Obesity in South and Southeast Asia-A new consensus on care and management.

Obesity is a chronic disease in which the abnormal or excessive accumulation of body fat leads to impaired health and increased risk of mortality and chronic health complications. Prevalence of obesity is rising rapidly in South and Southeast Asia, with potentially serious consequences for local economies, healthcare systems, and quality of life. Our group of obesity specialists from Bangladesh, Brunei Darussalam, India, Indonesia, Malaysia, Philippines, Singapore, Sri Lanka, Thailand, and Viet Nam undertook to develop consensus recommendations for management and care of adults and children with obesity in South and Southeast Asia. To this end, we identified and researched 12 clinical questions related to obesity. These questions address the optimal approaches for identifying and staging obesity, treatment (lifestyle, behavioral, pharmacologic, and surgical options) and maintenance of reduced weight, as well as issues related to weight stigma and patient engagement in the clinical setting. We achieved consensus on 42 clinical recommendations that address these questions. An algorithm describing obesity care is presented, keyed to the various consensus recommendations.

Time-in-range and frequency of continuous glucose monitoring: Recommendations for South Asia.

BACKGROUND AND AIM: The prevalence of diabetes is on its rise and South Asia bears a huge burden. Several factors such as heterogeneity in genetics, socio-economic factors, diet, and sedentary behavior contribute to the heightened risk of developing diabetes, its rapid progression, and the development of complications in this region. Even though there have been considerable advances in glucose monitoring technologies, diabetes treatments and therapeutics, glycemic control in South Asia remains suboptimal. The successful implementation of treatment interventions and metrics for the attainment of glycemic goals depends on appropriate guidelines that accord with the characteristics of the diabetes population. METHOD: The data were collected from studies published for more than the last ten years in the electronic databases PubMed and Google Scholar on the various challenges in the assessment and achievement of recommended TIR targets in the SA population using the keywords: Blood glucose, TIR, TAR, TBR, HbA1c, hypoglycemia, CGM, Gestational diabetes mellitus (GDM), and diabetes. RESULTS: The objective of this recommendation is to discuss the limitations in considering the IC-TIR Expert panel recommendations targets and to propose some modifications in the lower limit of TIR in older/high-risk population, upper limit of TAR, and flexibility in the percentage of time spent in TAR for pregnant women (GDM, T2DM) for the South Asian population. CONCLUSION: The review sheds insights into some of the major concerns in implementing the IC-TIR recommendations in South Asian population where the prevalence of diabetes and its complications are significantly higher and modifications to the existing guidelines for use in routine clinical practice.

The urgency in proposing the optimal obesity cutoff value in Indonesian population: A narrative review.

In developing nations such as Indonesia, obesity and central obesity have emerged as major public health issues. Many studies have revealed that morbidity and death from obesity-related diseases are already significant in some "Asian" communities at low body mass index (BMI) levels. A recent study showed that the obesity prevalence in Indonesia is underestimated when using the current BMI cutoff (obese ≥ 27.0). Indonesia faced an increase in obesity-related chronic diseases despite having a lower obesity prevalence than developed countries, which may be explained by the underestimation of obesity levels in Indonesia. This creates a huge global health problem, as well as an economic burden. Another recent study on the Indonesian population depicted the new proposed cutoff of waist circumference (WC), which is lower than the World Health Organization (WHO) standard for detecting the early detection of type 2 diabetes mellitus (T2DM), one of the comorbidities and a strong correlation with obesity. An analysis of 58 studies in 2021 that included Indonesian adult subjects revealed enormous differences and ambiguities in defining obesity cutoffs values among Indonesian researchers. Additionally, we advocate adding the Edmonton Obesity Staging System (EOSS) staging to the anthropometric classification for a better clinical evaluation of obesity. Considering the urgency of obesity determination in Indonesia for clinical application and study purposes, this review highlights the need to revise the optimal cutoff value for obesity to warrant early prevention and control of diabetes complications.

