Effects of meal replacement therapy on metabolic outcomes in Thai patients with type 2 diabetes: A randomized controlled trial.

BACKGROUND: A meal replacement (MR) with a low glycemic index (GI) is possibly beneficial for glycemic control. However, the effects of MR on diabetes mellitus have not been studied among Thai patients with type 2 diabetes (T2DM). AIM: To compare metabolic outcomes between T2DM patients receiving the new MR formula (ONCE PRO) and normal controlled diets. METHODS: A multicenter, open-labeled, randomized controlled trial was conducted. Eligible patients received either ONCE PRO for one meal daily with controlled diets or only controlled diets for 3 months. The differences in metabolic profile between the baseline and end point of each group and between groups were measured. RESULTS: 110 participants were enrolled; the mean difference and standard deviation in hemoglobin A1C (HbA1c) (%) from baseline were -0.21 ± 0.78 (p = 0.060) and -0.27 ± 0.60 (p = 0.001) in the MR and control groups, respectively; however, there was no significant difference between groups (p = 0.637). Patients consuming a MR instead of breakfast had a significant decrease in HbA1c (p = 0.040). Body weight (BW) and body mass index (BMI) were significantly reduced in both groups. There were no significant change in waist circumference, fasting plasma glucose, total cholesterol and triglycerides. Low-density lipoprotein cholesterol (LDL-C) was significantly decreased in the MR group compared with the control group (p = 0.049). CONCLUSIONS: Short-term conventional diet control and the low-GI MR product were associated with a decreased BW and BMI. Changes in the other metabolic outcomes, HbA1c, total cholesterol and triglycerides, were comparable despite ONCE PRO as the MR having a better effect on LDL-C lowering.

Comparative study between the Phramongkutklao's diabetic blenderized diets and commercial diabetic diets on glycemic variability in continuous tube fed patients with type 2 diabetes.

BACKGROUND: Rapid glucose fluctuations over daily period play an important role on diabetic complications. OBJECTIVE: To compare glycemic variability, mean plasma glucose, number ofcapillary blood glucose tests, and cost between the Phramongkutklao's diabetic formula and commercial diabetic formula in continuous tube fed patients with stable condition in type 2 diabetes. MATERIAL AND METHOD: A cross-over design study was performed between October 2010 and February 2011 in the medical department in Phramongkutklao Hospital. The researchers enrolled type 2 diabetic patients with stable condition who were on continuous tube fed. Seventy-two-hour continuous subcutaneous glucose monitoring was performed in all patients. Comparison ofmean amplitude ofglycemic excursions (MAGE), mean plasma glucose, cost, and number of capillary blood glucose tests were analyzed by using non-parametric Wilcoxon signed-rank test. Significance was defined as p<0.05. Results: Ten subjects were included in the present study. The Phramongkutklao's Diabetic Formula resulted in significantly lower mean plasma glucose (122±26.25 vs. 144.68±36.91 mg/dL, p = 0.022), cost (550.1±33.57 vs. 797.81±42.29 baht, p = 0.004), and number of capillary blood glucose tests (5±0.94 vs. 5.3±0.82 times, p = 0.083) when compared with commercial diabetic formula, but no significant difference in MAGE level (5.86±2.78 vs. 7.71±4.34 mg/dL, p = 0.333). CONCLUSION: The Phramongkutklao's diabetic formula has significantly lower mean plasma glucose, less number of capillary blood glucose tests, and is less expensive than commercial diabetic formula. The glucose variability (MAGE) of the Phramongkutklao diabetic formula has also less than commercial diabetic formula, but does not reach statistical significance. The level ofplasma glucose was lower than 180 mg/dL in both formulas.

Correlation between neck circumference and hepatic steatosis determined by controlled attenuation parameter.

