Risk of development of diabetes mellitus in Chinese women with persistently impaired glucose tolerance after gestational diabetes
|
|
- Darrell Hawkins
- 5 years ago
- Views:
Transcription
1 O R I G I N A L A R T I C L E Risk of development of diabetes mellitus in Chinese women with persistently impaired glucose tolerance after gestational diabetes KF Lee Maria WH Mak KO Lau Harriet HY Chung 李家輝麥慧嫻劉建安鍾巧儀 Key words Diabetes, gestational; Glucose intolerance; Metabolic syndrome; Pregnancy in diabetics; Prevalence Hong Kong Med J 2011;17: Department of Medicine and Geriatrics, Kwong Wah Hospital, 25 Waterloo Road, Hong Kong KF Lee, FRCP, FHKAM (Medicine) MWH Mak, MRCP, FHKAM (Medicine) KO Lau, MBA, APN (DM) HHY Chung, MSc, NS (DM) Correspondence to: Dr KF Lee leekf1@ha.org.hk Introduction Objectives To estimate the cumulative incidence for the development of diabetes mellitus in Chinese women with persistently impaired glucose tolerance after gestational diabetes, and evaluate putative risk factors. Design Historical cohort study. Setting A regional hospital in Hong Kong. Patients Women with postpartum impaired glucose tolerance (as confirmed by a 75-gram oral glucose tolerance test 6 weeks after delivery) seen between January 2000 and December Results After a mean follow-up period of 52 (standard deviation, 22; range, ) months, 47 (20%) of the 238 women converted to diabetes mellitus. Concomitant postpartum impaired fasting plasma glucose levels increased the risk of future diabetes mellitus by 3.5-fold (95% confidence interval, ; P=0.001) when compared to those with postpartum impaired glucose tolerance only. Based on multivariate analysis, only antepartum and postpartum fasting plasma glucose levels predicted future development of diabetes mellitus. At 1 year after delivery in 95/159 (60%) of the women, glucose tolerance regressed to normal, while in only 9/159 (6%) it progressed to diabetes mellitus. At this stage, 29% of those with impaired glucose regulation (impaired glucose tolerance, impaired fasting glucose or both) compared to 2% of those whose glucose tolerance reverted to normal developed diabetes mellitus upon subsequent followup (P<0.001). In all, 24/159 (15%) fulfilled the definition of metabolic syndrome and its presence was associated with 4.7- fold increased risk of future diabetes mellitus (95% confidence interval, ; P=0.004). Conclusions Women with persistent postpartum impaired glucose tolerance after gestational diabetes have a high risk of developing diabetes mellitus. However, a significant proportion of these women regress to normal glucose tolerance 1 year after delivery, and their risk of progression to diabetes mellitus is lower than those with persistent impaired glucose regulation. Therefore, women with a history of gestational diabetes, particularly those with persistent glucose intolerance 6 weeks and 1 year after delivery, should have regular surveillance for the development of diabetes mellitus. Depending on the prevalence of type 2 diabetes in a given population or ethnic group, gestational diabetes mellitus (GDM) is present in 0.6 to 15% of subjects, and has been shown to increase the risk of later diabetes mellitus (DM). 1,2 However, the reported rates of progression to DM vary widely from 3 to 70%, which were probably related to differences in GDM and DM definitions, tests for glucose tolerance, length of follow-up, retesting rates, selection biases, and ethnicity. 3 Although the local incidence of GDM was high (14% per year, based on 1998 World Health Organization [WHO] criteria) as reported by Ko et al, 4 reported incidence estimates of subsequent DM were limited. 5-7 As there is a growing body of Hong Kong Med J Vol 17 No 3 # June 2011 # 195
2 # Lee et al # 分娩後呈持續性葡萄糖耐受不良的妊娠期糖尿病華籍婦女的糖尿病風險 目的估計分娩後呈持續性葡萄糖耐受不良的妊娠期糖尿病華籍婦女, 其糖尿病風險的累積發病率, 以及評估其假定風險因素 設計歷史性隊列研究 安排香港一所分區醫院 患者 2000 年 1 月至 2006 年 12 月期間, 於分娩後六星期接受 75 克口服葡萄糖耐受試驗而確診為葡萄糖耐受不良的婦女 結果隨訪期平均為 52 個月 ( 標準差 22 個月 ; 介乎 12 至 106 個月 ) 結果發現 238 名婦女中,47 名 (20%) 患上糖尿病 與分娩後只呈葡萄糖耐受不良的婦女比較, 同時有分娩後空腹血糖高的婦女日後患糖尿病的風險高出 3.5 倍 (95% 置信區間 : ;P=0.001) 多元分析顯示, 只有分娩前及分娩後的空腹血糖水平可以預計日後的糖尿病風險 於分娩一年後接受檢查的婦女共 159 人, 其中 95 人 (60%) 已回復正常耐糖狀態, 另 9 人 (6%) 發展至糖尿病 在此階段, 葡萄糖調節不良 ( 包括葡萄糖耐受不良 高空腹血糖水平 或者兩者兼備 ) 的婦女中有 29% 最終會發展至糖尿病, 而回復正常耐糖狀態的婦女中則只有 2% 最終會發展至糖尿病 (P<0.001) 159 人中,24 人 (15%) 附合代謝症候群的定義, 有此症候群的婦女日後患糖尿病的風險要高出 4.7 倍 (95% 置信區間 : ; P=0.004) 結論分娩後呈持續性葡萄糖耐受不良的妊娠期糖尿病華籍婦女, 日後患有糖尿病的風險較高 可是, 亦有大部分婦女於分娩一年後回復正常耐糖狀態 ; 與呈持續性葡萄糖耐受不良的婦女比較, 回復正常耐糖狀態的婦女日後患糖尿病的風險相對較低 因此, 有妊娠期糖尿病的婦女, 尤其是那些於分娩後六個星期及一年仍然有持續性葡萄糖耐受不良的人, 應定期接受糖尿病檢查 evidence suggesting effective treatment including lifestyle and pharmacological intervention can delay the development of DM in women with previous GDM, 8 it is important to determine the cumulative incidence of DM accurately by following up patients over a longer period of time. Moreover, identification of multiple antepartum and postpartum predictors for future DM development is also important for the selection of high-risk women undergoing more intensive surveillance. 9 In view of high local prevalence of GDM, this seems to be a more cost-effective approach for screening. We therefore conducted a local study on a cohort of Chinese women with postpartum impaired glucose tolerance (IGT), aiming to estimate the cumulative incidence of DM and evaluate risk factors for its development. Methods Subjects The study population was derived from a cohort of 388 patients with postpartum IGT after GDM, being followed up (from January 2000 to December 2006) in the Diabetes Centre of Kwong Wah Hospital. In Kwong Wah Hospital, women with GDM or gestational IGT, as defined by WHO 1998 criteria, 10 were advised to return for a 75-gram oral glucose tolerance test (OGTT) between 4 and 8 weeks after delivery in the Department of Obstetrics and Gynaecology postnatal clinic. Women diagnosed to have DM were referred to the medical diabetes clinic, while those diagnosed to have IGT were referred to the diabetes nurse clinic for standard diabetes education and regular follow-up. The latter women were advised to return annually for a 75-gram OGTT and metabolic assessment including sitting blood pressure (BP) measurement, anthropometric measurement (body mass index [BMI] and waist circumference [WC]), and biochemical measurements (fasting lipid profile, glycosylated haemoglobin [HbA1c], electrolyte and serum creatinine, and liver enzymes). Due to limited resources, women with normal postpartum glucose tolerance were discharged after standard diabetes education but no subsequent follow-up was arranged. Of the 388 women, 238 (61%) had returned to the diabetes nurse clinic at least once before December 2008 and were included in the analysis. The women were followed up until their last visit before December 2008, or until they reached the study endpoint, diabetes, as defined by WHO 1998 criteria. 10 For patients who developed GDM in subsequent pregnancies during the follow-up period, for the purpose of analysis, the first pregnancy was regarded as the index pregnancy. Demographic data including age, family history of diabetes, smoking and drinking history were retrieved from clinical records. Antepartum variables including parity, insulin use during pregnancy, neonatal birth weight, and gestation were also retrieved from clinical records during their first postpartum visit. The glucose tolerance test result at 28 weeks of gestation was taken as the antepartum glycaemic variable. Definitions Antepartum and postpartum 75-gram OGTT results were defined by WHO (1998) criteria 10 ; DM was defined as a fasting blood glucose (FBG) 7.0 mmol/l and/or a 2-hour post-load glucose 11.1 mmol/l, and IGT was defined as a FBG <7.0 mmol/l and a 2-hour post-load glucose of 7.8 to 11.1 mmol/l. Impaired fasting glucose (IFG) was defined according to American Diabetes Association criteria 11 as a FBG Hong Kong Med J Vol 17 No 3 # June 2011 #
