TẠP CHÍ NỘI TIẾT & ĐÁI THÁO ĐƯỜNG

The term prediabetes refers to people who have impaired fasting plasma glucose (5.6 – 6.9 mmol/l or 100 – 125 mg/dl), or impaired glucose tolerance (2-hour postglucose load of 140 – 199 mg/dl or 7.8 – 11.1 mmol/l), or HbA1c 5.7 – 6.4 %, or both, or third. According to experts, if prediabetes is not detected, the progression to type 2 diabetes mellitus is 5-10% annually. Prediabetes is a disease that silently develops over time. It has almost no specific symptoms, which are easily overlooked, so it's easy to be developed when not be well screened. Objectives: To identify the prevalence of prediabetes, diabetes mellitus in outpatients department of Bach Mai Hospital. Subjects and methods: A cross– sectional, descriptive study was carried out on 1145 participants, from 30 to 69 years age, who were checked health in outpatient department of Bach Mai Hospital from 10. 2018 to 3.2019, implemented fasting plasma glucose (FPG), oral glucose tolerance test (OGTT), HbA1c and diagnosed prediabetes according to criteria of ADA and Vietnam Diabetic Association – 2018. Results: The prevalence of prediabetes is 35.8%, and prevalence of diabetes mellitus is 4.6%.

Background: Sleep disorders are commonly seen in type 2 diabetic patients. However, there is not much research about the association of diabetic complications and poor sleep quality. Objectives: To evaluate diabetic complications and to find out which diabetic complications are associated with poor sleep quality in older diabetic patients treated at National Geriatric Hospital. Methods: A cross-sectional study on 178 older diabetic patients treated at National Geriatric Hospital from March to October, 2020. Quality of sleep was assessed using the Pittsburgh Sleep Quality Index. Results: 93 patients (52.2%) had peripheral nerve complications. 50% patients had diabetic retinopathy. There were 86 patients (48.3%) had experienced hypoglycemia in the last 3 months.  The prevalence of diabetic neuropathy, cerebral vascular disease, cardiovascular disease, peripheral artery disease and foot complication were 12.9%; 12.9%; 9%; 8.4% and 7.3%, respectively. 19.1% patients didn’t have any complications of diabetes. Patients with diabetic retinopathy and cerebral vascular disease had a significantly higher rate of poor sleep quality compared with the group without these complications. There were no significant association between diabetic nephropathy, cardiovascular disease, peripheral nerve complication, foot complication, hypoglycemia and sleep quality. Conclusion: This study showed that older diabetic patients had many complications. Diabetic retinopathy and cerebral vascular disease were higher in the poor sleep quality group.

Objective: To evaluate the prevalence of newly diagnosed prediabetes, diabetes mellitus among the officers from Phuoc Long district of Binh Phuoc province. Subjects and methods: 268 personals communications service was examined the impaired fasting glucose (G0); impaired glucose tolerance (G2) anh HbA1c. Results: Prevalence of prediabetes, type 2 diabetes mellitus by G0, G2, HbA1c as follows 16,0%; 13,1%; 17,9% and 3,8%; 6,7%; 2,2%. Common prevalence of prediabetes in 26,9%; type 2 diabetes mellitus in 7,1%. Conclusion: Personal communications service from Phuoc Long district have percentage of prediabetes higher compared to type 2 diabetes mellitus which of prediabetes was diagnosed by HbA1c which takes up the highest percentage; diabetes mellitus was diagnosed by G2which takes up the highest percentage.

Background: Type 2 diabetes mellitus (T2DM) is rapidly emerging as a major cause of morbidity and mortality in Vietnam. In view of local treatment guidelines recommending the addition of insulin glargine 100 U/ml (Gla-100) to people uncontrolled onoral anti-diabetic drugs (OADs), real-world data on effectiveness and safety of this basal insulin are lacking. Methods: A 6-month prospective, observational, multicenter, real-world studywas conducted between May 2015 and January 2017 in Vietnam, includinginsulin-naïve people with T2DM having glycated hemoglobin [HbA1c] between 7.5%–10%, and to whom Gla-100 was prescribed.Change in HbA1c and fasting blood glucose (FBG), Gla-100 dose, percentage of participants achieving HbA1c<7.0%, and demographic characteristics, treatment satisfaction (measured using Diabetes Treatment Satisfaction Questionnaire [DTSQ]), and adverse events (AEs) from baseline to six months were evaluated. Results: Overall, 343 people were documented. Mean HbA1c decreased from 8.6±0.8% to 8.0±1.2% (p<0.001) and mean FBG decreased from 9.8±2.7 to 8.4±2.6 mmol/L(p<0.0001) from baseline tosix months. At 3 and 6 month, 14.0% and 19.2%of participants achieved HbA1c<7.0%, respectively. Mean daily dose of Gla-100 increased from 10.5±4.8 at baseline to 13.7±5.8U/day at six months p <0.0001). Baseline HbA1c and presence of diabetes complications were predictors for target HbA1c achievement. All parameters of DTSQ improved at six months. The incidence of severe hypoglycemia was low, with no weight gain and no new/unexpected AEs. Conclusions: In Vietnamese people with T2DM uncontrolled on OADs, addition of Gla-100 significantly improved glycemic control and was well tolerated. However, dose titration was suboptimal. More active dose titration of Gla-100 might further improve glycaemic outcome in patients in real-world daily practice.