Neck circumference is an attractive method for determining metabolic profiles and has many advantages over waist circumference. However, the correlation between neck circumference and hepatic fibrosis has not been evaluated. The aim of this study was to evaluate the correlation between neck circumference and hepatic fibrosis and define the optimal cut-off point for neck circumference to determine hepatic fibrosis. A cross-sectional study (n = 333) was conducted among Thai healthcare workers at Phramongkutklao Hospital who received an annual health maintenance program. Neck circumference was measured at the lower margin of the laryngeal prominence. Fibroscan® with a controlled attenuation parameter was used to measure the degree of hepatic fibrosis and steatosis by an experienced, well-trained operator. In the cross-sectional analysis, it was found that the large circumference of the neck was associated with hepatic fibrosis (r = 0.19, p = .001) and hepatic steatosis (r = 0.58, p < .001). Hepatic fibrosis (r = 0.15, p = .004) and steatosis (r = 0.53, p < .001) were also associated with waist circumference. The neck circumferences of 40 and 34 cm were the best cut-offs for male and female participants, respectively.Neck circumference is closely related to hepatic fibrosis and steatosis, which should be promoted and has a better advantage than waist circumference in the screening of hepatic steatosis.

Diabetes-specific formula with standard of care improves glycemic control, body composition, and cardiometabolic risk factors in overweight and obese adults with type 2 diabetes: results from a randomized controlled trial.

Background and aims: Medical nutrition therapy is important for diabetes management. This randomized controlled trial investigated the effects of a diabetes-specific formula (DSF) on glycemic control and cardiometabolic risk factors in adults with type 2 diabetes (T2D). Methods: Participants (n = 235) were randomized to either DSF with standard of care (SOC) (DSF group; n = 117) or SOC only (control group; n = 118). The DSF group consumed one or two DSF servings daily as meal replacement or partial meal replacement. The assessments were done at baseline, on day 45, and on day 90. Results: There were significant reductions in glycated hemoglobin (-0.44% vs. -0.26%, p = 0.015, at day 45; -0.50% vs. -0.21%, p = 0.002, at day 90) and fasting blood glucose (-0.14 mmol/L vs. +0.32 mmol/L, p = 0.036, at day 90), as well as twofold greater weight loss (-1.30 kg vs. -0.61 kg, p < 0.001, at day 45; -1.74 kg vs. -0.76 kg, p < 0.001, at day 90) in the DSF group compared with the control group. The decrease in percent body fat and increase in percent fat-free mass at day 90 in the DSF group were almost twice that of the control group (1.44% vs. 0.79%, p = 0.047). In addition, the percent change in visceral adipose tissue at day 90 in the DSF group was several-fold lower than in the control group (-6.52% vs. -0.95%, p < 0.001). The DSF group also showed smaller waist and hip circumferences, and lower diastolic blood pressure than the control group (all overall p ≤ 0.045). Conclusion: DSF with SOC yielded significantly greater improvements than only SOC in glycemic control, body composition, and cardiometabolic risk factors in adults with T2D.

ACTION APAC: Understanding perceptions, attitudes and behaviours in obesity and its management across south and Southeast Asia.

To identify perceptions and attitudes among people with obesity (PwO) and healthcare professionals (HCPs) toward obesity and its management in nine Asia-Pacific (APAC) countries, a cross-sectional online survey was conducted among adult PwO with self-reported body mass index of ≥25 kg/m2 (≥27 kg/m2, Singapore), and HCPs involved in direct patient care. In total, 10 429 PwO and 1901 HCPs completed the survey. Most PwO (68%) and HCPs (84%) agreed that obesity is a disease; however, a significant proportion of PwO (63%) and HCPs (41%) believed weight loss was the complete responsibility of PwO and only 43% of PwO discussed weight with an HCP in the prior 5 years. Most respondents acknowledged that weight loss would be extremely beneficial to PwO's overall health (PwO 76%, HCPs 85%), although nearly half (45%) of PwO misperceived themselves as overweight or of normal weight. Obesity was perceived by PwO (58%) and HCPs (53%) to negatively impact PwO forming romantic relationships. HCPs cited PwOs' lack of interest (41%) and poor motivation (37%) to lose weight as top reasons for not discussing weight. Most PwO (65%) preferred lifestyle changes over medications to lose weight. PwO and HCPs agreed that lack of exercise and unhealthy eating habits were the major barriers to weight loss. Our data highlights a discordance between the understanding of obesity as a disease and the actual behaviour and preferred approaches to manage it among PwO and HCPs. The study addresses a need to align these gaps to deliver optimal care for PwO.

