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Panday VB, Shabbir A, Kuntjoro I, Khoo EYH, So JBY, Poh KK. Authors' reply: Comment on: Long-term effects of bariatric surgery on cardiovascular risk factors in Singapore. Singapore Med J 2021. [DOI: 10.11622/smedj.2021149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Tan NC, Goh SY, Khoo EYH, Dalan R, Koong A, Khoo CM, Tan TS, Jain AB, Gadekar AV, Bee YM. Self-reported hypoglycaemia in insulin-treated patients with diabetes mellitus: results from the Singapore cohort of the International Operations Hypoglycaemia Assessment Tool study. Singapore Med J 2020; 61:129-136. [PMID: 32488272 PMCID: PMC7905111 DOI: 10.11622/smedj.2019081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Hypoglycaemia constitutes a significant barrier to achieving glycaemic control with insulin in both Type 1 (T1DM) and Type 2 diabetes mellitus (T2DM). The International Operations Hypoglycaemia Assessment Tool (IO HAT) study was designed to determine the incidence of hypoglycaemia in insulin-treated patients with T1DM and T2DM. METHODS The IO HAT study retrospectively and prospectively assessed the incidence of hypoglycaemia in patients with insulin-treated diabetes mellitus in nine countries. This sub-analysis included patients from Singapore with T1DM or T2DM who were aged ≥ 21 years and had completed two self-assessment questionnaires (SAQ1 and SAQ2). RESULTS Of the 50 T1DM and 320 T2DM patients who completed the SAQ1, 39 T1DM and 265 T2DM patients completed SAQ2; 100% and 90.9%, respectively, experienced at least one hypoglycaemic event prospectively. The incidence rates of any hypoglycaemia were 49.5 events per patient-year (EPPY) and 16.1 EPPY for T1DM and T2DM patients, respectively, in the four-week prospective period. Hypoglycaemia rate did not differ in terms of glycated haemoglobin level. The vast majority of T1DM or T2DM patients (92.0% and 90.7%, respectively) knew the overall definition of hypoglycaemia before study participation, although over half of the patients (T1DM 54.0%, T2DM 51.9%) defined hypoglycaemia based only on symptoms. CONCLUSION High proportions of insulin-treated patients with diabetes mellitus in Singapore reported hypoglycaemic events prospectively, showing that they had underreported hypoglycaemic episodes retrospectively. Patient education can help in improving hypoglycaemia awareness and its management in the region.
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Affiliation(s)
- Ngiap Chuan Tan
- Department of Endocrinology, SingHealth Polyclinics, Singapore
| | - Su-Yen Goh
- Department of Endocrinology, Singapore General Hospital, Singapore
| | - Eric Yin-Hao Khoo
- Department of Endocrinology, National University Hospital, Singapore
| | - Rinkoo Dalan
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore
| | - Agnes Koong
- Department of Endocrinology, SingHealth Polyclinics, Singapore
| | - Chin Meng Khoo
- Department of Endocrinology, National University Hospital, Singapore
| | - Teck Shi Tan
- Department of Endocrinology, SingHealth Polyclinics, Singapore
| | | | | | - Yong Mong Bee
- Department of Endocrinology, Singapore General Hospital, Singapore
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Alperet DJ, Rebello SA, Khoo EYH, Tay Z, Seah SSY, Tai BC, Tai ES, Emady-Azar S, Chou CJ, Darimont C, van Dam RM. The effect of coffee consumption on insulin sensitivity and other biological risk factors for type 2 diabetes: a randomized placebo-controlled trial. Am J Clin Nutr 2020; 111:448-458. [PMID: 31891374 DOI: 10.1093/ajcn/nqz306] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/14/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In observational studies, coffee consumption has been consistently associated with a lower risk of type 2 diabetes mellitus. Trials examining the effect of coffee consumption on glucose metabolism have been limited by the use of surrogate insulin sensitivity indices, small sample sizes, lack of blinding, and short follow-up duration. OBJECTIVES We aimed to overcome limitations of previously conducted coffee trials in a randomized placebo-controlled trial of the effect of coffee consumption on insulin sensitivity. METHODS We conducted a 24-wk randomized placebo-controlled trial in 126 overweight, non-insulin sensitive (HOMA-IR ≥1.30), Chinese, Malay, and Asian-Indian males and females aged 35-69 y. Participants were randomly assigned to receive 4 cups of instant regular coffee (n = 62) or 4 cups of a coffee-like placebo beverage (n = 64) per day. The primary outcome was the amount of glucose metabolized per kilogram of body weight per minute (Mbw) assessed during steady-state conditions with a hyperinsulinemic euglycemic clamp. Secondary outcomes included other clamp-based insulin sensitivity measures, biological mediators of insulin sensitivity, and measures of fasting glucose metabolism. RESULTS Coffee consumption did not significantly change insulin sensitivity compared with placebo (percentage mean difference in Mbw = 4.0%; 95% CI: -8.3, 18.0%; P = 0.53). Furthermore, no significant differences in fasting plasma glucose (2.9%; 