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Low prevalence of autoimmune diabetes markers in a mixed ethnic population of Singaporean diabetics

Todd AL, Ng WY, Lui KF, Thai AC

Intern Med J, 2004 Jan-Feb;34(1-2):24-30.
PMID: 14748910 DOI: 10.1111/j.1444-0903.2004.00482.x

BACKGROUND: Circulating antibodies to glutamic acid decarboxylase (GADab) and tyrosine phosphatase-like molecule IA-2 (IA-2ab) are major indicators for auto-immune destruction of pancreatic islet cells. They identify a majority of Caucasians with type 1 diabetes and approximately 50% of Asians, providing evidence of an idiopathic aetiology in the latter. The present study investigated these autoantibodies in a mixed ethnic group.
METHODS: Hospital clinic patients with clinically defined type 1 (n = 93) and type 2 (n = 300) diabetes and representing Singapore's major ethnic groups--Chinese, Indians and Malays--were studied. GADab and IA-2ab frequencies, and association of autoimmunity status with clinical and biochemical profiles were analysed.
RESULTS: Radio-immunoprecipitation assays detected either or both antibodies (seropositivity) in 41.9% of subjects with type 1 diabetes. GADab was detected in 36.6% and IA-2ab in 23.7% of type 1 diabetics. Prevalence of IA-2ab showed a reduction in frequency with disease duration (P = 0.026). In clinical type 2 diabetics, seropositivity was 10.0% with higher frequency in Malays (17.5%) than Chinese (9.7%) and Indians (4.5%). Multivariate analysis revealed that low fasting C-peptide was associated with seropositivity (odds ratio (OR) = 0.15; 95% confidence interval (CI) = 0.04-0.58). A significant relationship (OR = 13.5; 95% CI = 5.0-36.7) between insulin requirement and duration (>5 years) was also revealed. In patients with type 2 diabetes there was a trend of gradual progression to insulin dependency. However, there was considerable variation in body mass index between ethnic subgroups of type 2 diabetics, particularly for Chinese (mean (SD) = 26.0 (4.7)) and Malays (mean (SD) = 29.2 (5.9); P < 0.001).
CONCLUSIONS: Presence of both antibodies in our mixed ethnic group of type 1 diabetes patients was much lower than in Caucasians. Significant numbers of patients were seronegative for antibodies. Influences due to ethnicity and adiposity would require further investigations.
Fulltext Epidemiology of diabetes in Singapore

Cheah JS, Yeo PP, Lui KF, Tan BY, Tan YT, Ng YK

Med J Malaysia, 1982 Jun;37(2):141-9.
PMID: 7132833

A country-wide diabetic survey of the population (age 15 years and above) of Singapore shows that the prevalence of diabetes mellitus in Singapore is 1.99 percent. It is commoner in males (2.36 percent) than in females (1.64 percent). The prevalence of diabetes in the age group 15-39 years is only 0.40 percent and in the age group 40 years and older it is 5.08 percent. The prevalence of diabetes in Indians (6.07 percent) is significantly higher than that in Malays (2.43 percent) and Chinese (1.55 percent). Indian diabetics have an insignifi"cantly higher incidence of positive family of diabetes (12.7 percent) than Malays (10.9 percent) and Chinese (6.5 percent). Obesity was commoner in Malay diabetics (67.4 percent) than in Chinese diabetics (41.6 percent) and Indian diabetics (35.7 percent). The survey shows that 40.4 percent of the diabetics are known while 59.6 percent of the diabetics are newly diagnosed. The majority of the diabetics are treated with oral hypoglycaemic drugs (71.5 percent) and only 4.8 percent are receiving insulin injections. A mong the female diabetics, 63.0 percent have 4 or more pregnancies and large babies at birth are recorded in 12.3 percent. In the newly diagnosed diabetics, 64.3 percent have no symptoms. The complications of the diabetics are hypertension (26.8 percent), nephropathy (9.8 percent), retinopathy (8.5 percent), coronary heart disease (6.1 percent), skin infection (4.6 percent) and neuropathy (3.3 percent). The high prevalence of diabetes among the Indians is likely to be due to a genetic predisposition coupled with an environmental factor (obesity), although this hypothesis is not conclusively demonstrated by the present study.
Epidemiology of diabetes mellitus in Singapore: comparison with other ASEAN countries

Cheah JS, Yeo PP, Thai AC, Lui KF, Wang KW, Tan YT, et al.

