Glimepiride in type 2 diabetes mellitus Thai patients.

This study aimed to confirm the efficacy of glimepiride given once daily in the treatment of Thai type 2 diabetic patients and to find out the optimum dosage for Thai patients. The patients were enrolled at the diabetic clinics of 5 hospitals (Rajavithi, Chulalongkorn, Pramongkutklao, Siriraj and Theptarin Hospitals). All patients started glimepiride 1 mg once daily and escalated to 2, 3, 4 and until 6 mg every 4 weeks if fasting plasma glucose (FPG) exceeded 140 mg/dL. Subjects were 60 females and 29 males with an average age of 52.2 +/- 10.0 years. Mean BMI was 25.5 +/- 3.8 kg/m2. Fifty seven patients (64.0%) were drug naïve and thirty two patients (36.0%) had been previously treated with oral hypoglycemic agents. Seventy three per cent of the drug naïve and 37 per cent of the previously treated patients could be controlled with 1-2 mg of glimepiride once daily. At the twelfth week of treatment, mean fasting plasma glucose decreased from 224.6 to 156.6 mg/dL (30% reduction) and mean HbA1c decreased from 10.0 to 7.5 per cent (25% reduction). At the end of the study 49.4 per cent of the patients had HbA1c < 7.0 per cent, 21.3 per cent had HbA1c 7.0-8.0 per cent and 29.3 per cent had HbA1c > 8.0 per cent. Adverse events that were probably or possibly related to the drug were reported in 5 patients (5.6%). Three of them were hypoglycemia and two patients had skin rash. All hypoglycemic episodes were mild. Glimepiride was indicated to be safe. There were no clinically significant changes in clinical laboratory values, physical examinations and vital signs. In conclusion, glimepiride was efficacious and safe in type 2 diabetes Thai patients and 1-2 mg of glimepiride appeared to be a sufficient dose for most newly diagnosed type 2 diabetic patients.

A controlled clinical trial of multidisciplinary team approach in the general medical wards of Chulalongkorn Hospital.

The benefits and acceptability of a strengthened physician-nurse collaboration and a multidisciplinary team approach are demonstrated in the medical wards of a Thai acute-care hospital (Chulalongkorn University Hospital). The strengthened physician-nurse collaboration should be introduced or strengthened in all medical wards. Because of the lack of appropriately trained personnel, concentrating resources into a small unit or ward may be the appropriate measure at present if a multidisciplinary team approach is to be integrated into the medical ward of acute-care hospitals in South East Asia.

Disability among Thai elderly living in Klong Toey slum.

Forty three per cent of the elderly in Klong Toey slum had BAI score less than 20. One point six per cent were moderately severe or severely disabled and needed special care. Around one-third of them caused by stroke. Locomotion, reaching and stretching, dexterity, continence and seeing are common significant types of disability among this population study. Perceived health status, age and working status are independent factors related to disability level. The Barthel ADL index is suitable for using as a tool for a disability survey among Thai elderly. The ODS questionnaire may be applied after considerable modification of the questions concerning behavior and intelligence dimensions.

The prevalence of obesity, risk factors and associated diseases in Klong Toey slum and Klong Toey government apartment houses.

The epidemiological study in low socioeconomic area of Bangkok, Klong Toey slum residents (n = 976) and apartment house residents (n = 906) of both sexes revealed the prevalence rates of overweight of 25.5% and 30.5%, obesity 10% and 11.1%; hypertension 17.3%; and 14%; diabetes 4.5% and 5.9%; IGT 6.1% and 4.4%; total abnormal GTT 10.6% and 10.3%; hypercholesterolemia 14.1% and 12%; hypertriglyceridemia 24.8% and 22.7%; low HDL-C 3.1% and 1.8%; hyperuricemia 7.7% and 10.4% respectively. The prevalence rates of the related diseases and conditions were increased when BMI was over 25 in both populations except for those with abnormal GTT and hyperuricemia in the slum residents. Concerning risk factors, discriminant analysis disclosed diastolic blood pressure (DBP) and atherogenic index as the first two factors significantly associated with overweight and obesity (BMI greater than 25) in both populations. Restructuring of the health service delivery system and care-taker re-educating together with production of meaningful mass communication media are needed for promotion of health care, prevention of these non-communicable diseases and their sequelae by non-pharmacological approach.

The prevalence and risk factors of hypertension in Klong Toey slum and Klong Toey government apartment houses.

