Metabolic and genetic risk factors associated with pre-diabetes and type 2 diabetes in Thai healthcare employees: A long-term study from the Siriraj Health (SIH) cohort study.

BACKGROUND: The study of non-communicable diseases (NCDs) in a developing country like Thailand has rarely been conducted in long-term cohorts, especially among the working-age population. We aim to assess the prevalence and incidence of risk factors and their associations underlying NCDs, especially type-2 diabetes mellitus (T2DM) among healthcare workers enrolled in the Siriraj Health (SIH) study cohort. METHODS: The SIH study was designed as a longitudinal cohort and conducted at Siriraj hospital, Thailand. A total of 5,011 participants (77% women) were recruited and follow-up. Physical examinations, blood biochemical analyses, family history assessments, behavior evaluations, and genetics factors were assessed. RESULTS: The average age was 35.44±8.24 years and 51% of participants were overweight and obese. We observed that men were more likely to have a prevalence of T2DM and dyslipidemia (DLP) compared to women. Aging was significantly associated with pre-diabetes and T2DM (P<0.001). Additionally, aging, metabolic syndrome, and elevated triglycerides were associated with the development of pre-diabetes and T2DM. The minor T allele of the rs7903146(C/T) and rs4506565 (A/T) were associated with a high risk of developing pre-diabetes with odds ratios of 2.74 (95% confidence interval [CI]: 0.32-23.3) and 2.71 (95% CI: 0.32-23.07), respectively; however, these associations were statistically insignificant (P>0.05). CONCLUSION: The findings of the SIH study provide a comprehensive understanding of the health status, risk factors, and genetic factors related to T2DM in a specific working population and highlight areas for further research and intervention to address the growing burden of T2DM and NCDs.

Factors influencing optimal diabetes care and clinical outcomes in Thai patients with type 2 diabetes mellitus: a multilevel modelling analysis.

BACKGROUND: Increasing levels of poor glycaemic control among Thai patients with type 2 diabetes mellitus (T2DM) motivated us to compare T2DM care between urban and suburban primary care units (PCUs), to identify gaps in care, and to identify significant factors that may influence strategies to enhance the quality of care and clinical outcomes in this population. METHODS: We conducted a cross-sectional study involving 2160 patients with T2DM treated at four Thai PCUs from 2019 to 2021, comprising one urban and three suburban facilities. Using mixed effects logistic regression, we compared care factors between urban and suburban PCUs. RESULTS: Patients attending suburban PCUs were significantly more likely to undergo eye (adjusted OR (AOR): 1.83, 95% CI 1.35 to 1.72), foot (AOR: 1.61, 95% CI 0.65 to 4.59) and HbA1c (AOR: 1.66, 95% CI 1.09 to 2.30) exams and achieved all ABC (HbA1c, blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C)) goals (AOR: 2.23, 95% CI 1.30 to 3.83). Conversely, those at an urban PCU were more likely to undergo albuminuria exams. Variables significantly associated with good glycaemic control included age (AOR: 1.51, 95% CI 1.31 to 1.79), T2DM duration (AOR: 0.59, 95% CI 0.41 to 0.88), FAACE (foot, HbA1c, albuminuria, LDL-C and eye) goals (AOR: 1.23, 95% CI 1.12 to 1.36) and All8Q (AOR: 1.20, 95% CI 1.05 to 1.41). Chronic kidney disease (CKD) was significantly linked with high triglyceride and HbA1c levels (AOR: 5.23, 95% CI 1.21 to 7.61). Elevated HbA1c levels, longer T2DM duration, insulin use, high systolic BP and high lipid profile levels correlated strongly with diabetic retinopathy (DR) and CKD progression. CONCLUSION: This highlights the necessity for targeted interventions to bridge urban-suburban care gaps, optimise drug prescriptions and implement comprehensive care strategies for improved glycaemic control, DR prevention and CKD progression mitigation among in Thai patients with T2DM. The value of the clinical target aggregate (ABC) and the process of care aggregate (FAACE) was also conclusively demonstrated.

Diabetes-Specific Complete Smoothie Formulas Improve Postprandial Glycemic Response in Obese Type 2 Diabetic Individuals: A Randomized Crossover Trial.

