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

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0253434
Author(s):  
Tanapat Laowahutanon ◽  
Haruyo Nakamura ◽  
Hisateru Tachimori ◽  
Shuhei Nomura ◽  
Tippawan Liabsuetrakul ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Universal Coverage ◽  
Cerebrovascular Diseases ◽  
Thai Population ◽  
Admission Rates ◽  
Geographical Inequalities ◽  
Universal Coverage Scheme

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.

scholarly journals Increased Mortality Risk in People with Type 2 Diabetes Mellitus in Lithuania

2020 ◽  
Vol 17 (18) ◽  
pp. 6870
Author(s):  
Donata Linkeviciute-Ulinskiene ◽  
Auguste Kaceniene ◽  
Audrius Dulskas ◽  
Ausvydas Patasius ◽  
Lina Zabuliene ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Mortality Risk ◽  
Circulatory System ◽  
Cerebrovascular Diseases ◽  
Diabetes Duration ◽  
Insurance Fund ◽  
Diabetes Diagnosis

This retrospective cohort study aimed to analyze overall and cause-specific mortality risk in people with type 2 diabetes mellitus (T2DM) in Lithuania. Information on the diagnosis of T2DM and glucose-lowering medication was obtained from the National Health Insurance Fund database, causes of death–from death certificates. Sex, age, and calendar period-standardized mortality ratios (SMRs) were calculated. In addition, 89,512 patients were followed-up between 2010 and 2017, contributing to the observation period of 592,321 person-years. Overall mortality risk was increased for both sexes (overall SMR = 1.35, 95% confidence interval (CI) 1.34–1.37). Greatest mortality risk was in the age group of 40–49 years at diabetes diagnosis (SMR = 1.68, 95% CI 1.60–1.76) and among those who had died before the age of 50 (SMR = 22.04, 95% CI 18.82–25.81). Patients treated with insulin only had the highest SMR (2.43, 95% CI 2.32–2.55). Mortality risk increased with increasing diabetes duration and was higher in women in all these groups. The highest cause-specific SMRs were infection-related causes (SMR = 1.44), particularly septicemia (SMR = 1.78), diseases of the circulatory system (SMR = 1.42), especially ischemic heart (SMR = 1.46) and cerebrovascular diseases (SMR = 1.38), as well as diseases of the digestive system (SMR = 1.35). Cancer mortality risk was elevated for women (SMR = 1.13), but not for men (SMR = 0.93). In conclusion, people with T2DM had an excess mortality risk, which was higher in women compared to men, younger people, in those who were diagnosed with T2DM at a younger age, had longer diabetes duration, and who required treatment with insulin.

The state of carbohydrate metabolism and the development of cerebrovascular diseases in patients with type 2 diabetes mellitus

Pharmateca ◽  
2019 ◽  
Vol 4_2019 ◽  
pp. 61-67
Author(s):  
K.V. Antonova () Antonova ◽  
M.M. Tanashyan () Tanashyan ◽  
M.Yu. Maksimova () Maksimova ◽  
N.V. Shakhparonova () Shakhparonova ◽  
T.I. Romantsova () Romantsova ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Carbohydrate Metabolism ◽  
Cerebrovascular Diseases ◽  
The State

Hemostasis in patients with type 2 diabetes mellitus and obesity in acute and chronic cerebrovascular pathology

2020 ◽  
Author(s):  
К.В. Антонова ◽  
М.М. Танашян ◽  
А.А. Шабалина ◽  
М.Ю. Максимова ◽  
О.В. Лагода ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Platelet Aggregation ◽  
International Normalized Ratio ◽  
Cerebrovascular Diseases ◽  
Adverse Outcomes ◽  
Additional Risk Factor ◽  
Cerebrovascular Pathology

