Factors associated with early age at menarche among Thai adolescents in Bangkok: A cross-sectional study.

BACKGROUND: The age at menarche in the Thai population has not been determined since 1997. This study recruited adolescents in Bangkok Metropolis to determine the age at menarche and its associations with health and socioeconomic status. METHODS: This cross-sectional study used a two-step stratified sampling strategy to recruit 1,020 female students, aged 10-16 years, from schools in Dusit district, Bangkok, Thailand. Self-reported data on age at menarche and social determinants of health were collected from participants and their parents. A trained research nurse collected anthropometric data. RESULTS: Mean age at menarche was 11.8 ± 1.0 years, and age at menarche was significantly correlated with year of birth (r = -0.4, p < 0.001). Students from schools that are part of Bangkok Metropolis had the lowest mean age at menarche. Participants born in 2000-2003 having their first period at < 11.8 years numbered 5.5 times (95% CI: 3.80-8.18) and 5.0 times (95% CI: 3.6-8.0) greater than those born in 1997-1999 by univariate and multivariate analysis, respectively. Year of birth significantly associated with age at menarche in univariate and multivariate analysis (p = 0.001). CONCLUSION: The mean age at menarche among female adolescents in Bangkok Metropolis was occurring earlier and was inversely associated with year of birth in this cohort. Only year of birth were associated with age at menarche in the multivariate regression models to adjust for potential confounders.

Age at menarche and performance intelligence quotients of adolescents in Bangkok, Thailand: a cross-sectional study.

BACKGROUND: The presence of an association between age at the onset of puberty and intelligence quotient (IQ) in young adolescents remains controversial. The aim of this study was to explore the association between age at menarche and performance IQ scores of young female adolescents in Bangkok, Thailand. METHODS: A cross-sectional study was conducted among 537 students aged 11-15 years attending primary and secondary schools in the Dusit district of Bangkok, Thailand. The participants were selected based on two-step stratified sampling. Age at menarche and health and socioeconomic status were determined using a self-report questionnaire completed by participants. Performance IQ scores were determined using the Standard Progressive Matrices intelligence test (Thai version) administered by registered clinical psychologists. RESULTS: Of the 537 participants, 0.4 had reached menarche at 8 years of age, 1.9 at 9 years, 10.1 at 10 years, 36.1 at 11 years, 37.6 at 12 years, 10.4 at 13 years, 3.4 at 14 years, and 0.2 % at 15 years. Age at menarche was inversely correlated with performance IQ (Pearson correlation -0.087, p = 0.047). The regression equation predicting performance IQ by age at menarche was performance IQ = 128.06 - 1.16*age at menarche (R (2) = 0.008). In univariate analysis, performance IQ was inversely correlated with age at menarche, body mass index (BMI), time spent watching television, and time sleeping, but was directly correlated with maternal age at birth (all p < 0.05). In multivariate analysis, age at menarche and BMI remained significantly inversely correlated with performance IQ (p < 0.05), while maternal age at birth was directly correlated with performance IQ. The model consisting of age at menarche, BMI, and maternal age at birth best predicted performance IQ. CONCLUSION: After adjusting for confounders, multiple regression analysis showed that age at menarche and BMI of young female adolescents living in the Dusit district of Bangkok, Thailand, were inversely correlated with performance IQ, whereas maternal age at birth was directly correlated with performance IQ.

DIFFERENCES IN MORTALITY BY EDUCATION LEVEL AMONG PATIENTS IN DIABETIC REGISTRY FOR THAILAND.