3 # Gestational diabetes mellitus and type 2 diabetes # mmol/l but <7.0 mmol/l. A normal glucose tolerance (NGT) was defined as a FBG <5.6 mmol/l and 2-hour post-load glucose <7.8 mmol/l. Metabolic syndrome was defined according to International Diabetes Federation criteria, 12 as central obesity (defined as WC 80 cm for Chinese women) plus any two of the following four features. They were: (1) raised blood triglyceride level >1.7 mmol/l, or specific treatment for this lipid abnormality; (2) reduced high-density lipoprotein level <0.9 mmol/l in males and <1.1 mmol/l in females, or specific treatment for this lipid abnormality; (3) raised BP with systolic BP 130 or diastolic BP 85 mm Hg, or treatment of previously diagnosed hypertension; and (4) a FBG 5.6 mmol/l, or previously diagnosed type 2 diabetes. As all women had undergone 75-gram OGTT, those with IFG ( 5.6 mmol/l) and/or IGT (2-hour post-ogtt plasma glucose of 7.8 to 11.1 mmol/l) were included as criteria for the metabolic syndrome. Statistical analysis Cohort characteristics were described for categorical variables by n (%) and for continuous variables using mean ± standard deviation (SD) or median (interquartile range) according to their distribution. Group comparisons of continuous variables were by the Student s t-test or the Mann Whitney U test, where appropriate. Group comparisons of categorical data entailed Chi squared or Fisher s exact tests, as appropriate. The Cox proportional hazards regression analysis was used to examine the relationship between demographic, antepartum, postpartum and metabolic variables and the development of diabetes during follow-up. As the exact time of DM development was not ascertainable (due to irregular follow-up), it was estimated as the mid-point in time between the date of diagnosis (by 75-gram OGTT) and the date of the preceding test (by 75-gram OGTT) that yielded no DM. The date of first postpartum 75-gram OGTT was chosen as the point of entry for calculation of follow-up duration. A separate analysis was performed for women who had their first nurse clinic visit about 1 year after their postpartum 75-gram OGTT, in order to assess the association of various metabolic and anthropometric variables at this time and the subsequent development of diabetes. All analyses were performed with Statistical Package for the Social Sciences (Windows version 13.0; SPSS Inc, Chicago [IL], US). All reported P values were two-sided. Results Main cohort After a mean ± SD follow-up of 52 ± 22 (range, ) months, 47 (20%) out of 238 women (mean age at delivery, 34 ± 4 years) with postpartum IGT developed type 2 DM. The cumulative incidence was 7.5% (14 out of 186 women) after a mean follow-up of 19 ± 14 months. Regarding these women, 93% had a follow-up period exceeding 2 years and 82% had more than one visit after their 6-week postpartum OGTT. Of these 238 women who had postpartum IGT, 47 (20%) also had concomitant IFG; 18 (38%) of these 47 converted to DM while only 29 (15%) of the 191 women with only IGT developed DM eventually. Therefore, the co-existence of postpartum IFG on top of IGT further increased the risk of future DM by 3.5-fold (unadjusted odds ratio; 95% confidence interval, ; P=0.001). Table 1 shows a comparison of antepartum and postpartum characteristics in those who developed DM and those remained non-diabetic at the end of the study, using univariate analysis. Most of the metabolic variables were not measured because only a postpartum 75-gram OGTT was performed in the busy postnatal clinic. Apart from the antepartum and postpartum glycaemic variables, older age, higher parity and higher BMI were associated with the development of DM. Insulin use during pregnancy, representing the extent of underlying glucose disturbance, also yielded a significant predictive value. Based on multivariate regression analysis using the Cox proportional hazard model, only antepartum and postpartum fasting plasma glucose remained statistically significant predictors of DM (Table 2). TABLE 1. Antepartum and postpartum risk factors for the development of diabetes mellitus (DM) in 238 women with postpartum impaired glucose tolerance Variable* DM (n=47) Non-DM (n=191) P value Age at delivery (years) 34.1 ± ± Parity 1.83 ± ± Positive family history of DM 24 (51%) 74 (39%) 0.13 Smoking 2 (4%) 10 (5%) 0.78 Alcohol 2 (4%) 5 (3%) 0.56 Insulin use during pregnancy 8 (17%) 10 (5%) 0.01 Antepartum fasting plasma glucose Antepartum 2-hour post 75-gram OGTT plasma glucose 5.4 ( ) 4.6 ( ) < ( ) 9.0 ( ) <0.001 Birth weight (kg) 3.19 ± ± BMI at postpartum OGTT (kg/m 2 ) 25.6 ± ± Postpartum fasting plasma glucose Postpartum 2-hour post 75-gram OGTT plasma glucose 5.4 ( ) 4.9 ( ) < ( ) 8.8 ( ) * OGTT denotes oral glucose tolerance test, and BMI body mass index Data are shown as mean ± standard deviation, No. (%), or median (interquartile range) Hong Kong Med J Vol 17 No 3 # June 2011 # 197
4 # Lee et al # Subgroup analysis Glycaemic variables Of these 238 women with postpartum IGT, 159 (67%) had their first diabetic nurse clinic visit about 1 year (mean duration, 1.1 ± 0.4 years) after delivery. Their demographic, antepartum and postpartum characteristics were not statistically different from those of other women not turning up during that period (data not shown). Of these 159 women with postpartum IGT, glucose tolerance status of 95 (60%) had regressed to NGT, while only 9 (6%) progressed to diabetes. As shown in Table 3, glycaemic variables except HbA1c (fasting plasma glucose and 2-hour post 75-gram OGTT plasma glucose) measured during this period still showed a significant TABLE 2. Multivariate regression analysis of antepartum and postpartum variables in predicting the development of diabetes in 238 women with postpartum impaired glucose tolerance Variable Antepartum fasting plasma glucose Postpartum fasting plasma glucose Adjusted hazard ratio* (95% confidence interval) P value 1.93 ( ) < ( ) 0.03 * Adjusted hazard ratio from time-dependent Cox proportional hazard models using stepwise regression analysis independent variables entered for analysis included age at delivery, parity, insulin use during pregnancy, antepartum and postpartum fasting plasma glucose and 2-hour post 75-gram oral glucose tolerance test (OGTT) plasma glucose, and post-delivery body mass index. The time of diabetes development was estimated as the mid-point in time between the diagnosis (by OGTT) and the date of the immediate past OGTT TABLE 3. Metabolic risk factors at 1 year post-delivery for the development of diabetes in a subgroup of 150 women with persistent impaired glucose tolerance after gestational diabetes mellitus (DM) Variable* DM (n=18) Non-DM (n=132) P value BMI (kg/m 2 ) 23.6 ± ± WC (cm) 76.5 ± ± Systolic BP (mm Hg) ± ± Diastolic BP (mm Hg) 69.4 ± ± Fasting plasma glucose 2-hour post 75-gram OGTT plasma glucose 5.6 ± ± 0.5 < ± ± HbA1c (%) 5.5 ± ± Plasma triglyceride 1.3 ( ) 0.9 ( ) 0.37 Plasma LDL-C 2.6 ± ± Plasma HDL-C 1.3 ( ) 1.4 ( ) 0.49 Aspartate transaminase (IU/L) 17.0 ( ) 17.5 ( ) 0.38 Alanine transaminase (IU/L) 15.0 ( ) 16.5 ( ) 0.55 Metabolic syndrome 6 (33%) 9 (7%) * BMI denotes body mass index, WC waist circumference, BP blood pressure, OGTT oral glucose tolerance test, HbA1c glycosylated haemoglobin, LDL-C low-density lipoprotein cholesterol, and HDL-C high-density lipoprotein cholesterol Data are shown as mean ± standard deviation, No. (%), or median (interquartile range) association with DM development at the end of the study. In fact, the glycaemic status during this time determined the probability of developing future DM as shown in the Figure. Only two (2%) of the 95 women with NGT 1 year post-delivery converted to DM, while five of 13 (38%) with IFG and IGT 1 year post-delivery developed DM during subsequent follow-up (P<0.001 by Fisher s exact test). Six (23%; n=26) of the women with IGT only, and five (31%; n=16) with IFG only at this stage eventually developed DM (P=0.001 for both when compared to women having NGT by Fisher s exact test). Overall, 16 (29%; n=55) of women with abnormal glucose regulation (IGT, IFG, or both) eventually developed DM (P=0.001 vs women with NGT, by Fisher s exact test). Metabolic syndrome All women in this subgroup had full metabolic assessments as already described. Within this subgroup, 24 (15%; n=159) fulfilled the definition of metabolic syndrome. All nine women who developed DM at this stage also had metabolic syndrome. As shown in Table 3, apart from the glycaemic variables, the presence of metabolic syndrome at this stage increased the risk of future DM by 4.7-fold (unadjusted odds ratio; 95% confidence interval, ; P=0.004). However, individual metabolic parameters such as BMI, WC, systolic BP, diastolic BP, liver transaminase levels, plasma triglycerides, plasma low-density-lipoprotein cholesterol and high-density-lipoprotein cholesterol showed no significant association in the univariate analysis. Using multivariate regression analysis with the Cox proportional hazard model, only fasting plasma glucose and the 2-hour post 75-gram OGTT plasma glucose at 1 year after delivery remained statistically significant predictors of DM (Table 4). Discussion Incidence of type 2 diabetes Gestational diabetes mellitus, defined as glucose intolerance first detected during pregnancy, is recognised as a risk factor for adverse perinatal outcome and later development of type 2 diabetes. A recent meta-analysis confirmed that women with GDM had approximately a 7-fold increased risk of developing type 2 diabetes compared to those without GDM. 2 Furthermore, the Diabetes Prevention Program found that women with a self-reported history of GDM and IGT had a 74% increased risk of developing type 2 diabetes compared to a cohort of women with IGT but no history of GDM, even after adjusting for age. 8 The reported cumulative incidence of DM in women with a history of GDM varies from 3% to 70%. The difference in rates of progression between different ethnic groups was probably due 198 Hong Kong Med J Vol 17 No 3 # June 2011 #