95% CI: -0.4, 6.3%; P = 0.09) or biological mediators of insulin resistance, such as plasma adiponectin (2.3%; 95% CI: -1.4, 6.2%; P = 0.22), were observed between coffee and placebo groups over 24 wk of intervention. Participants in the coffee arm experienced a loss of fat mass (FM) (-3.7%; 95% CI: -6.3, -1.1%; P = 0.006) and reduction in urinary creatinine concentrations (-21.2%; 95% CI: -31.4, -9.5%; P = 0.001) compared with participants in the placebo arm over 24 wk of intervention. CONCLUSIONS Consuming 4 cups/d of caffeinated coffee for 24 wk had no significant effect on insulin sensitivity or biological mediators of insulin resistance but was associated with a modest loss of FM and reduction in urinary creatinine concentrations.This trial was registered at clinicaltrials.gov as NCT01738399. Registered on November 28, 2012. Trial sponsor: Nestlé Research, Lausanne, Switzerland. Trial site: National University of Singapore.
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Affiliation(s)
- Derrick Johnston Alperet
- NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore (NUS), Singapore
- A*STAR Graduate Academy, Agency for Science, Technology and Research (A*STAR), Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Eric Yin-Hao Khoo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Endocrinology, National University Hospital, National University Health System, Singapore
| | - Zoey Tay
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Sharna Si-Ying Seah
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Bee-Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Investigational Medicine Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - E-Shyong Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Division of Endocrinology, National University Hospital, National University Health System, Singapore
| | | | - Chieh Jason Chou
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland
| | - Christian Darimont
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland
| | - Rob M van Dam
- NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore (NUS), Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Griva K, Rajeswari M, Nandakumar M, Khoo EYH, Lee VYW, Chua CG, Goh ZS, Choong YTD, Newman SP. The combined diabetes and renal control trial (C-DIRECT) - a feasibility randomised controlled trial to evaluate outcomes in multi-morbid patients with diabetes and on dialysis using a mixed methods approach. BMC Nephrol 2019; 20:2. [PMID: 30606135 PMCID: PMC6318946 DOI: 10.1186/s12882-018-1183-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 12/11/2018] [Indexed: 12/24/2022] Open
Abstract
Background This cluster randomised controlled trial set out to investigate the feasibility and acceptability of the “Combined Diabetes and Renal Control Trial” (C-DIRECT) intervention, a nurse-led intervention based on motivational interviewing and self-management in patients with coexisting end stage renal diseases and diabetes mellitus (DM ESRD). Its efficacy to improve glycaemic control, as well as psychosocial and self-care outcomes were also evaluated as secondary outcomes. Methods An assessor-blinded, clustered randomised-controlled trial was conducted with 44 haemodialysis patients with DM ESRD and ≥ 8% glycated haemoglobin (HbA1c), in dialysis centres across Singapore. Patients were randomised according to dialysis shifts. 20 patients were assigned to intervention and 24 were in usual care. The C-DIRECT intervention consisted of three weekly chair-side sessions delivered by diabetes specialist nurses. Data on recruitment, randomisation, and retention, and secondary outcomes such as clinical endpoints, emotional distress, adherence, and self-management skills measures were obtained at baseline and at 12 weeks follow-up. A qualitative evaluation using interviews was conducted at the end of the trial. Results Of the 44 recruited at baseline, 42 patients were evaluated at follow-up. One patient died, and one discontinued the study due to deteriorating health. Recruitment, retention, and acceptability rates of C-DIRECT were generally satisfactory HbA1c levels decreased in both groups, but C-DIRECT had more participants with HbA1c < 8% at follow up compared to usual care. Significant improvements in role limitations due to physical health were noted for C-DIRECT whereas levels remained stable in usual care. No statistically significant differences between groups were observed for other clinical markers and other patient-reported outcomes. There were no adverse effects. Conclusions The trial demonstrated satisfactory feasibility. A brief intervention delivered on bedside as part of routine dialysis care showed some benefits in glycaemic control and on QOL domain compared with usual care, although no effect was observed in other secondary outcomes. Further research is needed to design and assess interventions to promote diabetes self-management in socially vulnerable patients. Trial registration number Trial registered with the International Standard Randomised Controlled Trial (ISRCTN10546597). Registered 12 September 2016 (Retrospectively registered).
