BACKGROUND

Despite the beneficial effects of SGLT2i in reducing kidney disease progression and mortality in people with diabetic kidney disease (DKD), the use of SGLT2i in this population remains low.

To explore the prescription rates of SGLT2i in type 2 diabetes (T2D) patients with albuminuric DKD and to assess clinician-perceived barriers to prescribing SGLT2i.

A retrospective study of all medical records of T2D patients with albuminuric DKD and eGFR ≥20 ml/min/1.73 m2 in 2023 who had been treated by 13 diabetologists was conducted at Vimut-Theptarin Hospital, a private tertiary diabetes center in Bangkok. In cases of no documentation of non-prescribed SGLT2i, treating physicians were contacted to explore the reasons.

A total of 282 medical records were reviewed (mean age 65.9 ± 10.0 years, A1C 7.5 ± 1.2 %, duration of diabetes 19.7 ± 10.4 years, mean eGFR 68.3 ± 24.1 mL/min/1.73 m2, median UACR 151 (IQR 309) mg/g Cr, RAS inhibitors usage 80.1%). The SGLT2i prescription rate was 58.9% in 2023. Coronary artery disease, age ≥65 years, eGFR

Prescribing SGLT2i to T2D patients with albuminuric DKD remains suboptimal among diabetologists due to clinical inertia, medication costs, and frailty. Our study underscores actions aimed at improving SGLT2i prescription rates in routine practice.

Objective: To compare insulin surrogate indices with the homeostasis model assessment of insulin resistance (HOMA-IR) in Thai people with type 2 diabetes (T2D). Methodology: A cross-sectional study of 97 individuals with T2D was done to determine the association between HOMA-IR and seven surrogate indices for insulin resistance. IR was defined as HOMA-IR ≥2.0. The indices included Waist Circumference (WC), Waist-to-Hip Ratio (WHR), Waist-to-Height Ratio (WHtR), Triglyceride-Glucose (TyG) index, estimated Glucose Disposal Rate (eGDR) calculated by WC, BMI, and WHR. Results: A total of 97 subjects with T2D (36.1% female, mean age 61.7 ± 12.0 years, BMI 26.4 ± 3.7 kg/m2, A1C 6.9 ± 1.2%) were studied. The TyG index showed a positive association with HOMA-IR, while eGDR exhibited a negative association. TyG index had the strongest correlation with IR (r = 0.49), while various eGDR formulas showed weaker negative correlations (r = 0.12-0.25). However, subgroup analysis in individuals with T2D and coronary artery disease (CAD) showed that only eGDR-WC and eGDR-BMI demonstrated a significant correlation with triple vessel disease. Conclusion The TyG index was a useful and simple marker for identifying the presence of IR in Thai people with T2D. Future longitudinal studies are warranted to demonstrate the prediction value of cardiovascular outcomes.
Insulin Resistance ; Surrogate Markers ; Biomarkers

Objective: To evaluate the real-world use of once-weekly semaglutide among Thai patients with type 2 diabetes (T2DM) in a private hospital setting. Methodology: A retrospective review of Thai patients with T2DM who have initiated semaglutide for at least 1 month between June 2020 and March 2022 at Theptarin Hospital, Bangkok, Thailand. Results: A total of 58 patients (50% female, mean age 55.6 ± 15.9 years, with duration of diabetes 12.6 ± 10.3 years, BMI 31.5 ± 4.4 kg/m2, baseline HbA1c 7.9 ± 1.9%, with prior GLP-1 RA use 24.1%, and concomitant SGLT2i intake (41.4%) were included. During a median follow-up of 6 months, the mean serum HbA1c level reduction was 1.3 ± 1.7% with weight loss of 4.7 ± 4.1 kg. The proportion of patients who achieved optimal and sustainable glycemic control (HbA1c <7.0%) increased from 43.1% to 55.8% at the last follow-up. The proportion of patients reaching both HbA1c targets of <7.0% and 5% weight loss was 27.8%. No cases of pancreatitis, cancer, or progressive retinopathy were observed. Conclusion In this single center undertaking, it was shown that in among persons with T2DM and obesity in Thailand, semaglutide was associated with short-term glycemic control and weight loss comparable with what has been observed in randomized clinical trials and other RWE.
real-world ; Thai

Objective: To evaluate the status of euthyroidism achieved among Thai patients with post-ablative hypothyroidism and to examine the difference between various weight-based daily levothyroxine (LT4) replacement regimens in these patients. Methodology: We conducted a retrospective review of Thai patients with Graves’ disease (GD) who developed hypothyroidism following radioactive iodine treatment from 2016 to 2020 at Theptarin hospital. Daily LT4 dose was calculated based on actual body weight (ABW), ideal body weight (IBW), and estimated lean body mass (LBM). Results: We reviewed a total of 271 patient records. Of these, 81.2% were females with a mean age of 40.8±11.7 years, LT4 intake duration of 27.1±14.6 months, and LT4 dose/kg ABW of 1.4±0.5 μg/kg/day. At the final follow-up, 62.4% of patients achieved thyroid-stimulating hormone (TSH) levels within the reference interval, 15.5% had TSH levels over, and 22.1% had TSH levels under the reference range. Obese patients required a lower daily LT4 dose relative to ABW and higher daily LT4 dose relative to IBW to attain euthyroidism (ABW 1.1±0.4 μg/kg/day and IBW 2.0±0.8 μg/kg/day). Estimated daily LT4 dose based on LBM showed a constant dosage of 2.0 μg/kg/day in all BMI categories. Conclusions Suboptimum LT4 replacement therapy was found in almost half of hypothyroid patients with GD treated with radioactive iodine. Estimated LBM was a better indicator for dosing calculation in these patients compared with ABW and IBW.
Hypothyroidism