5 # Gestational diabetes mellitus and type 2 diabetes # to the different definition of GDM and DM, different tests for glucose tolerance, different lengths of follow-up, different retesting rates and selection biases. 3 Using the WHO (1998) criteria, 7.5% and 20% of Chinese women with GDM and postpartum IGT in our study developed DM after a mean follow-up of 1.6 years and 4.3 years, respectively. This finding seems comparable to a study on 671 Latino women, 13 in which 22% with GDM developed type 2 diabetes after 5 to 7 years follow-up. However, their study included women with normal and abnormal glucose tolerance at the 4 to 16 weeks postpartum examination. In these Latino women with postpartum IGT and NGT as defined by WHO criteria, the respective 5-year unadjusted cumulative rates for the incidence of DM were 80% and 12%. Therefore we expected a lower cumulative incidence in our study if women with GDM and postpartum NGT were included. When compared with the Caucasian population, 14 they had a lower cumulative incidence of DM (19% nine years after delivery), though the reported rate might be an underestimate as the development of DM was based on self-reporting or hospital records. Although it is difficult to compare the risk of DM development with another local prospective study 7 because of different inclusion criteria and methods of analysis, our GDM patients seem to have a higher conversion rate to DM. The cumulative incidence of DM in our patients was 20% after a mean follow-up of 4.3 years, while 9.0% of their patients converted to DM within 8 years of delivery related to the index pregnancy. This was possibly because our study was limited to patients with postpartum IGT only. Due to limitations posed by our study design, a significant proportion of women might have had a delayed diagnosis of DM conversion, because they did not turn up regularly for testing. As a result, our cumulative incidence might be an underestimate. Selection bias were also possible; only 238 (61%) of 388 of eligible women turned up for at least one visit after their postpartum examination, but there were even lower turnout rates in similar studies. 13,15 Risk factors for type 2 diabetes Factors associated with long-term development of type 2 diabetes have been examined in various studies using univariate or multivariate analysis. 3,5,9,13,15-17 The fasting plasma glucose encountered with an OGTT during pregnancy was the strongest independent predictive factor in the majority of studies. Other factors such as the degree of antepartum and postpartum glucose intolerance, HbA1c level during pregnancy, gestational age at the diagnosis of GDM, maternal BMI (before, during, or after pregnancy), maternal age, parity, insulin use during pregnancy, family history of diabetes, prior history of GDM, and specific measure for β-cell % of women developing DM 100% 80% 60% 40% 20% 0% P=0.001* P=0.001* P<0.001* 2% 23% 31% 38% NGT igt ifg igt+ifg Glycaemic status at 1 year post-delivery * Comparison between different groups was tested by Chi squared or Fisher s exact test, where appropriate FIG. Glycaemic status at 1 year post-delivery and its association with final diabetes mellitus (DM) development NGT denotes normal glucose tolerance, IGT impaired glucose tolerance, and IFG impaired fasting glucose function such as HOMA-β (homeostasis model assessment of β-cell function), insulinogenic index and disposition index were also associated with DM development. Notably, most associations were lost upon multivariate analysis. Similarly, our study also showed that antepartum and the 6-week postpartum fasting plasma glucose were the only independent risk factors for DM development. As expected, insulin use during pregnancy, which reflected the Final glycaemic status Non-DM TABLE 4. Multivariate regression analysis of metabolic risk factors at 1 year postdelivery for the development of diabetes in a subgroup of 150 women with persistent impaired glucose tolerance after gestational diabetes mellitus Variable Adjusted hazard ratio* (95% confidence interval) P value Fasting plasma glucose at 1 year post-delivery 2-Hour post 75-gram OGTT plasma glucose at 1 year postdelivery * Adjusted hazard ratio from time-dependent Cox proportional hazard models using stepwise regression analysis independent variables entered for analysis included age at delivery, parity, fasting plasma glucose and 2-hour post 75-gram oral glucose tolerance test (OGTT) plasma glucose at 1 year post-delivery, and the presence of metabolic syndrome. The time of diabetes development was estimated as the mid-point in time between the diagnosis (by OGTT) and the date of the immediate past OGTT DM 3.25 ( ) ( ) 0.04 Hong Kong Med J Vol 17 No 3 # June 2011 # 199
6 # Lee et al # degree of glucose intolerance at this stage, was predictive in DM development in the univariate analysis. Furthermore, the concomitant presence of IFG at this stage increased the risk of future DM in our patients (3.5-fold). Therefore, we think that the postpartum glucose tolerance test is important not only for diagnosing women with pre-existing DM, but also as a means of selecting high-risk subjects for more intensive DM screening. Due to limited referral criteria and hence the inclusion criteria, in the present study, women with IFG only were not followed up and hence their natural history could not be delineated. Because of the significant predictive power of fasting plasma glucose, we recommend that women with postpartum IFG only should be followed up like those with postpartum IGT. As in another local study, 5 60% of our patients with initial postpartum IGT reverted to NGT and only 6% progressed to diabetes within 1 year of delivery. This interesting finding suggests that the exaggerated insulin resistance of pregnancy takes time to abate. Assessing the glucose tolerance level 1-year postdelivery may provide additional information for later development of type 2 diabetes. This was shown in our study that women with IGT, IFG or both 1-year post-delivery had a higher conversion rate to type 2 diabetes than those who regressed to NGT at the same stage. Metabolic assessment at this stage revealed that 15% of the women had metabolic syndrome, and its presence was associated with 4.7-fold increased risk of developing DM. Since individual metabolic parameters were not associated with the development of DM, the predictive power of the syndrome was largely attributable to glucose intolerance. This was confirmed by the loss of significant predictive power of metabolic syndrome upon multivariate analysis with other independent variables such as fasting and 2-hour post 75-gram OGTT plasma glucose levels. Nevertheless, women with metabolic syndrome constitute another highrisk group deserving intensive screening. These findings were comparable to a local study of 801 Chinese women with a history of GDM. 6 The latter study found that women with a GDM history had more adverse cardiovascular risk factors, including higher BP, dysglycaemia and dyslipidaemia than controls, even after adjustment for age, BMI, and smoking history. As only 48 (of 238) and 18 (of 150) patients in the main and subgroup analyses developed DM respectively, our study was not sufficiently powered to examine independent effects of multiple risk factors for DM by multivariate regression analysis. Therefore, our findings need to be confirmed in a larger prospective study with regular follow-up. Implication for postpartum screening Although our study focused only on women with GDM and postpartum IGT and excluded those with GDM but NGT postpartum, our findings support recommendations for metabolic assessments after GDM, as suggested in the Fifth International Workshop-Conference on GDM. 18 The panel recommended a 75-gram OGTT early postpartum, 1 year postpartum and at a minimum, every 3 years thereafter. Based on our findings, metabolic assessment 1 year postpartum is pivotal in further refining a screening strategy. We recommend that women with persistent glucose intolerance 1 year postpartum should have more intensive metabolic screening (possibly every year), while women with NGT at this stage can be screened every 3 years. As women with IGT and previous GDM were 50% less likely to progress to type 2 diabetes when treated with metformin, 8 vigorous metabolic screening is mandatory. Although a well-defined and structured screening protocol is available, its success largely depends on public awareness and attendance rates. When co-ordinated with postpartum visits, the default rate for immediate postpartum glucose tolerance testing can be minimised. 