Purpose: Continuous glucose monitoring (CGM) is recommended by clinical guidelines for children and adults with type 1 diabetes mellitus (T1DM) to improve clinical outcomes. In Thailand, CGM was incorporated into the Universal Healthcare Coverage (UHC) program in mid-2023. This study aimed to evaluate preliminary clinical outcomes and device adoption at a single tertiary care center. Glycemic outcomes were assessed before and after CGM use following the UHC reimbursement program and results were compared across 4 groups: self-monitoring blood glucose, CGM, open-loop insulin pump, and hybrid closed-loop (HCL). CGM adherence and parameters were also analyzed. Methods: This retrospective-prospective study collected and analyzed demographic data, hemoglobin A1c (HbA1c) levels, and CGM parameters. Results: A total of 142 T1DM patients (median age, 17.3 years; range, 3.5–69.2 years) were included. Baseline HbA1c was 8.1%±1.5%, with no significant differences among groups (P=0.223). The HCL group showed the largest HbA1c reduction at 12 months (-0.99%, P= 0.001), particularly in patients <18 years (-1.21%, P=0.014). CGM users showed improvements in HbA1c (-0.29%) and a higher proportion achieving time in range (TIR) ≥70% at 12 months (69.2% vs. 47.1%, P=0.08), though this was not statistically significant. Preliminary CGM uptake was 12% (17 of 142). The HCL group exhibited higher TIR and better sensor adherence (P<0.05), while other groups showed no significant changes. Conclusion The HCL system significantly improved glycemic outcomes, particularly in younger patients. However, CGM adoption remains low, highlighting the need for expanded access, enhanced reimbursement policies, and improved adherence strategies.

Purpose: There is growing global concern about the shift to earlier onset of puberty among girls; however, the prevalences of precocious and normal variant puberty among Thai girls are uncertain. We conducted a study at King Chulalongkorn Memorial Hospital in Bangkok from 2018 to 2022 (amid the coronavirus disease 2019 pandemic) to investigate the prevalence, characteristics, and treatment of early puberty in a large cohort of Thai girls. Methods: The medical records of 583 girls who had been evaluated for early puberty were reviewed. Demographic and clinical characteristics, and treatment approaches were analyzed. Results: The analyses found a significant annual increase in evaluations for early signs of puberty (P-value for trend 0.04). The majority (71.2%) of cases were categorized as gonadotropin-releasing-hormone (GnRH)-dependent or central precocious puberty (CPP), with 16 cases showing abnormal brain magnetic resonance imaging findings. Among girls with normal variant puberty, early normal puberty was the most common category (10.5%), followed by premature thelarche (9.5%), slow-progressive precocious puberty (6.6%), and premature adrenarche (2.2%). Median age at presentation, basal luteinizing hormone (LH) and follicle-stimulating hormone (FSH), and bone age differed significantly among groups. Importantly, 97% of girls with CPP received GnRH agonists. Girls with CPP exhibited higher body mass index z-scores and basal LH and FSH compared with those with slow-progressive precocious puberty. Conclusion Our analyses of the prevalence, characteristics, and treatment of early puberty in Thai girls highlighted the impact of obesity on pubertal timing. The findings underscore the need for preventive weight management and country-specific guideline updates to enhance healthcare strategies for young girls.

Purpose: There is growing global concern about the shift to earlier onset of puberty among girls; however, the prevalences of precocious and normal variant puberty among Thai girls are uncertain. We conducted a study at King Chulalongkorn Memorial Hospital in Bangkok from 2018 to 2022 (amid the coronavirus disease 2019 pandemic) to investigate the prevalence, characteristics, and treatment of early puberty in a large cohort of Thai girls. Methods: The medical records of 583 girls who had been evaluated for early puberty were reviewed. Demographic and clinical characteristics, and treatment approaches were analyzed. Results: The analyses found a significant annual increase in evaluations for early signs of puberty (P-value for trend 0.04). The majority (71.2%) of cases were categorized as gonadotropin-releasing-hormone (GnRH)-dependent or central precocious puberty (CPP), with 16 cases showing abnormal brain magnetic resonance imaging findings. Among girls with normal variant puberty, early normal puberty was the most common category (10.5%), followed by premature thelarche (9.5%), slow-progressive precocious puberty (6.6%), and premature adrenarche (2.2%). Median age at presentation, basal luteinizing hormone (LH) and follicle-stimulating hormone (FSH), and bone age differed significantly among groups. Importantly, 97% of girls with CPP received GnRH agonists. Girls with CPP exhibited higher body mass index z-scores and basal LH and FSH compared with those with slow-progressive precocious puberty. Conclusion Our analyses of the prevalence, characteristics, and treatment of early puberty in Thai girls highlighted the impact of obesity on pubertal timing. The findings underscore the need for preventive weight management and country-specific guideline updates to enhance healthcare strategies for young girls.