Введение. В настоящее время цереброваскулярные заболевания (ЦВЗ) в России являются второй по частоте причиной смерти среди больных сахарным диабетом (СД). С гипергликемией и избыточной массой тела связывают протромботические и провоспалительные изменения, приводящие к неблагоприятным исходам инсульта и прогрессированию ЦВЗ. Цель исследования: оценить роль избыточной массы тела как дополнительного фактора риска развития нарушений гемостаза при острых и хронических формах цереброваскулярной патологии у пациентов с СД 2‑го типа (СД‑2). Материалы и методы. В исследование включено 305 пациентов с ишемическими ЦВЗ: группа 1 — 87 больных с ишемическим инсультом (ИИ) и СД‑2; группа 2 — 58 пациентов с ИИ без СД; группа 3 — 80 больных с хроническими ЦВЗ (ХЦВЗ) и СД‑2; группа 4 — 80 пациентов с ХЦВЗ без СД. Выполнены общесоматический и неврологический осмотр, магнитно-резонансная томография головного мозга, инструментальные исследования с расчетом индекса массы тела (ИМТ) и лабораторные исследования с определением гликемии и гликированного гемоглобина (HbA1c), АДФ-индуцированной (АДФ-АТ) и адреналин-индуцированной (Адр-АТ) агрегации тромбоцитов, коагулограммы, включающей содержание фибриногена и Д-димеров, международное нормализованное отношение, активированное частичное тромбопластиновое время, фибринолитическую активность (ФА), индекс фибринолиза, активность плазминогена и уровень тканевого активатора плазминогена (t-РА). Результаты. Наибольших значений глюкоза и HbA1c достигали у пациентов с ИИ и СД‑2. Во всех группах больных с цереброваскулярной патологией СД‑2 сопровождался ожирением и повышенным ИМТ. ЦВЗ (как ИИ, так и хроническая форма) в сочетании с СД‑2 протекали на фоне протромботического состояния крови, связанного с нарушением всех звеньев гемостаза, и проявлялись увеличением АДФ-АТ и Адр-АТ, повышением содержания фибриногена и Д-димеров при одновременном снижении ФА, индекса фибринолиза, активности плазминогена и уровня t-PA. Самые выраженные нарушения наблюдали у пациентов с ИИ и СД‑2, особенно со стороны фибринолиза. Выявлены значимые корреляции между ИМТ и агрегацией тромбоцитов, уровнями фибриногена и Д-димеров, ФА и t-PA. Заключение. У лиц с СД‑2 острые и хронические ЦВЗ сопровождаются ожирением и увеличенным ИМТ, который взаимосвязан с активацией тромбоцитарного и плазменного гемостаза и снижением фибринолиза. Наибольшие изменения отмечены у пациентов с острым инсультом и СД‑2, для которых характерно сочетание гиперфибриногенемии и значительное снижение фибринолиза. Повышение ИМТ у больных ЦВЗ ассоциировано с выраженностью протромботических изменений. Introduction. At present cerebrovascular diseases (CVD) in Russia is the second most common cause of death among patients with diabetes mellitus (DM). Prothrombotic and pro-inflammatory changes leading to adverse outcomes of stroke and progression of CVD are associated with hyperglycemia and obesity. Aim: to assess the role of obesity as an additional risk factor for the development of hemostasis disorders in acute and chronic forms of cerebrovascular pathology in patients with type 2 diabetes mellitus (DM‑2). Materials and methods. The study included 305 patients with ischemic CVD: group 1 — 87 patients with ischemic stroke (IS) and DM‑2; group 2 — 58 patients with IS without DM; group 3 — 80 patients with chronic CVD (CCVD) and DM‑2; group 4 — 80 patients with CCVD without DM. The following studies were completed: somatic and neurological examinations, magnetic resonance imaging of the brain, calculation of body mass index (BMI) and laboratory tests with the determination of glycemia and glycated hemoglobin (HbA1c), ADP-induced (ADP-AT) and adrenaline-induced (Adr-AT) platelet aggregation, coagulogram with fibrinogen and D-dimers content, international normalized ratio, activated partial thromboplastin time, fibrinolytic activity (FA), fibrinolysis index (FI), plasminogen activity and level of tissue plasminogen activator (t-PA). Results. The highest values of glucose and HbA1c were found in patients with IS and DM‑2. In all groups of patients with cerebrovascular pathology DM‑2 was accompanied with obesity and increased BMI. CVD (both IS and chronic form) in combination with DM‑2 were accompanied by prothrombotic blood state (associated with hemostasis disorders), and manifested by enhancement of ADP-AT and Adr-AT, increasing of fibrinogen and D-dimers content and decreasing of FA, FI, plasminogen activity and t-PA. Most expressed disturbances (especially in fibrinolysis) were observed in patients with IS and DM‑2. Significant correlations were found between BMI and platelet aggregation, levels of fibrinogen and D-dimers, FA and t-PA. Conclusion. In patients with DM‑2 acute and chronic CVD are accompanied by obesity and increased BMI and associated with activation of platelet and plasma hemostasis and decreased fibrinolysis. The largest changes were noted in patients with acute stroke and DM‑2 and characterized by a combination of hyperfibrinogenemia and a significantly decreased fibrinolysis. Increasing of BMI in patients with CVD was associated with the severity of prothrombotic changes.