18 As in our study however, the attendance rate for subsequent follow-up drops off significantly. Measures should be formulated to enhance compliance to the screening programme. A nurse-led clinic provides a one-stop service involving education, metabolic assessment, and screening could be a cost-effective way to enforce the screening programme. With better coordination with obstetricians, more public awareness promotion and automated re-call systems, screening rates can be improved. Conclusions In this cohort study, 20% of Chinese women with GDM and postpartum IGT developed type 2 diabetes after a mean follow-up of 4.3 years. Fasting plasma glucose levels during and 6 weeks after pregnancy were the strongest independent risk factor for DM development. Even though a significant proportion of these women reverted to NGT 1 year after delivery, those retaining persistent glucose intolerance had a particularly high rate of conversion to type 2 diabetes. The presence of metabolic syndrome at this stage was also associated with future DM development. Therefore, repeating the OGTT and metabolic assessment at 1 year after delivery are strongly recommended in the follow-up programme, in order to provide more cost-effective surveillance for future DM. As the use of lifestyle modification and pharmacological interventions for preventing diabetes are gaining more evidence, systematic postpartum surveillances of women with GDM represents a golden opportunity for improving the diagnosis and prevention of type 2 diabetes. 200 Hong Kong Med J Vol 17 No 3 # June 2011 #
7 # Gestational diabetes mellitus and type 2 diabetes # References 1. Diabetes and impaired glucose tolerance in women aged years. World Health Organization Ad Hoc Diabetes Reporting Group. World Health Stat Q 1992;45: Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet 2009;373: Kim C, Newton KM, Knopp RH. Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care 2002;25: Ko GT, Tam WH, Chan JC, Rogers M. Prevalence of gestational diabetes mellitus in Hong Kong based on the 1998 WHO criteria. Diabet Med 2002;19: Lam KS, Li DF, Lauder IJ, Lee CP, Kung AW, Ma JT. Prediction of persistent carbohydrate intolerance in patients with gestational diabetes. Diabetes Res Clin Pract 1991;12: Ko GT, Chan JC, Tsang LW, Li CY, Cockram CS. Glucose intolerance and other cardiovascular risk factors in Chinese women with a history of gestational diabetes mellitus. Aust N Z J Obstet Gynaecol 1999;39: Tam WH, Yang XL, Chan JC, et al. Progression to impaired glucose regulation, diabetes and metabolic syndrome in Chinese women with a past history of gestational diabetes. Diabetes Metab Res Rev 2007;23: Ratner RE, Christophi CA, Metzger BE, et al. Prevention of diabetes in women with a history of gestational diabetes: effects of metformin and lifestyle intervention. J Clin Endocrinol Metab 2008;93: Ratner RE. Prevention of type 2 diabetes in women with previous gestational diabetes. Diabetes Care 2007;30 Suppl 2:S Erratum in: Diabetes Care 2007;30: World Health Organization. Definition, diagnosis and classification of diabetes mellitus and its complications: report of a WHO consultation. Geneva: WHO; American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2006;29 Suppl 1:S IDF worldwide definition of metabolic syndrome. International Diabetes Federation website: org/metabolic_syndrome. Accessed Dec Kjos SL, Peters RK, Xiang A, Henry O, Montoro M, Buchanan TA. Predicting future diabetes in Latino women with gestational diabetes. Utility of early postpartum glucose tolerance testing. Diabetes 1995;44: Feig DS, Zinman B, Wang X, Hux JE. Risk of development of diabetes mellitus after diagnosis of gestational diabetes. CMAJ 2008;179: Steinhart JR, Sugarman JR, Connell FA. Gestational diabetes is a herald of NIDDM in Navajo women. High rate of abnormal glucose tolerance after GDM. Diabetes Care 1997;20: Ekelund M, Shaat N, Almgren P, Groop L, Berntrop K. Prediction of postpartum diabetes in women with gestational diabetes mellitus. Diabetologia 2010;53: Schaefer-Graf UM, Buchanan TA, Xiang AH, Peters RK, Kjos SL. Clinical predictors for a high risk for the development of diabetes mellitus in the early puerperium in women with recent gestational diabetes mellitus. Am J Obstet Gynecol 2002;186: Metzger BE, Buchanan TA, Coustan DR, et al. Summary and recommendations of the Fifth International Workshop- Conference on Gestational Diabetes Mellitus. Diabetes Care 2007;30 Suppl 2:S Erratum in: Diabetes Care 2007;30:3154. Hong Kong Med J Vol 17 No 3 # June 2011 # 201
Surveillance and outcome of liver metastasis in patients with colorectal cancer who had undergone curative-intent operation
O R I G I N A L A R T I C L E KC Cheng YP Yeung Patrick YY Lau William CS Meng 鄭繼志楊玉鵬劉應裕蒙家興 Surveillance and outcome of liver metastasis in patients with colorectal cancer who had undergone curative-intent
Using the 100-g Oral Glucose Tolerance Test to Predict Fetal and Maternal Outcomes in Women with Gestational Diabetes Mellitus
Original Article 283 Using the 100-g Oral Glucose Tolerance Test to Predict Fetal and Maternal Outcomes in Women with Gestational Diabetes Mellitus Chia-Hung Lin, MD; Shih-Fen Wen, BSc; Ya-Hui Wu, BSc;
Total knee arthroplasty for primary knee osteoarthritis: changing pattern over the past 10 years
O R I G I N A L A R T I C L E CH Yan KY Chiu FY Ng 忻振凱曲廣運吳富源 Total knee arthroplasty for primary knee osteoarthritis: changing pattern over the past 1 years CME Objective To review the epidemiology of
Size, location, and multiplicity of ruptured intracranial aneurysms in the Hong Kong Chinese population with subarachnoid haemorrhage
O R I G I N A L A R T I C L E HP Lai 賴曉平 KM Cheng 鄭建明 Simon CH Yu 余俊豪 KM Au Yeung 歐陽啟明 YL Cheung CM Chan WS Poon WM Lui 張毓靈陳智明潘偉生呂偉文 Key words Aneurysm, ruptured; Intracranial aneurysm; Subarachnoid hemorrhage
Uncertainty of Measurement Application to Laboratory Medicine 鏡檢組 蔡雅雯 2014/09/09
Uncertainty of Measurement Application to Laboratory Medicine 鏡檢組 蔡雅雯 2014/09/09 Objectives Definitions Methodology Equation of Measurement Uncertainty Measurement Uncertainty Goal Examples Uncertainty
Introduction CME. KY Lo *, CK Chan
CME Original Article Characteristics and outcomes of patients with percutaneous coronary intervention for unprotected left main coronary artery disease: a Hong Kong experience KY Lo *, CK Chan This article
Children on continuous renal replacement therapy: prognostic factors
O R I G I N A L A R T I C L E Children on continuous renal replacement therapy: prognostic factors WF Hui Winnie KY Chan KW Lee 許桓峰陳桂如李國偉 Objectives To identify prognostic factors in children receiving
Amiodarone-induced thyroid dysfunction in the Hong Kong Chinese population
O R I G I N A L A R T I C L E KF Lee KM Lee TT Fung 李家輝李啟文馮騰達 Amiodarone-induced thyroid dysfunction in the Hong Kong Chinese population CME Objective To determine the frequency, risk factors, clinical
Metabolically obese but normal weight (MONW) and metabolically healthy but obese (MHO) phenotypes in Koreans: characteristics and health behaviors
280 Asia Pac J Clin Nutr 2009;18 (2): 280-284 Short Communication Metabolically obese but normal weight (MONW) and metabolically healthy but obese (MHO) phenotypes in Koreans: characteristics and health
Delayed presentation of symptomatic breast cancers in Hong Kong: experience in a public cancer centre
O R I G I N A L A R T I C L E Delayed presentation of symptomatic breast cancers in Hong Kong: experience in a public cancer centre TK Yau CW Choi Esther Ng Rebecca Yeung Inda S Soong Anne WM Lee 游子覺蔡卓偉吳如花楊美雲宋崧李詠梅
The epidemiology of patients with dizziness in an emergency department
Hong Kong Journal of Emergency Medicine The epidemiology of patients with dizziness in an emergency department 急症室頭暈病者的流行病學 JMY Lam 林美怡, WS Siu 蕭詠詩, TS Lam 林子森, NK Cheung 張乃光, CA Graham 簡家廉, TH Rainer
Case-control study of Sichuan and Hong Kong children with melamine-associated renal stones: renal ultrasonography and urinary IL-8 and MCP-1 levels
Title Case-control study of and children with melamine-associated renal stones: renal ultrasonography and urinary IL-8 and MCP-1 levels Author(s) Lau, YL; Tu, W Citation Medical Journal, 213, v. 19 n.
