Publications by authors named "Supawan Buranapin"

11 Publications

  • Page 1 of 1

The effects of dapagliflozin on hepatic and visceral fat in type 2 diabetes patients with non-alcoholic fatty liver disease.

J Gastroenterol Hepatol 2021 Jun 15. Epub 2021 Jun 15.

Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.

Background And Aim: Sodium-glucose cotransporter 2 inhibitors have shown excellent results in glucose control in type 2 diabetes mellitus (T2DM) patients, while also promoting weight loss. These mechanisms may be beneficial in the treatment of non-alcoholic fatty liver disease (NAFLD). Our study aims to investigate the effect of dapagliflozin on hepatic and visceral fat contents and related biochemical markers in T2DM with NAFLD patients.

Methods: This is a double-blinded placebo-controlled randomized, single-center study. Non-insulin-dependent T2DM patients with NAFLD were prospectively enrolled and randomly assigned to receive either dapagliflozin (10 mg/day) or placebo for 12 weeks. The primary end-point was the changes in intrahepatic lipid contents, evaluated by the liver attenuation index.

Results: Of 40 patients enrolled, 38 patients completed the study (dapagliflozin group, n = 18; placebo group, n = 20). Baseline demographic and laboratory findings were similar in both groups. After 12 weeks of treatment, dapagliflozin significantly decreased intrahepatic lipid contents demonstrated by an increase in liver attenuation index in comparison with the placebo treatment (5.8 ± 5.1 vs 0.5 ± 6.1 Hounsfield units, P = 0.006). Significant reduction in bodyweight, bodyfat, visceral fat/subcutaneous fat ratio, hemoglobin A1c, and alanine aminotransferase were also observed in the dapagliflozin-treated group as compared with the placebo group (all P < 0.05). There was no significant difference in adipokines including adiponectin, leptin, and tumor necrosis factor-α changes between the dapagliflozin-treated group and the placebo group (all P = nonsignificant).

Conclusion: Dapagliflozin treatment for 12 weeks is associated with improvement in hepatic fat content, a decrease in visceral fat and bodyweight, enhanced glycemic control, and improved liver biochemistry among T2DM patients with NAFLD.
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http://dx.doi.org/10.1111/jgh.15580DOI Listing
June 2021

Standardized Glycemic Management versus Conventional Glycemic Management and Postoperative Outcomes in Type 2 Diabetes Patients Undergoing Elective Surgery.

Diabetes Metab Syndr Obes 2020 22;13:2593-2601. Epub 2020 Jul 22.

Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.

Purpose: Optimized postoperative blood glucose control can minimize postoperative complications. Conventional perioperative glycemic control protocol (CG), which has been routinely used in our institution, lacks detailed perioperative glycemic management. A new standardized glycemic control protocol (SG) was designed which employs frequent postoperative monitoring of blood glucose, more tightly targeted blood glucose control, and adjustment of insulin dosage prior to surgery. This study compared the efficacy of postoperative glycemic control and complications with the two protocols, CG and SG.

Patients And Methods: Three hundred and eighty type 2 diabetes patients who underwent elective surgeries were included in the study. Of those, 182 patients with CG were identified retrospectively as a historical control cohort. Additional 198 patients with SG were prospectively enrolled. Covariate imbalance was controlled using propensity score matching. Outcomes were evaluated using regression analysis clustered by type of surgery.

Results: The SG group had lower mean levels of postoperative 24-hr blood glucose than the CG group (β =-8.6 mg/dL; 95% CI (-16.5 to -7.9), =0.042). In SG group, the incidence of ICU admission and of acute kidney injury after surgery was lower than in the CG group (OR 0.36; 95% CI (0.18-0.74), =0.005 and OR=0.59; 95% CI (0.41-0.85), =0.005, respectively). There was no significant difference in postoperative hypoglycemia, infection, cardiovascular complications, stroke, or mortality rate between the two groups.

Conclusion: For type 2 diabetes patients undergoing elective surgery, the SG protocol is more effective in controlling blood glucose. The protocol can also reduce the incidence of some postoperative complications compared to CG with no increased risk of hypoglycemia.
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http://dx.doi.org/10.2147/DMSO.S262444DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7383109PMC
July 2020

Effectiveness and safety of sodium-glucose co-transporter-2 inhibitors in Thai adults with type 2 diabetes mellitus: a real-world study.