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Affiliation(s)
- K Griva
- Centre for Population Health Sciences, Clinical Sciences Building, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, 308232, Singapore. .,Department of Psychology, National University of Singapore, 9 Arts Link AS4, Singapore, 117570, Singapore.
| | - M Rajeswari
- National Kidney Foundation, 81 Kim Keat Road, Singapore, 328836, Singapore
| | - M Nandakumar
- National Kidney Foundation, 81 Kim Keat Road, Singapore, 328836, Singapore
| | - E Y H Khoo
- Department of Medicine, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore.,Division of Endocrinology, University Medicine Cluster, National University Health System, Singapore, Singapore
| | - V Y W Lee
- Department of Psychology, National University of Singapore, 9 Arts Link AS4, Singapore, 117570, Singapore
| | - C G Chua
- National Kidney Foundation, 81 Kim Keat Road, Singapore, 328836, Singapore
| | - Z S Goh
- Centre for Population Health Sciences, Clinical Sciences Building, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, 308232, Singapore
| | - Y T D Choong
- Department of Psychology, National University of Singapore, 9 Arts Link AS4, Singapore, 117570, Singapore
| | - S P Newman
- School of Health Sciences, City University of London, Northampton Square, London, UK
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Affiliation(s)
- C E Chua
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - E Choi
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - E Y H Khoo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, and Division of Endocrinology, University Medicine Cluster, National University Health System, Singapore
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Alperet DJ, Rebello SA, Khoo EYH, Tay Z, Seah SSY, Tai BC, Tai ES, Emady-Azar S, Chou CJ, Darimont C, van Dam RM. The effects of coffee consumption on insulin sensitivity and other risk factors for type 2 diabetes. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- DJ Alperet
- NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Singapore, Singapore
| | - SA Rebello
- NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Singapore, Singapore
| | - EYH Khoo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Z Tay
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - SSY Seah
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - BC Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - ES Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - S Emady-Azar
- Nestlé Clinical Development Unit, Lausanne, Switzerland
| | - CJ Chou
- Microbiome and Metabolism, Nestlé Institute of Health Sciences, Lausanne, Switzerland
| | - C Darimont
- Nutrition & Health Research, Nestlé Research Center, Lausanne, Switzerland
| | - RM van Dam
- NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Singapore, Singapore
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Alperet DJ, Rebello SA, Khoo EYH, Tay Z, Seah SSY, Tai BC, Emady-Azar S, Chou CJ, Darimont C, van Dam RM. A randomized placebo-controlled trial of the effect of coffee consumption on insulin sensitivity: Design and baseline characteristics of the Coffee for METabolic Health (COMETH) study. Contemp Clin Trials Commun 2016; 4:105-117. [PMID: 29736473 PMCID: PMC5935862 DOI: 10.1016/j.conctc.2016.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 05/17/2016] [Accepted: 06/22/2016] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Coffee consumption has been consistently associated with a lower risk of type 2 diabetes mellitus in cohort studies. In addition, coffee components increased insulin sensitivity in animal models. However, data from intervention studies on the effect of coffee consumption on glucose metabolism have been limited by small sample sizes, lack of blinding, short follow-up duration and the use of surrogate indices of insulin sensitivity. We designed the Coffee for Metabolic Health (COMETH) study to evaluate the effect of coffee consumption on insulin sensitivity. METHODOLOGY The COMETH study is a double-blind randomized placebo-controlled 24-week trial. Participants were overweight, male and female habitual coffee consumers who were of Chinese, Malay and Asian-Indian ethnicity. We excluded smokers, persons with diabetes, and persons with low insulin resistance (HOMA-IR < 1.30). Participants were randomly assigned to receive daily 4 cups of instant regular coffee or 4 cups of a coffee-like placebo beverage. The hyperinsulinemic euglycemic clamp was performed at baseline and at the end of 24 weeks to determine changes in the bodyweight standardized M-value. Secondary outcomes included changes in fasting glucose and insulin sensitivity mediators such as adiponectin, markers of inflammation, liver function, and oxidative stress.We enrolled 128 participants, 126 (57.1% males; aged 35-67 years) of whom completed baseline assessments. DISCUSSION If improvement in insulin sensitivity in the coffee group is significantly greater than that of the placebo group, this would support the hypothesis that coffee consumption reduced risk of type 2 diabetes through biological pathways involving insulin sensitivity. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01738399. Registered on 28 November 2012. Trial Sponsor: Nestlé Research Center, Lausanne, Switzerland. Trial Site: National University of Singapore.
