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JAGS NOVEMBER 2006–VOL. 54, NO.

11 LETTERS TO THE EDITOR 1791

HIGH PREVALENCE OF DIABETES MELLITUS IN (RBG 200 mg/dL), 180 had high RBG (110–199 mg/dL),
OLDER PEOPLE IN A RURAL AREA IN LAOS and 252 had normal RBG (o110 mg/dL) (Figure 1).
In 2005, 252 people with high RBG ( 110 mg/dL)
To the Editor: The global prevalence of diabetes mellitus were recommended for OGTT; of these, 209 (82.9%)
(DM) has been estimated as 2.8% in 2000 and to become agreed to participate. According to the criteria of the World
4.4% in 2030, and the number of people with DM is ex- Health Organization, DM (fasting blood sugar (FBS) 
pected to approximately double between 2000 and 2030.1 126 mg/dL or 2-hour plasma glucose (PG) 200 mg/dL),
However, the most striking demographic change in global IGT (FBS 110–125 mg/dL or 2-hour PG 140–199 mg/dL),
terms will be the increase in the proportion of people and normal glucose tolerance (NGT) (FBSo110 mg/dL and
aged 65 and older.1 There is little population-based epide- 2-hour PGo140 mg/dL) were defined using OGTT, which
miological data on DM in southeast Asia, and the preva- indicated that there were 28 subjects (18.3%) with DM and
lence of DM in Laos remains unknown.1–5 In Laos, a 39 (25.5%) with IGT among the 153 subjects with RBG
developing Asian country, a previous study found a between 110 and 199 mg/dL and 44 subjects (78.6%) with
high prevalence of random blood glucose (RBG) higher DM and six (10.7%) with IGT among the 56 subjects with
than 140 mg/dL (28.3%) and higher than 200 mg/dL RBG of 200 mg/dL or higher (Figure 1).
(11.6%) in community-dwelling older people.6 The prev- From the results of OGTT, the estimated prevalence of
alence of DM according to RBG (subjects with DM or IGT was calculated for all 504 subjects (Figure 1).
RBG  200 mg/dL or those taking blood glucose–lowering For this estimate, it was hypothesized that nonresponders
medicine) in community-dwelling older people was much in each of the two groups (RBG 110–199 mg/dL or RBG
higher in Laos (11.6%) than in other nearby southeast 200 mg/dL) would have the same prevalence of DM or
Asian countries in the survey (1.6% in Vietnam, 1.7% in IGT according to OGTT as the responders. The estimated
Indonesia, and 5.7% in Myanmar).6–9 In this study, to prevalence of DM and IGT according to OGTT were as
clarify the exact prevalence of DM and impaired glucose much as 17.7% and 10.7%, respectively. Because OGTT
tolerance (IGT), 75-g oral glucose tolerance tests (OGTTs) was not given to people with normal RBG (o110 mg/dL),
were conducted in Laos. some people with IGT or DM who might have had high
In the previous study, examination of RBG, medical blood glucose levels only after glucose intake may have
history interviews, and physical examinations had been been overlooked.
conducted on 504 Laotians aged 60 and older (male: A high prevalence of DM and IGT was shown in com-
female 5 207:297, mean age 70.2) living in rural villages in munity-dwelling older people in a rural area of Laos, a de-
the Lahanam and Paxon zones in Songkhon District in Sa- veloping southeast Asian country. This might reflect that the
vannakhet Province in Laos. The villages had a total pop- rate of increase of DM is much faster in developing coun-
ulation of 12,009 people, with 744 people aged 60 and tries than in developed ones.1,2 By 2030, it is estimated that
older; and 504 older people were examined (67.7% the number of people aged 65 and older with DM will be 82
of all eligible subjects). Of those tested, 72 had DM million in developing countries and more than 48 million in

All subjects (RBG examination)


N = 504

RBG < 110 mg RBG = 110 −199 mg /dL RBG ≥ 200 mg /dL or on treatment
n = 252 n = 180 n = 72

OGTT Nonresponder OGTT Nonresponder


n = 153 n = 27 n = 56 n = 16

DM IGT NGT DM IGT NGT


n = 28 n = 39 n = 86 n = 44 n=6 n=6
18.3% 25.5% 56.2% 78.6% 10.7% 10.7%

Estimated prevalence of DM and IGT for all 504 subjects


DM IGT NGT
n 89 54 361
% 17.7 10.7 71.6

Figure 1. Estimated prevalence of diabetes mellitus (DM) and impaired glucose tolerance (IGT) in community-dwelling older people
in Laos using 75-g oral glucose tolerance test (OGTT). OGTT was performed on 209 subjects, 82.9% of all people in the district noted
with high random blood glucose (RBG) (  110 mg/dL). NGT 5 normal glucose tolerance.
1792 LETTERS TO THE EDITOR NOVEMBER 2006–VOL. 54, NO. 11 JAGS

