TẠP CHÍ NỘI TIẾT & ĐÁI THÁO ĐƯỜNG

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.

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.

Mở đầu: Độ phân bố kích thước hồng cầu (RDW: Red blood cell Distribution Width) là một trong những chỉ số của xét nghiệm công thức máu, đo độ không đồng nhất về kích thước hồng cầu. Tăng đường huyết ở bệnh nhân tiểu đường thúc đẩy quá trình gắn đường vào phân tử hemoglobin trong hồng cầu (HbA1C) làm giảm khả năng biến dạng và tăng độ thẩm thấu của hồng cầu có thể ảnh hưởng đền giá trị RDW. Mục tiêu: Khảo sát mối tương quan giữa các chỉ số RDW, MCV, MCHC và kiểm soát đường huyết của bệnh nhân tiểu đường type 2. Phương pháp: Nghiên cứu hồi cứu gồm 107 bệnh nhân tiểu đường type 2 đang điều trị tại bệnh viện Đa Khoa Trung Tâm Tiền Giang từ tháng 4  đến tháng 8 năm 2019. Các số liệu về giới tính, tuổi, kết quả xét nghiệm công thức máu, đường huyết, HbA1C, cholesterol và triglyceride được thu thập tại khoa Xét Nghiệm, bệnh viện Đa Khoa Trung Tâm Tiền Giang. Bệnh nhân được chia thành II nhóm dựa vào HbA1C, nhóm I gồm 51 người có HbA1C trong khoảng 6.5 – 6.9 %, nhóm II có 56 người thuộc nhóm có HbA1C ≥ 7.0%. Kết quả: Trung bình độ phân bố kích thước hồng cầu (RDW) của nhóm I và II là 13.32 và 13.95. MCHC của hai nhóm I và II là  32.21 và 32.84 cho thấy rằng RDW và MCHC cao hơn đáng kể ở nhóm bệnh nhân không kiểm soát đường huyết tốt (HbA1C ≥ 7.0%)  so với đối tượng kiểm soát tốt HbA1C (6.5 – 6.9 %). Phân tích mối tương quan giữa nồng độ đường huyết với MCHC và RDW cho thấy có sự tương quan thuận đáng kể giữa các thông số này. Tương tự kết quả cũng chứng minh có sự tương quan chặt chẽ giữa HbA1C và MCHC. Kết luận: Bệnh nhân tiểu đường có chế độ kiểm soát đường huyết tốt sẽ không ảnh hưởng đến RDW và MCHC. Bệnh nhân kiểm soát đường huyết tốt có giá trị RDW và MCHC thấp hơn ở những bệnh nhân kiểm soát kém. Vì vậy, chỉ số RDW và MCHC trong xét nghiệm công thức máu có thể được sử dụng như yếu tố tiên lượng hỗ trợ đánh giá tình trạng kiểm soát đường huyết của bệnh nhân tiểu đường type 2.

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: 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.

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.

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.

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.

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%.