This study was conducted in order to determine the impact of education on mortality due cardiovascular, infectious and renal disease, and cancer among Thai diabetics using data from the Thailand diabetes registry cohort prospected and conducted between April 2003 and February 2006. The study population consisted of 9,370 registered diabetic patients attending ten diabetes clinics at tertiary medical centers in Bangkok and major provinces. The population was classified by education level: those who had not yet attained a bachelor's degree classified as having "lower education" (7,684: 82%) and those with a bachelor's degree or higher classified as having "higher education" (1,686:18%). The overall mortality rate among those in the higher education group was lower than those in the lower education group (8.9 vs 20.5 per 1,000 patient-years, respectively) with a hazard ratio (HR) of 0.43 (0.31-0.61). The higher education group also had lower mortality rates due to infectious disease [HR 0.10 (0.02-0.41)], renal disease [HR 0.24 (0.06-0.99)] and cardiovascular disease [HR 0.42 (0.22-0.80)]. There was no difference in cancer mortality between the two groups [HR 1.25 (0.74-2.11)].

A prospective, longitudinal, multicenter, observational study to assess insulin treatment patterns in diabetic patients in Thailand: results from the TITAN Study.

OBJECTIVE: To assess usage patterns, effectiveness, andsafety of newly prescribed insulin treatment in patients with diabetes in Thailand MATERIAL AND METHOD: Type 1 or type 2 diabetes mellitus patients who failed achievement of HbA1c <7%, and were about to start or switch to a new insulin treatment were enrolled into this prospective, longitudinal, multicenter observational study. Data regarding insulin usage pattern, HbA1c, fasting plasma glucose (FPG), and hypoglycemia were collected at enrollment, three and six-month. RESULTS: Between July 2008 and February 2010, 751 patients were recruited Mean (SD) age was 57.0 (12.8) years. Mean BMI was 26.1 (5.0) kg/m2. At enrollment, 269 (35.8%), 241 (32.1%), 206 (27.4%), and 35 (4.7%) patients were prescribed neutral protamine Hagedorn (NPH) insulin, long-acting insulin analogues (LAA), premixed insulin (Premixed), and insulin combinations, respectively. Significant HbA1c and FPG reductions were noted at six-month (-1.4% and -56.2 mg/dl, respectively, p<0.01). After stratifying patients into three subgroups according to insulin, the patients could continue throughout six months (588 patients, 211 NPH-group, 201 LAA-group, and 176 Premixed-group). Patients in LAA-group attained higher rate of achievement HbA1c <7% without any hypoglycemia (18.9%) than NPH-group (7.1%) and Premixed-group (6.3%; p<0. 001). Mild-to-moderate hypoglycemic events were reported at 638 events (1.9 events/patient-year) while severe hypoglycemia was reported at 10 events (3.0 event/l00 patient-year). CONCLUSION: In this observational study of real-life clinical practice in Thailand, most common newly prescribed insulin for patients having inadequate glycemic control was NPH, followed by LAA and premixed insulin. More patients on LAA achieved target HbA1c without hypoglycemic events than those on NPH and premixed insulin.

Smoking and death in Thai diabetic patients: the Thailand Diabetic Registry cohort.

OBJECTIVE: To determine the impact of smoking and quit smoking on mortality rate. MATERIAL AND METHOD: This prospective cohort was a three-year follow-up of Thai Diabetes Registry project that registered 9,370 diabetic patients from 10 diabetic clinics in tertiary medical centers in Bangkok and major provinces between April 2003 and February 2006. RESULTS: The groups of 7,487 (80%), 1,315 (14%), and 568 (6%) patients were classified as non-smokers, ex-smokers, and current smokers. The crude death rate of ex-smokers (Hazard Ratio (HR) 1.52 (95% CI 1.19-1.95)) and current smokers (HR 1.55 (1.10-2.19)) were higher than death rate of non-smokers. After control for covariates, the HR comparing ex-smokers with non-smokers was not different (1.10 (0.81-1.50)), while the HR comparing current smokers with non-smokers remained statistical significant (1.74 (1.17-2.61)). CONCLUSION: Smoking increases mortality rate in diabetic patients by about 74%. Quitting smoking decreased mortality rate to the same rate as of diabetic non-smokers.

Meta-regression of risk factors for microalbuminuria in type 2 diabetes.