Clinical Nursing Application of Tidal Peritoneal Dialysis
Clinical Nursing Application of Tidal Peritoneal Dialysis 高雄長庚醫院腹膜透析室 郭麗雀 PD catheter implantation This 76 years old male has history of ESRD and initiated CAPD since 2005 PD catheter was implanted on
Surgical Management of Complete Rectal Prolapse. Purpose. To review our experience in the surgical management of complete
J Soc Colon Rectal Surgeon (Taiwan) December 2007 Original Article Surgical Management of Complete Rectal Prolapse Chung-Chi Huang Hong-Hwa Chen Shung-Eing Lin Chia-Lo Chang Chien-Chang Lu Wang-Hseng Hu
Anterior cruciate ligament tear in Hong Kong Chinese patients
ORIGINAL ARTICLE Anterior cruciate ligament tear in Hong Kong Chinese patients August WM Fok *, WP Yau This article was published on 19 Dec 2014 at www.hkmj.org. A B S T R A C T Objective: To investigate
Occlusion therapy in amblyopia: an experience from Hong Kong
Original ARTICLE Occlusion therapy in amblyopia: an experience from Hong Kong Emily WH Tang *, Brian CY Li, Ian YL Yeung, Kenneth KW Li This article was published on 9 January 204 at www. hkmj.org. A B
Predictive factors for colonoscopy complications
ORIGINAL ARTICLE Predictive factors for colonoscopy complications Annie OO Chan, Louis NW Lee, Angus CW Chan, WN Ho, Queenie WL Chan *, Silvia Lau, Joseph WT Chan This article was published on 30 Jan 015
Concordance between side-stream end-tidal carbon dioxide and arterial carbon dioxide partial pressure in respiratory service setting
O R I G I N A L A R T I C L E Concordance between side-stream dioxide and arterial carbon dioxide partial pressure in respiratory service setting Grace TS Law CY Wong CW Kwan KY Wong FP Wong HN Tse 羅子珊黃澤仁關志威黃琼英黃鳳屏謝海南
Clinical Scenario. L1 laminectomy and decompression T11-12, L2-3 posterior instrumented fusion L1 vertebroplasty
骨科 R1 蔡沅欣 2013.3.18 Clinical Scenario 82 y/o male Fell down about 3 months ago, no significant discomfort, except mild back pain In recent 2 months, back pain progressed, bilateral lower leg weakness and
Assessment of postoperative short-term and longterm mortality risk in Chinese geriatric patients for hip fracture using the Charlson comorbidity score
CME Original ARTICLE Assessment of postoperative short-term and longterm mortality risk in Chinese geriatric patients for hip fracture using the Charlson comorbidity score TW Lau *, Christian Fang, Frankie
荷爾蒙補充療法及癌症 Hormone Replacement Therapy and Cancers 黃思誠 台大醫院婦產科
荷爾蒙補充療法及癌症 Hormone Replacement Therapy and Cancers 黃思誠 台大醫院婦產科 停經後的荷爾蒙補充療法 (HRT) 可以治療停經後症候群, 如潮紅 心悸 失眠等, 也可以防止及治療骨質疏鬆 常用藥物口服動情激素 ( 如 premarin), 經皮膚吸收動情激素 (estradiol) 黃體素 ( 如 provera) 動情激素及黃體素混合經皮膚吸收劑 動情激素及
Advance directives and life-sustaining treatment: attitudes of Hong Kong Chinese elders with chronic disease
O R I G I N A L A R T I C L E Advance directives and life-sustaining treatment: attitudes of Hong Kong Chinese elders with chronic disease Fion H Ting 丁葓 Esther Mok 莫孫淑冰 Objective To examine the attitudes
Horng-Yih Ou, Shu-Hwa Hsiao*, Eugene Hsin Yu, and Ta-Jen Wu
Etiologies and Clinical Manifestations of Hyperprolactinemia in A Medical Center in Southern Taiwan Horng-Yih Ou, Shu-Hwa Hsiao*, Eugene Hsin Yu, and Ta-Jen Wu Department of Internal Medicine, *Department
Differences in cancer characteristics of Chinese patients with prostate cancer who present with different symptoms
CME ORIGINAL ARTICLE Differences in cancer characteristics of Chinese patients with prostate cancer who present with different symptoms Samson YS Chan, CF Ng *, Kim WM Lee, CH Yee, Peter KF Chiu, Jeremy
Public lacks knowledge on chronic kidney disease: telephone survey
ORIGINAL ARTICLE Public lacks knowledge on chronic kidney disease: telephone survey KM Chow *, CC Szeto, Bonnie CH Kwan, CB Leung, Philip KT Li This article was published on 14 Mar 2014 at www.hkmj.org.
Bayesian Trail Design 貝式試驗設計
北院區臨床試驗中心生物統計組 Biostatistics Unit Clinical Trial Center, CGMH Bayesian Trail Design 貝式試驗設計 Lan-Yan Yang, PhD ( 楊嵐燕 ) 2018/03/05 1 Contents 1 Motivation 2 Bayesian methods 3 Examples 4 Considerations and
Surgical excision for challenging upper limb nerve sheath tumours: a single centre retrospective review of treatment results
O R I G I N A L A R T I C L E Surgical excision for challenging upper limb nerve sheath tumours: a single centre retrospective review of treatment results YW Hung WL Tse HS Cheng PC Ho 洪煜華謝永廉鄭喜珊何百昌 Key
Predictive factors for length of hospital stay following primary total knee replacement in a total joint replacement centre in Hong Kong
ORIGINAL ARTICLE Predictive factors for length of hospital stay following primary total knee replacement in a total joint replacement centre in Hong Kong CK Lo *, QJ Lee, YC Wong This article was published
Type 2 diabetes management in Hong Kong ethnic minorities: what primary care physicians need to know
Original Article Type 2 diabetes management in Hong Kong ethnic minorities: what primary care physicians need to know Catherine XR Chen *, KH Chan This article was published on 30 January 2014 at www.hkmj.org.