Acarbose reduces body weight irrespective of glycemic control in patients with diabetes: results of a worldwide, non-interventional, observational study data pool.

OBJECTIVE: The objective of this study is to examine the effect of acarbose, an alpha-glucosidase inhibitor, on body weight in a real-life setting by pooling data from post-marketing surveillance. METHODS: Data from 10 studies were pooled (n=67,682) and the effect of acarbose on body weight was analysed taking into account baseline body weight, glycemic parameters and other baseline characteristics. RESULTS: The mean relative reduction in body weight was 1.45 ± 3.24% at the 3-month visit (n=43,510; mean baseline 73.4 kg) and 1.40 ± 3.28% at the last visit (n=54,760; mean baseline 73.6 kg) (both p<0.0001). These reductions were dependent on baseline body weight (overweight: -1.33 ± 2.98% [n=13,498; mean baseline 71.6 kg]; obese: -1.98 ± 3.40% [n=20,216; mean baseline 81.3 kg]). When analysed by baseline glycemic parameter quartiles, the reduction was independent of fasting plasma glucose (FPG), postprandial plasma glucose (PPG), glycated hemoglobin (HbA1c) and postprandial glucose excursion (PPGE). A bivariate analysis of covariance identified female sex, South East Asian and East Asian ethnicity, younger age, higher body mass index, short duration of diabetes, and no previous treatment as factors likely to impact positively on body weight reduction with acarbose. CONCLUSIONS: This post-hoc analysis showed that acarbose treatment reduces body weight independent of glycemic control status but dependent on baseline body weight.

Model and effectiveness of endurance exercise to increase physical fitness in intellectual disability subjects with obesity: a randomized controlled trial.

AIM: to design a model and assess the effectiveness of endurance exercise to increase physical fitness in intelectual disability (ID) patients with obesity. METHODS: a randomized-controlled clinical trial was performed in ID patients with obesity aged 10-30 years old from all Special School in DKI Jakarta, which were randomly allocated into 3 groups and then given 3 different type of exercises: lower extremity muscles endurance exercise for 20 RM followed by cardiorespiratory endurance exercise for 24-25 minutes (type I), lower extremity muscles endurance exercises for 10 RM followed by cardiorespiratory endurance exercises for 26-27 minutes (type II), and threw a tennis ball with 10 m distance for 10 minutes as control (type III). These program was performed 3 times a week for 4 months. Assesment of the exercise effectiveness was done by measuring maximum load that can be lifted and six-minutes walking test on rectangular track which was converted with the VO2 max prediction formula. Analysis was perfomed with Kruskal Wallis test. RESULTS: two hundred and twelve (212) subjects were included in the study, randomly allocated into three types (I, II, and III) of exercises groups. The type II of endurance exercise model was proved to be more effective in increasing lower extremity muscles endurance level compared to type I and III for ID patients with obesity (p<0.05). Meanwhile, type I of endurance exercise model was proved to be more effective in increasing cardiorespiratory endurance level compared to type II and III for ID patients with obesity (p<0.05). CONCLUSION: lower extremity muscles endurance exercise followed by a cardiorespiratory endurance exercise can be used to increase physical fitness in ID patients with obesity.

Efficacy of acarbose in different geographical regions of the world: analysis of a real-life database.