We aimed to determine the risk factors associated with microalbuminuria in type 2 diabetes patients through a systematic review and meta-regression analysis. The analyzed studies were obtained from PubMed, Scopus, British Medical Journal and ProQuest databases. All studies published from 2000 to 2009 were included. The search yielded 1,243 citations, of which 22 studies were analyzed. Pooled odds ratio estimates were obtained using a random effect model. The association of each risk factor with microalbuminuria was examined after adjusting for age and sex using meta-regression analysis. The adjusted odds ratio was 1.26 (95% CI 1.08-1.46) for systolic blood pressure; 1.16 (95% CI 1.03-1.31) for diastolic blood pressure; 1.43 (95% CI 1.14-1.80) for fasting plasma glucose level; 1.37 (95% CI 0.95-1.98) for smoking and 1.49 (95% CI 0.91-2.46) for waist circumference. The risk factors associated with microalbuminuria were found to be poor glycemic control, uncontrolled hypertension, smoking and central obesity. There is an urgent need to launch a health promotion program for changes in individual health behaviors to mitigate these risk factors for microalbuminuria in patients with type 2 diabetes.

Factors Associated with Depressive Symptoms in Elderly Individuals Living in Urban Communities.

Background: Depression is one of the most significant mental illnesses in the elderly population. Societal and economic changes in the social structure, particularly in urban communities, have led to a tendency toward depression in the elderly. Therefore, understanding the factors associated with depression among the elderly living in urban areas in Thailand is important to prevent and mitigate depression. Objective: To investigate the proportion of depression and its associated factors in the elderly living in Bangkok. Materials and Methods: This was a cross-sectional descriptive study with a sample size of 888 people living in Thai urban communities, including those in slum, urban, suburban, and high-rise building areas. A two-parts questionnaire was used: 1) the Thai Geriatric Depression Scale (TGDS) to assess depression and 2) associated factors. Results: The overall percentage of depression in the sample population was 7.3%, and the proportion of depression was associated with community density (p = 0.031). The factors significantly associated with depression in the elderly included anxiety about an underlying disease [adjusted odds ratio (AOR) = 7.51; 95% CI 3.47-16.27], family conflict (AOR = 6.30; 95% CI 1.34-29.55), family history of psychiatric illness (AOR = 5.78; 95% CI 2.35-14.21), financial problems (AOR = 3.81; 95% CI 2.08-6.98), living separately from a spouse (AOR = 3.31; 95% CI 1.22-8.98), and less or no activity participation (AOR = 3.09; 95% CI 1.32-7.26 and AOR = 3.02; 95% CI 1.29-7.09). Conclusion: To mitigate depression in the elderly, attention should be given to any underlying medical disease. The community also should promote more activities accessible to the elderly, especially income-earning activities. These activities might promote better relationships or ease conflict among elderly and other family members.

Young-onset diabetes patients in Thailand: Data from Thai Type 1 Diabetes and Diabetes diagnosed Age before 30 years Registry, Care and Network (T1DDAR CN).

AIMS/INTRODUCTION: There is a lack of current information regarding young-onset diabetes in Thailand. Thus, the objectives of this study were to describe the types of diabetes, the clinical characteristics, the treatment regimens and achievement of glycemic control in Thai patients with young-onset diabetes. MATERIALS AND METHODS: Data of 2,844 patients with diabetes onset before 30 years-of-age were retrospectively reviewed from a diabetes registry comprising 31 hospitals in Thailand. Gestational diabetes was excluded. RESULTS: Based on clinical criteria, type 1 diabetes was identified in 62.6% of patients, type 2 diabetes in 30.7%, neonatal diabetes in 0.8%, other monogenic diabetes in 1.7%, secondary diabetes in 3.0%, genetic syndromes associated with diabetes in 0.9% and other types of diabetes in 0.4%. Type 1 diabetes accounted for 72.3% of patients with age of onset <20 years. The proportion of type 2 diabetes was 61.0% of patients with age of onset from 20 to <30 years. Intensive insulin treatment was prescribed to 55.2% of type 1 diabetes patients. Oral antidiabetic agent alone was used in 50.8% of type 2 diabetes patients, whereas 44.1% received insulin treatment. Most monogenic diabetes, secondary diabetes and genetic syndromes associated with diabetes required insulin treatment. Achievement of glycemic control was identified in 12.4% of type 1 diabetes patients, 30% of type 2 diabetes patients, 36.4% of neonatal diabetes patients, 28.3% of other monogenic diabetes patients, 45.6% of secondary diabetes patients and 28% of genetic syndromes associated with diabetes patients. CONCLUSION: In this registry, type 1 diabetes remains the most common type and the prevalence of type 2 diabetes increases with age. The majority of patients did not achieve the glycemic target, especially type 1 diabetes patients.