This study aimed to compare newly developed diabetes-specific complete smoothie formulas with a standard diabetes-specific nutritional formula (DSNF) regarding their effects on glucose homeostasis, insulin levels, and lipid metabolism in obese type 2 diabetes (T2DM) patients. We conducted a randomized, double-blind, crossover study with 41 obese T2DM participants to compare two developed diabetes-specific complete smoothie formulas, a soy-based regular smoothie (SM) and a smoothie with modified carbohydrate content (SMMC), with the standard DSNF, Glucerna. Glycemic and insulin responses were assessed after the participants randomly consumed 300 kilocalories of each formulation on three separate days with a 7-day gap between. Postprandial effects on glycemic control, insulin levels, and lipid metabolism were measured. SMMC resulted in a significantly lower glucose area under the curve (AUC0-240) compared to Glucerna and SM (p < 0.05 for both). Insulin AUC0-240 after SMMC was significantly lower than that after SM and Glucerna (p < 0.05). During the diets, the suppression of NEFA was more augmented on SM, resulting in a less total AUC0-240 of NEFA compared to the SMMC diet (p < 0.05). C-peptide AUC0-240 after SMMC was significantly lower than that after Glucerna (p < 0.001). Conversely, glucagon AUC0-240 after SMMC was significantly higher than that after SM and Glucerna (p < 0.05). These results highlight SMMC as the better insulin-sensitive formula, potentially achieved through increased insulin secretion or a direct reduction in glucose absorption. The unique composition of carbohydrates, amino acids, and fats from natural ingredients in the smoothies may contribute to these positive effects, making them promising functional foods for managing diabetes and obesity.

Influence of Prolonged Whole Egg Supplementation on Insulin-like Growth Factor 1 and Short-Chain Fatty Acids Product: Implications for Human Health and Gut Microbiota.

The gut microbiota exert a profound influence on human health and metabolism, with microbial metabolites playing a pivotal role in shaping host physiology. This study investigated the impact of prolonged egg supplementation on insulin-like growth factor 1 (IGF-1) and circulating short-chain fatty acids (SCFAs). In a subset of a cluster-randomized trial, participants aged 8-14 years were randomly assigned into three groups: (1) Whole Egg (WE)-consuming 10 additional eggs per week [n = 24], (2) Protein Substitute (PS)-consuming yolk-free egg substitute equivalent to 10 eggs per week [n = 25], and (3) Control Group (C) [n = 26]. At week 35, IGF-1 levels in WE significantly increased (66.6 ± 27.7 ng/mL, p < 0.05) compared to C, with positive SCFA correlations, except acetate. Acetate was stable in WE, increasing in PS and C. Significant propionate differences occurred between WE and PS (14.8 ± 5.6 µmol/L, p = 0.010). WE exhibited notable changes in the relative abundance of the Bifidobacterium and Prevotella genera. Strong positive SCFA correlations were observed with MAT-CR-H4-C10 and Libanicoccus, while Roseburia, Terrisporobacter, Clostridia_UCG-014, and Coprococcus showed negative correlations. In conclusion, whole egg supplementation improves growth factors that may be related to bone formation and growth; it may also promote benefits to gut microbiota but may not affect SCFAs.

Immune Response after SARS-CoV-2 Infection with Residual Post-COVID Symptoms.

Many patients develop post-acute COVID syndrome (long COVID (LC)). We compared the immune response of LC and individuals with post-COVID full recovery (HC) during the Omicron pandemic. Two hundred ninety-two patients with confirmed COVID infections from January to May 2022 were enrolled. We observed anti-SARS-CoV-2 receptor-binding domain immunoglobulin G, surrogate virus neutralization test, T cell subsets, and neutralizing antibodies against Wuhan, BA.1, and BA.5 viruses (NeuT). NeuT was markedly reduced against BA.1 and BA.5 in HC and LC groups, while antibodies were more sustained with three doses and an updated booster shot than ≤2-dose vaccinations. The viral neutralization ability declined at >84-days after COVID-19 onset (PC) in both groups. PD1-expressed central and effector memory CD4+ T cells, and central memory CD8+ T cells were reduced in the first months PC in LC. Therefore, booster vaccines may be required sooner after the most recent infection to rescue T cell function for people with symptomatic LC.

Prolonged Egg Supplement Advances Growing Child's Growth and Gut Microbiota.

Protein-energy malnutrition still impacts children's growth and development. We investigated the prolonged effects of egg supplementation on growth and microbiota in primary school children. For this study, 8-14-year-old students (51.5% F) in six rural schools in Thailand were randomly assigned into three groups: (1) whole egg (WE), consuming 10 additional eggs/week (n = 238) (n = 238); (2) protein substitute (PS), consuming yolk-free egg substitutes equivalent to 10 eggs/week (n = 200); and (3) control group (C, (n = 197)). The outcomes were measured at week 0, 14, and 35. At the baseline, 17% of the students were underweight, 18% were stunted, and 13% were wasted. At week 35, compared to the C group the weight and height difference increased significantly in the WE group (3.6 ± 23.5 kg, p < 0.001; 5.1 ± 23.2 cm, p < 0.001). No significant differences in weight or height were observed between the PS and C groups. Significant decreases in atherogenic lipoproteins were observed in the WE, but not in PS group. HDL-cholesterol tended to increase in the WE group (0.02 ± 0.59 mmol/L, ns). The bacterial diversity was similar among the groups. The relative abundance of Bifidobacterium increased by 1.28-fold in the WE group compared to the baseline and differential abundance analysis which indicated that Lachnospira increased and Varibaculum decreased significantly. In conclusion, prolonged whole egg supplementation is an effective intervention to improve growth, nutritional biomarkers, and gut microbiota with unaltered adverse effects on blood lipoproteins.