Ann Acad Med Singap, 1985 Apr;14(2):232-9.
PMID: 4037681

Singapore is a tropical island city-state with a population of 2.4178 million consisting of Chinese (76.7%), Malays (14.7%), Indians (6.4%) and other races (2.2%). A diabetic survey of the adult population, aged 15 years and above, carried out in 1975, shows that the prevalence of diabetes is 1.99%; it is higher in males (2.36%) than in females (1.64%). It occurs mainly in the age group 40 years and above (5.08%) and is uncommon in the age group 15-39 years (0.40%). In males, the highest prevalence of diabetes (7.0%) is in the age group 45-49 years while in females the highest prevalence (7.2%) is in the age group 55-59 years. 43.3% of the diabetics are of normal weight while 44.3% are overweight and 12.4% are underweight. 59.6% of the diabetics are newly diagnosed while 40.4% are known diabetics; 64.3% of the newly diagnosed diabetics have no symptoms. The prevalence of diabetes among the Indians (6.07%) is significantly higher than that in Malays (2.43%) and Chinese (1.55%). Indian diabetics have a slightly higher positive family history of diabetes (12.7%) than Malays (10.9%) and Chinese (6.5%). Obesity is commoner in Malay diabetics (64.7%) than in Chinese (41.6%) and Indians (35.7%). The possible factors leading to the significantly higher prevalence of diabetes among the Indians compared to the other ethnic groups in Singapore are discussed. It is suggested that the Indian gene is susceptible to diabetes (diabetic genotype) and increased food consumption, altered lifestyle and greater obesity leads to the expression of diabetes.(ABSTRACT TRUNCATED AT 250 WORDS)
Changing prevalence of diabetes mellitus in Singapore over a ten year period

Thai AC, Yeo PP, Lun KC, Hughes K, Wang KW, Sothy SP, et al.

J Med Assoc Thai, 1987 Mar;70 Suppl 2:63-7.
PMID: 3598446
Fulltext Targeted Oxygen in the Resuscitation of Preterm Infants, a Randomized Clinical Trial

Oei JL, Saugstad OD, Lui K, Wright IM, Smyth JP, Craven P, et al.

Pediatrics, 2017 01;139(1).
PMID: 28034908 DOI: 10.1542/peds.2016-1452

BACKGROUND AND OBJECTIVES: Lower concentrations of oxygen (O2) (≤30%) are recommended for preterm resuscitation to avoid oxidative injury and cerebral ischemia. Effects on long-term outcomes are uncertain. We aimed to determine the effects of using room air (RA) or 100% O2 on the combined risk of death and disability at 2 years in infants <32 weeks' gestation.
METHODS: A randomized, unmasked study designed to determine major disability and death at 2 years in infants <32 weeks' gestation after delivery room resuscitation was initiated with either RA or 100% O2 and which were adjusted to target pulse oximetry of 65% to 95% at 5 minutes and 85% to 95% until NICU admission.
RESULTS: Of 6291 eligible patients, 292 were recruited and 287 (mean gestation: 28.9 weeks) were included in the analysis (RA: n = 144; 100% O2: n = 143). Recruitment ceased in June 2014, per the recommendations of the Data and Safety Monitoring Committee owing to loss of equipoise for the use of 100% O2. In non-prespecified analyses, infants <28 weeks who received RA resuscitation had higher hospital mortality (RA: 10 of 46 [22%]; than those given 100% O2: 3 of 54 [6%]; risk ratio: 3.9 [95% confidence interval: 1.1-13.4]; P = .01). Respiratory failure was the most common cause of death (n = 13).
CONCLUSIONS: Using RA to initiate resuscitation was associated with an increased risk of death in infants <28 weeks' gestation. This study was not a prespecified analysis, and it was underpowered to address this post hoc hypothesis reliably. Additional data are needed.
Preterm Infant Outcomes after Randomization to Initial Resuscitation with FiO2 0.21 or 1.0

Thamrin V, Saugstad OD, Tarnow-Mordi W, Wang YA, Lui K, Wright IM, et al.