The study of glycemic index of Gen-Premium.

OBJECTIVE: To determine the glycemic index of Gen-Premium. MATERIAL AND METHOD: Ten healthy volunteers were included for testing glycemic index of Gen-Premium. After the overnight fast, the subjects consumed 50 grams of glucose (reference food) within five minutes. The blood samples were collected at 0, 30, 60, 90, and 120 minutes for measuring of plasma glucose. One day later the same subjects consumed 50 grams of carbohydrate from Gen-Premium (test food) within five minutes. After complete the data, the glycemic index was calculated by the standard method. RESULTS: The glycemic index of Gen-Premium was 27.29, which classify in low GI food. CONCLUSION: According to the methodology of glycemic index determination, the glycemic index of Gen-Premium is 27.29, which is considered to be favorably low.

Apolipoprotein B level in patients with type 2 diabetes who achieved goal of low density lipoprotein cholesterol and non-high density lipoprotein cholesterol.

OBJECTIVE: To demonstrate an apolipoprotein B (apo B) level in type 2 diabetic patients who achieved goal of low density lipoprotein cholesterol (LDL-c) and non-high density lipoprotein cholesterol (non-HDL-c). To identify the percentage of type 2 diabetes patients who achieved goal of apo B level. MATERIAL AND METHOD: A cross-sectional study was carried out from 1 October to 31 December 2008. Type2 diabetes patients who attended at diabetes clinics in the Phramongkutklao hospitals have determined the risk for develop cardiovascular diseases (CVD) and set up the goal for lipid level according to consensus statement from the American Diabetes Association (ADA) and the American College of Cardiology (ACC) foundation. Blood test for apo B will be done only the patients who achieved goal of LDL-c and non-HDL-c. RESULTS: 133 of the 162 registered diabetic patients can achieve goal of lipid level In this population, 9.7 percent (%) (n = 13) had a history of CVD. ApoB level in diabetic patients with and without CVD is 61.72 +/- 12.63 and 67.2 +/- 12.92 milligram per deciliter (mg/dL), respectively. Nearly ninety-eight percent of patients without cardiovascular diseases (CVD) have achieved apo B (< 90 mg/dL) goal, and 92.3% of patients with CVD have achieved apo B (< 80 mg/dL) goal. The two most commonly used lipid-lowering agents were statins and fibrates. CONCLUSION: In patients with type 2 diabetes who achieved goal of LDL-c and non-HDL-c have also achieved apo B level. Thus, apo B measurement in addition to reached LDL-c and non-HDL-c targets may be not necessary especially in diabetic patients who did not previous CVD.

Efficacy and safety of generic and original pioglitazone in type 2 diabetes mellitus: a multicenter, a double-blinded, randomized-controlled study.

OBJECTIVE: To compare the efficacy and safety of generic (Utmos) and original (Actos) 30 mg Pioglitazone tablets. STUDY DESIGN: A multicenter, parallel randomized, double-blinded, controlled study. MATERIAL AND METHOD: Type 2 diabetic patients, with glycosylated hemoglobin (HbA,) > or = 7.0%, who received Metformin not less than 1000 mg/day over three months were recruited. Patients were randomized to receive either generic or original Pioglitazone 30 mg/day for 24 weeks. RESULTS: Eighty-five patients were enrolled, forty-four patients received generic Pioglitazone andforty-one received original Pioglitazone. There were no significant differences in baseline characteristics between generic and original Pioglitazone group. There were significantly reduced HbA(1c), fasting plasma glucose (FPG) and significantly increased HDL-cholesterol from baseline (p < 0.0001) without statistically differences between the two groups. Headache and edema were found in both groups at comparable rates (p > 0.05). CONCLUSION: Generic Pioglitazone (Utmos) is effective in controlling blood glucose and has similar effects on lipid profile as the original one. Both generic (Utmos) and original (Actos) 30 mg Pioglitazone tablets were not different in the efficacy and safety profiles.