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Affiliation(s)
- Derrick Johnston Alperet
- NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | - Eric Yin-Hao Khoo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Endocrinology, National University Hospital, National University Health System, Singapore
| | - Zoey Tay
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Sharna Si-Ying Seah
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Bee-Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Investigational Medicine Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Chieh Jason Chou
- Gastrointestinal Health & Microbiome, Nestlé Institute of Health Sciences, Lausanne, Switzerland
| | - Christian Darimont
- Nutrition & Health Research, Nestlé Research Center, Lausanne, Switzerland
| | - Rob M. van Dam
- NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Chong MFF, Ayob MNM, Chong KJ, Tai ES, Khoo CM, Leow MKS, Lee YS, Tham KW, Venkataraman K, Meaney MJ, Wee HL, Khoo EYH. Psychometric analysis of an eating behaviour questionnaire for an overweight and obese Chinese population in Singapore. Appetite 2016; 101:119-24. [PMID: 26946279 DOI: 10.1016/j.appet.2016.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 01/25/2016] [Accepted: 03/02/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Previous studies reveal that the Three-Factor Eating Questionnaire (TFEQ), which assesses eating behaviour, performs differently across population groups and cultures. We aimed to identify the factor structure that is most appropriate to capture eating behaviour in an overweight and obese Chinese population in Singapore. METHODS TFEQ-51 was administered to 444 Chinese subjects pooled from four separate studies and scored according to various alternative versions of the TFEQ. Confirmatory factor analyses and goodness of fit indices were used to determine the most appropriate factor structure. Known-group validity analyses were conducted. RESULTS Niemeier's Disinhibition Factors and the TFEQ-R18 factor structures were found to be the most applicable in our population based on goodness of fit indices, with a x(2)/df ratio of <3, RMSEA of ≤ 0.6 and a CFI value of >0.9 for both. Only two of three factors (Emotional Eating and Uncontrolled Eating) of the TFEQ-R18 showed good internal consistency, while none of Niemeier's Disinhibition Factors showed good internal consistency. Known-group validity showed that Emotional Eating and Internal Disinhibition were significantly associated with higher BMI. CONCLUSION We found that the TFEQ-R18 factor structure is the most appropriate and practical for use in measuring eating behaviour in an overweight and obese Chinese population in Singapore.
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Affiliation(s)
- Mary Foong-Fong Chong
- Singapore Institute for Clinical Sciences, A*STAR, Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, A*STAR, Singapore.
| | - M Na'im M Ayob
- Singapore Institute for Clinical Sciences, A*STAR, Singapore
| | - Kok Joon Chong
- Division of Endocrinology, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - E-Shyong Tai
- Division of Endocrinology, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore
| | - Chin Meng Khoo
- Division of Endocrinology, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Melvin Khee-Shing Leow
- Singapore Institute for Clinical Sciences, A*STAR, Singapore; Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, A*STAR, Singapore; Department of Endocrinology, Tan Tock Seng Hospital, Singapore
| | - Yung Seng Lee
- Singapore Institute for Clinical Sciences, A*STAR, Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, A*STAR, Singapore; Division of Paediatric Endocrinology and Diabetes, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore
| | - Kwang Wei Tham
- Department of Endocrinology, Singapore General Hospital, Singapore; Obesity Unit, Singapore General Hospital, Singapore
| | - Kavita Venkataraman
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Department of Obstetrics and Gynaecology, National University of Singapore, Singapore
| | - Michael J Meaney
- Singapore Institute for Clinical Sciences, A*STAR, Singapore; Ludmer Centre for Neuroinformatics and Mental Health, Douglas Mental Health University Institute, McGill University, Montréal, Canada
| | - Hwee Lin Wee
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore
| | - Eric Yin-Hao Khoo
- Division of Endocrinology, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Song LLT, Venkataraman K, Gluckman P, Chong YS, Chee MWL, Khoo CM, Leow MK, Lee YS, Tai ES, Khoo EYH. Smaller size of high metabolic rate organs explains lower resting energy expenditure in Asian-Indian Than Chinese men. Int J Obes (Lond) 2015; 40:633-8. [PMID: 26568151 DOI: 10.1038/ijo.2015.233] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 07/28/2015] [Accepted: 08/10/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND In Singapore, the obesity prevalence is disproportionately higher in the Asian-Indians and Malays than the Chinese. Lower resting energy expenditure (REE) may be a contributory factor. OBJECTIVE We explored the association between ethnicity and REE in Chinese, Asian-Indian and Malay men living in Singapore and determined the influence of body composition, mass/volume of high metabolic rate organs, represented by brain volume and trunk fat-free mass (FFM), and physical activity on ethnic differences. DESIGN Two hundred and forty-four men from Singapore (n=100 Chinese, 70 