OBJECTIVE -The objective of this study was to develop and evaluate a risk score to predict people at high risk of diabetes in Thailand.RESEARCH DESIGN AND METHODS -A Thai cohort of 2,677 individuals, aged 35-55 years, without diabetes at baseline, was resurveyed after 12 years. Logistic regression models were used to identify baseline risk factors that predicted the incidence of diabetes; a simple model that included only those risk factors as significant (P Ͻ 0.05) when adjusted for each other was developed. The coefficients from this model were transformed into components of a diabetes score. This score was tested in a Thai validation cohort of a different 2,420 individuals.RESULTS -A total of 361 individuals developed type 2 diabetes in the exploratory cohort during the follow-up period. The significant predictive variables in the simple model were age, BMI, waist circumference, hypertension, and history of diabetes in parents or siblings A cutoff score of 6 of 17 produced the optimal sum of sensitivity (77%) and specificity (60%). The area under the receiver-operating characteristic curve (AUC) was 0.74. Adding impaired fasting glucose or impaired glucose tolerance status to the model slightly increased the AUC to 0.78; adding low HDL cholesterol and/or high triglycerides barely improved the model. The validation cohort demonstrated similar results.CONCLUSIONS -A simple diabetes risk score, based on a set of variables not requiring laboratory tests, can be used for early intervention to delay or prevent the disease in Thailand. Adding impaired fasting glucose or impaired glucose tolerance or triglyceride and HDL cholesterol status to this model only modestly improves the predictive ability. Diabetes Care 29:1872-1877, 2006A remarkable worldwide increase in the number of people with type 2 diabetes has been predicted (1). Prevalence rates in the developing world, particularly in the Asia-Pacific region, are already high and expected to rise more quickly than elsewhere. In Thailand, the prevalence of type 2 diabetes among the population aged Յ35 years was 9.6% in 2001, an increase of 20% over a period of 5 years (2). Cardiovascular disease (CVD) is one of the leading causes of death in Thailand (3), and individuals with diabetes have a two to fourfold greater risk of developing CVD than those without (4). The burden of diabetes and its complications, which include other diseases besides CVD (5), imposes a massive load on the Thai health care system. Lifestyle modification has been proven to effectively prevent and delay the development of diabetes (6 -8).Therefore, early recognition of and intervention for the condition will be beneficial, particularly as cardiovascular complications set in early after the onset of diabetes (9). Delay and lack of detection of the disease are mostly due to patients being asymptomatic during the early stage of the disease; hence an accurate screening tool to identify those at high risk of developing diabetes will be of great value. Knowledge of the risk of diabetes could enhance...

End-stage kidney disease has become an increasing burden in all regions of the world. However, limited epidemiologic data on chronic kidney disease in Southeast Asian populations are available. Therefore, a cohort study over a period of 12 yr (1985 to 1997) in 3499 employees of the Electric Generation Authority of Thailand, aged 35 to 55 yr, was conducted to determine the prevalence of decreased kidney function and risk factors associated with future development of decreased kidney function. The prevalence of decreased kidney function (GFR <60 ml/min) increased from 1.7% (95% confidence interval [CI], 1.3 to 2.1) in 1985 to 6.8% (95% CI, 5.7 to 7.9) in 1997, and the prevalence of elevated serum creatinine was 6.1% (95% CI, 5.3 to 6.9) and 16.9% (95% CI, 15.3 to 18.5) in 1985 and 1997 surveys, respectively. The adjusted odds ratio for future development of decreased kidney function was 2.57 (1.0 to 6.81) for systolic hypertension (>159 mmHg), 1.82 (1.12 to 2.98) for hyperuricemia (>6.29 mg/dl), 1.68 (1.02 to 2.77) for elevated body mass index (>24.9 kg/m 2 ) compared with subjects with systolic BP <140 mmHg, serum uric acid <4.5 mg/dl, and body mass index 20.8 to 22.8 kg/m 2 . The rising prevalence of decreased kidney function in this population resulted mainly from the increasing prevalence of the risk factors in the population. Screening to detect decreased kidney function and early intervention to modify the associated risk factors should be considered in otherwise healthy individuals. Future studies are also necessary to determine whether implementation of these measures results in a reduction of ESRD incidence in the population.