在一所巿區急症室內評估分流心電圖方案的角色
Hong Kong Journal of Emergency Medicine Evaluating the role of a triage electrocardiogram protocol at an urban emergency department 在一所巿區急症室內評估分流心電圖方案的角色 BL Lim 林明良, A Vasu, GH Lim 林義賢 Objective: Our emergency
A cost benefit analysis of weight management strategies
74 Asia Pac J Clin Nutr 2006;15 (Suppl): 74-79 Original Article A cost benefit analysis of weight management strategies Jodie Yates and Chris Murphy Econtech Over the past twenty years, obesity has become
Acute kidney injury in the paediatric intensive care unit: identification by modified RIFLE criteria
O R I G I N A L A R T I C L E Acute kidney injury in the paediatric intensive care unit: identification by modified RIFLE criteria WF Hui Winnie KY Chan TY Miu 許桓峰陳桂如繆定逸 Objective To evaluate the prevalence
Association between Raised Blood Pressure and Dysglycemia in Hong Kong Chinese
Diabetes Care Publish Ahead of Print, published online June 12, 2008 Raised Blood Pressure and Dysglycemia Association between Raised Blood Pressure and Dysglycemia in Hong Kong Chinese Bernard My Cheung,
在急症環境下以護理點脂肪酸結合蛋白決定胸痛病人心肌梗塞之價值
Hong Kong Journal of Emergency Medicine The value of point-of-care fatty acid binding protein in patients with chest pain in determining myocardial infarction in the emergency setting 在急症環境下以護理點脂肪酸結合蛋白決定胸痛病人心肌梗塞之價值
Pain management programme for Chinese patients: a 10-year outcome review
Original ARTICLE Pain management programme for Chinese patients: a 10-year outcome review MC Chu *, Rainbow KY Law, Leo CT Cheung, Marlene L Ma, Ewert YW Tse, Tony CM Wong, PP Chen This article was published
Population-based survey of the prevalence of lower urinary tract symptoms in adolescents with and without psychotropic substance abuse
ORIGINAL ARTICLE Population-based survey of the prevalence of lower urinary tract symptoms in adolescents with and without psychotropic substance abuse YH Tam *, CF Ng, YS Wong, Kristine KY Pang, YL Hong,
子宮頸癌. Cervical Cancer 三軍總醫院 余慕賢
子宮頸癌 Cervical Cancer 三軍總醫院 余慕賢 96 台灣女性 10 大癌症 ( 發生率排序 ) 乳癌 7,502 66.10 結腸癌 4,471 39.39 肺癌 3,161 27.85 肝癌 2,900 25.55 子宮頸癌 1,749 15.41 甲狀腺癌 1,407 12.40 胃癌 1,301 11.46 子宮體癌 1,165 10.26 皮膚癌 1,113 9.81 卵巢癌
Case Conference. Basic Information. Chief Complaint PMH PDH. 2013/06/22 台南奇美醫院 Reporter: 黃鈺芬醫師. Gender: female Age: 68 y/o Attitude: philosophical
Case Conference Basic Information 2013/06/22 台南奇美醫院 Reporter: 黃鈺芬醫師 Gender: female Age: 68 y/o Attitude: philosophical Chief Complaint Pus discharge over upper anterior area for several days PMH PDH Hypertension
Photoselective vaporisation prostatectomy using a GreenLight High Performance System for patients with bleeding tendency
O R I G I N A L A R T I C L E Photoselective vaporisation prostatectomy using a GreenLight High Performance System for patients with bleeding tendency HM Tam SK Mak MC Law Ringo WH Chu Sidney KH Yip 譚皓汶麥肇敬羅敏聰朱永康葉錦洪
Childhood intussusception: 17-year experience at a tertiary referral centre in Hong Kong
Original Article Childhood intussusception: 7-year experience at a tertiary referral centre in Hong Kong Carol WY Wong, Ivy HY Chan, Patrick HY Chung, Lawrence CL Lan, Wendy WM Lam, Kenneth KY Wong *,
Surgical management of primary non small-cell carcinoma of lung with synchronous solitary brain metastasis: local experience
O R I G I N A L A R T I C L E Surgical management of primary non small-cell carcinoma of lung with synchronous solitary brain metastasis: local experience CK Lo CH Yu CC Ma KM Ko Samuel CL Leung 勞卓堅余志雄馬燦忠高啟明梁昌倫
Experience in Iatrogenic Colonic Perforation Caused by Colonoscopy: A Review of 26,729 Colonoscopic Procedures
J Soc Colon Rectal Surgeon (Taiwan) June 2009 Case Analysis Experience in Iatrogenic Colonic Perforation Caused by Colonoscopy: A Review of 26,729 Colonoscopic Procedures Chia-Cheng Wen Shu-Hui Wen 2 Tsai-Yu
A Sustainable Hospitalcommunity. Programme for Orthopaedic Patients with Chronic Pain Syndrome
A Sustainable Hospitalcommunity Partnership Programme for Orthopaedic Patients with Chronic Pain Syndrome Cheung KK 1 Chan PH 1 Chow YY 1 Hung ATF 2 Ho JPS 2 Tse A 1 Chan I 1 Ip A 1 Wong C 1 Fung C 1 Kwok
Primary hyperaldosteronism among Chinese hypertensive patients: how are we doing in a local district in Hong Kong
O R I G I N A L A R T I C L E Primary hyperaldosteronism among Chinese hypertensive patients: how are we doing in a local district in Hong Kong WM Sy SN Fu W Luk Carlos KH Wong LM Fung 施詠雯傅秀雅陸雲黃競浩馮麗明 Key
Co-morbidities of patients with knee osteoarthritis
O R I G I N A L A R T I C L E KW Chan HY Ngai KK Ip KH Lam WW Lai 陳國維倪浩然葉傑權林敬熹黎偉華 Co-morbidities of patients with knee osteoarthritis CME Objectives To study the co-morbidities of general practice patients
Treatment of Anorectal Abscess with Identified Anal Fistula: One-stage or Two-stage Operation
J Soc Colon Rectal Surgeon (Taiwan) September 200 Original Article Treatment of Anorectal Abscess with Identified Anal Fistula: One-stage or Two-stage Operation Chao-Yang Chen Shu-Wen Jao Chang-Chieh Wu
Acanthosis nigricans in obese Chinese children
ORIGINAL ARTICLE Acanthosis nigricans in obese Chinese children HY Ng *, Jack HM Young, KF Huen, Louis TW Chan This article was published on 25 Apr 2014 at www.hkmj.org. A B S T R A C T Objectives: To
IMPLEMENTING THE CDC S COLORECTAL CANCER DEMONSTRATION PROGRAM:
IMPLEMENTING THE CDC S COLORECTAL CANCER SCREENING DEMONSTRATION PROGRAM: WISDOM FROM THE FIELD Rohan EA et al., Cancer 2013;119(15 suppl):2870-83 LEO CHAN 24 AUG 2013 BACKGROUND Colorectal Cancer (CRC)
Introduction ORIGINAL ARTICLE. Tracy SM Law *, Rachel YK Cheung, Tony KH Chung, Symphorosa SC Chan
ORIGINAL ARTICLE Efficacy and outcomes of transobturator tensionfree vaginal tape with or without concomitant pelvic floor repair surgery for urinary stress incontinence: five-year follow-up Tracy SM Law
Screening and Diagnosis of Diabetes Mellitus in Taiwan
Screening and Diagnosis of Diabetes Mellitus in Taiwan Hung-Yuan Li, MD, MMSc, PhD Attending Physician, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan Associate Professor,
Effect of Alendronate and Teriparatide on Bone Mineral Density in Postmenopausal Women
35 Original Article Effect of Alendronate and Teriparatide on Bone Mineral Density in Postmenopausal Women Pei-Tsen Chen, Piya-on Numpaisal, 2 Ching-Chuan Jiang, Hongsen Chiang Departments of Physical
Postpartum Diabetes Screening: adherence rate and the performance of fasting plasma glucose versus oral glucose tolerance test
Diabetes Care Publish Ahead of Print, published online September 9, 2009 adherence of postpartum diabetes screening Postpartum Diabetes Screening: adherence rate and the performance of fasting plasma glucose
Colorectal cancer surgery of octogenarians in Hong Kong: who will survive?