BACKGROUND: Alpha-glucosidase inhibitors are recommended in some international guidelines as first-line, second-line and third-line treatment options but are not used worldwide due to perceived greater effectiveness in Asians than Caucasians. METHODS: Data from ten post-marketing non-interventional studies using acarbose, the most widely used alpha-glucosidase inhibitor, from 21 countries, provinces and country groups were pooled. Effects on glycated hemoglobin (HbA1c ) were analysed for four major ethnicity/region groups (European Caucasians and Asians from East, Southeast and South Asia) to identify differences in the response to acarbose. RESULTS: The safety and efficacy populations included 67 682 and 62 905 patients, respectively. Mean HbA1c in the total population decreased by 1.12 ± 1.31% at the 3-month visit from 8.4% at baseline (p < 0.0001). Reductions in HbA1c , fasting plasma glucose and post-prandial plasma glucose were greater in patients with higher baseline values. Acarbose was well tolerated, with few episodes of hypoglycemia (0.03%) and gastrointestinal adverse events (2.76%). Data from 30 730 Caucasians from Europe and Asians from three major regions of Asia with non-missing gender/age information and baseline/3-month HbA1c data were analysed by multivariable analyses of covariance. After adjustment for relevant baseline confounding factors, Southeast and East Asians had slightly better responses to acarbose than South Asians and European Caucasians; however, the differences were small. CONCLUSIONS: Acarbose was effective in both European Caucasians and Asians; however, after adjustment for baseline confounding factors, significant small differences in response favoured Southeast and East Asians.

Prevalence and clinical profile of diabetes mellitus in productive aged urban Indonesians.

AIMS/INTRODUCTION: To estimate the prevalence and clinical profile of diabetes mellitus in productive aged urban Indonesians based on the National Basic Health Research 2007. MATERIALS AND METHODS: The statistical analyses of a cross-sectional survey included the data of 15,332 adults, aged 18-55 years, living in an urban area. Blood glucose was measured by an automatic clinical chemistry analyzer by 2-h, 75-g post glucose load after an overnight fast. Weight, height, waist circumference and blood pressure data were measured and recorded, whereas the sociodemographic and prior illness data were collected by interviewing the participants. RESULTS: The prevalence of diabetes mellitus in productive age urban Indonesians was 4.6%, consisting of 1.1% previously diagnosed diabetes mellitus and 3.5% undiagnosed diabetes mellitus. Diabetes mellitus affected more women than men, which increased with age, was higher among the high socioeconomic group and increased with increasing body mass index. The prevalence of diabetes mellitus was higher in centrally obese people. Hypertension was highly related with diabetes mellitus occurrence. The prevalence of previously diagnosed diabetes mellitus with overweight or obese was 68.4%, with central obesity 41.7%, with hypertension 41.4% and with dyslipidemia more than 50%. The prevalence of undiagnosed diabetes respondents with overweight or obese was 68,7%, with central obesity 43.8%, with hypertension 49.4% and with dyslipidemia more than 50%. CONCLUSIONS: These results show that comprehensive strategies for the prevention and control of the problem of diabetes are urgently required.

Underweight is an important risk factor for coronary heart disease in the population of Ceningan Island, Bali.

A study on the prevalence of coronary heart disease (CHD) and its risk factors in Ceningan Island was conducted. The prevalence of CHD was 11.5%. Older age (odds ratio, OR, 27.0), underweight (OR, 3.6), systolic hypertension (OR, 4.6), high total cholesterol (OR, 5.9), and high low-density lipoprotein cholesterol (OR, 3.1) were risk factors for a history of myocardial infarction (MI). By logistic regression analysis, only age (B=3.937) and underweight (B=1.275) consistently appeared to be risk factors for MI. The prevalence of CHD in the population was comparatively high.

Prevalence of diabetes among suburban population of Ternate--a small remote island in the eastern part of Indonesia.