Hospital admission for type 2 diabetes mellitus under the Universal Coverage Scheme in Thailand: A time- and geographical-trend analysis, 2009-2016.

BACKGROUND: Descriptive analyses of 2009-2016 were performed using the data of the Universal Coverage Scheme (UCS) which covers nearly 70 percent of the Thai population. The analyses described the time and geographical trends of nationwide admission rates of type 2 diabetes mellitus (T2DM) and its complications, including chronic kidney disease (CKD), myocardial infarction, cerebrovascular diseases, retinopathy, cataract, and diabetic foot amputation. METHODS AND FINDINGS: The database of T2DM patients aged 15-100 years who were admitted between 2009 and 2016 under the UCS and that of the UCS population were retrieved for the analyses. The admitted cases of T2DM were extracted from the database using disease codes of principal and secondary diagnoses defined by the International Classification of Diseases 9th and 10th Revisions. The T2DM admission rates in 2009-2016 were the number of admissions divided by the number of the UCS population. The standardized admission rates (SARs)were further estimated in contrast to the expected number of admissions considering age and sex composition of the UCS population in each region. A linearly increased trend was found in T2DM admission rates from 2009 to 2016. Female admission rates were persistently higher than that of males. In 2016, an increase in the T2DM admission rates was observed among the older ages relative to that in 2009. Although the SARs of T2DM were generally higher in Bangkok and central regions in 2009, except that with CKD and foot amputation which had higher trends in northeastern regions, the geographical inequalities were fairly reduced by 2016. CONCLUSION: Admission rates of T2DM and its major complications increased in Thailand from 2009 to 2016. Although the overall geographical inequalities in the SARs of T2DM were reduced in the country, further efforts are required to improve the health system and policies focusing on risk factors and regions to manage the increasing T2DM.

An Implementation Framework for Telemedicine to Address Noncommunicable Diseases in Thailand.

To maintain the continuity of noncommunicable disease (NCD) services and ascertain the health outcomes of patients with NCDs during the COVID-19 (coronavirus disease 2019) outbreak in Thailand, various telemedicine services have been developed. To achieve this determination, the implementation framework has been constructed based on recommendations from multidisciplinary experts (Thai NCD Collaboration Group). Within the framework, all key elements are illustrated with their priority and expected collaborations. Ultimately, active collaborations from multi-stakeholders are vitally important to ensure that telemedicine services for NCDs will finally become practical, successful, and sustainable.

Type 1 diabetes management and outcomes: A multicenter study in Thailand.

AIMS/INTRODUCTION: The Thai Type 1 Diabetes and Diabetes Diagnosed Before Age 30 Years Registry, Care and Network was established in 2014 and involved 31 hospitals. The objective of the registry was to evaluate glycemic control and complications of patients with type 1 diabetes. MATERIALS AND METHODS: Patients' demographics, clinical data, frequencies of daily self-monitoring of blood glucose (SMBG), glycemic control and complications were collected. RESULTS: Among the 1,907 type 1 diabetes patients, the mean age was 21.2 ± 11.3 years. The mean glycated hemoglobin level was 9.35 ± 2.41%, with significant variations among age groups (P < 0.001). Conventional insulin treatment and intensive insulin treatment were used in 43 and 57% of patients, respectively. Mean glycated hemoglobin levels were significantly higher in patients treated with conventional insulin treatment compared to those treated with intensive insulin treatment (9.63 ± 2.34 vs 9.17 ± 2.46%, P = 0.002). Compared to the conventional insulin treatment group, significantly more patients in the intensive insulin treatment group achieved good glycemic control (P < 0.001), and fewer had diabetic retinopathy (P = 0.031). The prevalence of microvascular complications increased significantly with age (P < 0.001). Multivariate analysis showed good glycemic control to be associated with age 25 to <45 years, intensive insulin treatment with SMBG three or more times daily and diabetes duration of 1 to <5 years. CONCLUSIONS: Most Thai type 1 diabetes patients were not meeting the recommended glycemic target. As a result of this study, the national program to improve the quality of diabetes treatment and education has been implemented, and the results are ongoing.