Asian-Indians and 74 Malays), aged 21-40 years and body mass index of 18.5-30.0 kg m(-2), were recruited in this cross-sectional study. REE was assessed by indirect calorimetry and body composition by dual-energy X-ray absorptiometry. Brain volume was measured by magnetic resonance imaging. Physical activity was assessed by the Singapore Prospective Study Program Physical Activity Questionnaire. RESULTS REE was significantly lower in Asian-Indians compared with that in Chinese after adjusting for body weight. FFM (total, trunk and limb) and total fat mass were important predictors of REE across all ethnic groups. Brain volume was positively associated with REE only in Malays. Moderate and vigorous physical activity was positively associated with REE only in Asian-Indians and Malays. The difference in REE between Asian-Indians and Chinese was attenuated but remained statistically significant after adjustment for total FFM (59±20 kcal per day), fat mass (67±20 kcal per day) and brain volume (54±22 kcal per day). The association between REE and ethnicity was no longer statistically significant after total FFM was replaced by trunk FFM (which includes heart, liver, kidney and spleen) but not when it was replaced by limb FFM (skeletal muscle). CONCLUSIONS We have demonstrated a lower REE in Asian-Indians compared with Chinese who may contribute to the higher rates of obesity in the former. This difference could be accounted for by differences in metabolically active organs.
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Affiliation(s)
- L L T Song
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - K Venkataraman
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - P Gluckman
- Singapore Institute for Clinical Sciences, Singapore
| | - Y S Chong
- Department of Obstetrics and Gynaecology, National University of Singapore, Singapore
| | - M-W L Chee
- Center for Cognitive Neuroscience, Neuroscience and Behavioral Disorders Program, Duke-National University of Singapore Graduate Medical School, Singapore
| | - C M Khoo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Duke-National University of Singapore Graduate Medical School, Singapore.,Division of Endocrinology, National University Health System, Singapore
| | - M-Ks Leow
- Office of Clinical Sciences, Duke-National University of Singapore Graduate Medical School, Singapore
| | - Y S Lee
- Singapore Institute for Clinical Sciences, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Paediatric Endocrinology and Diabetes, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore
| | - E S Tai
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore.,Duke-National University of Singapore Graduate Medical School, Singapore.,Division of Endocrinology, National University Health System, Singapore
| | - E Y H Khoo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Endocrinology, National University Health System, Singapore
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Tan VMH, Lee YS, Venkataraman K, Khoo EYH, Tai ES, Chong YS, Gluckman P, Leow MKS, Khoo CM. Ethnic differences in insulin sensitivity and beta-cell function among Asian men. Nutr Diabetes 2015; 5:e173. [PMID: 26192451 PMCID: PMC4521178 DOI: 10.1038/nutd.2015.24] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 06/17/2015] [Accepted: 06/21/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Lean Asian Indians are less insulin sensitive compared with Chinese and Malays, but the pancreatic beta-cell function among these ethnic groups has yet to be studied in depth. We aimed to study beta-cell function in relation to insulin sensitivity among individuals of Chinese, Malay and Asian-Indian ethnicity living in Singapore. SUBJECTS AND METHODS This is a sub-group analysis of 59 normoglycemic lean (body mass index (BMI) <23 kg m(-)(2)) adult males (14 Chinese, 21 Malays and 24 Asian Indians) from the Singapore Adults Metabolism Study. Insulin sensitivity was determined using fasting state indices (homeostatic model assessment-insulin resistance), the euglycemic-hyperinsulinemic clamp (ISI-clamp) and a liquid mixed-meal tolerance test (LMMTT) (Matsuda insulin sensitivity index (ISI-Mat)). Beta-cell function was assessed using fasting state indices (homeostatic model assessment-beta-cell function) and from the LMMTT (insulinogenic index and insulin secretion index). The oral disposition index (DI), a measure of beta-cell function relative to insulin sensitivity during the LMMTT, was calculated as a product of ISI-Mat and insulin secretion index. RESULTS Asian Indians had higher waist circumference and percent body fat than Chinese and Malays despite similar BMI. Overall, Asian Indians were the least insulin sensitive whereas the Chinese were most insulin sensitive. Asian Indians had higher beta-cell function compared with Chinese or Malays but these were not statistically different. Malays had the highest incremental area under the curve for glucose during LMMTT compared with Asian Indians and Chinese. However, there were no significant ethnic differences in the incremental insulin area under the curve. The oral DI was the lowest in Malays, followed by Asian Indians and Chinese. CONCLUSION Among lean Asians, Chinese are the most insulin sensitive whereas Asian Indians are the least insulin sensitive. However, Malays demonstrate higher postprandial glucose excursion with lower beta-cell response compare with Chinese or Asian Indians. The paths leading to type 2 diabetes mellitus might differ between these Asian ethnic groups.