Curr Med Res Opin 2020 10 26;36(10):1601-1610. Epub 2020 Aug 26.

Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand.

Background: Sodium-glucose co-transporter-2 inhibitors (SGLT2is) are widely used to improve both glycemic control and cardio-renal outcomes. We aim to evaluate the real-life clinical effectiveness, safety and outcomes of SGLT2is in Thai adults with type 2 diabetes mellitus (T2DM).

Methods: This was a retrospective study involving adults with T2DM who were treated with SGLT2is for ≥3 months.

Results: Among 1159 participants (women 52.6%; age: 61.1 ± 10.9 years; body mass index: 28.7 ± 5.2 kg/m), 65.1%, 34.3% and 0.6% received dapagliflozin, empagliflozin and canagliflozin, respectively. Median SGLT2i treatment duration was 15 (IQR, 8-23) months. Of the patients, 16.5%, 6.4%, 4.9% and 1.6% had pre-existing coronary artery disease, stroke, heart failure and peripheral arterial disease, respectively. Mean HbA1c decreased by 0.7% (95% CI, -1.0 to -0.4) from a baseline of 8.3 ± 1.5%. At 24 months, body weight, and systolic and diastolic blood pressure decreased significantly from the baseline average of 2.5 kg, 3.5 mmHg and 2.4 mmHg, respectively. The median decline in eGFR was -1.3 ml/min/1.73 m/year. The incidences of pollakiuria, genital tract infection, urinary tract infection and hypoglycemia were 7.2%, 2.8%, 2.2% and 0.9%, respectively. No participants developed diabetic ketoacidosis during the observation period.

Conclusions: SGLT2is improved cardiometabolic parameters in Thai adults, clinically confirming findings in controlled trials.
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http://dx.doi.org/10.1080/03007995.2020.1808454DOI Listing
October 2020

30-Minute Delta Cortisol Post-ACTH Stimulation Test and Proposed Cut-Off Levels for Adrenal Insufficiency Diagnosis.

J Med Invest 2020 ;67(1.2):95-101

Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.

The ACTH stimulation test is used to diagnose adrenal insufficiency (AI). This study evaluated the diagnostic performance of serum delta cortisol from ACTH stimulation tests and determined appropriate cut-off levels of serum 30-minute delta cortisol for the diagnosis of AI, allowing a reduction in the number of 60-minute cortisol tests. A 6-year retrospective study in 471 patients was conducted. The performance of the serum delta cortisol in diagnosing AI was assessd using a multivariable logistic regression model and the area under ROC curves (AuROC). Both serum 30-minute and 60-minute delta cortisol demonstrated equally high diagnostic accuracy for AI (AuROC for LDT : 0.91 vs 0.90 ; HDT : 0.91 vs 0.92, respectively). The 30-minute delta cortisol test was chosen to develop proposed diagnostic cut-off levels due to its simplicity. The proposed lower cut-off level for 30-minute delta cortisol was Δ < 1.8 µg/dL for both LDT and HDT. The upper cut-off levels were Δ > 11.8 µg/dL for LDT and Δ > 10.5 µg/dL for HDT. These cut-off levels yielded high sensitivity and specificity > 90%. The 30-minute serum delta cortisol using the proposed cut-off levels provides diagnostic performance for AI equal to that of the 60-minute test and is more convenient, requires less time, less invasive and is cost-saving. 67 : 95-101, February, 2020.
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http://dx.doi.org/10.2152/jmi.67.95DOI Listing
June 2021

Effects of nutrition factors on mortality and sepsis occurrence in a multicenter university-based surgical intensive care unit in Thailand (THAI-SICU study).

Nutrition 2019 02 2;58:94-99. Epub 2018 Nov 2.

Department of Medicine, Faculty of Medicine, Chiang Mai University, Thailand.

Objectives: The aim of this study was to demonstrate the role of nutrition factors on a 28-d mortality outcome and sepsis occurrence in surgical intensive care unit.