Thailand Diabetic Registry cohort: predicting death in Thai diabetic patients and causes of death.

INTRODUCTION: The prevalence of type 2 diabetes in Thailand is 9.8 percent which is double the number forecast by World Health Organization. There is inadequate information to statistically represent all Thai diabetic patients for their causes of death. OBJECTIVE: To determine the clinical characteristics that predicted death and causes of death in Thai diabetic patients. MATERIAL AND METHOD: This prospective cohort was a 3-year follow-up study of the Thai Diabetes Registry project done between April, 2003, and February, 2006, which registered 9,419 diabetic patients attending 11 diabetic clinics in tertiary medical centers in Bangkok and major provinces of Thailand. The dead or alive status (99.5%) was determined. The causes of death were defined by reviewing the medical records. RESULTS: Of the 9,370 diabetic patients registered, 425 patients died, 1.84 percent per year. There was an increased risk of death associated with age, type of healthcare plan, lower education, insulin use, smoking, history of coronary artery disease and cerebrovascular disease, serum creatinine and high HbA1c. Lipid-lowering medication and metformin decreased the risk of death. Cardiovascular disease, infection and cancer were the prevalent causes of death. CONCLUSION: The present study showed risk factors that influenced death and causes of death in Thai diabetics.

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.

Accuracy of single-field nonmydriatic digital fundus image in screening for diabetic retinopathy.

OBJECTIVE: To determine the accuracy, the sensitivity and the specificity of a single-field nonmydriatic digital fundus image interpreted by an endocrinologist for diabetic retinopathy (DR) screening. MATERIAL AND METHOD: Two hundred and forty-eight diabetic patients who attended the Diabetic Center BMA Medical College and Vajira Hospital between May 2007 and March 2008 were included in the present study. The fundus images of all patients, which would include optic nerve and macular area, were captured by a digital camera without any mydriatic agent. After image taking, the patients were subsequently examined for any evidence of diabetic retinopathy by an experienced ophthalmologist. The fundus images were later interpreted by a trained endocrinologist and would be compared with the findings from the ophthalmologist, which were used as a gold standard RESULTS: The prevalence of DR was 24.2% of the population or 22.8% of the 495 eyes studied. Ninety-three fundus images were considered low quality for interpretation and were excluded from the analysis. From the remaining 402 eyes (155 patients), the Kappa value of the endocrinologist's interpretation and the ophthalmologist's findings was 0.48. The accuracy for screening DR by the image capture was 80.6% (95% confidence interval [CI], 76.4-84.3) while the sensitivity and specificity were 65.6% (95% CI, 60.9-70.2) and 84.9% (95% CI, 81.4-88.4), respectively. Positive predictive value and negative predictive value were 55.7% (95% CI, 50.8-60.5) and 89.5% (95% CI, 86.5-92.5), respectively CONCLUSION: Single-field nonmydriatic digital fundus image is a convenient screening tool for a diagnosis of diabetic retinopathy. The test could be achieved by a trained endocrinologist who could practically serve the patients in one visit at diabetic clinics. A referral to an ophthalmologist is still recommended in any cases with abnormal findings, or those with questionable findings, and those with poor quality photographs when diabetic retinopathy could not be definitely excluded.

Thailand diabetes registry project: prevalence of diabetic retinopathy and associated factors in type 2 diabetes mellitus.