O R I G I N A L A R T I C L E WH Li Tommy CF Lau KK Wong Arthur WH Chan MT Cheung 李永康劉俊輝黃國基陳維㬢張滿棠 Colorectal cancer surgery of octogenarians in Hong Kong: who will survive? CME Objective To assess the
Body fat measured by bioelectrical impedance in Hong Kong Chinese children
O R I G I N A L A R T I C L E Body fat measured by bioelectrical impedance in Hong Kong Chinese children Rita YT Sung HK So KC Choi Albert M Li Jane Yin Edmund AS Nelson 宋銀子蘇鴻鈞蔡繼洲李民瞻殷愛珍 Key words Body
Module: Hope and Optimism. Hope
Module: Hope and Optimism Hope In a nutshell: Cognitive theory of hope (C.R. Snyder, 2002) denotes that a person with high hope is able to use various pathways or waypower to achieve goals. Throughout
Brugada Syndrome in the Elderly in Taiwan Report of Two Cases
Case Report Acta Cardiol Sin 2005;21:62 7 Brugada Syndrome in the Elderly in Taiwan Report of Two Cases Jyh-Ming Juang, Ling-Ping Lai, Jiunn-lee Lin and Fu-Tien Chiang Brugada syndrome is a potentially
Hong Kong Chinese parents attitudes towards circumcision
O R I G I N A L A R T I C L E Hong Kong Chinese parents attitudes towards circumcision Michael WY Leung Paula MY Tang Nicholas SY Chao Kelvin KW Liu 梁偉業鄧敏兒趙式言廖鑑榮 Objective To investigate Hong Kong Chinese
Epidemiological Evidence of Seasonality in Kawasaki Disease in Taiwan
Original Acta Cardiol Sin 2007;23:29 34 Pediatric Cardiology Epidemiological Evidence of Seasonality in Kawasaki Disease in Taiwan Ming-Tai Lin, Jou-Kou Wang, Shuenn-Nan Chiu, Chun-An Chen, Hung-Chi Lue
Racial and ethnic disparities in diabetes risk after gestational diabetes mellitus
Diabetologia (2011) 54:3016 3021 DOI 10.1007/s00125-011-2330-2 ARTICLE Racial and ethnic disparities in diabetes risk after gestational diabetes mellitus A. H. Xiang & B. H. Li & M. H. Black & D. A. Sacks
Clinical predictors of response to cetuximabchemotherapy in metastatic colorectal cancer
O R I G I N A L A R T I C L E Clinical predictors of response to cetuximabchemotherapy in metastatic colorectal cancer Ada TW Ma Brigette BY Ma Kenny IK Lei Frankie KF Mo Anthony TC Chan 馬天慧馬碧如李英傑巫國輝陳德章
意思是工作的法則 目 標是以操作者作中心 根據人體的能力設計最適合人體使用的工作間 器 材 工具及工作方法等 以提高生產力及工作效率 簡化工作程序及減少 出錯甚至是發生工傷意外的機會 除了應用於工業之外 人體工效學亦可適用於辦 公室 以提供一個安全 健康及舒適的工作環境予文職系人員
第34期 Issue 34 2010年2月 2.2010 言 引 Introduction 人體工效學 Ergonomics 一詞源於希臘文 意思是工作的法則 目 標是以操作者作中心 根據人體的能力設計最適合人體使用的工作間 器 材 工具及工作方法等 以提高生產力及工作效率 簡化工作程序及減少 出錯甚至是發生工傷意外的機會 除了應用於工業之外 人體工效學亦可適用於辦 公室 以提供一個安全 健康及舒適的工作環境予文職系人員
Hepatocarcinogenesis of regenerative and dysplastic nodules in Chinese patients
O R I G I N A L A R T I C L E CH Ng 吳志豪 SW Chan 陳施媛 WK Lee 李偉奇 Lawrence Lai 黎兆榮 KH Lok 樂家豪 KK Li 李建綱 SH Luk 陸秀霞 ML Szeto 司徒明亮 Hepatocarcinogenesis of regenerative and dysplastic nodules in Chinese patients
戒菸治療新進展 郭斐然 臺大醫院家庭醫學部
戒菸治療新進展 郭斐然 臺大醫院家庭醫學部 今天的議題 Varenicline 對精神病患之安全性 尼古丁代謝與戒菸治療之研究 Part One Varenicline 對精神病患之安全性 輝瑞公司加註的警語 曾有接受 Champix 治療的病人發生嚴重的神經精神症狀 有些停止吸菸病患因發生尼古丁戒斷症狀而使評估複雜化, 然而有些症狀仍發生在繼續吸菸的病人身上 所有正在接受 Champix 治療的病患應觀察其精神症狀,
Oral Soft Tissue Metastases
Research Report Oral Soft Tissue Metastases Yuk-Kwan Chen, Wen-Chen Wang, Jin-Yi Chen, Li-Min Lin Department of Oral Pathology, School of Dentistry, College of Dental Medicine, Kaohsiung Medical University,
Neoadjuvant chemotherapy increases rates of breast-conserving surgery in early operable breast cancer
ORIGINAL ARTICLE Neoadjuvant chemotherapy increases rates of breast-conserving surgery in early operable breast cancer Vivian CM Man, Polly SY Cheung * This article was published on 9 May 2017 at www.hkmj.org.
Knowledge of Radiation Dose and Awareness of Risks: a Cross-sectional Survey of Junior Clinicians
J Hong Kong Col Radiol. 2010;13:189-94 ORIGINAL ARTICLE Knowledge of Radiation Dose and Awareness of Risks: a Cross-sectional Survey of Junior Clinicians SY Luk, JLY Leung, CS Cheng Department of Radiology,
腹主動脈瘤破裂 : 在香港一急症室的 7 年回顧性觀察研究
Hong Kong Journal of Emergency Medicine Ruptured abdominal aortic aneurysm: a 7-year retrospective observational study in an emergency department of Hong Kong 腹主動脈瘤破裂 : 在香港一急症室的 7 年回顧性觀察研究 NH Chu 朱雁鴻 Objectives:
Utilisation and outcome of renal replacement therapy in an Asian tertiary intensive care unit
O R I G I N A L A R T I C L E Utilisation and outcome of renal replacement therapy in an Asian tertiary intensive care unit Gordon YS Choi Gavin M Joynt Charles D Gomersall HY So 蔡玉生喬伊諾葛列格蘇慶餘 Key words
Surgical ablation of hepatocellular carcinoma with 2.45-GHz microwave: a critical appraisal of treatment outcomes
O R I G I N A L A R T I C L E Surgical ablation of hepatocellular carcinoma with 2.45-GHz microwave: a critical appraisal of treatment outcomes KF Lee Joyce WY Hui YS Cheung Jeff SW Wong CN Chong John
No Definite Benefit of 5-FU/LV Chemotherapy in Patient with Stage III Colorectal Cancer but Only One Lymph Node Metastasis
J Soc Colon Rectal Surgeon (Taiwan) March 2011 Original Article No Definite Benefit of 5-FU/LV Chemotherapy in Patient with Stage III Colorectal Cancer but Only One Lymph Node Metastasis Shang-Chiung Wang
10 Year Experience of Iatrogenic Colon Perforation: Clinical Presentation and Management
J Soc Colon Rectal Surgeon (Taiwan) December 2010 Case Analysis 10 Year Experience of Iatrogenic Colon Perforation: Clinical Presentation and Management Yan-Jiun Huang 1 John Huang 2 Jin-Tung Liang 2 1
SSM Wong, K Wang, EHY Yuen, JKT Wong, A King, AT Ahuja
Hong Kong J Radiol. 2011;14:155-60 ORIGINAL ARTICLE Visual and Quantitative Analysis by Gallium-67 Single-photon Emission Computed Tomography/Computed Tomography in the Management of Malignant Otitis Externa
Corticosteroid adulteration in proprietary Chinese medicines: a recurring problem
Original ARTICLE Corticosteroid adulteration in proprietary Chinese medicines: a recurring problem YK Chong, CK Ching, SW Ng, Tony WL Mak * This article was published on 28 Aug 2015 at www.hkmj.org. A
兒童及青少年肥胖評估工具 黃秀玫張碧真 * Cole & Rolland-Cachera, body mass index, BMI Mei et al., 2002 BMI. body mass index, BMI BMI
78 兒童及青少年肥胖評估工具 黃秀玫張碧真 * 身體組成的測量可以觀察身體的相關生長與疾病的狀態, 臨床與研究上常運用各種測量方式以定 義兒童及青少年肥胖 本文主要回顧實地測量方 式, 探討各種工具的運用與信 效度, 並以臺 灣實施現況加以討論, 以期在未來可以正確地評 估兒童及青少年肥胖 測量身體組成的方式包括 實驗室檢查法與實地測量法, 其中實地測量法包 括重高指標與脂肪分佈的測量, 而實地測量方式
20 December 2018 Ms. M Y Kong (CICO Office)
20 December 2018 Ms. M Y Kong (CICO Office) 1 Purpose 目的 To provide and elaborate HA TFIC s recommendations on immunization requirement for volunteers in HA hospitals. 提供及詳述醫管局感染控制專責小組對醫管局轄下義工免疫要求的建議 2
Is stroke thrombolysis safe and efficacious in Hong Kong?