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Affiliation(s)
- V M H Tan
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore
- Department of Paediatric, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Y S Lee
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore
- Department of Paediatric, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Paediatric Endocrinology and Diabetes, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore
| | - K Venkataraman
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - E Y H Khoo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Endocrinology, Department of Medicine, National University Health System, Singapore
| | - E S Tai
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Endocrinology, Department of Medicine, National University Health System, Singapore
- Duke-NUS Graduate Medical School, Singapore
| | - Y S Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore
- Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - P Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore
- Liggins Institute, Auckland, New Zealand
| | - M K S Leow
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore
| | - C M Khoo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Endocrinology, Department of Medicine, National University Health System, Singapore
- Duke-NUS Graduate Medical School, Singapore
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11
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Co MA, Tan LSM, Tai ES, Griva K, Amir M, Chong KJ, Lee YS, Lee J, Khoo EYH, Wee HL. Factors associated with psychological distress, behavioral impact and health-related quality of life among patients with type 2 diabetes mellitus. J Diabetes Complications 2015; 29:378-83. [PMID: 25666950 DOI: 10.1016/j.jdiacomp.2015.01.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 12/19/2014] [Accepted: 01/17/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND Data on psychological distress (DIS), behavioral impact (BI) and health-related quality of life (HRQoL) are important yet lacking among Asian patients with Type 2 diabetes mellitus (T2DM). We aim to identify factors associated with DIS, BI and HRQoL among T2DM to better understand patient needs. METHODS DIS was measured with Diabetes Health Profile (DHP-18) Psychological Distress (DHP-PD) subscale, Problem Areas in Diabetes (PAID) and Kessler-10 (K10), BI with DHP-18 Barriers to Activity and Disinhibited Eating subscales and HRQoL with Audit of Diabetes-Dependent Quality of Life. Multiple linear regression analyses were performed to evaluate the associations between these outcomes and patient demographic, socioeconomic status, glycated hemoglobin (HbA1C) and comorbidities. RESULTS 213 T2DM patients (mean (SD) age: 45.0 (12.1) years, mean (SD) HbA1C: 8.3% (1.9%) and 70.0% reported at least one comorbidity) were evaluated. Poorer glycemic control was significantly associated with higher DHP-PD, PAID and worse HRQoL. Taking oral hypoglycemic agents plus insulin was independently associated with Barrier to Activity and Disinhibited Eating. CONCLUSION Poorer glycemic control was only associated with diabetes-related distress (measured by DHP-PD and PAID) but not major depressive disorder (measured by K10). It may be more appropriate to screen for diabetes-related distress rather than major depressive disorder for patients with T2DM.
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Affiliation(s)
- Michelle Ang Co
- Department of Medicine, National University Health System, Singapore
| | - Luor Shyuan Maudrene Tan
- School of Public Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - E Shyong Tai
- Department of Medicine, National University Health System, Singapore; School of Public Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Konstadina Griva
- Department of Psychology, National University of Singapore, Singapore
| | - Mohamed Amir
- Department of Psychology, National University of Singapore, Singapore
| | - Kok Joon Chong
- Department of Medicine, National University Health System, Singapore
| | - Yung Seng Lee
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jeannette Lee
- Department of Medicine, National University Health System, Singapore
| | - Eric Yin-Hao Khoo
- Department of Medicine, National University Health System, Singapore
| | - Hwee-Lin Wee
- Department of Pharmacy, National University of Singapore, Singapore.