Progression of Prediabetes to Type 2 Diabetes Mellitus in Thai Population

2021 ◽  
Vol 104 (5) ◽  
pp. 772-780
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Family History ◽  
Glucose Tolerance Test ◽  
Tolerance Test ◽  
Thai Population ◽  
History Of

Background: Pre-diabetes (pre-DM) increases the risk of developing type 2 diabetes mellitus (T2DM). The incidence of progression from pre-DM to T2DM varies in different ethnic populations. Objective: To examine the rate of progression from pre-DM to T2DM in a Thai population. Materials and Methods: This was a cohort study involving participants with pre-DM, diagnosed according to the results of fasting plasma glucose (FPG) and plasma glucose levels two hours after a 75-g oral glucose tolerance test (OGTT) (2-h PG), including IFG+/IGT–, defined by an FPG of 100 to 125 mg/dL (IFG+) and a normal 2-h PG of less than 140 mg/dL (IGT–); IFG–/IGT+, defined by a normal FPG of less than 100 mg/dL (IFG–) and a 2-h PG of 140 to 199 mg/dL (IGT+), and IFG+/IGT+. Each participant was followed-up until diabetes developed or for three years. The incidence of progression to T2DM was calculated every year until the 3-year follow-up period. Results: Three hundred twenty-five pre-DM participants were enrolled and classified into the following categories: IFG+/IGT– (22.5%), IFG–/IGT+ (44.3%), and IFG+/IGT+ (33.2%). During the 3-year follow-up period, 63 of 325 (19.4%) participants developed T2DM. The incidence of progression to T2DM was 3.1%, 5.7%, and 11.8% at 1, 2, and 3 years, respectively. The mean time to progression to T2DM was 25.5 months. When comparing between subgroups of pre-DM, the IFG–/IGT+ or IFG+/IGT+ subgroups had a higher chance of developing T2DM than the IFG+/IGT– subgroup (p<0.05). Some risk factors, which were a family history of T2DM in first-degree relatives, FPG of 110 mg/dL or more, and an HbA1C of 6.0% or greater were significantly associated with the progression of T2DM in univariate analysis (p<0.05). However moderate-intensity exercise and diabetes self-management education (DSME) attainment were the protective factors (p<0.05). Conclusion: Almost one-fifth of the participants with pre-DM progressed to T2DM within three years. The annual incidence of DM development was 3.1%, 5.7%, and 11.8% at 1, 2, and 3 years, respectively. People with FPG of 110 mg/dL or more, and an HbA1C of 6.0% or higher, or IGT or combined IGT&IFG should be screened for DM more frequently, using FPG and HbA1C, perhaps every three to six months, especially in those with a family history of T2DM in first-degree relatives. Otherwise, lifestyle modification should be strongly emphasized to prevent development of T2DM in these people. Keywords: Pre-diabetes, Glucose tolerance test, Diabetes mellitus

scholarly journals Low Branched Chain Amino Acids and Tyrosine in Thai Patients with Type 2 Diabetes Mellitus Treated with Metformin and Metformin-Sulfonylurea Combination Therapies

2021 ◽  
Vol 10 (22) ◽  
pp. 5424
Author(s):  
Natthida Sriboonvorakul ◽  
Wirichada Pan-Ngum ◽  
Kittiyod Poovorawan ◽  
Sant Muangnoicharoen ◽  
Lauren M. Quinn ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Amino Acids ◽  
Type 2 Diabetes Mellitus ◽  
Healthy Controls ◽  
Thai Population ◽  
Insulin Resistant ◽  
Current Prevalence ◽  
Branched Chain

Type 2 diabetes mellitus (T2DM) is a growing public health challenge for Thailand (current prevalence ~10.0%). Amino acids offer novel biomarkers to predict risk of T2DM and indicate sub-optimal disease management, which could facilitate earlier treatment. We studied amino acid profiles in a Thai cohort comprising of individuals with T2DM (n = 65 single-drug-treated; n = 38 multi-drug-treated) compared to healthy controls (n = 104) using liquid chromatography-mass spectrometry. Age and BMI were significantly lower in the healthy controls compared to the single or multi-treated T2DM groups. The BCAA (leucine and valine) were significantly lower in the single and multi-treated T2DM groups compared to healthy controls (p < 0.001 and p < 0.001) and isoleucine was significantly lower in the single-treated compared to the healthy controls (p = 0.014). These findings beg the question whether BCAAs supplementation be beneficial in T2DM patients treated with single or multi-drug therapy? Tyrosine was significantly lower in the single and multi-treated T2DM groups compared to healthy controls (p < 0.001 and p = 0.002), whereas phenylalanine was significantly higher in the multi-treated T2DM group compared to the single treated T2DM group (p = 0.045). We provide novel insights into the effects of diabetes treatments on these amino acids in insulin resistant states such as T2DM in a unique but understudied Thai population.

