantly associated with the overall self-management, physical activity, and medication taking behaviors. Personal support was found to interact negatively with neighborhood support on the overall self-management and medication taking behaviors. Conclusion: Personal and neighborhood supports are two potential leverage points for self-management support interventions for Thai patients with type 2 diabetes. Patients with low and high personal supports may need different strategies for neighborhood support.

Efficacy of Blood Pressure reduction of Losartan in selected Thai populations using Home Blood Pressure Monitoring and Office Blood Pressure measurements.

BACKGROUND: Angiotensin Receptor Blockades (ARB) is becoming a first line drug for essential Hypertension for many types of patient. Losartan is the prototype of ARB due to its vast clinical trials. Home Blood pressure monitoring can provide accurate evaluation of certain drug effect on blood pressure with small number of patient samples. Local production of medicine has made the Medicine readily available and could bring about clinical improvement. Our hypothesis was that Thai population with essential hypertension responded quite well to Losartan and Generic Losartan was not inferior to Original- Losartan. OBJECTIVE: To evaluate the effectiveness and safety in BP reduction by Losartan in certain Thai population and to compare these parameters between Generic Losartan and Original-Losartan using both office and HBPM method. METHOD: After a two-week run-in period when they would learn to use HBPM device and their blood pressure were still recorded to be higher than 140/90 by office BP or 135/85 by HBPM with or without previous medical regimen, 24 patients were randomized to receive either Generic Losartan or Original-Losartan for 6 weeks. Then they would cross over to receive the alternative and were followed again at 6 weeks. HBPM was performed in the morning and in the evening for 5 days, at baseline, and after 6 & 12 weeks. Office BP measurements were obtained at baseline and after 6 & 12 weeks. RESULT: One patient in each group dropped out from the study. 22 patients with average age of 54 and averaged office BP 154/88 completed the 12 weeks study. By office BP, SBP was reduced by 27±14.2 at week 6 and 28±15.1 mmHg at week 12. By HBPM, SBP dropped by 17±10.8 at week 6 and by 18±9. at week12. At the end of 12 weeks 68% (15/22) of patients had Office BP <140/90 and 64% (14/22) of patients had HBPM <135/85. There was no significant difference of BP reduction at week 6 between Original-xLosartan and Generic Losartan group. After crossover the BP reduction was maintained in both groups. The percentage of patient whose Office BP <140/90 or HBPM <135/85 were not different among the two Losartan groups. There was no serious adverse side effect. CONCLUSION: Using both office BP and HBPM this group of Thai patient with essential hypertension responded well to Losartan and Generic Losartan.

Analysis of Foxp3, CD25, and CD127 expressed on regulatory T cells in Thai subjects.

Foxp3+ natural regulatory T cells (nTreg) play a distinct role in maintaining self tolerance at the periphery. CD25hi and CD127lo were proposed for the identification and purification of nTreg but they have not been confirmed in non-Caucasian populations. This study examined the sensitivity and purity of Foxp3 nTreg identified by CD25 and CD127 in the peripheral blood of Thai subjects (13 males, 15 females with age range of 20-42 years old). The proportions of nTreg/CD4+ as identified by the different markers were as follows: Foxp3+, 18.3 +/- 6.4%; CD25hi 6.4 +/- 3.2%; and CD127lo, 54.3 +/- 14.2%. Sensitivity tests showed the following results: CD25hi, 23.1%; CD127lo, 40.6%; CD25hiCD127lo, 7.4%. Purity tests concluded as follows: CD25hi, 63.6%; CD25int, 24.9%; CD2510, 8.7%, CD127lo, 26.5%; CD127hi, 14.9%, and CD25hiCD127lo, 52.0%. In conclusion, the proportions of nTreg in Thai subjects are similar to Caucasian populations. CD25hi is superior to CD127lo for separating Foxp3+ nTreg. Combining CD25hi and CD127lo does not improve the nTreg purity.

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.