CHO LI WEI
Email Address
gmsclw@nus.edu.sg
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Publication Low-dose levothyroxine reduces intrahepatic lipid content in patients with type 2 diabetes mellitus and NAFLD(Oxford University Press, 2018) Bruinstroop E.; Dalan R.; Cao Y.; Bee Y.M.; Chandran K.; Cho L.W.; Soh S.B.; Teo E.K.; Toh S.-A.; Leow M.K.S.; Sinha R.A.; Sadananthan S.A.; Michael N.; Stapleton H.M.; Leung C.; Angus P.W.; Patel S.K.; Burrell L.M.; Lim S.C.; Sum C.F.; Velan S.S.; Yen P.M.; MEDICINE; DEAN'S OFFICE (SSH SCH OF PUBLIC HEALTH); DUKE-NUS MEDICAL SCHOOL; OBSTETRICS & GYNAECOLOGYContext Nonalcoholic fatty liver disease (NAFLD) is highly prevalent in patients with type 2 diabetes mellitus (T2DM) and associated with significant morbidity and mortality. Thyroid hormone (TH) increases β-oxidation of fatty acids and decreases intrahepatic lipid content (IHLC) in rodents with NAFLD. Objective We investigated the possibility of low intrahepatic TH concentration in NAFLD and studied the effect of TH treatment in humans. Design/Setting This was a phase 2b single-arm study in six hospitals in Singapore. Intrahepatic thyroid hormone concentrations were measured in rats with induced NAFLD. Patients Euthyroid patients with T2DM and steatosis measured by ultrasonography. Intervention Levothyroxine was titrated to reach a thyroid-stimulating hormone level of 0.34 to 1.70 mIU/L before a 16-week maintenance phase. Main Outcome Measures The primary outcome measure was change in IHLC measured by proton magnetic resonance spectroscopy after treatment. Results Twenty male patients were included in the per-protocol analysis [mean SD: age, 47.8 ± 7.8 years; body mass index (BMI), 30.9 ± 4.4 kg/m 2; baseline IHLC, 13% ± 4%]. After treatment, IHLC was decreased 12% (±SEM, 26%) relative to baseline (absolute change, -2%; 95% CI, -3 to 0; P = 0.046). Small decreases in BMI (P = 0.044), visceral adipose tissue volume (P = 0.047), and subcutaneous adipose tissue volume (P = 0.045) were observed. No significant changes in glucose regulation or lipid profile occurred. Conclusion This study demonstrated the efficacy and safety of low-dose TH therapy for NAFLD in men. TH or TH analogs may be beneficial for this condition. Copyright 2018 Endocrine Society.Publication Association between glycemic control and hip fracture(2012-08) Puar, T.H.; Khoo, J.J.; Cho, L.W.; Xu, Y.; Chen, Y.T.; Chuo, A.M.; Poh, C.B.; Ng, J.M.; DUKE-NUS GRADUATE MEDICAL SCHOOL S'POREObjectives To determine whether tight glycemic control is associated with greater risk of hip fractures in individuals being treated for type 2 diabetes mellitus. Design Case-control study. Setting Tertiary hospital. Participants Cases were selected from all individuals with diabetes mellitus admitted between 2005 and 2010 to Changi General Hospital for hip fracture (N = 932). Cases were included if their glycosylated hemoglobin (HbA1c) had been measured within 3 months of the fracture and they were undergoing treatment with oral hypoglycemic medications or insulin. Each case was matched with one control for sex, age, race, duration of diabetes mellitus, and comorbidities. Measurements Information on baseline characteristics, HbA1c, and use of diabetic medications was obtained. The likelihood of hip fracture was determined comparing four different values of HbA1c [8% (reference group)] and use of diabetic medications. Results The mean age of cases was 77.3 ± 7.7, and 73.3% were female. After adjusting for age, sex, race, comorbidities, and other covariates, participants with tighter glycemic control (HbA1c < 6% and 6.1-7.0%) were more likely to have a hip fracture than those with HbA1c >8% (odds ratio (OR) = 3.01, 95% confidence interval (CI) = 2.01-4.51, P