OBJECTIVE: To determine the prevalence of and factors associated with Diabetic Retinopathy (DR) in type 2 diabetes in Thailand. MATERIAL AND METHOD: A cross-sectional, multicenter; hospital-based study was carried out between April and December 2003. Diabetic patients in diabetic clinics of 11 tertiary centers in Thailand were registered. Retinal examination of the participants was performed by ophthalmologists. RESULTS: 7119 of 9419 (75.6%) diabetic patients received retinal examination using direct ophthalmoscopy after full dilatation of pupils. 6707 cases were type 2 diabetic patients. The prevalence of DR was 31.4% (N=2105) which consisted of Non-Proliferative DR (NPDR) 22% (N=1475), Proliferative DR (PDR) 9.4% (N= 630). Patients with DR were significantly older; had longer duration ofdiabetes, and higher Fasting Plasma Glucose (FPG), HbA1c, serum LDL, serum Tri Glyceride (TG) and systolic Blood Pressure (BP) levels than those without DR. Nephropathy (which consisted of positive microalbuminuria, proteinuria or renal insufficiency). Thepatients with DR presented in a significantly higher number of than those without DR. A. The factors associated with DR (adjusted Odds Ratio (OR) [95% CI]) were (1) duration of diabetes 1.4 [1.04-1.82]for duration of 5-9.9 years, 1.9 [1.47-2.58] for duration of 10-14.9 years, 2.9 [2.11-3.95] for duration of 15-19.9 years, 3.5 [2.58-4.79]for duration of > or =20 years when compared with duration of diabetes of less than 5 years, (2) latest HbA1c > 7% (1.5 [1.24-1.88]) when compared with HbAlc < or = 7%, (3) systolic BP > 140 mmHg (1.4 [1.18-1.71]) when compared with systolic BP < or =140 mmHg, (4) nephropathy status i.e. positive microalbuminuria (1.5 [1.21-1.93]), positive proteinuria (1.9 [1.45-2.35]) and renal insufficiency (3.3 [2.29-4.70]) when compared with no nephropathy. CONCLUSION: Diabetic retinopathy was present in about one third of type 2 diabetic patients in Thailand. The authors found the factors associated with DR were duration of diabetes, latest HbA1c level, systolic BP and diabetic nephropathy. Regular screening for DR and more aggressive management of associated factors should be done to reduce the prevalence ofDR.

Thailand diabetes registry project: prevalence, characteristics and treatment of patients with diabetic nephropathy.

OBJECTIVES: To identify the prevalence and characteristics of patients with Diabetic Nephropathy (DN) and to evaluate adequacy of glycemic and blood pressure control of these patients in the authors' registry. MATERIAL AND METHOD: A cross-sectional, multicenter, hospital-based diabetic registry was carried out in diabetes clinics of 11 tertiary centers in Thailand. DN was defined as the presence of at least two out of three of these symptoms; positive microalbuminuria, positive dipstick proteinuria or creatinine levels equal to or greater than 2 mg/dl. One center that did not perform urine microalbumin measurement was excludedfrom the analysis. Overt nephropathy was defined as the presence of gross proteinuria or renal insufficiency. RESULTS: The study included 4875 patients (females 63.8%) with a mean (SD) duration ofdiabetes of 12.8 (8.2) years. The prevalence of DN was 42.9% (microalbuminuria 19.7% and overt nephropathy 23.2%). There were 373 (7.7%) patients with renal insufficiency and 24 (0.47%) with end-stage renal disease. By multivariate analysis, factors associated with DN were age, duration of diabetes, male sex, smoking, blood pressure, HbA1c, dyslipidemia and presence of diabetic retinopathy. Prevalence of ischemic heart disease and cerebrovascular disease in patients with DN was 11.5% and 6.6% respectively. Mean (SD) HbA1c in patients with nephropathy was 8.2 (2.6)%. Only 25% of subject had HbA1c of less than 7%, 46% had blood pressure ofmore than 140/90 mmHg and 84% received at least one antihypertensive drug. However, the target blood pressure of less than 130/80 mmHg could be achieved in only 18% of these patients. The mean (SD) number of antihypertensive drugs was 1.7 (1.1). Nearly 60% of patients received either ACE inhibitors or ARBs. CONCLUSION: DN was very common. The overall picture of DN in the present survey suggests the seriousness of the problem and prompts more aggressive intervention.