AIM: to study the prevalence of diabetes in a sub-urban population of one of the less developed provinces in eastern part of Indonesia and its associated risk factors. METHODS: a cross-sectional survey was conducted in 2008 in adult population of TernateCityof North Moluccas Province, Indonesia, aged 20 years or more. Subjects were interviewed regarding diabetes risk factors by a standard questionnaire.Anthropometric (height, weight, waist and hip circumference) and blood pressure measurements were also taken. Diagnosis of diabetes was established by measuring overnight fasting capillary blood glucose with a glucose meter. Venous blood was also drawn for blood lipid profiling. RESULTS: 495 subjects consisted of 187 (37.8%) men and 308 (62.2%) women aged 20 to 84 years (mean age 47.30±12.78)were enrolled. Prevalence of diabetes (fasting blood glucose >126 mg/dL) was 19.6%. Four independent risk factors were identified, i.e. age at 45 years or older (OR=4.1, 95% CI = 2.4-7.1), having a positive family history (OR=2.4, 95% CI=1.5-4.0), a body mass index more than 23 kg/m2 (OR=1.8, 95% CI=1.02-3.3) and triglycerides levels more than 200 mg/dL (OR=2.6, 95% CI=1.2-5.6). CONCLUSION: the prevalence of diabetes in Ternate City, a sub-urban population in the eastern part of Indonesia is high. Having a family history of diabetes and being older are major risk factors of developing the disease. Metabolic factors are identified as the potential modifiable risk factors requiring intervention in the future.

Insulin resistance profile among siblings of type 2 diabetes mellitus (preliminary study).

AIM: to obtain prevalence of insulin resistance among siblings of subjects with type 2 DM and their metabolic abnormality profiles as measured by their BMI, waist circumference (WC), blood pressure, glucose intolerance, concentration of triglyceride, HDL cholesterol, and uric acid. METHODS: a preliminary, cross sectional study conducted among 30 siblings from seven type 2 DM subjects under medical treatment in Dr. Cipto Mangunkusumo Hospital and other places where the subjects lived. Those subjects underwent interviews, physical examination including weight, height, abdominal circumference, blood pressure and laboratory examinations including glucose tolerance test, fasting insulin, triglycerides, HDL cholesterol and uric acid level. Data processed to obtain body mass index (BMI), homeostasis model assessment of insulin resistance (HOMA-IR) and HOMA-IR cut-off, which is determined based on 75 percentile. The criteria of hypertension, dyslipidemia, central obesity and hyperglycemia are based on Asian modification NCEP/ATP III criteria for metabolic syndrome. Hyperuricemia is diagnosed based on uric acid level >7mg/dl in men and >6 mg/dl in women. RESULTS: the prevalence of insulin resistance among siblings of type 2 DM in this study is 26.67% with the proportion in each family varies from 0% to 75%. The most metabolic component found in this study is central obesity (56.7%), followed by hypertension (46.7%), decreased HDL cholesterol level (26.6%), hyper-triglyceridemia (26.6%) and hyperglycemia (20%). As many as three-quarters of subjects with insulin resistance have BMI >25 kg/m2. Among subjects with insulin resistance, all have central obesity, half of them have hypertension, decreased HDL cholesterol level and hyper-triglyceridemia. While hyperglycemia is found in 37.5% subjects. CONCLUSION: the prevalence of insulin resistance among siblings of type 2 DM in this study was 26.67% with the proportion in each family varies between 0-75%. Central obesity is the most metabolic component commonly found.

Prevalence of metabolic syndrome using NCEP/ATP III criteria in Jakarta, Indonesia: the Jakarta primary non-communicable disease risk factors surveillance 2006.