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12
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Stephenson MC, Leverton E, Khoo EYH, Poucher SM, Johansson L, Lockton JA, Eriksson JW, Mansell P, Morris PG, MacDonald IA. Variability in fasting lipid and glycogen contents in hepatic and skeletal muscle tissue in subjects with and without type 2 diabetes: a 1H and 13C MRS study. NMR Biomed 2013; 26:1518-1526. [PMID: 23836451 DOI: 10.1002/nbm.2985] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 04/19/2013] [Accepted: 05/14/2013] [Indexed: 06/02/2023]
Abstract
The measurement of tissue lipid and glycogen contents and the establishment of normal levels of variability are important when assessing changes caused by pathology or treatment. We measured hepatic and skeletal muscle lipid and glycogen levels using (1)H and (13)C MRS at 3 T in groups of subjects with and without type 2 diabetes. Within-visit reproducibility, due to repositioning and instrument errors was determined from repeat measurements made over 1 h. Natural variability was assessed from separate measurements made on three occasions over 1 month. Hepatic lipid content was greater in subjects with diabetes relative to healthy subjects (p = 0.03), whereas levels of hepatic and skeletal muscle glycogen, and of intra- and extra-myocellular lipid, were similar. The single-session reproducibility values (coefficient of variation, CV) for hepatic lipid content were 12% and 7% in groups of subjects with and without diabetes, respectively. The variability of hepatic lipid content over 1 month was greater than the reproducibility, with CV = 22% (p = 0.08) and CV = 44% (p = 0.004) in subjects with and without diabetes, respectively. Similarly, levels of variation in basal hepatic glycogen concentrations (subjects with diabetes, CV = 38%; healthy volunteers, CV = 35%) were significantly larger than single-session reproducibility values (CV = 17%, p = 0.02 and CV = 13%, p = 0.05, respectively), indicating substantial biological changes in basal concentrations over 1 month. There was a decreasing correlation in measurements of both hepatic lipid and glycogen content with increasing time between scans. Levels of variability in intra- and extra-myocellular lipid in the soleus muscle, and glycogen concentrations in the gastrocnemius muscle, tended to be larger than expected from single-session reproducibility, although these did not reach significance.
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Affiliation(s)
- M C Stephenson
- Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
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13
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Yang PLS, Lu Y, Khoo CM, Leow MKS, Khoo EYH, Teo A, Lee YS, Das De S, Chong YS, Gluckman PD, Tai ES, Venkataraman K, Ng CMA. Associations between ethnicity, body composition, and bone mineral density in a Southeast Asian population. J Clin Endocrinol Metab 2013; 98:4516-23. [PMID: 24037892 DOI: 10.1210/jc.2013-2454] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT AND OBJECTIVE Chinese men in Singapore have a higher incidence of hip fractures than Malay and Indian men. We investigated whether there were corresponding ethnic differences in peak bone mineral density (BMD) in young men and whether differences in body composition influenced peak BMD. DESIGN AND SETTING This was a cross-sectional study of healthy volunteers in a tertiary medical center. PARTICIPANTS A total of 100 Chinese, 82 Malay, and 80 Indian men aged 21 to 40 years, with body mass index between 18 and 30 kg/m(2) underwent dual-energy x-ray absorptiometry to assess BMD, lean mass (LM) and fat mass (FM), and magnetic resonance imaging to quantify abdominal subcutaneous and visceral adipose tissue. Multiple linear regression models, with adjustment for age and height (as a proxy for skeletal size), were used. RESULTS Malay and Indian men had significantly higher BMD than Chinese men at the lumbar spine (Malay: B, 0.06 ± 0.02, P = .001; Indian: B, 0.03 ± 0.02, P = .049), femoral neck (Malay: B 0.04 ± 0.02, P = .034; Indian: B, 0.04 ± 0.02, P = .041), hip (Malay: B, 0.05 ± 0.02, P = .016; Indian: B, 0.06 ± 0.02, P = .001), and ultradistal radius (Malay: B, 0.03 ± 0.01, P < .001; Indian: B, 0.02 ± 0.01, P = .029), and this difference was retained after adjustment for LM and FM, except in Malay men at the femoral neck and in Indian men at the ultradistal radius. LM was an important independent determinant of BMD at all sites, whereas FM, subcutaneous adipose tissue, and visceral adipose tissue were not significantly associated with BMD at any site. CONCLUSIONS Lower peak BMD in Chinese men may partly explain the higher fracture incidence in this ethnic group. Further studies are needed to elucidate the reasons for these ethnic differences in bone accumulation.
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Affiliation(s)
- P L S Yang
- The Endocrine Clinic, Mount Elizabeth Medical Centre, 3 Mount Elizabeth, No. 17-08, Singapore 228510.