Thailand diabetes registry project: prevalence and risk factors associated with lower extremity amputation in Thai diabetics.

OBJECTIVE: To determine the prevalence and risk factors associated with lower extremity amputation (LEA) in Thai diabetics. MATERIAL AND METHOD: A cross-sectional, multicenter hospital-based diabetes registry was carried out from April to December 2003. Baseline characteristics and risk factors were analysed from 9419 diabetic patients. peripheral vascular disease (PVD) was defined as absent or diminished dorsalis pedis (DP) and posterior tibialis (PT) pulses to palpation in the same limb. LEA was defined as surgical removal of part of a lower extremity. RESULTS: The prevalence of LEA was 1.5% (142). Mean diabetes duration was 10 years (SD = 7.6). Out of 556 patients with a history of foot ulcer 123 (22.1%) underwent amputation. PVD was present in 370 patients. Most ofLEAs were toe amputations (64.1%). Multiple logistic regression analysis of risk factors (adjusted OR, [95% confidence interval], p value) revealed a high risk of LEA in patients with a history of ulcer (59.2, [32.8-106.8], p < 0.001), peripheral vascular disease (5.3, [3.1-9.2], p < 0.001), diabetic retinopathy (2.2, [1.3-3.8], p = 0.004), and insulin injection (1.9, [1.1-3.2], p < 0.023). CONCLUSION: Patients at risk for LEA were those with a history of foot ulcer, absence of peripheral pulse, diabetic retinopathy and insulin injection. Preventive strategies should be considered in these groups of patients. Data should be interpreted with caution as the number of patients with amputation was few and information on neuropathy was not available.

Thailand diabetes registry project: prevalence of vascular complications in long-standing type 2 diabetes.

OBJECTIVE: To explore the nature of diabetic complications in type 2 diabetic patients who had had diabetes for longer than 15 years (long-DM), compared to those with duration of less than 15 years (short-DM). MATERIAL AND METHOD: Patients studied were adult type 2 diabetic patients registered to the Diabetes Registry Project, a nationwide cross-sectional study of diabetes mellitus in Thailand. Information collected included demographic data, age at diagnosis of diabetes, blood pressure, body mass index, fasting plasma glucose, HbA(1c), serum creatinine, and major diabetic vascular complications, including diabetic retinopathy (DR), albuminuria or renal insufficiency (diabetic nephropathy; DN), myocardial infarction (MI), stroke, peripheral arterial disease (PAD), foot ulcer and amputation. RESULTS: There were 9284 patients, consisting of 2244 (24.17%) subjects with long-DM (mean +/- SD, mean duration of DM21.3 +/- 5.8 years), and 7040 subjects with short-DM (mean duration 7.0 +/- 3.9 years). The long-DM group was older than the short-DM group (65.5 +/- 10.3 vs. 58.2 +/- 12.6 year-old, p less than 0.0001), and had higher HbA(1c) (8.5 vs. 8.0%, p = 0.009). The prevalence of diabetic complications in the long-DM group was higher than that in the short-DM group (DN 49.4% vs. 33.9%, DR 54.3% vs. 22.8%; MI 9.4% vs. 3.5%, PAD 17.3% vs. 5.5%, foot ulcer 13.4% vs. 5.3%, stroke 9.4% vs. 7.0% and amputation 5.5% vs 2.0%; allp values less than 0.01). The duration of DM significantly affected the risk of diabetic complications after adjustment for age, hypertension, and levels of glycemic control. CONCLUSION: Diabetic duration was independently associated with increased risk of having diabetes-related complications without threshold. Monitoring of complications in patients having long-standing diabetes is warranted in order to provide appropriate management.

