Tada Kunavisarut

Background: Systemic corticosteroids, particularly oral minipulse dexamethasone (OMP-D), are commonly used to stabilize active vitiligo. Intramuscular triamcinolone acetonide (IMTA), though effective in other dermatoses, has limited studies for vitiligo. Objectives: To compare the efficacy and safety of IMTA versus OMP-D in adults with active vitiligo. Methods: This observational study included patients aged 18 to 60 years with clinically active vitiligo. Patients received either IMTA 40 mg monthly or OMP-D 2.5 mg twice weekly for 3 months. Vitiligo extent score (VES) and adverse events were assessed at baseline, months 1, 2, 3, and 6. Biochemical parameters were evaluated at baseline and month 3. Results: Nineteen patients (9 in the IMTA group and 10 in the OMP-D group) were included. All patients achieved disease stabilization within the first month. The IMTA group showed an earlier onset of repigmentation, evidenced by a significant reduction in VES at month 1. By months 2, 3, and 6, both groups demonstrated significant reductions in VES compared to baseline. Notably, at months 2 and 3, the OMP-D group exhibited a more pronounced decrease in VES ( P ≤ .01) than the IMTA group ( P ≤ .05). One patient in the IMTA group began to experience vitiligo relapse at month 6. Both treatments were well-tolerated. Cortisol suppression was observed in 1 patient from each group. Conclusions: IMTA shows promising results, comparable in efficacy and safety to OMP-D for active vitiligo, achieving early disease stabilization and repigmentation. IMTA represents a practical first-line alternative for active vitiligo management.

Purpose Allulose is a rare monosaccharide with almost zero calories. There is no study of short-term allulose consumption in patients with type 2 diabetes (T2D). Thus, we aimed to study the effect of allulose consumption for 12 weeks on glucose homeostasis, lipid profile, body composition, incretin levels, and inflammatory markers in patients with T2D. Methods A double-blind, randomized, controlled crossover study was conducted on sixteen patients with T2D. Patients were randomly assigned to allulose 7 g twice daily or aspartame 0.03 g twice daily for 12 weeks. After a 2-week washout, patients were crossed over to the other sweetener for an additional 12 weeks. Oral glucose tolerance tests, laboratory measurements, and dual-energy X-ray absorptiometry were conducted before and after each phase. Results This study revealed that short-term allulose consumption exerted no significant effect on glucose homeostasis, incretin levels, or body composition but significantly increased MCP-1 levels (259 ± 101 pg/ml at baseline vs. 297 ± 108 pg/mL after 12 weeks of allulose, p = 0.002). High-density lipoprotein cholesterol (HDL-C) significantly decreased from 51 ± 13 mg/dl at baseline to 41 ± 12 mg/dL after 12 weeks of allulose, p < 0.001. Conclusion Twelve weeks of allulose consumption had a neutral effect on glucose homeostasis, body composition, and incretin levels. Additionally, it decreased HDL-C levels and increased MCP-1 levels. Trial registration This trial was retrospectively registered on the Thai Clinical Trials Registry (TCTR20220516006) on December 5, 2022.

Background. The long-term continuation of the low-dose antithyroid drug (ATD) beyond the standard duration of ATD therapy of 12–18 months to prevent recurrent hyperthyroidism (RH) is recommended with low quality of evidence. Objectives. To examine whether long-term continuation of low-dose ATD beyond the recommended duration of treatment would provide a benefit in the prevention of RH in patients with Graves’ hyperthyroidism (GH) who achieved euthyroid status with a standard course of ATD therapy. Methods. A 36-month prospective randomized controlled study was conducted in 184 patients who had first diagnosed GH and were treated with a standard regimen of ATD therapy using methimazole (MMI) until achieving euthyroidism that was stably maintained for at least 6 months with a low-dose of (2.5–5 mg/day) MMI. All patients had neither a history of adverse effects from MMI, recurrent GH, severe and active ophthalmopathy nor conditions known to affect thyroid function before randomization. The patients were randomized into 2 groups: one group (92 cases) was assigned to discontinue (DISCONT-MMI) and the other (92 cases) was assigned to continue low-dose MMI (CONT-MMI) that was taken at the time of enrollment. The patients in both groups were followed up at 3, 6, 12, 18, 24, 30, and 36 months. The rate of RH was compared between both groups, and the adverse effects and risk factors of RH were also studied. Results. At the end of the 36-month study, 83 cases in CONT-MMI and 90 cases in DISCONT-MMI were eligible for analysis. The cumulative rates of RH in CONT-MMI were significantly lower than those in DISCONT-MMI at every follow-up time point (1.2% vs. 11.2%, 6.8% vs. 18.4%, 11.0% vs. 27.2%, 11.0% vs. 35.0%, and 11.0% vs. 41.2% at 6, 12, 18, 24, and 36 months, respectively; ). Cox proportional hazard multivariate analysis showed that there were 2 factors independently associated with the risk of RH, including continuation of low-dose MMI therapy, which decreased the risk of RH by 3.8 times (HR = 0.26, , 95% CI = 0.10–0.70) and age onset of hyperthyroidism before 40 years, which increased the risk of RH by 2.9 times (HR = 2.9, , 95% CI = 1.23–6.88). Neither minor nor major adverse effects of low-dose MMI therapy were observed during the study period. Conclusions. In Graves’ hyperthyroid patients with no or nonsevere ophthalmopathy who have completed a standard course of methimazole therapy without an adverse effect and have achieved an euthyroid status that is stably maintained with low-dose methimazole, a long-term continuation of the low-dose methimazole of 2.5–5 mg daily is effective and safe in the prevention of recurrent hyperthyroidism or maintenance of euthyroid status as long as the low-dose methimazole is continued. (TCTR20170705002).