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14
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Venkataraman K, Kao SL, Thai AC, Salim A, Lee JJM, Heng D, Tai ES, Khoo EYH. Ethnicity modifies the relation between fasting plasma glucose and HbA1c in Indians, Malays and Chinese. Diabet Med 2012; 29:911-7. [PMID: 22283416 PMCID: PMC3504343 DOI: 10.1111/j.1464-5491.2012.03599.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2012] [Indexed: 12/22/2022]
Abstract
AIMS To study whether HbA(1c) , and its relationship with fasting plasma glucose, was significantly different among Chinese, Malays and Indians in Singapore. METHODS A sample of 3895 individuals without known diabetes underwent detailed interview and health examination, including anthropometric and biochemical evaluation, between 2004 and 2007. Pearson's correlation, analysis of variance and multiple linear regression analyses were used to examine the influence of ethnicity on HbA(1c) . RESULTS As fasting plasma glucose increased, HbA(1c) increased more in Malays and Indians compared with Chinese after adjustment for age, gender, waist circumference, serum cholesterol, serum triglyceride and homeostasis model assessment of insulin resistance (P-interaction < 0.001). This translates to an HbA(1c) difference of 1.1 mmol/mol (0.1%, Indians vs. Chinese), and 0.9 mmol/mol (0.08%, Malays vs. Chinese) at fasting plasma glucose 5.6 mmol/l (the American Diabetes Association criterion for impaired fasting glycaemia); and 2.1 mmol/mol (0.19%, Indians vs. Chinese) and 2.6 mmol/mol (0.24%, Malays vs. Chinese) at fasting plasma glucose 7.0 mmol/l, the diagnostic criterion for diabetes mellitus. CONCLUSIONS Using HbA(1c) in place of fasting plasma glucose will reclassify different proportions of the population in different ethnic groups. This may have implications in interpretation of HbA(1c) results across ethnic groups and the use of HbA(1c) for diagnosing diabetes mellitus.
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Affiliation(s)
- K Venkataraman
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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15
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Khoo EYH, Wallis J, Tsintzas K, Macdonald IA, Mansell P. Effects of exenatide on circulating glucose, insulin, glucagon, cortisol and catecholamines in healthy volunteers during exercise. Diabetologia 2010; 53:139-43. [PMID: 19898831 DOI: 10.1007/s00125-009-1579-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Accepted: 09/24/2009] [Indexed: 10/20/2022]
Abstract
AIMS/HYPOTHESIS Exenatide, a glucagon like peptide-1 agonist, is a treatment for type 2 diabetes mellitus that stimulates insulin and suppresses glucagon secretion in a glucose-dependent manner. By contrast, during aerobic exercise, the serum insulin concentration normally falls, with a rise in plasma glucagon. We therefore assessed whether exenatide might predispose to hypoglycaemia during exercise. METHODS We studied eight non-diabetic men, who were 35.3 +/- 6.3 years of age with BMI of 24.7 +/- 1.7 kg/m(2) (mean +/- SD), using a randomised, crossover, double-blind design investigation. After an overnight fast, participants received 5 microg of subcutaneous exenatide or placebo and rested for 105 min before cycling at 60% of their maximal oxygen uptake (VO(2max)) for 75 min and then recovering for a further 60 min. RESULTS The insulin/glucagon molar ratio rose with exenatide at rest (p < 0.01), then fell during exercise with placebo and with exenatide. At rest, fasting blood glucose fell by approximately 1 mmol/l with exenatide to a nadir of 3.4 +/- 0.1 mmol/l (p < 0.01). During exercise, blood glucose fell with placebo but, unexpectedly, rose with exenatide. Plasma adrenaline (epinephrine) and noradrenaline (norepinephrine), but not cortisol concentrations increased to a greater extent during exercise after exenatide. No participant developed symptomatic hypoglycaemia and the lowest individual blood glucose recorded was 2.8 mmol/l with exenatide at 50 min in the pre-exercise period. CONCLUSIONS/INTERPRETATION In non-diabetic participants given exenatide, blood glucose concentrations rise rather than fall during aerobic exercise with an associated greater catecholamine response.
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Affiliation(s)
- E Y H Khoo
- Department of Diabetes and Endocrinology, Nottingham University Hospitals, Queens Medical Centre Campus, Nottingham NG7 2UH, UK
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16
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Kennedy RL, Khoo EYH. New options for drug treatment of obesity in patients with Type 2 diabetes. Diabet Med 2005; 22 Suppl 4:23-6. [PMID: 16109016 DOI: 10.1111/j.1464-5491.2005.1761h.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- R L Kennedy
- Department of Medicine, James Cook University, Queensland, Australia
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