AIM: To obtain the prevalence of MetS in Jakarta, as a capital city of Indonesia. METHODS: Data were obtained from surveillance of primary non-communicable disease in five regions in Jakarta, Indonesia, conducted in 2006. Targeting for 1,800 samples, we performed a purposive and simple random sampling of subjects within the age range of 25-64 years old in selected sampling areas, and stratified random sampling by adjusting to age and sex within those selected sampling areas. We use The WHO Step Wise in collecting data. We also collected blood sample for total cholesterol, LDL cholesterol, HDL cholesterol and triglyceride level. The ATP III modified Asian criteria require the presence of 3 or more of the following: 1. Abdominal obesity (waist circumference ≥ 90 cm in men and ≥ 80 cm in women; 2. A high triglyceride level (≥ 150 mg/dL); 3. A low HDL-cholesterol level < 40 mg/dL for men and < 50 mg/dL for women); 4. High blood pressure (systolic ≥ 130 mmHg or diastolic ≥ 80 mmHg; and 5. A high fasting plasma glucose concentration (≥ 110 mg/dL). RESULTS: Among 1,591 subjects, there are 641 men (40.3%) and 950 women (59.7%). The crude prevalence of MetS using the ATP III modified Asian criteria is 28.4% with prevalences in men and women are 25.4 and 30.4% respectively. The prevalences of MetS in NGT, prediabetes, and diabetes group are 16.4, 35.1, and 73.4% respectively. The prevalences of MetS and central obesity in prediabetes group and diabetes group are higher significantly than those in normal glucose tolerance group (p<0.01). The most common component of MetS in men is hypertension (84.7%), followed by hypertriglyceridemia (83.4%), central obesity (75.5%), hyperglycemia (50.9%) and low HDL-cholesterol (43.6%). While in women, the most common component is central obesity (84.1%), followed by hypertension (84.1%), hypertriglyceridemia (66.1%), low HDL-cholesterol (57.8%), and hyperglycemia (50.2%). CONCLUSION: The prevalence of MetS in this study is 28.4%. The most component found in men is hypertension while in women is central obesity.

Prevalence and determinants of diabetes mellitus and impaired glucose tolerance in Indonesia (a part of basic health research/Riskesdas).

AIM: To estimate the prevalence of diagnosed and undiagnosed diabetes mellitus (DM) and impaired glucose tolerance (IGT) in 15 year old and over in urban Indonesia and their association with risk factors such as age, smoking, physical inactivity, obesity, hypertension. METHODS: A national sample involving 24,417 participants living in urban Indonesia aged > 15 years were examined for 2 hours of plasma glucose concentrations in a cross sectional survey using the 75-g oral glucose. Diagnostic criteria of the World Health Organization 1999 and American Diabetes Association (ADA) 2003 were used to determine the prevalence of abnormal glucose tolerance. Data on age, smoking, physical activity were obtained from the personal interview, and obesity included body mass index and waist circumference and blood pressure were measured. RESULTS: The prevalences of diabetes in urban Indonesia was 5.7%, consisting of diagnosed diabetes mellitus (DDM) 1.5%, undiagnosed diabetes mellitus (UDDM) 4.2% and IGT 10.2%. The prevalence of DM was 6.4% in women and 4.9% in men. In the youngest group (15-24 years) 5.3% had IGT. Prevalence increases with age with a sharp rise from middle age (35-54 years). Determinant factors for IGT and diabetes were age, smoking, obesity, central obesity and hypertension. CONCLUSION: these results indicate that diabetes has become a major public health problem in Indonesia and needs national strategies to screen, prevent and treat the disease.

Dyslipidemia in newly diagnosed diabetes mellitus: the Jakarta primary non-communicable disease risk factors surveillance 2006.

AIM: To obtain the prevalence of dyslipidemia and other cardiovascular risk factors in subjects with undiagnosed DM in Jakarta, Indonesia. METHODS: Data were obtained from surveillance of primary non-communicable disease in five regions in Jakarta, Indonesia, conducted in 2006. Targeting for 1,800 samples, we performed a purposive and simple random sampling of subjects within the age range of 25-64 years old in selected sampling areas, and stratified random sampling by adjusting to age and sex within those selected sampling areas. DM was diagnosed according to WHO criteria after an oral glucose test, i.e fasting blood glucose > or = 126 mg/dL or post loading blood glucose > or = 200 mg/dL and subjects had no history of DM. Dyslipidemia was diagnosed if triglyceride > or = 150 mg/dL, HDL-cholesterol in men < 40 mg/dL or < 50 mg/dL in women and total cholesterol > or = 200 mg/dL. RESULTS: From 1,591 subjects, comprising 640 men and 951 women, the prevalence of newly diagnosed DM is 8.4%. Among this subjects, the prevalences of hypercholesterolemia, hypertriglyceridemia and low HDL-cholesterol are 66.1 (OR 2.28; P=0.004), 54.3 (OR 3.02; P= 0.0001) and 38.6% (OR 2.27; P=0.009) respectively. The prevalence of dyslipidemia in subjects with newly diagnosed DM remains higher among all age groups than that in subjects without DM. CONCLUSION: the prevalence of dyslipidemia among subjects with newly diagnosed DM is higher than that in subjects without DM.