Purpose: To evaluate metformin’s benefit on the incidence and survival of hepatocellular carcinoma (HCC) in cirrhosis with type 2 diabetes mellitus (T2DM) patients. Patients and Methods: We conducted a retrospective study from 2006 to 2019. The patients were assigned to metformin exposure if they administered metformin at least 3 months after diagnosis of cirrhosis. The outcomes were incidence and survival of HCC in T2DM with cirrhosis treated with metformin compared with those who were not treated with metformin. For the incidence of HCC, the follow-up time was 5 years after cirrhosis was diagnosed. For the survival of HCC, we censored for vital status in June 2019. Results: Of 1061 patients, the patients were divided into 719 patients with metformin exposure and 342 in metformin non-exposure. In metformin exposure, 125 patients (17.4%) developed HCC. In metformin non-exposure, 128 patients (37.4%) developed HCC. Metformin exposure had a significantly lower risk of developing HCC in multivariate analysis HR 0.48 (0.36– 0.61); P< 0.001. For the survival of HCC, 327 patients were recruited. One-hundred and sixty-two patients were in metformin exposure and 165 patients were in metformin non-exposure. Sixty patients (37%) in metformin exposure died, while 84 patients (50.9%) in metformin non-exposure died. The median survival of metformin exposure and metformin non-exposure were 6.9 years and 3.88 years, respectively; P=0.003. In univariate analysis, the metformin exposure was significantly associated with better survival than in the non-exposure group, HR 0.63 (0.45– 0.88); P=0.006. No significant difference was observed in multivariate analysis between two groups, HR 1.07 (0.74– 1.54); P=0.72. Conclusion: Metformin exposure was associated with a lower incidence of HCC in cirrhosis with T2DM patients and seemed to extend survival. Continuing metformin in patients with cirrhosis with T2DM should be considered if there was no contraindication.

Several studies demonstrated an association between type 2 diabetes (T2D) and a higher risk of hepatocellular carcinoma (HCC). Metformin is widely prescribed for T2D. Metformin has been shown to prevent various cancer developments. The association of metformin use and development of HCC among T2D with cirrhosis is investigated. This study aims to determine if metformin significantly reduces the incidence of HCC in this population. T2D with cirrhosis patients from 2006 to 2014 with age 20 to 80 years were studied as a retrospective cohort. An incidence of HCC in T2D with/without metformin exposure after cirrhosis diagnosis within 5 years was determined by Chi-square test. The exposure was defined as a drug intake at the time of cirrhosis diagnosis, continuing for at least 90 days beyond the diagnosis. The 5-year disease-free survival of HCC in each group was compared using the log-rank test and Kaplan-Meier method. The total of 1,061 T2D with cirrhosis included metformin exposure (N=719) and metformin non-exposure (N=342). The overall HCC incidence was 253 (23.85%). Among patients with metformin exposure, the HCC incidence was 125 (17.39%), compared to 128 (37.42%) in non-exposure group. The development of HCC within 5 years was significantly lower in metformin exposure than in non-exposure group (RR=0.76; 95% CI:0.69-0.83; P<0.001). The 5-year disease-free survival of HCC with metformin exposure is greater than that of non-exposure (0.80 vs. 0.57; HR=0.42; 95% CI:0.33-0.54; p<0.001). Moreover, the result shows that male gender (HR=1.64; 95% CI:1.25-2.14), HbA1C≥7.5% (HR=1.30; 95% CI:1.00-1.68), HBV cirrhosis (HR=1.80; 95% CI:1.13-2.85), HCV cirrhosis (HR=2.31; 95% CI:1.43-3.74), smoking and drinking cessation ≥5 years (HR=1.78; 95% CI:1.31-2.42 and HR=1.74; 95% CI:1.27-2.38 respectively) were linked to a rising 5-year HCC incidence in T2D. Conclusion: The metformin treatment might reduce the incidence of HCC in T2D with cirrhosis during 5-years and benefit HCC prognosis. Disclosure: T. Tangjarusritaratorn: None. T. Kunavisarut: None. W. Tangjittipokin: None.

