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%.

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: 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.

Giới thiệu: Tại Việt Nam, gần 6% người lớn tuổi mắc bệnh đái tháo đường và có nguy cơ mất thị lực do các biến chứng đáy mắt của bệnh lí Võng mạc đái tháo đường (VMĐTĐ). Phát hiện sớm và điều trị kịp thời võng mạc đái tháo đường có thể làm giảm mất thị lực. Mục tiêu: Xác định tỉ lệ biến chứng mắt trên bệnh nhân đái tháo đường tại bệnh viện Đa khoa Trung tâm Tiền Giang và tìm mối liên quan giữa biến chứng mắt và một số yếu tố nguy cơ. Phương pháp: Nghiên cứu cắt ngang mô tả bao gồm 111 bệnh nhân đái tháo đường tại bệnh viện Đa khoa Trung tâm Tiền Giang. Tất cả bệnh nhân được sàng lọc bệnh võng mạc bằng máy Canon EOS 60Da. Kết quả: Tỷ lệ bệnh mắt đái tháo đường chiếm 32,43%. Trong đó đục thủy tinh thể là 11,71%; bệnh võng mạc đái tháo đường 23,42%, R1M0 là 14,41%, R1M1: 2,7%, R2M0:0,9%, R2M1: 1,8%, R3M1: 0,9%. Bệnh mắt đái tháo đường có liên quan đến thời gian mắc bệnh đái tháo đường, giới tính, tăng huyết áp, mức đường huyết và bệnh thận mạn. Kết luận: Bệnh võng mạc có thể gây mù lòa. Việc phát hiện và điều trị sớm rất quan trọng. Để ngăn ngừa bệnh mắt đái tháo đường hoặc làm chậm tiến triển bệnh nên quản lý tốt đường huyết, huyết áp và cholesterol, và bỏ thuốc lá nếu có hút.

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.

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.

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: Neonatal diabetes mellitus (NDM) is defined as hyperglycemia diagnosed within the first 6 months of life and can result from mutations in at least 23 different genes. The most common genetic cause is activating mutations in the KCNJ11 and ABCC8 genes which encode the subunits of the beta-cell KATP channel. In these patients failure of the channel to close in response to increased intracellular ATP results in impaired insulin secretion. Sulfonylureas are an effective treatment for the majority of patients with this genetic subtype as the drug binds to and closes the KATP channel by an ATP-independent route. Patients and method: We identified 20 patients with NDM resulting from ABCC8 or KCNJ11 mutations who were treated at the Vietnam National Hospital of Pediatrics. We assessed the outcome of oral sulfonylurea therapy in all patients for whom transfer was attempted and compared theclinical characteristics of those with ABCC8 and KCNJ11 mutations. Results: Nineteen patients successfully transferred from insulin to sulfonylurea therapy. In the remaining case remission of the diabetes occurred prior to transfer. Glycated hemoglobin levels improved in all patients who switched to sulfonylurea therapy. HbA1c decreased from 8.0 ±2.2% when treated with insulin to 5.9 ±1.1% when treated with SU, blood sugar fluctuation was also less when on SU treatment compared to insulin treatment (from 3-17 mmol/l on insulin to 4-10 mmol/l on SU). Conclusions: This is the first case series of KATP channel NDM reported from Vietnam. Sulfonylurea therapy is safe in the short term for patients with diabetes caused by KCNJ11 or ABCC8 mutations and is more effective than insulin therapy consistent with all the studies reported to date.