developed ones.1 Even considering such study limitations as designed the project. All authors participated in the medical
the small data sampling, the high prevalence of DM and survey in Laos. Kentaro Suzuki, Kiyohito Okumiya, and
IGT in community-dwelling older people in a developing Kozo Matsubayashi were engaged in analysis and interpre-
country, Laos, is of particular note. tation of data and preparation of the manuscript.
The high prevalence of DM in older people in a rural Sponsor’s Role: None.
area in Laos could be associated with factors such as ethnic
and genetic vulnerable factors, rapid economic develop- REFERENCES
ment followed by nutritional transition, and other factors,
1. Wild S, Roglic G, Green A et al. Global prevalence of diabetes: Estimates for
such as the ‘‘fetal origins of disease’’ hypothesis, which the year 2000 and projections for 2030. Diabetes Care 2004;27:1047–1053.
postulates that early undernutrition increases the risk of 2. King H, Aubert RE, Herman WH. Global burden of diabetes, 1995–2025: Prev-
certain chronic diseases in adulthood.10 It will be necessary alence, numerical estimates, and projections. Diabetes Care 1998;21:1414–1431.
3. Tan CE, Emmanuel SC, Tan BY et al. Prevalence of diabetes in the cardio-
to investigate the causes behind the high prevalence of DM
vascular risk factors. The 1992 Singapore National Health Survey. Diabetes
and IGT and their risk factors in Laos to prevent not only Care 1999;22:241–247.
DM, but also related cardiovascular diseases, which are 4. Aekplakorn W, Stolk RP, Neal B et al. The prevalence and management of
increasing in Asian countries. diabetes in Thai adults: The international collaborative study of cardiovascular
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5. King H, Keuky L, Seng S et al. Diabetes and associated disorders in Cambodia:
Kentaro Suzuki Two epidemiological surveys. Lancet 2005;366:1633–1639.
Department of Field Medicine 6. Okumiya K, Ishine M, Wada T et al. Comprehensive geriatric assessment for
Graduate School of Medicine community-dwelling elderly in Asia compared with those in Japan. IV. Sa-
vannakhet, Laos. Geriatr Gerontol Int 2005;5:159–167.
Kyoto University 7. Ishine M, Wada T, Sakagami T et al. Comprehensive geriatric assessment for
Kyoto, Japan community-dwelling elderly in Asia compared with those in Japan. III. Phuto
in Vietnam. Geriatr Gerontol Int 2005;5:115–121.
Kiyohito Okumiya, MD, PhD 8. Wada T, Ishine M, Okumiya K et al. Comprehensive geriatric assessment for
community-dwelling elderly in Asia compared with those in Japan. V. West
Research Institute for Humanity and Nature Java, Indonesia. Geriatr Gerontol Int 2005;5:168–175.
Kyoto, Japan 9. Wada T, Okumiya K, Suzuki K et al. Comprehensive geriatric assessment for
community-dwelling elderly in Asia compared with those in Japan. VI. Mau-
Masayuki Ishine, MD bin in Myanmar. Geriatr Gerontol Int 2005;5:276–285.
10. Caballero B. A nutritional paradoxFunderweight and obesity in developing
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Department of Field Medicine
Teiji Sakagami, MD
Department of Psychiatry CARBOCYSTEINE THERAPY IN OLDER PEOPLE
Matheus Roriz-Cruz, MD WITH CHRONIC OBSTRUCTIVE
Idiane Rosset, MD PULMONARY DISEASE
Department of Field Medicine
Graduate School of Medicine, To the Editor: As revealed by Yasuda et al. in their paper
Kyoto University recently published in the Journal of the American Geriatrics
Kyoto, Japan Society,1 the administration of the mucoactive agent, car-
bocysteine (S-carboxymethyl-L-cysteine), to patients with
Tiengkham Pongvongsa, MD chronic obstructive pulmonary disease (COPD) may have
Station of Malariology, Parasitology, and Entomology additional beneficial effects on the reduction of common
Savannakhet Province, Lao PDR colds and episodes of exacerbation. Although, a statistically
significant improvement was observed, there was, never-
Boungnong Boupha, MD, PhD theless, a range of interindividual variation apparent within
National Institute of Public Health their treated patient group.
Vientiane, Lao PDR Metabolism is usually a major factor influencing the
efficacy of a therapeutic agent, and that of carbocysteine is
Kozo Matsubayashi, MD, PhD known to be especially complex, with the pathways of de-
Center for Southeast Asian Studies carboxylation, N-acetylation, sulfoxidation, and ester gluco-
Kyoto University ronidation all being involved to differing degrees.2–5 It is
Kyoto, Japan this consequent spectrum of metabolites to which an indi-
vidual is exposed and not simply the administered parent
compound. Several studies have indicated that the metab-
ACKNOWLEDGMENTS olism of carbocysteine varies widely within the same indi-
Financial Disclosure vidual, with few sulfoxide (sulfur oxygenated) metabolites
Kiyohito Okumiya received funding for Project 4–2 of being produced after nighttime administration.4,5 Such di-
the Research Institute for Humanity and Nature from the urnal variation in metabolism, presumably under hormonal
Japanese Ministry of Education, Science and Culture. The control, is overlaid on an underlying and apparently gen-
study was also supported by the overseas grant-in-aid of etically determined ability to produce sulfur-oxygenated
the Ministry of Health, Labor and Welfare, Japan. metabolites. This later spread of ‘‘sulfoxidation capacities’’
Author Contributions: Kentaro Suzuki, Kiyohito Ok- separates individuals with respect to their metabolic han-
umiya, Masayuki Ishine, Tiengkham Pongvongsa Boung- dling of the drug.4,6,7 Clearly, the effects of this later inherent
nong Boupha, and Kozo Matsubayashi conceived and variation are phenotypically more pronounced after morn-