RESUMO
Background: It is critical to determine the exact type of diabetes because misclassification led to inappropriate treatments. The classification of DM can be aided by the measurement of pancreatic autoantibodies and plasma C-peptide levels. Previous studies suggested that random plasma C-peptide testing in those with clinically diagnosed adult T1DM of at least 3 years duration has led to reclassification in some cases. Aim: This study aimed to assess the prevalence and characteristics of misdiagnosed adult-onset type 1 diabetes mellitus in Thai people by random plasma C-peptide testing. Methods: A cross-sectional study of adult Thai patients diagnosed with clinically diagnosed T1DM and DM duration of at least 3 years at Theptarin Hospital, a diabetes center in Bangkok, Thailand was studied. Clinically misdiagnosis of T1DM was defined by preserved endogenous insulin secretion. Characteristics of the misdiagnosed patients were compared with definite T1DM patients. Results: A total of 73 patients (females 52.1%, mean age 42.2 ± 12.5 years, duration of DM 20.3 ± 11.3 years) were studied. The prevalence of available anti-GAD and anti-IA2 were 53.3% and 20.8%, respectively. Preserved endogenous insulin secretion evaluated by random C-peptide or stimulated C-peptide was found in 8 patients (11.0%). The misdiagnosed patients had higher prevalence of hypertension and diabetic complications. Three patients were suspected to have monogenic diabetes and five patients were reclassified as possible T2DM. Conclusions: Approximately one-tenth of adult T1DM patients were misdiagnosed. Random plasma C-peptide testing at least 3 years after a diagnosis of T1DM was superior to the measurement of pancreatic autoantibodies. Our present study highlights the need to increase accuracy in the diagnosis of T1DM patients by re-assessing endogenous insulin production with measurement of random plasma C-peptide levels.
RESUMO
Background: Weight gain post-radioiodine (RAI) treatment is observed in patients with hyperthyroid Graves' disease. Previous studies, mostly in Caucasian patients, demonstrated excessive weight gain averaging 5-7 kg from initial presentation. Aim: The aim of this study was to determine the extent and risk factors of weight gain in Thai patients with RAI-treated Graves' disease. Methods: This was a 5-year retrospective study of patients with hyperthyroid Graves' disease who received RAI treatment during 2016-2020. The proportion and associated risk factors of weight gain ≥5% in patients who was followed for at least 3 months when compared with weight at RAI administration were analyzed. Results: There were 347 patients with Graves' disease (females 81.0%, mean age 38.8 ± 12.1 years, BMI 23.3 ± 4.0 kg/m2) who were treated with RAI. Almost all RAI-treated patients (91.9%) eventually developed hypothyroidism. During the median follow-up period of 25 months, 73.1% of them had weight gain. The mean weight change was +2.5 ± 4.9 kgs when compared with weight at the time RAI administration and +3.4 ± 6.5 kgs when compared with recalled body weight before the onset of hyperthyroidism. The proportion of patient in the obesity class I (BMI 25.0-29.9 kg/m2) increased from 23.6% to 28.0% and obesity class II (BMI ≥30.0 kg/m2) increased from 5.2% to 8.9%. Duration of antithyroid drug treatment less than 6 months after the diagnosis of hyperthyroidism was the only factor associated with weight gain ≥5%. Conclusions: Weight gain post-RAI treatment was common, and a significant proportion of patients went on to develop obesity. Early intervention with weight management support should be employed in patients with less than 6 months of antithyroid drug treatment before RAI.