Methods: The data was extracted from a THAI-SICU study that prospectively recruited participants (≥18 y of age) from three Thai surgical intensive care units (SICUs) of university-based hospitals. The demographic data and nutrition factors at SICU admission included energy delivery deficit, weight loss severity, route of energy delivery, and albumin and nutrition risk screening (NRS-2002). The outcomes were 28-d hospital mortality and sepsis occurrence. The statistical analysis was performed using Cox regression.

Results: The study included 1503 eligible patients with a predominantly male population. The 28-d mortality and sepsis occurrences were 211 (14%) and 452 (30%), respectively. Regarding multivariable analysis, for mortality outcome, the protective effects of nutrition variables were higher body mass index (BMI; hazard ratio [HR], 0.82; 95% confidence interval [CI], 0.68-0.99; P = 0.039), tube feeding (HR, 0.46; 95% CI, 0.26-0.83; P = 0.010), and a combination of enteral and parenteral nutrition (HR, 0.24; 95% CI, 0.07-0.77; P = 0.016). The harmful effects were severe weight loss (HR, 1.61; 95% CI, 1.16-2.22; P = 0.004), albumin ≤2.5 (HR, 2.15; 95% CI, 1.20-3.84; P = 0.010), and at risk according to NRS-2002 (HR, 1.34; 95% CI, 0.98-1.85; P = 0.071). For the sepsis occurrence, only tube feeding had a protective effect (HR, 0.58; 95% CI, 0.39-0.88; P = 0.009), and only albumin ≤2.5 had a harmful effect (HR, 1.71; 95% CI, 1.20-2.45; P = 0.003).

Conclusion: Nutrition factors affecting the mortality or sepsis occurrence in this study were BMI, enteral feeding or combination with parenteral nutrition, severe weight loss, preadmission albumin ≤2.5, and at risk according to NRS-2002.
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http://dx.doi.org/10.1016/j.nut.2018.06.021DOI Listing
February 2019

Effects of meal replacement therapy on metabolic outcomes in Thai patients with type 2 diabetes: A randomized controlled trial.

Nutr Health 2018 Dec 1;24(4):261-268. Epub 2018 Oct 1.

Division of Nutrition, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand.

Background: A meal replacement (MR) with a low glycemic index (GI) is possibly beneficial for glycemic control. However, the effects of MR on diabetes mellitus have not been studied among Thai patients with type 2 diabetes (T2DM).

Aim: To compare metabolic outcomes between T2DM patients receiving the new MR formula (ONCE PRO) and normal controlled diets.

Methods: A multicenter, open-labeled, randomized controlled trial was conducted. Eligible patients received either ONCE PRO for one meal daily with controlled diets or only controlled diets for 3 months. The differences in metabolic profile between the baseline and end point of each group and between groups were measured.

Results: 110 participants were enrolled; the mean difference and standard deviation in hemoglobin A1C (HbA1c) (%) from baseline were -0.21 ± 0.78 ( = 0.060) and -0.27 ± 0.60 ( = 0.001) in the MR and control groups, respectively; however, there was no significant difference between groups ( = 0.637). Patients consuming a MR instead of breakfast had a significant decrease in HbA1c ( = 0.040). Body weight (BW) and body mass index (BMI) were significantly reduced in both groups. There were no significant change in waist circumference, fasting plasma glucose, total cholesterol and triglycerides. Low-density lipoprotein cholesterol (LDL-C) was significantly decreased in the MR group compared with the control group ( = 0.049).

Conclusions: Short-term conventional diet control and the low-GI MR product were associated with a decreased BW and BMI. Changes in the other metabolic outcomes, HbA1c, total cholesterol and triglycerides, were comparable despite ONCE PRO as the MR having a better effect on LDL-C lowering.
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http://dx.doi.org/10.1177/0260106018800074DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6340108PMC
December 2018

Characters of Nutrition Status and Energy-delivery Patterns of the University-based Surgical Intensive Care Units in Thailand (Multi-center THAI-SICU Study).

Med Arch 2018 Feb;72(1):36-40

Department of Medicine, Faculty of Medicine, Chiang Mai University, Thailand.