Thailand diabetes registry project: type of diabetes, glycemic control and prevalence of microvascular complications in children and adolescents with diabetes.

OBJECTIVE: To determine the etiology, glycemic control and prevalence of microvascular complications in Thai diabetic patients who were diagnosed at the age of less than 18 years and who attended diabetes clinics in university or tertiary care hospitals. MATERIAL AND METHOD: A cross-sectional, multi-center, hospital-based diabetes registry was carried out from diabetes clinics of 11 tertiary centers. Demographic data including laboratory results and microvascular complications were recorded. RESULTS: Two-hundred-and-fifty out of the 9419 (2.66%) diabetic patients were diagnosed before the age of 18 years, 78% had Type 1 diabetes (T1DM), 18.4% had Type2 diabetes (T2DM) and 3.6% had other types of diabetes. Mean +/- SD HbAlc of T1DM was 9.3 +/- 2.5, T2DM was 9.7 +/- 2.6 and other types of diabetes were 8.6 +/- 4%. The majority of patients had poor glycemic control according to ADA and WHO guidelines. The percentage of patients who had diabetes for more than 5 years but had not been screened for nephropathy and retinopathy were 57.7% and 16% in T1DM and were 46.4% and 14.2% in T2DM respectively. A significant correlation between microvacular complications (nephropathy and retinopathy) and duration of disease was found in T1DM (p < 0.001). CONCLUSION: The majority of Thai children and adolescents with diabetes had TIDM and unsatisfactory glycemic control. Screening for microvascular complications was under international standard. The national strategic plan for management of this disease especially in this age group should be urgently implemented.

Thailand diabetes registry project: prevalence of diabetic retinopathy and associated factors in type 1 diabetes mellitus.

OBJECTIVE: To determine the prevalence and factors associated with Diabetic Retinopathy (DR) of type 1 diabetes mellitus in Thailand. MATERIAL AND METHOD: A cross-sectional, multicenter hospital-based study was carried out from April to December 2003. Diabetic patients in diabetic clinics of 11 tertiary centers were registered. Retinopathy was evaluated by the ophthalmologists. RESULTS: Seven thousand one hundred and ni neteen diabetic patients received retinal examination. The number of patients with type 1 diabetes was 347. The prevalence of DR in type 1 diabetes was 21.6% (75). This consisted of Non-Proliferative DR (NPDR) 10.9% (38) and Proliferative DR (PDR) 10.7%. Patients with DR were significantly older, predominantly female, longer duration ofdiabetes, had higher BMI, systolic Blood Pressure (BP), diastolic BP serum creatinine, and TriGlycerides (TG) levels than those without DR. Both groups ofpatients were not different in term ofplasma glucose and glycosylated hemoglobin levels. Although the patients with DR had a higher percentage of overt proteinuria than those without DR, there was no difference in percentage of patients with positive microalbuminuria in both groups. This may be explained by limitation of data (only 16% had results of microalbuminuria and 19% had results of proteinuria). After adjusted for duration of diabetes, serum creatinine and smoking status, factors (adjusted odds ratio [95% confidence interval]) associated with DR were duration of diabetes 5-9.9 years (4.0 [1.49-10.91]), 10-14.9 years (6.86 [2.45-19.20]), 15-19.9 years (21.13 [7.22-61.78]), > or =20 years (22.15 [7.32-66.99]) when compared with duration of diabetes less than 5 years, serum creatinine >2 mg/dl (6.0 [2.09-17.22]) when compared with creatinine less than 2 mg/dl. From the presented model, age, gender, systolic BP >140 mmHg, diastolic BP >90 mmHg, serum TG and smoking status were not factors associated with DR. CONCLUSION: Diabetic retinopathy affects about one fifth of type 1 diabetic patients in our study. The authors found the factors associated with DR in type 1 DM were duration of diabetes and serum creatinine. Regular screening for DR and more aggressive management of metabolic factors should be done to reduce the prevalence ofDR.