Objective: To describe the characteristics of wounds, ischemia, and foot infections classification system (WIfI) in patients with diabetic foot and analyze risk factors relating to the WIfI classification in these patients. Methodology: A cross-sectional descriptive study, 30 patients with diabetic foot disease at Hue Central Hospital from December 19, 2021 to April 29, 2022. Results: Prevalence of amputation risk WIfI classification is 26.7 in stage 1 (VL), 30% in stage 2 (L), 23.3% in stage 3 (M) and 20% in stage 4 (H). The related factors of the WIfI classification stages were HbA1C     (p=0.035),     ABI     (p=0.05),    TBI (p=0.01), TP (p=0.01). The regression model is described  by the equation: Risk of  amputation =  3.701  - 0.788ABI - 1.260TP.  Conclusion: It is necessary to apply the WIfI classification for the assessment of patients with diabetic foot in Vietnam, paying special attention to the TP and ABI index.

Background: Secondary osteoporosis contributes to reduced quality of life, while increasing the risk of morbidity and mortality in type 2 diabetes patients. Diabetes  and related complications can be detrimental to bone quality. Objective: Survey on bone mineral density, Osteoporosis by Dual energy X – ray absorptionmetry (DEXA) in type 2 diabetic patients at the Endocrine hospital of Thanh Hoa province; To evaluate the relation between bone mineral density, Osteoporosis and age, gender. Methods: A cross- sectional study on 1538 type 2 diabetes patients at the Endocrine hospital of Thanh Hoa province, from April 2019 to April 2021.  Type  2 diabetes were diagnosed by Vietnam Ministry of Health Criteria. All patients were interviewed for getting information of age, gender. Bone mineral density were evaluated by Dual energy X – ray absorptionmetry (DEXA). Data were analysed by SPSS 13.0 software. Results: The mean value of bone mineral density at lumbar spine was 0.755 ± 0.151g/cm2; at femur neck was 0.774 ± 0.17 g/cm2. The percentage of decreased bone mineral density was 37%, in which:  32,74% for men and 40.84% for women. The percentage of osteoporosis was 13.46%, in which: 10.68% for men and 15.96% for women. The older the age, the lower the reduction of bone mineral density and the higher the rate of osteoporosis. Conclusion: It should be pay attention in the diagnosis and treatment of osteoporosis in patients with type 2 diabetes.

Đái tháo đường làm gia tăng nguy cơ mắc lao gấp 2-3 lần và nguy cơ xuất hiện những bất lợi khi điều trị. Đái tháo đường gây nên ức chế miễn dịch, ngày càng được thừa nhận là một yếu tố nguy cơ của bệnh lao, và hai bệnh lý này tồn tại và tác động lẫn nhau. Bệnh lao có hai giai đoạn: lao tiềm ẩn và bệnh lao (lao hoạt động). Vì vậy, bệnh nhân đái tháo đường, đặc biệt mới được chẩn đoán, nên được sàng lọc bệnh lao có hệ thống. Bệnh lao gây nên tình trạng “tăng đường máu do stress”, điều này dẫn đến việc điều trị đái tháo đường khó khăn hơn. Điều trị lao nhạy cảm thuốc hay lao kháng thuốc ở bệnh nhân mắc hay không đái tháo đường không khác nhau. Đái tháo đường có thể làm nặng nề hơn bệnh lao, làm tái hoạt các ổ lao không hoạt động, và làm giảm hiệu quả điều trị. Mặt khác bệnh lao là một bệnh lý thực thể và một số thuốc kháng lao sử dụng đơn độc có thể gây nên rối loạn dung nạp glucose. Metformin là thuốc được lựa chọn đầu tiên điều trị đái tháo đường nếu cần sử dụng thuốc để kiểm soát glucose máu. Insulin được cân nhắc nếu glucose máu cao hoặc glucose máu không được kiểm soát với thuốc hạ glucose máu đường uống. Bệnh nhân đái tháo đường có biến chứng tim mạch nên được sử dụng aspirin liều thấp và một thuốc nhóm statin, và cần được tư vấn một lối sống phù hợp (không hút thuốc lá, chế độ ăn hợp lý và hoạt động thể lực). Nhận thức của các bác sĩ lâm sàng và nhà quản lý bệnh lao và đái tháo đường về sự tác động giữa hai bệnh lý này là rất quan trọng không chỉ về phương diện sàng lọc mà còn trong điều trị bệnh nhân đái tháo đường mắc lao.