Purpose: There is growing global concern about the shift to earlier onset of puberty among girls; however, the prevalences of precocious and normal variant puberty among Thai girls are uncertain. We conducted a study at King Chulalongkorn Memorial Hospital in Bangkok from 2018 to 2022 (amid the coronavirus disease 2019 pandemic) to investigate the prevalence, characteristics, and treatment of early puberty in a large cohort of Thai girls. Methods: The medical records of 583 girls who had been evaluated for early puberty were reviewed. Demographic and clinical characteristics, and treatment approaches were analyzed. Results: The analyses found a significant annual increase in evaluations for early signs of puberty (P-value for trend 0.04). The majority (71.2%) of cases were categorized as gonadotropin-releasing-hormone (GnRH)-dependent or central precocious puberty (CPP), with 16 cases showing abnormal brain magnetic resonance imaging findings. Among girls with normal variant puberty, early normal puberty was the most common category (10.5%), followed by premature thelarche (9.5%), slow-progressive precocious puberty (6.6%), and premature adrenarche (2.2%). Median age at presentation, basal luteinizing hormone (LH) and follicle-stimulating hormone (FSH), and bone age differed significantly among groups. Importantly, 97% of girls with CPP received GnRH agonists. Girls with CPP exhibited higher body mass index z-scores and basal LH and FSH compared with those with slow-progressive precocious puberty. Conclusion Our analyses of the prevalence, characteristics, and treatment of early puberty in Thai girls highlighted the impact of obesity on pubertal timing. The findings underscore the need for preventive weight management and country-specific guideline updates to enhance healthcare strategies for young girls.

Purpose: Diabetic neuropathy (DN) is a serious complication in diabetes mellitus. We aimed to determine the prevalence of DN in pediatric-onset diabetes in a tertiary care center and to assess the sensitivity and specificity of monofilament testing and noninvasive screening to diagnose DN compared with the gold standard nerve conduction study (NCS). Methods: Sixty-five Thai children and adolescents (39 females) diagnosed with diabetes before 15 years of age were included. All subjects were screened for DN by foot and neurological examinations, light touch sensation by 10 g Semmes-Weinstein monofilaments, and the Michigan Neuropathy Screening Instrument (MNSI). NCSs were used as the gold standard for diagnosis of DN. Results: Fifty-eight patients had type 1 diabetes ( T1D), 5 patients had type 2 diabetes, and 2 patients had other types of diabetes. The mean age was 17.7±4.6 years (8–33 years). The prevalence of DN in this cohort was 12.3% by NCS. All subjects were asymptomatic. Mean diabetes duration did not differ between the groups (with DN 8.0±3.0 years vs. no DN 8.2±5.0 years). Notably, one patient with T1D developed DN within 3 years after diagnosis. Poor glycemic control was a significant risk factor for DN. Glycosylated hemoglobin was higher in the DN group (10.6%±2.3% vs. 8.5%±1.6%, P=0.008). The occurrence of diabetic nephropathy was associated with DN (prevalence rate ratio, 4.97; 95% confidence interval, 1.5–16.46). Foot and neurological examinations, monofilaments, and the MNSI failed to detect DN in all subjects with abnormal NCS. Conclusion The prevalence of DN in pediatric-onset diabetes is not uncommon but mainly is subclinical. Poor glycemic control is the main risk factor. Noninvasive screening tests for DN exhibited poor diagnostic sensitivity in the pediatric population.

Congenital adrenal hyperplasia (CAH) is one of the most common inherited metabolic disorders. It comprises a group of autosomal recessive disorders caused by the mutations in the genes encoding for steroidogenic enzymes that involved cortisol synthesis. More than 90% of cases are caused by a defect in the enzyme 21-hydroxylase. Four other enzyme deficiencies (cholesterol side-chain cleavage, 17alpha-hydroxylase [P450c17], 11beta-hydroxylase [P450c11beta], 3beta-hydroxysteroid dehydrogenase) in the steroid biosynthesis pathway, along with one cholesterol transport protein defect (steroidogenic acute regulatory protein), and one electrontransfer protein (P450 oxidoreductase) account for the remaining cases. The clinical symptoms of the different forms of CAH result from the particular hormones that are deficient and those that are produced in excess. A characteristic feature of CAH is genital ambiguity or disordered sex development, and most variants are associated with glucocorticoid deficiency. However, in the rare forms of CAH other than 21-hydroxylase deficiency so-called "atypical CAH", the clinical and hormonal phenotypes can be more complicated, and are not well recognized. This review will focus on the atypical forms of CAH, including the genetic analyses, and phenotypic correlates.
Adrenal Hyperplasia, Congenital* ; Cholesterol ; Disorders of Sex Development ; Genotype ; Hydrocortisone ; Phenotype ; Rare Diseases ; Sexual Development ; Steroid 21-Hydroxylase