We have investigated the prevalence and factors associated with hypertension in 976 residents of Klong Toey Slum and 909 residents of government apartment houses, aged 30 and above, selected by probability sampling after systematic household surveys with an average response rate of over 80%. Hypertensives were those who had, on at least three measurements, average diastolic blood pressure equal to or above 95 mmHg and/or systolic blood pressure equal to or above 160 mmHg or had blood pressure below 160/95 mmHg but were currently on antihypertensive medication. The prevalence of total hypertensives were found to be 17.3% and 14.0% for residents of slum and government apartment houses respectively. Men and women had more or less equal mean blood pressure and similar prevalence of hypertension. The mean systolic blood pressure increased with age while the mean diastolic blood pressure, after an initial rise with age in lower age groups, tended to level off from the age group 55-64 years upwards. Only one quarter to one third were aware of their illness and less than 15% were receiving treatment. Significant risk factors include age, duration of smoking, duration of alcohol intake, high body mass index, high Cholesterol, high Triglyceride, high Low Density Lipoprotein Cholesterol (LDLC), low High Density Lipoprotein Cholesterol (HDLC), high Total Cholesterol (TC) to High Density Lipoprotein ratio (TC/HDLC), high LDLC to HDLC ratio and diabetes mellitus. The data suggested that hypertension was an important public health problem in low socioeconomic groups in Bangkok. Some of the risk factors were related to an unhealthy lifestyle which should receive due consideration in planning for appropriate control.

Pregnancy in Sheehan's syndrome.

This is the first report of pregnancy in a patient with Sheehan's syndrome in Thailand. Resumption of menstruation and pregnancy following massive postpartum hemorrhage although rare, can occur if there is selective hypopituitarism with normal gonadotropin level and are not against the diagnosis. Since the maternal and fetal mortality is far more common in unrecognized cases, therefore, early diagnosis is crucial. Physicians should consider this syndrome every patient who has a history of postpartum hemorrhage and symptoms and signs of hypopituitarism.

Unusual locations of localized myxedema in Graves' disease. Report of three cases.

Three patients with Graves' disease had very unusual locations of localized myxedema. One patient had localized myxedema on the pretibial and shoulder areas after sodium iodide I 131 therapy. The second patient had localized myxedema on his neck, shoulders, and upper part of the back as well as on the pretibial area. The third patient had localized myxedema on the pinnae, also following sodium iodide I 131 therapy. After surgical removal followed by intralesional triamcinolone acetonide injections, the first patient's lesions recurred. The lesions in the second case did not respond to topical steroid cream. The third patient had a partial response to intralesional steroid injections.

Insulin antibodies in diabetics after changeover from conventional NPH to highly purified insulin.

The levels of insulin binding immunoglobulin (IgG) were determined by the method of Christiansen in 12 diabetics who were previously treated with conventional beef-pork NPH insulin for at least 6 months. High titers of IgG were found in 9 patients, moderately high in one, and low level in two according to grouping categories. No relationships among insulin dosage, duration of insulin therapy and levels of IgG were demonstrated. After changing over to highly purified insulin (monocomponent-pork insulin) the titers of IgG dropped within 3 months in 10 patients, within one year in 2. The IgG decreased significantly after one year in all cases. The reduction of insulin dosage did not correlate with the decrease of IgG during the 2-year-period of study. Lipoatrophy disappeared in 2 patients. The benefit of long term use of monocomponent insulin in improvement of diabetic control, reduction or delay of chronic complications remains to be investigated.

Lipid disorders in Thai diabetics.

The incidence of fasting HLP in 326 diabetics was 68.4 percent. The common types of HLP were type IV, IIb, IIa and III respectively. There was one case of type V. HDLC was decreased in all three groups of diabetics together with elevated ratio of TC to HDLC comparing with the controls of similar age and sex VLDL and TG were significantly elevated in NIDDM aged 60 and over comparing with IDDM but not significantly different from NIDDM aged below 60. The early detection and treatment of HLP along with optimum control of blood glucose are of utmost importance to prevent further complications caused by atherosclerosis.

Diabetes mellitus and tropical form of chronic calcific pancreatitis in Thailand.

Six cases of chronic calcific pancreatitis in Thailand occurring in patients aged 13 to 22 years are reported. Protein malnutrition was a possible aetiologic factor. Abdominal pain was mild to moderate and intermittent and not a presenting feature. Severe diabetes mellitus was present at all. Extensive pancreatic calcification was seeen on abdominal X-ray.