Real-world Evaluation of glycemic control and hypoglycemic Events among type 2 Diabetes mellitus study (REEDS): a multicentre, cross-sectional study in Thailand.

OBJECTIVE: Patients with type 2 diabetes mellitus (T2DM) often experience hypoglycaemia and weight gain due to treatment side effects. Sulfonylureas (SU) and the combination of SU and metformin (SU+MET) were the most common monotherapy and combination therapies used in Thailand tertiary care hospitals. This study aimed to assess the glycaemic goal attainment rates, hypoglycaemic episodes, weight gain and treatment compliance among patients with T2DM receiving SU or SU+MET. RESEARCH DESIGN AND METHODS: A multicentre cross-sectional survey and retrospective review was conducted in five tertiary care hospitals, Thailand. Patients with T2DM aged ≥30 years were included consecutively during a 12-month period. Glycaemic control, experiences of hypoglycaemia, weight gain and compliance were evaluated. Glycaemic goal attainment was defined by HbA1c level less than 7%. RESULTS: Out of the 659 patients (mean age (±SD)), 65.5 (10.0) years and median duration of T2DM (IQR), 10 (5-15) years), 313 (47.5%) achieved the glycaemic goal. HbA1c levels in the patients with goal attainment was significantly lower compared with those without (6.3%±0.5% vs 8.1%±1.2%, p<0.001). Goal attainment was significantly lower among patients treated with SU+MET than those treated with SU alone (43.5% vs 63.0%; OR 0.45, 95% CI 0.31, 0.66, p<0.001). A third of patients reported experiencing hypoglycaemia (30.7%) and weight gain (35.4%). Weight gain in the SU+MET group was lower than those receiving SU alone (33.1% vs 44.6%, p=0.015), but there was no difference in hypoglycaemic events. Major events in the previous 12 months were experienced by 68 patients, most commonly congestive heart failure and ischaemic heart disease. Approximately half of the patients (52.2%) reported not always taking their medication as prescribed. CONCLUSIONS: Among patients with T2DM receiving SU or SU+MET, only about half of the patients achieved glycaemic goal and compliance with the treatment. Hypoglycaemia and weight gain posed a significant burden with risk of weight gain higher in the SU group.

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)].

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.

Clinical efficacy of pioglitazone: generic vs. original product.

BACKGROUND: Pioglitazone, an oral antidiabetic agent in the class of thiazolidinediones (TZDs), was widely used in the case of insulin tolerance as it provided more benefit to patients with type 2 diabetes. However, the original product is costly while some generic products are available at the substantial lower cost in Thailand. The objective of the present study was to assess bioequivalence in terms of efficacy between generic and original pioglitazone products. MATERIAL AND METHOD: A randomized double blind, crossover controlled trial was performed on 60 patients with type 2 diabetes at the Endocrine Unit, Department of Medicine, Phramongkutklao Hospital, Thailand. All subjects were randomly selected for group A and B (30 volunteers in each group). Duration of observation for efficacy of treatment with pioglitazone (both generic and original products) was totally 24 weeks. The dose of pioglitazone was 15 mg once daily. RESULTS: Finally, 22 males and 37 females remained in the trial. The reduction in means of HbA1c in group A and group B were 0.7% and 0.6% respectively. The least squares means of the HbA1c reduction of the generic and original group were 0.75% and 0.79%, respectively. There was no significant difference in HbA1c reduction between both groups. The average equality of HbA1c in all subjects in both groups was 100.7% (87.9-113.5%) at 90% confidence interval. CONCLUSION: These findings indicated that both formulations were bioequivalent as their efficacy or therapeutic effects in reduction ofHbA1c in the type 2 diabetic subjects were statistically the same.

First insulinization with basal insulin in patients with Type 2 diabetes in a real-world setting in Asia.

BACKGROUND: The First Basal Insulin Evaluation (FINE) Asia study is a multinational, prospective, observational study of insulin-naïve Type 2 diabetes mellitus (T2DM) patients in Asia, uncontrolled (A1c ≥ 8%) on oral hypoglycemic agents, designed to evaluate the impact of basal insulin initiation. METHODS: Basal insulin was initiated with or without concomitant oral therapy and doses were adjusted individually. All treatment choices, including the decision to initiate insulin, were at the physician's discretion to reflect real-life practice. RESULTS: Patients (n=2679) from 11 Asian countries were enrolled (mean [±SD] duration of diabetes 9.3±6.5 years; weight 68.1±12.7 kg; A1c 9.8 ± 1.6%). After 6 months of basal insulin (NPH insulin, insulin glargine, or insulin detemir), A1c decreased to 7.7±1.4%; 33.7% patients reached A1c <7%. Fasting blood glucose (FBG) decreased from 11.7±3.6 to 7.2±2.5 mmol/L and 36.8% of patients reached FBG <6.1 mmol/L. The mean daily insulin dose prescribed increased marginally from 0.18 to 0.23 U/kg per day at baseline to 0.22-0.24 U/kg per day at Month 6. Mean changes in body weight and reported rates of hypoglycemia were low over the duration of the study. CONCLUSIONS: Initiation of insulin therapy is still being delayed by approximately 9 years, resulting in many Asian patients developing severe hyperglycemia. Initiating insulin treatment with basal insulin was effective and safe in Asian T2DM patients in a real-world setting, but insulin needs may differ from those in Western countries.