O R I G I N A L A R T I C L E Edward HC Wong Alexander YL Lau Yannie OY Soo Deyond YW Siu Venus SW Hui Colin A Graham Thomas WH Leung Lawrence KS Wong 王浩中劉玉麟蘇藹欣蕭容媛許詩韻簡家簾梁慧康黃家星 Key words Brain ischemia;
Citation Hong Kong Medical Journal, 2016, v. 22 n. 1, p
Title Partial nephrectomy for T1 renal cancer can achieve an equivalent oncological outcome to radical nephrectomy with better renal preservation: the way to go Author(s) Lai, TCT; Ma, WK; Yiu, MK Citation
Hong Kong College of Radiologists Palliative Medicine Training Programme
Hong Kong J Radiol. 2017;20:227-31 DOI: 10.12809/hkjr1716802 ORIGINAL ARTICLE Hong Kong College of Radiologists Palliative Medicine Training Programme LCY Lui 1, KH Wong 2, R Ngan 2, SWK Siu 3, E Chow
Antibiotic lock solutions for the prevention of catheter-related bacteraemia in haemodialysis patients
O R I G I N A L A R T I C L E Antibiotic lock solutions for the prevention of catheter-related bacteraemia in haemodialysis patients KM Chow 周啟明 YL Poon 潘月玲 MP Lam 林敏萍 KL Poon 潘家麗 CC Szeto 司徒卓俊 Philip
Hypospadias surgery in children: improved service model of enhanced recovery pathway and dedicated surgical team
Original Article Hypospadias surgery in children: improved service model of enhanced recovery pathway and dedicated surgical team YS Wong, Kristine KY Pang, YH Tam * This article was published on 21 May
Lymphoscintigraphy in the evaluation of lower extremity lymphedema: local experience
ORIGINAL ARTICLE Lymphoscintigraphy in the evaluation of lower extremity lymphedema: local experience MC Lam *, WH Luk, KH Tse This article was published on 7 Oct 2013 at www.hkmj.org. A B S T R A C T
A simplified appendicitis score in the diagnosis of acute appendicitis
Hong Kong Journal of Emergency Medicine A simplified appendicitis score in the diagnosis of acute appendicitis 診斷急性闌尾炎的一個簡化闌尾炎指數 PL Goh 吳柏良 Introduction: Scoring systems such as the Modified Alvarado Score
宫颈上皮内瘤变 ; IgG1 IgG2 亚类 ; 酶联免疫吸附试验 R A (2009)
2009 年第 19 卷第 11 期 CHINA ONCOLOGY 2009 Vol.19 No.11 831 免疫球蛋白 G(immunoglobulin G,IgG) 是血清和细胞外液中含量最高的免疫球蛋白, 其某个亚类的升高, 可能与宫颈上皮内瘤变 (cervical intraepithelial neoplasia, CIN) 的发生 发展及转归有密切相关 然而对于 CIN 患者血清人乳头瘤病毒样颗粒
Stereotactic radiotherapy for hepatocellular carcinoma: report of a local single-centre experience
O R I G I N A L A R T I C L E Stereotactic radiotherapy for hepatocellular carcinoma: report of a local single-centre experience LC Chan Samuel KW Chiu Stephen L Chan 陳亮祖招國榮陳林 Objective To evaluate the
A Pilot High-volume Low-cost Hospital-community Partnership Programme in the Management of Orthopaedic Patients With Chronic Pain Syndrome
A Pilot High-volume Low-cost Hospital-community Partnership Programme in the Management of Orthopaedic Patients With Chronic Pain Syndrome Cheung KK 1 Chan PH 1 Chow YY 1 Hung ATF 2 Ho JPS 2 Tse A 1 Chan
Improving the emergency department management of post-chemotherapy sepsis in haematological malignancy patients
ORIGINAL ARTICLE Improving the emergency department management of post-chemotherapy sepsis in haematological malignancy patients HF Ko *, SS Tsui, Johnson WK Tse, WY Kwong, OY Chan, Gordon CK Wong This
Association of Serum Lipid Profiles with Depressive and Anxiety Disorders in Menopausal Women. Chien-Chih Chen, MD; Tiao-Lai Huang, MD
Original Article 325 Association of Serum Lipid Profiles with Depressive and Anxiety Disorders in Menopausal Women Chien-Chih Chen, MD; Tiao-Lai Huang, MD Results: Background: Several studies have investigated
Anterior Cruciate Ligament and Synovial Tophi Deposition Causes Knee Locking
DOI 0.3966/8020932052304005 Case Report Anterior Cruciate Ligament and Synovial Tophi Deposition Causes Knee Locking Che-Wei Liu Hsin-Pu Hsieh Chin-Yu Chen Hsi-Ting Lin,* Knee locking is a condition in
( 計畫名稱 ) 第一型糖尿病人之癌症風險以及低血糖導致大血管疾病之風險
附件一 行政院國家科學委員會補助專題研究計畫 期中進度報告 期末報告 ( 計畫名稱 ) 第一型糖尿病人之癌症風險以及低血糖導致大血管疾病之風險 計畫類別 : 個別型計畫 整合型計畫 計畫編號 :MOST 104-2314-B-006-020 -MY2 執行期間 :2015 年 8 月 1 日至 2017 年 7 月 31 日 執行機構及系所 : 國立成功大學醫學系公共衛生科暨研究所 計畫主持人 :
Ibuprofen versus indomethacin treatment of patent ductus arteriosus: comparative effectiveness and complications
Original Article Ibuprofen versus indomethacin treatment of patent ductus arteriosus: comparative effectiveness and complications NM Chan *, CW Law, KF Kwan This article was published on 30 January 2014
Phaeochromocytoma in the Hong Kong Chinese population
O R I G I N A L A R T I C L E Joyce SY Yau June KY Li Vicki HK Tam LM Fung CK Yeung KW Chan KM Lee KF Lee WS Cheung Vincent TF Yeung YP Yuen WK Kwan 丘思欣李錦燕譚可璣馮麗明楊智堅陳健華李啟文李家輝張偉成楊鐸輝袁月冰關煒強 Key words Adrenal
Impact of skeletal-related events on survival in patients with metastatic prostate cancer prescribed androgen deprivation therapy
ORIGINAL ARTICLE Impact of skeletal-related events on survival in patients with metastatic prostate cancer prescribed androgen deprivation therapy KW Wong, WK Ma, CW Wong, MH Wong, CF Tsang, HL Tsu, KL
Using bevacizumab in the fight against malignant glioma: first results in Asian patients
O R I G I N A L A R T I C L E Using bevacizumab in the fight against malignant glioma: first results in Asian patients Jenny KS Pu Raymond TT Chan Gloria KB Ng Gilberto KK Leung KN Hung CF Fung 浦勤孫陳子棠吳幗寶梁嘉傑洪君毅馮正輝
The Role of Herbal Medication in Poor TACE Response Hepatocellular Carcinoma:
DOI 10.3966/181020932017121504006 Case Report The Role of Herbal Medication in Poor TACE Response Hepatocellular Carcinoma: Case Report Chao-Hua Fang 1, Chin-Chuan Tsai 1,2, Chien-Lin Chen 3, Jiann-Hwa
Prevalence of metabolically healthy obesity and its impacts on incidences of hypertension, diabetes and the metabolic syndrome in Taiwan
Asia Pac J Clin Nutr 2012;21 (2):227-233 227 Original Article Prevalence of metabolically healthy obesity and its impacts on incidences of hypertension, diabetes and the metabolic syndrome in Taiwan Lee-Ching
高度生殖補助医療および一般不妊治療後妊産褥婦の抑うつ傾向とストレス対処能力の関連
J. Jpn. Acad. Midwif., Vol. 28, No. 2, 260-267, 2014 資 料 高度生殖補助医療および一般不妊治療後妊産褥婦の抑うつ傾向とストレス対処能力の関連 妊娠末期から産後 1 ヶ月までの縦断的調査 Association between depressive tendency and stress-coping ability of pregnant and
行政院國家科學委員會補助專題研究計畫期中進度報告 有關鼻咽癌與 EB 病毒感染的長期追蹤研究之初步探討 計畫類別 : 個別型計畫 整合型計畫計畫編號 :NSC B 執行期間 :95 年 8 月 1 日至 96 年 7 月 31 日
行 咽 精 類 行 年 年 行 立 參 理 年 成果報告 行政院國家科學委員會補助專題研究計畫期中進度報告 有關鼻咽癌與 EB 病毒感染的長期追蹤研究之初步探討 計畫類別 : 個別型計畫 整合型計畫計畫編號 :NSC 95-2314-B -002-178 - 執行期間 :95 年 8 月 1 日至 96 年 7 月 31 日 計畫主持人 : 王成平共同主持人 : 婁培人 陳建仁計畫參與人員 : 成果報告類型
血清中微量元素與腎毒理學之相關性研究 - 以老年糖尿病病人為例
Association between Serum Trace Elements and Renal Toxicology in Elderly Diabetic Patients: A Cross-Sectional Study in Taiwan 血清中微量元素與腎毒理學之相關性研究 - 以老年糖尿病病人為例 林健良 1,2, 莊弘毅 1,3 1. 高雄醫學大學公共衛生學系職業安全衛生研究所 2.