Achievement of Metabolic Goals among Different Health Insurance Schemes in Thai Patients with Type 2 Diabetes Mellitus: a Nationwide Study

Background: The aim of this study was to investigate beta-cell function and examine whether sulfonylureas (SUs) are still useful in patients with type 2 diabetes (T2DM) who failed to maintain optimal glycemic control with a combination of maximum dosages of metformin and SU. Method: T2DM who had Hb_A1c >8% during treatment with a combination of maximum dosages of metformin and SU were studied. After enrollment, the patients were assigned to continue maximum dosages of SU and metformin for 2 weeks and then underwent the first oral glucose tolerance test (OGTT), the Max-SU OGTT. After the Max-SU OGTT, SUs were discontinued for 4 weeks and the second OGTT, the Discont-SU OGTT, was performed. After the Discont-SU OGTT, the same SU was restarted at 25% of the maximum dosage (25%Max-SU). After taking 25%Max-SU for 4 weeks, the third OGTT, the 25%Max-SU OGTT, was performed. Metformin at the same dosage was continued throughout the study. Normal OGTT (NGT) subjects, matched for age and body mass index (BMI), were also studied. Results: There were 25 T2DM and 28 NGT subjects. There was no difference in age and BMI between the two groups. The beta-cell function during Max-SU was 0.1, which was higher than 0.06 during Discont-SU (pp=0.269). The beta-cell function during 25%Max-SU was higher than during Discont-SU (ppppConclusion: In T2DM patients who failed to achieve glycemic control with a combination of maximum dosages of metformin and SU, the beta-cell function declined compared to NGT subjects. However, the beta-cells were still responsive to SUs, which play a significant role in glycemic control.

Hyperthyroidism is a common endocrine disease. Although thionamide antithyroid drugs are the cornerstone of hyperthyroidism treatment, some patients cannot tolerate this drug class because of its serious side effects including agranulocytosis, hepatotoxicity, and vasculitis. Therefore, nonthionamide antithyroid drugs (NTADs) still have an important role in controlling hyperthyroidism in clinical practice. Furthermore, some situations such as thyroid storm or preoperative preparation require a rapid decrease in thyroid hormone by combination treatment with multiple classes of antithyroid drugs. NTADs include iodine-containing compounds, lithium carbonate, perchlorate, glucocorticoid, and cholestyramine. In this narrative review, we summarize the mechanisms of action, indications, dosages, and side effects of currently used NTADs for the treatment of hyperthyroidism. In addition, we also describe the state-of-the-art in future drugs under development including rituximab, small-molecule ligands (SMLs), and monoclonal antibodies with a thyroid-stimulating hormone receptor (TSHR) antagonist effect.

The incidence of thyroid cancer has been increasing all around the world in the past decades. Early detection is one of the keys to reduce the mortality. Currently, fine-needle aspiration (FNA) guides the management of patients with a thyroid nodule. The use of FNA can reduce unnecessary thyroid surgery by twenty-five percent. However, the prevalence of non-diagnostic and indeterminate cytology from FNA is still high, approximately thirty percent. Many biomarkers were developed to differentiate between the benign and malignant thyroid nodule. This review summarizes each diagnostic biomarker of differentiated thyroid cancer. Sensitivity, specificity, and positive and negative predictive values of individual cytological laboratory need to be considered before implementation of each biomarker. Moreover, follow-up is still mandatory in negative biomarker tests because all genomic and proteomic alterations in thyroid cancer are still unknown.