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.

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.

Adverse effect of pioglitazone in military personnel and their families: a preliminary report.

BACKGROUND: Thiazolidinediones (rosiglitazone and pioglitazone) whether administered alone or in combination with metformin, sulfonylurea, or insulin, are often accompanied by an increase in weight and/or plasma volume. Several studies have shown the adverse effect of weight gain and edema with rosiglitazone. But there was less data with pioglitazone, especially in military personnel and their families. MATERIAL AND METHOD: The authors prospectively recorded the adverse events in 40 patients with type 2 diabetes mellitus who underwent administration with pioglitazone 15 mg once daily between June 2005 to May 2007. RESULTS: Weight gain was reported in 30/40 of patients (75%). The mean weight gain was 2.25 +/- 2.23 kg and the median was 2 kg. The slightly lower proportion of patients, 21/40 (52.5%) developed edema and some of them were associated with weight gain. CONCLUSION: Pioglitazone was associated with a significant increase in body weight and edema. This finding may lead to increase the risk of myocardial infarction in military personnel and their families, especially those who had underlying disease of congestive heart failure, which was not included in the present study.

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.

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 and risk factors of stroke in thai diabetic patients.

OBJECTIVE: To determine the prevalence of stroke and its risk factors in Thai diabetic patients who attended the diabetes clinics of university and tertiary-care hospitals. MATERIAL AND METHOD: A cross-sectional, multi-center hospital-based diabetes registry was carried out at diabetes clinics of 11 university and tertiary-care hospitals. Demographic data, clinical characteristics, common drugs used and laboratory parameters were analyzed for prevalence and risk factors associated with stroke. RESULTS: The prevalence of stroke in the patients studied was 3.5%. Most of the patients were type 2 diabetes and had ischemic stroke. One of the risk factors associated with stroke was age greater than 60 years, and the risk appeared to be highest if the patients' age was greater than 70 years (adjust OR = 3.29, p = 0.012). Other risk factors included male sex, systolic blood pressure of > or =140 mmHg, use of oral hypoglycemic agents, lipid lowering agents and aspirin. There was no association between stroke and duration of diabetes, occupation, educational level, BMI, smoking, alcohol drinking, diastolic blood pressure, use of antihypertensive drugs or insulin, glycemic control, lipid profiles and kidney function. CONCLUSION: Ischemic stroke was common among Thai patients with diabetes especially in the elderly. The present result emphasizes the relationship between level of systolic blood pressure and the occurrence of stroke. Optimal blood pressure control should be underscored in caring for diabetic patients.

Thailand diabetes registry project: current status of dyslipidemia in Thai diabetic patients.

OBJECTIVE: To determine the prevalence of dyslipidemia in adult Thai type 2 diabetes who attended diabetes clinics in university and tertiary-care hospitals. MATERIAL AND METHOD: A cross-sectional, multi-center, hospital-based diabetes registry was conducted in 11 diabetic clinics in tertiary medical centers in Bangkok and major provinces between April and December 2003. A group of 9419 diabetic patients were registered. Individual Demographic data including education and socioeconomic status were collected. The results of the physical examination for complications, history screening and laboratory results were recorded. The prevalence of the various complications of diabetes was analyzed and the percentage achievement of metabolic control calculated. RESULTS: Of the 9419 diabetic patients registered 8769 had complete demographic and plasma lipid data. Mean age was 59.5 +/- 13.3 years. The percentage of male patients was 33.9%. In the present study, there were 8464 type 2 diabetes and 383 type I diabetes. History of coronary artery disease and cerebrovascular disease were present in 8.1 and 4.2 percent ofthepatients, respectively. More than 80% of the patients had dyslipidemia. The patients with CVD had higher proportion of achieving the LDL target (< 100 mg/dl, 43 vs. 34%). More than half of the patients (55%) were taking lipid lowering medications, but one-third (30%) did not despite havingfulfilled indications. The patients covered by government supported health plan were less likely to received lipid-lowering medication than the patients covered by private health plans (OR 0.65, 95% CI 0.57-0.75). The two most commonly used lipid-lowering agents were HMG CoA reductase inhibitors (76%) and fibrates (19%), both agents were used in combination in 5% ofthe patients. Only 40.1% ofthe patients on lipid-lowering medications reached the target LDL goal (<100 mg/dl). CONCLUSION: Elevated LDL cholesterol was the most common lipid abnormality in the present study. Although 55% of the patients were taking lipid lowering agents, another 42% of the patients needed the medication. More than half of the patients treated needed more intensive lipid lowering in order to achieve the LDL goal. If the authors wish to follow the current (2005) American Diabetes Association recommendations, we would have to treat up to 97% of diabetic patients with lipid lowering

Thailand diabetes registry project: glycemic control in Thai type 2 diabetes and its relation to hypoglycemic agent usage.