Aim: The authors aimed to describe nutrition status and energy-delivery characters in multi-center THAI-SICU study.

Material And Methods: Eligible patients admitted in SICU were 1,686 after excluding 563 of 2,249 participants owing to very short stay or non-alive within 24 hours after admission and missing data. The study was a posthoc analysis and multicenter descriptive design. The analytic methods described categorical data in percentage and the continuous data in the median with interquartile range. Variables divided into baseline characteristics and nutrition data before SICU admission, and the pattern of energy delivery in SICU. Statistical significance accepted as a p-value less than 0.05.

Results: The average age was 64 (52-76) years with 57% male. The median of serum albumin level at admission (interquartile range, IQR) was 2.8 (2.2-3.4). There was 46 -47 percent of nutrition risk patient. Less than 10 percent of the patient had enteral (EN), parenteral (PN) or their combination before admission. History of weight loss and appetite loss was 27-31 percent. However, seventy percent of the patient could not define the duration of the symptom. EN was initiated early, but the tendency of full feeding was 7-10 days. At that period, supplemental PN was added around 30 percent of total calories. The composition of PN was quite low in these study which contains only 15-16 percent of total calories. The average energy delivery was 20 kcal/kg/day (the recommendation is 25-30 kcal/kg/day).

Conclusion: The patient's nutrition status before SICU admission was at risk of 46-47% and weight loss and appetite loss might unreliable in ICU setting. EN is started early with gradually increase up to 7-10 days. The average total calories requirement is lower than a recommendation.
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http://dx.doi.org/10.5455/medarh.2018.72.36-40DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5789566PMC
February 2018

Prevalence of Pressure Ulcer and Nutritional Factors Affecting Wound Closure Success in Thailand.

Mater Sociomed 2017 Sep;29(3):196-200

Department of Surgery, Faculty of Medicine, Chiang Mai University, Thailand.

Introduction: The authors aimed to estimate the prevalence of pressure ulcers and to explore the nutritional effects of the prognostic factors on successful pressure ulcer closure in a public tertiary care hospital in Thailand.

Patients And Methods: The study was a retrospective cohort analysis of seven-year census (2008 - 2014) at Surin hospital in Thailand. There were 424 of total 240,826 patients aged over than 15 years admitted to surgery, orthopedics and medicine wards during the study period with documented pressure ulcers (ICD 10TM). We analyzed four hundred and ten patients after excluding 14 patients with non-pressure ulcers (due to burning/ diabetic/ ischemic neuropathic ulcers, and less than 24 hours of admission) and loss medical record. We selected independent factors from demographic data, nutritional factors, pressure ulcer characteristics, and management data. The outcome of interest was successful pressure ulcer closure. The analysis method was the semi-parametric Cox regression model and reported as Hazard Ratios (HR) with 95% confidence interval (95% CI).

Results: The total hospital admission was 240,826 patients between 2008 - 2014. 410 patients were developing pressure ulcers, of these, 7% (28/410) success in ulcer closure, and 77% (314/410) failure in closure requiring for additional procedures (excisional debridement). The rest of patients (16%, 68/410) was non-operative care. The prevalence of pressure ulcers was 1.7 per 1,000 person-year. The multivariable model found that only the Nottingham Hospital Screening Tool (NS) score was a statistically significant nutritional variable, and additional subgroup analysis of two models of sepsis and spinal cord co-morbidities was also significant. Adjusted hazard ratios (HR) for NS score = 0.355 (95% CI: 0.187, 0.674), p=0.002), for sepsis = 0.312 (95% CI: 0.140, 0.695), p=0.004), and for spinal cord co-morbidity = 0.420 (95% CI: 0.184, 0.958), p=0.039).

Conclusions: The annual prevalence was 1.7 per 1,000 persons. NS score was strongly associated with ulcer closure success.
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http://dx.doi.org/10.5455/msm.2017.29.196-200DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5644201PMC
September 2017

Dietary Counseling Outcomes in Locally Advanced Unresectable or Metastatic Cancer Patients Undergoing Chemotherapy.