J Pediatr, 2018 10;201:55-61.e1.
PMID: 30251639 DOI: 10.1016/j.jpeds.2018.05.053

OBJECTIVE: To determine rates of death or neurodevelopmental impairment (NDI) at 2 years corrected age (primary outcome) in children <32 weeks' gestation randomized to initial resuscitation with a fraction of inspired oxygen (FiO2) value of 0.21 or 1.0.
STUDY DESIGN: Blinded assessments were conducted at 2-3 years corrected age with the Bayley Scales of Infant and Toddler Development, Third Edition or the Ages and Stages Questionnaire by intention to treat.
RESULTS: Of the 290 children enrolled, 40 could not be contacted and 10 failed to attend appointments. Among the 240 children for whom outcomes at age 2 years were available, 1 child had a lethal congenital anomaly, 1 child had consent for follow-up withdrawn, and 23 children died. The primary outcome, which was available in 238 (82%) of those randomized, occurred in 47 of the 117 (40%) children assigned to initial FiO2 0.21 and in 38 of the 121 (31%) assigned to initial FiO2 1.0 (OR, 1.47; 95% CI, 0.86-2.5; P = .16). No difference in NDI was found in 215 survivors randomized to FiO2 0.21 vs 1.0 (OR, 1.26; 95% CI, 0.70-2.28; P = .11). In post hoc exploratory analyses in the whole cohort, children with a 5-minute blood oxygen saturation (SpO2) <80% were more likely to die or to have NDI (OR, 1.85; 95% CI, 1.07-3.2; P = .03).
CONCLUSIONS: Initial resuscitation of infants <32 weeks' gestation with initial FiO2 0.21 had no significant effect on death or NDI compared with initial FiO2 1.0. Further evaluation of optimum initial FiO2, including SpO2 targeting, in a large randomized controlled trial is needed.
TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Network Registry ACTRN 12610001059055 and the National Malaysian Research Registry NMRR-07-685-957.
Fulltext Standardised neonatal parenteral nutrition formulations - Australasian neonatal parenteral nutrition consensus update 2017

Bolisetty S, Osborn D, Schindler T, Sinn J, Deshpande G, Wong CS, et al.

BMC Pediatr, 2020 02 08;20(1):59.
PMID: 32035481 DOI: 10.1186/s12887-020-1958-9

BACKGROUND: The first consensus standardised neonatal parenteral nutrition formulations were implemented in many neonatal units in Australia in 2012. The current update involving 49 units from Australia, New Zealand, Singapore, Malaysia and India was conducted between September 2015 and December 2017 with the aim to review and update the 2012 formulations and guidelines.
METHODS: A systematic review of available evidence for each parenteral nutrient was undertaken and new standardised formulations and guidelines were developed.
RESULTS: Five existing preterm Amino acid-Dextrose formulations have been modified and two new concentrated Amino acid-Dextrose formulations added to optimise amino acid and nutrient intake according to gestation. Organic phosphate has replaced inorganic phosphate allowing for an increase in calcium and phosphate content, and acetate reduced. Lipid emulsions are unchanged, with both SMOFlipid (Fresenius Kabi, Australia) and ClinOleic (Baxter Healthcare, Australia) preparations included. The physicochemical compatibility and stability of all formulations have been tested and confirmed. Guidelines to standardise the parenteral nutrition clinical practice across facilities have also been developed.
CONCLUSIONS: The 2017 PN formulations and guidelines developed by the 2017 Neonatal Parenteral Nutrition Consensus Group offer concise and practical instructions to clinicians on how to implement current and up-to-date evidence based PN to the NICU population.