OBJECTIVE: To determine the pattern of hyperglycemic agent usage in Thai type 2 diabetics (T2 DM) who attended the diabetes clinic in university and tertiary-care hospitals. The achievement oftarget glycemic control by various modalities of treatment was also analyzed. MATERIAL AND METHOD: A cross-sectional, hospital-based diabetes registry of 8913 type 2 diabetic patients in 11 tertiary care hospitals and medical schools was carried out from April to December 2003. Demographic data, usage of hypoglycemic agents and level of glycemic control were collected to determine the pattern ofuse, associated factors, and achievement of glycemic control. RESULTS: Overall, 2342 (26.3%) of T2 DM achieved HbA1C less than 7%. The percentage of patients treated with metformin was 70.8%, sulfonylureas (SU) was 68.7% and insulin was 25.3%. Only 7.0% of patients received alpha-Glucosidase Inhibitor (AGI), 5.7% received ThaiZoliDinediones (TZD), 1.1% received repaglinide, and 3.2% was on diet control alone. Target glycemic control was achieved in 57.6%, 37.1%, 52%, 16.7%, 62.5%, 52% and 16.9% of patients who were on diet control only, monotherapy with SQU, metformin, TZD, AGI, repaglinide and insulin,respectively. Sulfonylureas were the most commonly used drug for monotherapy. Metformin with sulfonylurea was the most common combination therapy and was used in 39.5% of patients. More than 60% of the patients treated with metformin monotherapy had body mass index (BMI) of more than 25 kg/m2, as compare to less than half of patient treated with other monotherapy agent. Mean +/- SD duration of diabetes in thepatients treated with metformin alone was 5.9 +/- 5.5 years, less than that in the SU-treated patients (8.3 +/- 7.1 years) and also in the insulin-treated patients (14.8 +/- 9.0 years). TDZ were commonly prescribed in combination with sulfonylureas and metformin in subjects with relatively longer duration of diabetes. CONCLUSION: Better treatment strategies for glucose control ofdiabetic patients on medical treatments should be encouraged to improve glycemic control and reduce long term complications.

Thailand diabetes registry project: prevalence of hypertension, treatment and control of blood pressure in hypertensive adults with type 2 diabetes.

OBJECTIVE: To determine the prevalence of hypertension, patterns of antihypertensive treatment and level of blood pressure control in adult Thai type 2 diabetic patients who attended diabetes clinics in university and tertiary-care hospitals. MATERIAL AND METHOD: A cross-sectional, multi-center, hospital-based diabetes registry of 8884 adults 18 years old and older was carried out from diabetes clinics of 11 tertiary centers. Demographic data, including use of antihypertensive drugs and blood samples were collected and analyzed for prevalence, associated factors, patterns of antihypertensive therapy and level of blood pressure control. RESULTS: The prevalence of hypertension in adult Thai type 2 diabetic patients was 78.4 (6965)%. Antihypertensive drugs were prescribed in 84.4 (5878)% of all hypertensive patients. The achievement of blood pressure control (less than 130/80 mmHg) w as 13.85%. Thepercentage of patients receiving 1, 2, 3, 4, and 5 drugs were 45 (2645)%, 33.4 (1963)%, 16.8 (987)%, 4.4 (259)%, and 0.4 (24)% respectively. Angiotensin-converting enzyme inhibitors were the most commonly prescribed antihypertensive agents (54.6%), followed by diuretics (43.8%), and calcium channel blockers (34.6%). CONCLUSION: Blood pressure control in hypertensive adults with type 2 diabetes was suboptimal. Strategies to improve awareness and adequacy of blood pressure control in these subjects should be seriously considered.

Thailand diabetes registry (TDR) project: clinical status and long term vascular complications in diabetic patients.

OBJECTIVE: The primary objectives of the Thailand Diabetes Registry project were to identify the characteristics of Thai diabetic patients in tertiary care medical centers and to determine the extent of long term diabetic complications. The secondary objective aimed at building up and strengthening clinical research network among Thai experts in diabetes mellitus and collection of baseline data for future follow-up study. MATERIAL AND METHOD: A cross-sectional, multi-center, hospital-based diabetes registry was carried out from diabetes clinics of 11 tertiary centers. Demographic data, clinical status of diabetes and its complications were collected and analyzed for the prevalence of complications and risk factors. RESULTS: Nine-thousand-four-hundred-and-nineteen patients were registered for the project and 94.6% were type 2 diabetes. Mean +/- SD of age was 59.4 +/- 13.5 and duration of diabetes was and 10 +/- 7.6 years. Only 38.2% of the subjects achieved glycemic control of FPG under 130 mg/dl in only 30.7% had an HbA lc of less than 7%. The overall prevalence of dyslipidemia found in this population was 73.3%, hypertension was 63.3% and obesity (BMI >25 kg/m2) was 52.6%. Diabetic nephropathy was the most common complication accounting for 43.9% followed by retinopathy 30.7%, IHD 8.1% and cerebrovascular disease 4.4%. CONCLUSION: The prevalence of dyslipidemia and hypertension were high in this population, which may be associated with the high prevalence of diabetic complications. The unsatisfactory control of metabolic status may be due to aging and long duration of diabetic patients in this registry.

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.