Validation of a Thai semiquantitative food frequency questionnaire (semi-FFQ) for people at risk of metabolic syndrome.

BACKGROUND: Food frequency questionnaires (FFQ) are a useful dietary assessment tool to determine relationships between diet and non-communicable diseases (NCDs). Our purpose was to validate a semiquantitative FFQ (semi-FFQ) for Thais at risk of metabolic syndrome (MS). METHODS: The researchers identified 345 men and women aged 30-65 years who were eligible for the study. Ninety-four participants were finally enrolled (54 in a "urine-collection not-required" group and 40 in a "urine collection" group). They were asked to maintain a 4-day food record for 4 weeks and partook in a semi-FFQ interview during week 4. Urine samples and biochemical results related to MS were collected. Validation results were associated with three primary nutrients for MS (sugar, fat, and sodium) and biochemical results (blood glucose, lipid profiles, blood pressure, and 24-h urine sodium). RESULTS: The biomarker level of each key MS nutrient significantly increased commensurate with rises in semi-FFQ estimated intakes. Correlation coefficients (r) were as follows: fasting blood glucose, r = 0.221 (fruits) and r = 0.229 (desserts); triglycerides, r = 0.112 (a la carte-dishes); low-density lipoprotein cholesterol, r = 0.205 (rice-with-topping dishes); systolic blood pressure, r = 0.272 (snacks) and r = 0.190 (a la carte dishes). Fasting blood glucose was a significant biomarker associated with the development of metabolic syndrome (OR 1.42, 95% CI 1.12-1.81). We also found that fat (OR 1.28, 95% CI 1.09-1.89), sodium (OR 1.98, 95% CI 1.05-1.95) and energy (OR 1.09, 95% CI 1.01-1.17) from an a la carte meal were significantly associated with the development of metabolic syndrome. CONCLUSIONS: Thai food has a unique characteristic since it often pairs various ingredients and seasoning in one menu. This semi-FFQ is a tool that offers relatively valid ranking for intake of energy, nutrients, single foods, and mixed dishes based on Thai menus associated with a risk for developing metabolic syndrome and NCDs. Using this tool could help identify unhealthy dietary patterns and help develop recommendations for people at risk with the goal of preventing NCDs.

Control and complications of diabetes in urban primary care units in Thailand: a cross-sectional study.

BACKGROUND: Primary health care system plays a central role in caring for persons with diabetes. Thai National Health Examination Survey (NHES) reports that only 40% of patients with type 2 diabetes mellitus (T2DM) achieve optimal glycemic control. We sought to evaluate the quality of diabetic care (QOC), prevalence of microvascular complications, and associated risk factors among T2DM patients treated at primary care units in urban areas in Thailand. METHODS: A population-based, cross-sectional study of 488 T2DM patients aged over 35 years from 25 primary care units in Samutsakhon, Thailand was conducted during February 2018 to March 2019. Clinical targets of care (TOC) and processes of care (POC) were measured to evaluate QOC. Multivariate logistic regression models were applied to explore the association between risk factors and glycemic control. RESULTS: 41.2% of women and 44.4% of men achieved hemoglobin A1C (A1C) < 53 mmol/mol, while 31.3% of women and 29.7% of men had poor glycemic control (A1C > 63 mmol/mol). 39 participants (8%) achieved all TOC and 318 participants (65.2%) achieved all POC. Significant risk factors for poor glycemic control included diabetes duration > 6 years (AOR = 1.83, 95% CI = 1.20-2.79), being overweight (AOR = 2.54, 95% CI = 1.58-4.08), obesity (AOR = 1.71, 95% CI = 1.05-2.89), triglycerides > 1.7 mmol/l (AOR = 1.81, 95% CI = 1.25-2.78), low density lipoprotein-cholesterol (LDL-C) ≥ 2.6 mmol/l (AOR = 1.55, 95% CI = 1.04-2.28). On the other hand, participants aged > 65 years (AOR = 0.25, 95% CI = 0.14-0.55) or achieved TOC indicators (AOR = 0.69, 95% CI = 0.43-0.89) were significantly associated with glycemic control. Diabetic retinopathy was significantly related to obesity (AOR = 2.21, 95% CI = 1.00-4.86), over waist circumference (AOR = 2.23, 95% CI = 0.77-2.31), and diastolic blood pressure > 90 mmHg (AOR = 1.81, 95% CI = 1.48-1.96). CONCLUSION: Access to essential diabetic screening in primary care units is crucial to determine status of disease control and guide disease management. Duration of T2DM, high body mass index, triglyceride and LDL-C were independently associated with poor glycemic control. Obesity was highly associated with diabetes retinopathy. Effort should be taken seriously toward monitoring these factors and providing effective care.