Background: Vietnam's salt iodine supplementation program is a Government funded activity. Since 2005, the reduction of the funding source has had a direct impact on the effort to reduce iodine deficiency disorders nationwide, including Vinh Phuc. Objectives: Assessing the current situation of using salt and iodine-containing products of people in Vinh Phuc province. Determining the impact of iodine deficiency on the high risk subjects. Methods: The study applied the Descriptive Epidemiology method - Cross-sectional investigation to evaluate the current situation of iodized salt use and the effect of iodine deficiency on the at-risk subjects. The study was conducted in 2017 on 540 households, 108 women of reproductive age from 18-49 years old and 720 primary school students in 36 communes of Vinh Phuc province. Results: The results showed that 98.1% of the households use fish sauce, 11.9% use salt, 93.9% use used any type of seasoning powder, and 72,4% used iodized seasoning powder. 540 samples of salt and seasoning powder were taken for testing and all samples (100%) did not contain sufficient iodine content to meet disease prevention standards. The goitre rate in primary school students is 2.5%, mainly at level 1A (94.4%). There was no relationship between gender and goitre rate in students (p = 0.6). In women, there was no relationship between occupational status and iodine salt use (p = 0.453) and use of iodized seasoning powder (p = 0. 57). There was no correlation between literacy and iodized salt and iodized powder use (p = 0.3 and p = 0.7). Conclusion: Iodine supplementation in salt, fish sauce and spices is one of the effective measures in iodine deficiency disorders prevention. The study proposes to strengthen inspection and implement strict sanction the production of iodine products that do not meet the quality standards to ensure the quality of products that reach consumers.

Osteoporosis in patients had Cushing’s syndrome by long-term using glucocorticoids is dual risk factors of fractures, disability and death. The metabolic disordersin Cushing’s syndrome by long-term using of glucocorticoids created a complex clinical feature and a bad outcome for osteoporosis. Objects: 1. Describe the clinical, paraclinical feature relatively of osteoporosis in 64 patients with Cushing’s syndrome long-term use of glucocorticoids at the endocrinology department, Hai Duong General Hospital. 2. Determine the rate of osteoporosis by dual energy X-ray absorptiometry and relative factors. Methods: Cross-sectional study, 64 patients with Cushing’s syndrome by long-term use of glucocorticoids at the endocrinology department, Hai Duong General Hospital from March to September, 2018. All patients are calculated BMD by DEXA at lumber spine, X ray vertebral column and tested some relative factors of osteoporosis. Results and Conclusions: 64 in-patients were included, containing 17 (26.6%) males and 47 (73.4%) females; mean age were 64,7 ± 12.6 years old; 50 year and more 89%. Ache of bone 100%; vertebral flat 65,6%; vertebral hump backed 40,0%; fracture 32,8%; and others problems: hypertension 78,1%; overweight and obesity 43,8%; abnormal fat 92,2%, abnormal WHR 93,8%; low cortisol concentrate 67,2%; high cortisol concentrate 6,2%; normal ACTH 78,1%; low ACTH 15,2%; osteoporosis in Cushing’s syndrome by using glucocorticoids for a longtime 62,5%; low BMD 32,3%; vertebral X - ray: 12,5% none hurt; above sunken of vertebra 28,1%; amphicoelous centra 25,0%; wedge vertebra 18,8%; blade vertebra 15,6%; more 60 years old, osteoporosis 65%, females with osteoporosis higher than males; osteoporosis with abnormal fat 95%; abnormal WHR 92,5%; lipid disorders 87,5%; low cortisol 67,5%.

Objective: To describe the characteristics of wounds, ischemia, and foot infections classification system (WIfI) in patients with diabetic foot and analyze risk factors relating to the WIfI classification in these patients. Creation of an early version of a risk calculator for diabetic foot patients in Vietnam. Methodology: A cross-sectional descriptive study, 60 patients with diabetic foot disease at Hue Central Hospital from December 19, 2021 to April 29, 2022. Results: Prevalence of amputation risk WIfI classification is 26.7 in stage 1 (very low), 30% in stage 2 (low), 23.3% in stage 3 (medium) and 20% in stage 4 (high). The related factors of the WIfI classification stages were HbA1C (p=0.035), ankle brachial index (ABI) (p=0.05), toe brachial index (TBI) (p=0.01), toe pressure (TP) (p=0.01). The regression model is described by the equation: Risk of amputation = 3.701 - 0.788ABI - 1.260TP. An online calculation tool has been installed at banchandaithaoduong.vn,  which can be used initially for reference. Conclusion: It is necessary to apply the WIfI classification for the assessment of patients with diabetic foot in Vietnam, paying special attention to the TP and ABI index. The online assessment tool banchandaithaoduong.vn has the potential to develop and be widely used in the future.