The role of SOCS-3 protein in leptin resistance and obesity.

Obesity is one of the risk factors in various chronic diseases and malignancy. It may result from excess accumulation of body fat. This condition may be caused by dysfunction of appetite-regulating pathways and energy balance due to leptin resistance. Leptin, a 16 kDa hormone, is the most important regulator of appetite and energy balance in the body. Most individuals with obesity have leptin resistance characterized by increased leptin blood levels. Some possibilities of mechanism involved in leptin resistance have been proposed by researchers despite the fact that it is still being studied hitherto. One of the mechanisms considered to have a role in leptin resistance is disruption in signal transduction process through Janus-activating kinase2-signal transducer and activator of transcription 3 (JAK2-STAT3) pathway on leptin receptors by suppressor of cytokine signaling-3 (SOCS-3). SOCS-3 is a protein that inhibits the signal transduction process of various cytokines in the body, including leptin. SOCS-3 expression is induced by leptin and SOCS-3 activation will inhibit STAT3 phosphorylation which is important in signal transmission on leptin receptors. Such inhibition will consequently cause leptin resistance characterized by dysfunction of leptin biological function.

Role of metformin in the initiation of pharmacotherapy for type 2 diabetes: an Asian-Pacific perspective.

Increases in the prevalence of type 2 diabetes of 30-60% will occur in many Asian-Pacific countries by 2025, driven by urbanisation, sedentary habits and energy-rich diets. Obesity, insulin resistance, metabolic syndrome and diabetes are closely interrelated. Optimal control of diabetes and associated risk factors has reduced the risk of diabetes-related complications. In the UK Prospective Diabetes Study (UKPDS), metformin reduced the risk of macrovascular complications and retrospective analyses have confirmed the efficacy of metformin in improving clinical outcomes in type 2 diabetic patients with a history of cardiovascular disease. This growing body of evidence has led to the recommendation of metformin as optimum initial pharmacotherapy in overweight type 2 diabetic patients. Obesity is less prevalent in the Asian-Pacific population than in Caucasian populations. Nevertheless, metformin has multiple beneficial metabolic effects, which provide sufficient rationale for it to be recommended as the initial oral anti-diabetic pharmacotherapy, alone or in combination, irrespective of body mass index. This recommendation is consistent with global guidelines and regional recommendations for the Asian-Pacific region from the International Diabetes Federation. These recommendations can serve as templates for development of local guidelines for Asian people with diabetes, given the ethnic and cultural diversity within the region.

Correlation between CD4 count and intensity of Candida colonization in the oropharynx of HIV-infected/ AIDS patient.