One of the main branches of the left main coronary artery of normally beating dog hearts was perfused with a silicone elastomer which solidified within the vasculature. Prolonged immersion in increasingly concentrated ethanol and in methyl salicylate rendered the tissue translucent and the vasculature clearly visible. Surfaces were photographed by reflected or transmitted light microscopy, showing large groups of capillaries running parallel to muscle fibers and extending for up to a few centimeters. The arrangement of arteriolar inflows to the capillary network and venular outflows (two to four times as frequent) suggested that functional capillary lengths were 500-1000 μm. Estimates of capillary diameters, presumably at maximal dilatation, were 5.6 ± 1.3 μm. Capillary densities within muscle groups were 3100-3800/mm 2 , giving intercapillary distances of 19-17.5 μm. With the lesser density value, the capillary surface area is estimated to be 500 cm 2 /g of myocardium. Inclusion of interfascial spaces lowered the average density to about 2500/mm 2 . Unbranched capillary lengths averaged 100 μm, with a strongly right-skewed distribution. The anatomic arrangement provides a basis mainly for concurrent flow in neighboring capillaries, and also for some diffusional exchange between inflow and outflow regions.This study was undertaken because of the need for precise descriptions of the geometric arrangement of myocardial capillaries and of their dimensions, so that accurate values could be used for models describing the exchanges of tracers in the heart. Wearn (1928) and later Roberts and Wearn (1941) perfused isolated and beating human, cat, and rabbit hearts with dye suspensions, and reported that there were about 5000 capillaries/ mm 2 of ventricular myocardium, a value which is too high because of their failure to correct for shrinkage with fixation. They also showed that anastomoses between capillaries were numerous and that at times the branchings were so profuse as to give the impression of single muscle fibers being completely surrounded by capillaries.From studies in dead rabbits, Stoel (1925) stated that the capillary diameter in papillary muscle was 5 μm, the intercapillary distance was 18 μm (cylinder of influence = 9 μm in radius), and the capillary density was 3230/mm 2 . In the same study, the capillary diameters in the adductor magnus and the semitendinosus muscles were 2.5 and 5.0 μm, respectively. Reynolds, Kirsch, and Bing (1958) reported values of 3-5 μm for capillary diameters in dog hearts. They also stated that these can double if the once arrested hearts were reperfused. In normally beating hearts they observed large gradients in capillary density between epicardium (1200-1600/mm 2 ) and endocardium (100-340/mm 2 ) which may have been related to the experimental technique of counting only those capillaries that contained erythrocytes. Although it is commonly assumed that erythrocyte and capillary diameters are similar, Krogh (1919) showed that there was considerable variation in capi...

To explore the effects of diabetes on myocardial function and metabolism we injected male rats with streptozotocin and studied their hearts 8 weeks later. Blood sugar levels in the treated rats were about 600 mg/100 ml. Body and heart growth rates were diminished. When studied in an isolated working rat heart apparatus using 5.5 mM glucose, hearts of diabetic animals showed diminished cardiac output and stroke work at high filling pressures. There also were significant depressions in peak left ventricular systolic pressure, peak aortic flow rate, maximum negative dP/dt, myocardial oxygen extraction, myocardial lactate production, and effluent lactate:pyruvate ratios. Myocardial glycogen stores, calculated glycogen utilization, and pyruvate production were increased in hearts of diabetics, and myocardial oxygen consumption was the same as in control hearts. The end-diastolic pressure-volume relationship was shifted to the right in hearts of diabetics. Most of the abnormalities observed in hearts of diabetic rats persisted when insulin and 15 mM glucose were included in the perfusion medium. Hearts from young rats or from age-matched food-restricted rats with heart weights similar to those of diabetics did not show depressed function or a pressure-volume shift. Our findings indicate that streptozotocin diabetes in rats results in abnormal myocardial performance. This is not due to restrictions in coronary flow or myocardial oxygenation and is not correctable by the provision of high glucose plus insulin in the perfusion medium.