J Med Assoc Thai 2016 Dec;99(12):1283-90

Background: Cancer-related malnutrition led to poor outcomes of treatment, decreased functional status, decreased quality of life, and delay treatment.

Objective: To examine the effects of dietary counseling for regular foods consumption on nutritional outcomes in patients with cancer undergoing chemotherapy.

Material And Methods: A prospective randomized study was performed on locally advanced unresectable or metastatic cancer patients undergoing chemotherapy at Department of Medicine, Chiang Mai University, between December 2013 and July 2014. Fifty patients were randomly assigned to dietary counseling group and routine care group. The dietary counseling was performed by a dietitian before starting chemotherapy. Outcomes were evaluated at the end of three to four cycles and six to eight cycles of chemotherapy or after two months if the chemotherapy was stopped earlier.

Results: The dietary counseling group significantly increased percent change of body weight 2.29 (±6.20) vs. -1.70 (±6.23) percent in the routine care group, p = 0.03 and increased BMI 2.27 (±6.09) vs. -1.53 (±5.92) percent, p = 0.03 at the end of three to four cycles of chemotherapy, but there was no significant change at the next two months. Furthermore, PG-SGA score was lower in the dietary counseling group (6.67 (±1.99) vs. 10.04 (±3.73), p<0.001, and quality of life was significant increased in dietary counseling group at the end of three to four cycles of chemotherapy and at the next two months (score 39.40 (±10.61) vs 46.16 (±7.55), p = 0.01). Absolute lymphocyte count, serum albumin, energy intake, number of patients who delayed chemotherapy, cause of delay chemotherapy, and number of total cycles did not differ between the groups.

Conclusion: Dietary counseling have significantly improved body weight, BMI, PG-SGA scores, and quality of life scores in patients with locally advanced unresectable or metastatic cancer undergoing chemotherapy compared with routine care. We should be concerned about screening for malnutrition in all cancer patients and we should provide nutritional counseling.
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December 2016

The comparative study of diabetic specific formula and standard formula on postprandial plasma glucose control in type 2 DM patients.

J Med Assoc Thai 2014 Jun;97(6):582-8

Objective: To compare the postprandial plasma glucose level after diabetic specific formula (DSF) and standard formula (SF) administration in type 2 diabetic patients.

Material And Method: Thirty type 2 diabetic patients were included in the present randomized, controlled, double-blind, cross-over study. Subjects received DSF and isocaloric SF as a bolus administration of 400 mL while continuing their anti-diabetic medications. Venous blood samples were collected and analyzed to assess plasma glucose levels at pre- and at 30, 60, 90, 120, and 180 min post-administration of the formulas.

Results: Postprandial glucose profiles were significantly lower with DSF compared to SF administration determined as a mean glucose concentration at 2-hour post-administration. The glucose area under the curve (AUC) after DSF consumption was 33% lower than the AUC after SF consumption, p < 0.001.

Conclusion: Use of DSF resulted in a significantly lower postprandial rise in plasma glucose concentrations than using SF. It should be the preferred option in diabetic patients who need nutritional support.
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June 2014

Reducing lower extremity amputations due to diabetes: the application of diabetic-foot protocol in Chiang Mai University Hospital.

Int J Low Extrem Wounds 2008 Jun 14;7(2):88-92. Epub 2008 May 14.

Department of Surgery, Chiang Mai University, Chiang Mai, Thailand.

The aim of this study was to determine whether intensive treatment and education strategies for diabetic patients with ulcers help in preventing leg amputation. From August 2005 to March 2007, a diabetic-foot protocol using a multidisciplinary approach was applied at our hospital. All the subjects were educated regarding diabetic-foot disease and its complications and prevention. This report compares the amputation rate in patients receiving the protocol care from August 2005 to March 2007 with those who had standard care from August 2003 to July 2005. Seventy-three and 110 diabetic-foot ulcer patients received protocol and standard foot care, respectively. The incidence of major amputations in the protocol and standard care groups was 4.1% and 13.6%, respectively (P= .03). Our protocol was associated with improved diabetic-foot care outcomes. It can be used by any hospital to improve outcomes for patients with diabetes.
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http://dx.doi.org/10.1177/1534734608317939DOI Listing
June 2008
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