Search Results

You are looking at 1 - 4 of 4 items for

  • Author: Taninee Sahakitrungruang x
Clear All Modify Search
Open access

Termpong Dumrisilp, Vichit Supornsilchai, Suttipong Wacharasindhu, Suphab Aroonparkmongkol and Taninee Sahakitrungruang

Abstract

Background

Children and adolescents with type 1 diabetes mellitus (T1D), even those with intensive insulin treatment regimens, often have higher glycated hemoglobin (HbA1c) levels than adults.

Objective

To delineate the medical and psychosocial factors associated with glycemic control in an unselected pediatric population with T1D.

Methods

We included a cross-section of 58 adolescents (28 boys and 30 girls) aged 13.6 ± 4.0 years with T1D ≥1 year attending a well-established pediatric diabetes clinic in Thailand. Median diabetes duration was 4.1 years (range 1–18 years). Participants were divided into 2 subgroups according to their average HbA1c level over the past year. Those with good control (HbA1c <8%) (n = 13) were compared with those with poor control (HbA1c ≥8%) (n = 45). Data collected from self-report standardized questionnaires and medical records were used to compare variables between groups.

Results

Adolescents with good control used significantly less daily insulin and had higher family income, higher scores for family support, and quality of life (QoL) than those in the group with poor control (P < 0.05). Age, sex, puberty, duration of diabetes, insulin regimen, frequency of blood glucose monitoring, and self-report adherence did not differ between groups. By univariate logistic regression, the only factor associated significantly with poor glycemic control was a QoL score <25.

Conclusion

Adolescents with T1D may be at a higher risk of poor glycemic control if they have poor QoL, impaired family functioning, poor coping skills, and lower socioeconomic status, suggesting that psychosocial interventions could potentially improve glycemic control in this population.

Open access

Supawadee Bunraungsak, Tippayakarn Klomchan and Taninee Sahakitrungruang

Abstract

Background: The goal of treatment in children with congenital adrenal hyperplasia (CAH) is to normalize growth and pubertal development. There are limited studies reporting on growth and pubertal outcome in CAH patients from low-resource settings as in Thailand, where CAH newborn screening is lacking, and standard medications are not widely available.

Objective: We analyzed the longitudinal growth data, and pubertal characteristics in children and adolescents with CAH, compared with population-based references.

Methods: Fifty-eight patients with classic 21-hydroxylase deficiency (21OHD) [49 had salt-wasting (SW)-CAH and 9 patients had simple virilizing (SV)-CAH] were retrospectively assessed for growth and pubertal development until they reached their final height (FH). Details of treatment, and hormonal profiles were recorded.

Results: Mean FH SD scores (SDS) of patients were in the lower range of normal population (SW boys -1.88±0.6, SW girls -1.88±1.1 and SV boys -1.06, SV girls -1.56±1.4). Nine of the 19 male, and 6 of the 39 female patients had BMI SDS >2.0. Mean ages of pubertal onset in SW, and SV boys were 8.2±2.4 years, and 7.1±1.9 years, respectively, while in SW girls were 9.7±2.2 years, and SV 7.0±1.7 years. Twelve of the 38 patients had central precocious puberty and required GnRH analog treatment. Total pubertal growth was significantly decreased in the SW group, but not in the SV group; SW boys 15.5±10.6 cm (reference 22.1±3.6 cm), and SW-females 10.6±5.5 cm (reference 18.3±4.0 cm). Glucocorticoid dose was not associated with FH-SDS (n = 19, r = -0.132, p = 0.589). Markedly elevated 17-hydroxyprogesterone and testosterone levels were observed during the pubertal period.

Conclusion: Our results demonstrate poor final height outcome in Thai children with classic 21OHD. Obesity, secondary central precocious puberty, and poor hormonal control are common. These findings necessitate early diagnosis and treatment by establishing newborn screening system in Thailand as well as new treatment regimen and monitoring methods.

Open access

Sirawut Trepatchayakorn, Vichit Supornsilchai, Suttipong Wacharasindhu, Suphab Aroonparkmongkol and Taninee Sahakitrungruang

Abstract

Background: Reports on characteristics of pediatric diabetes in children from Southeast Asian countries are limited.

Objectives: To describe the clinical characteristics, prevalence, glycemic control, and current treatment regimens of diabetes in Thai children.

Materials and Methods: Data from 132 patients seen at our pediatric diabetes clinic at Chulalongkorn University during 2001−2013 were retrospectively reviewed.

Results: We found an increasing number of patients newly-diagnosed with type 1- (T1DM) or type 2- diabetes mellitus (T2DM). The overall proportion of T1DM was 69.7%, T2DM 23.4%, and other types 6.9%. Children with T1DM were younger at diagnosis, had higher initial glucose and glycated hemoglobin A1c (HbA1c), a lower body mass index z-score, lower C-peptide and insulin levels, and were more likely to have classic diabetes symptoms and ketoacidosis, compared with children with T2DM. Mixed diabetes phenotypes were found in about 12%−14% of these children. Glutamic acid decarboxylase and islet antigen-2 autoantibodies were found in 70% and 54% of T1DM patients, respectively, and not in T2DM patients. HbA1c in T1DM was 9.6 ± 2.2% total hemoglobin, and in T2DM was 7.9 ± 2.6%. There were no differences in HbA1c levels between different insulin regimens in the T1DM group.

Conclusion: The number of children with T1DM or T2DM has been increasing and there are overlapping phenotypes in a significant proportion of these children. Correct diagnosis requires clinical evaluation and monitoring of the clinical course. Further research is needed to determine the risk factors for the poor glycemic control found in children with T1DM.

Open access

Sukumarn Siripunthana, Taninee Sahakitrungruang, Suttipong Wacharasindhu, Darintr Sosothikul and Vichit Supornsilchai

Abstract

Background

Regular blood transfusion and iron chelation therapy have improved the quality of life of patients with thalassemia and increased their longevity, but transfusion also increases the frequency of endocrine complications, possibly because of iron deposition in the pituitary gland or the gonads, or both.

Objective

To evaluate testicular function in patients with thalassemia major by basal hormonal study, and identify risk factors for dysfunction.

Methods

We performed a cross-sectional study of 28 patients with thalassemia major aged 11.7 ± 1.8 (8–14.9) years (15 in prepuberty, 13 in puberty with no delayed puberty) who had regular blood transfusions. A normal control group comprised 64 boys who were matched for age and Tanner genital stage.

Results

The mean level of serum ferritin in the previous year was 1,575 ± 642 ng/mL, and the onset of blood transfusion was at 3.8 ± 2.3 years and iron chelation therapy was 6.6 ± 2.8 years. The trend for anti-Müllerian hormone levels in patients and controls was similar with age, and although higher in the patients, particularly at Tanner stage II, was not significantly different. Testosterone levels were lower in the patients compared with controls; particularly at Tanner stages IV–V (290.88 vs. 537.4 ng/dL, P < 0.05). Serum follicle-stimulating hormone and luteinizing hormone levels were not significantly different between the groups at any Tanner stage.

Conclusion

Patients who received regular blood transfusions had normal Sertoli cell function. Leydig cell dysfunction may occur, even though the patients had a normal pubertal onset.