AIM: To know the correlation between CD4 count and intensity of Candida colonizations in the oropharynx of HIV-infected/AIDS patients, to get the prevalence of oropharyngeal candidiasis (OPC), and to know what kind of Candida species that causes oropharynx candidiasis of HIV-infected/AIDS patients. METHODS: A cross-sectional study was conducted in HIV-infected/AIDS patients who came as outpatients and inpatients in Cipto Mangunkusumo Hospital. The patients were interviewed, physically examined, their CD4 counts were checked, and their mouth rinse samples were taken to be cultured. Candida species was identified in CHROMagar media, and data were processed. RESULTS: From September 2004 until January 2005, 60 HIV-infected/AIDS patients were included in this study. There were 86.7% males and 13.3% females. Majority of the patients were from 20-30 years age group (85%). The most frequent transmission was among drug users (75%) followed by sexual contact (18.3%). The median of CD4 counts was 100 cells/il, ranged from 2 to 842 cells/il. Proportion of the OPC was 63.3% (CI 95% = 51.1 - 75.5). From 59 Candida isolates in this study, 74.58% were C. albicans. Candida non C. albicans species that were found in this trial were C. krusei, C. parapsilosis and C. tropicalis. There was significant correlation between low CD4 counts and high intensity of Candida colonization on the oropharynx of the subjects (r = -0.756). CONCLUSION: There was strong negative correlation (r = -0.756) between CD4 count and intensity of Candida colonization in the oropharynx of HIV-infected/AIDS patients. Proportion of OPC in this study was 63.3%. The most frequent species found in the oropharynx of the subjects was C. albicans.

Left ventricular diastolic dysfunction in obese women.

AIM: To determine the direct effect of obesity on echocardiographic indices of diastolic left ventricular function METHODS: 44 obese (BMI > or =25 kg/m2) and 45 normal weight women were studied. They had no other pathological conditions. Echocardiographic indices of diastolic function were obtained, and dysfunction was assumed when at least two values differed by > or =2 SD from the normal weight group. RESULTS: In obese subjects, the values of maximum velocity of active mitral filling (A) were increased and pulmonary diastolic velocity was decreased significantly (p< 0,01); all other diastolic variables were unchanged. Subclinical diastolic dysfunction tend to be more prevalent among obese subjects but it was not significantly different from non obese (p= 0.11), being present in nine obese (20.5%) and 4 normal (8.9%) subjects. CONCLUSION: Subclinical left ventricular diastolic dysfunction is present in obese women.

The correlation between insulin resistance and left ventricular systolic function in obese women.

AIM: To determine the correlation between insulin resistance and left ventricular systolic function in obese women. METHODS: 44 obese (BMI > or =25 kg/m2) and 45 normal weight women were studied. They had no other pathological conditions. Echocardiograms were undertaken in our echocardiographic laboratory following standard methods. The homeostasis model was used to assess insulin resistance (HOMA IR). RESULTS: Ejection fraction (p =0.22) and fractional shortening (p= 0.58) were not difference between obese women and the normal group. There was no correlation between insulin resistance and left ventricular systolic function. CONCLUSION: There was no correlation between insulin resistance and left ventricular ejection fraction.

Comparisons of the outcomes on control, type of management and complications status in early onset and late onset type 2 diabetes in Asia.

OBJECTIVE: To describe the clinical characteristics and chronic diabetic complications in early (EOD) and late onset type 2 diabetes mellitus (LOD) in Asia. RESEARCH DESIGN AND METHODS: Retrospective collection of information (basic patient data, treatment received for diabetes, hypertension, dyslipidaemia, clinical measurements, complications, life-style management, etc.) on paper form and prospective collection of blood samples for HbA(1c) assessment were performed. Means, proportions and associated factors were analyzed using non-parametric and logistic regression. RESULTS: The frequency of EOD (<30 years) varies in different Asian countries (0.4-5.3%). Overweight (BMI>or=23 kg/m2) was common in both EOD (60%) and LOD (66%). EOD was characterized by significantly higher levels of HbA(1c) (median 8.9% versus 7.9%) and FPG (median 9.8 mmol/L versus 8.3 mmol/L) but hypertension was less common (43% versus 59%). Lipid profiles (cholesterol and triglycerides) were similar between both groups of patients. Cataract was more common in LOD and was associated with onset age and diabetes duration whereas an increase in frequency of advanced eye disease, retinopathy and history of photocoagulation was found in EOD cohort. CONCLUSIONS: In addition to diabetic control and duration of the disease, the onset age conferred risk to certain subsets of chronic complications in type 2 diabetes population.