Prevalence of the metabolic syndrome, and its association factors between percentage body fat and body mass index in rural Thai population aged 35 years and older.

OBJECTIVES: To obtain the prevalence of metabolic syndrome (MS) and its associated socioeconomic factors, and also to evaluate the association between percentage body fat (BF) and body mass index (BMI) in a rural Thai population. MATERIAL AND METHOD: MS defined by the National Cholesterol Education Program Adult Treatment Panel III criteria. The prevalence of the MS was then determined using the NCEP III criteria with and without the modified waist circumference criteria. BMI indicating normal weight, overweight and obesity as re-defined for the Asian by International Association for the Study of Obesity (IASO), WHO. Four-hundred and four rural Thai men and women aged 35 years and older were evaluated. Data on anthropometry, blood pressure, socioeconomic status, lifestyle-related information, blood studies, and bioelectrical impedance (BIA) values had been collected. RESULTS: The prevalence of the MS in the rural Thai people was 18%, but increased to 23% with the modified Asian criteria. High BMI, female gender, and older age were associated with increased odds of the MS. Household income, dietary composition, smoking and drinking status were not associated with increased odds of the MS. There was significant association between percent BF and BMI in men and women in rural Thai population. CONCLUSION: The MS was present in about 18% of the rural Thai population and was significantly influenced by body mass index, gender and age. Metabolic syndrome becomes an important problem in rural Thai populations who even live basic lifestyle in the non-urbanized and non-industrialized areas. Identification and clinical management of this high-risk group is an important strategy for coronary heart disease prevention.

The correlation of insulin resistance and renal function in non diabetic chronic kidney disease patients.

INTRODUCTION: A greater degree of insulin resistance may predispose to renal injury by worsening renal hemodynamics through the elevation of glomerular filtration fraction. However, there are sparse data on the relationship between insulin resistance, glomerular filtration rate (GFR) and body composition in chronic kidney disease (CKD) without diabetes. OBJECTIVES: To evaluate the relationship between insulin resistance, total body fat and GFR in CKD without diabetes. MATERIAL AND METHOD: The authors screened 84 non-diabetic CKD patients according to the K/DOQI definitions and only 78 patients were enrolled into the study (CKD stages 2-4, GFR between 15 and 90 ml/min/ 1.73 m2). Insulin resistance was evaluated by homeostasis model assessment (HOMA-IR). Bioelectrical impedance analysis was performed to determine the percentage of total body fat. GFR was calculated by the average of creatinine and urea clearances. RESULTS: The correlation analysis showed that HOMA-IR was positively correlated with percent body fat (r = 0.32, P<0.05), BMI (r = 0.46, P<0.01), serum triglyceride (TG) (r =0.29, P<0.01), and mean arterial pressure (r =0.25, P<0.05), but not significantly correlated with GFR, age, cholesterol, HDL, uric acid and 24-hr urinary protein. CONCLUSION: In non-diabetic CKD patients, the independent factor for insulin resistance was the amount of total body fat. The insulin level and HOMA-IR were not dependent on the GFR in the present study.

Homocystinuria in Thai patient--Phramongkutklao Hospital experience.

Homocystinuria is a rare autosomal recessive disorder of amino acid metabolism. Classic (type I) homocystinuria is the most common type and occurs as a consequence of a deficiency of cystathionine-b-synthase, producing increased blood and urine homocysteine. The authors report a 15-year-old Thai male who presented with generalized tonic-clonic seizures from superior sagittal sinus thrombosis, bilateral downward subluxation of ocular lenses (ectopia lentis), Marfanoid habitus, osteoporosis, attention deficit and hyperactivity disorder. Urine metabolic screening was positive for cyanide nitroprusside test. Levels of plasma homocysteine and methionine were elevated. The clinical and laboratory findings in this case are consistent with the diagnosis of "type I" or "classical homocystinuria". The treatment was started with a low methionine diet, vitamin B6 or pyridoxine, folic acid, anticonvulsants, antithrombotic treatment and calcium supplementation. Genetic counseling was provided to the family with the recurrent risk of 25%. Definite diagnosis by enzyme assay or mutation analysis and also prenatal diagnosis are not established in Thailand.