Paraoxonase 1 (PON1) L55M and Q192R Polymorphisms are Associated with Type 2 Diabetes Mellitus in Southern Thai Subjects

2020 ◽  
Vol 103 (5) ◽  
pp. 472-480
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Critical Role ◽  
Paraoxonase 1 ◽  
Healthy Controls ◽  
Thai Population ◽  
Genotype Frequencies ◽  
Pon1 Polymorphisms

Background: Paraoxonase 1 (PON1) plays a critical role in the prevention of cardiovascular disease, diabetes mellitus, and other chronic diseases. Objective: The aim of the present study was to investigate the association of PON1 L55M and Q192R polymorphisms with type 2 diabetes mellitus (T2DM), and pre-diabetes. Materials and Methods: The present study included 512 subjects (223 T2DM patients, 150 pre-diabetes, and 139 healthy controls) from Southern Thailand. The PON1 L55M and Q192R polymorphisms were analyzed by polymerase chain reactionrestriction fragment length polymorphism (PCR-RFLP) technique. Results: PON1 Q192R polymorphism showed a statistical difference in genotype frequencies between T2DM patients and healthy controls (p<0.0001). Multiple logistic regression analyses after adjusting for age, gender, and BMI showed that LM and RR genotypes increased the risk for T2DM compared with LL and QQ+QR genotypes (OR 1.96; 95% CI 1.02 to 3.76, p=0.042, and OR 1.85; 95% CI 1.11 to 3.10, p=0.019, respectively). Whereas, QR, genotype was associated with decreased risk for T2DM (OR 0.240; 95% CI 0.13 to 0.45, p<0.0001), and pre-diabetes (OR 0.549; 95% CI 0.30 to 0.99, p=0.048) compared with QQ genotype. Conclusion: PON1 LM and RR genotypes may be genetic risk factors for developing T2DM but QR genotype may prevent T2DM, and pre-diabetes in Southern Thai population. Keywords: PON1, Polymorphisms, Type 2 diabetes, Pre-diabetes

scholarly journals Does Use of Acupuncture Reduce the Risk of Type 2 Diabetes Mellitus in Patients With Rheumatoid Arthritis? Evidence From a Universal Coverage Health Care System

2021 ◽  
Vol 8 ◽  
Author(s):  
Wei-Jen Chen ◽  
Hanoch Livneh ◽  
Chi-Hsien Chen ◽  
Hui-Ju Huang ◽  
Wen-Jiun Liu ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Proportional Hazards ◽  
Universal Coverage ◽  
Incidence Rates ◽  
Cox Proportional Hazards ◽  
Control Group

Objectives: Although acupuncture is often advocated for patients with rheumatoid arthritis (RA), its efficacy for type 2 diabetes mellitus (T2DM), a common metabolic disease among RA cohorts, has not yet been established. This retrospective cohort study aimed to determine the association between acupuncture use and the development of T2DM among them.Methods: Data were collected from 1999 through 2008 for individuals aged 20–70 years in the nationwide insurance database of Taiwan. From them, we extracted 4,941 subjects within newly diagnosed RA and being T2DM free at baseline. A total of 2,237 patients had ever received acupuncture, and 2,704 patients without receiving acupuncture were designated as a control group. All of them were followed to the end of 2013 to identify T2DM incidence. The Cox proportional hazards regression model was utilized to obtain the adjusted hazard ratio (HR) for acupuncture use.Results: Compared with the RA subjects without use of acupuncture, the incidence of T2DM was lower for those who received acupuncture, with the incidence rates of 24.50 and 18.00 per 1,000 person-years (PYs), respectively. After adjusting for potential confounders, use of acupuncture was significantly related to the lower T2DM risk, with the adjusted HR of 0.73 [95% confidence interval (CI) 0.65–0.86]. Those who used acupuncture for more than five sessions had the greatest benefit in lowering the susceptibility to T2DM.Conclusion: Adding acupuncture into conventional treatment for RA was found to be related to lower risk of T2DM among RA patients. Further clinical and mechanistic studies are warranted.

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