Papers by Chardpraorn Ngarmukos
PubMed, Aug 1, 2006
Objective: To determine the prevalence and factors associated with Diabetic Retinopathy (DR) of t... more Objective: To determine the prevalence and factors associated with Diabetic Retinopathy (DR) of type 1 diabetes mellitus in Thailand. Material and method: A cross-sectional, multicenter hospital-based study was carried out from April to December 2003. Diabetic patients in diabetic clinics of 11 tertiary centers were registered. Retinopathy was evaluated by the ophthalmologists. Results: Seven thousand one hundred and ni neteen diabetic patients received retinal examination. The number of patients with type 1 diabetes was 347. The prevalence of DR in type 1 diabetes was 21.6% (75). This consisted of Non-Proliferative DR (NPDR) 10.9% (38) and Proliferative DR (PDR) 10.7%. Patients with DR were significantly older, predominantly female, longer duration ofdiabetes, had higher BMI, systolic Blood Pressure (BP), diastolic BP serum creatinine, and TriGlycerides (TG) levels than those without DR. Both groups ofpatients were not different in term ofplasma glucose and glycosylated hemoglobin levels. Although the patients with DR had a higher percentage of overt proteinuria than those without DR, there was no difference in percentage of patients with positive microalbuminuria in both groups. This may be explained by limitation of data (only 16% had results of microalbuminuria and 19% had results of proteinuria). After adjusted for duration of diabetes, serum creatinine and smoking status, factors (adjusted odds ratio [95% confidence interval]) associated with DR were duration of diabetes 5-9.9 years (4.0 [1.49-10.91]), 10-14.9 years (6.86 [2.45-19.20]), 15-19.9 years (21.13 [7.22-61.78]), > or =20 years (22.15 [7.32-66.99]) when compared with duration of diabetes less than 5 years, serum creatinine >2 mg/dl (6.0 [2.09-17.22]) when compared with creatinine less than 2 mg/dl. From the presented model, age, gender, systolic BP >140 mmHg, diastolic BP >90 mmHg, serum TG and smoking status were not factors associated with DR. Conclusion: Diabetic retinopathy affects about one fifth of type 1 diabetic patients in our study. The authors found the factors associated with DR in type 1 DM were duration of diabetes and serum creatinine. Regular screening for DR and more aggressive management of metabolic factors should be done to reduce the prevalence ofDR.
PubMed, Aug 1, 2006
Objectives: To identify the prevalence and characteristics of patients with Diabetic Nephropathy ... more Objectives: To identify the prevalence and characteristics of patients with Diabetic Nephropathy (DN) and to evaluate adequacy of glycemic and blood pressure control of these patients in the authors' registry. Material and method: A cross-sectional, multicenter, hospital-based diabetic registry was carried out in diabetes clinics of 11 tertiary centers in Thailand. DN was defined as the presence of at least two out of three of these symptoms; positive microalbuminuria, positive dipstick proteinuria or creatinine levels equal to or greater than 2 mg/dl. One center that did not perform urine microalbumin measurement was excludedfrom the analysis. Overt nephropathy was defined as the presence of gross proteinuria or renal insufficiency. Results: The study included 4875 patients (females 63.8%) with a mean (SD) duration ofdiabetes of 12.8 (8.2) years. The prevalence of DN was 42.9% (microalbuminuria 19.7% and overt nephropathy 23.2%). There were 373 (7.7%) patients with renal insufficiency and 24 (0.47%) with end-stage renal disease. By multivariate analysis, factors associated with DN were age, duration of diabetes, male sex, smoking, blood pressure, HbA1c, dyslipidemia and presence of diabetic retinopathy. Prevalence of ischemic heart disease and cerebrovascular disease in patients with DN was 11.5% and 6.6% respectively. Mean (SD) HbA1c in patients with nephropathy was 8.2 (2.6)%. Only 25% of subject had HbA1c of less than 7%, 46% had blood pressure ofmore than 140/90 mmHg and 84% received at least one antihypertensive drug. However, the target blood pressure of less than 130/80 mmHg could be achieved in only 18% of these patients. The mean (SD) number of antihypertensive drugs was 1.7 (1.1). Nearly 60% of patients received either ACE inhibitors or ARBs. Conclusion: DN was very common. The overall picture of DN in the present survey suggests the seriousness of the problem and prompts more aggressive intervention.
PubMed, Aug 1, 2006
Objective: To explore the nature of diabetic complications in type 2 diabetic patients who had ha... more Objective: To explore the nature of diabetic complications in type 2 diabetic patients who had had diabetes for longer than 15 years (long-DM), compared to those with duration of less than 15 years (short-DM). Material and method: Patients studied were adult type 2 diabetic patients registered to the Diabetes Registry Project, a nationwide cross-sectional study of diabetes mellitus in Thailand. Information collected included demographic data, age at diagnosis of diabetes, blood pressure, body mass index, fasting plasma glucose, HbA(1c), serum creatinine, and major diabetic vascular complications, including diabetic retinopathy (DR), albuminuria or renal insufficiency (diabetic nephropathy; DN), myocardial infarction (MI), stroke, peripheral arterial disease (PAD), foot ulcer and amputation. Results: There were 9284 patients, consisting of 2244 (24.17%) subjects with long-DM (mean +/- SD, mean duration of DM21.3 +/- 5.8 years), and 7040 subjects with short-DM (mean duration 7.0 +/- 3.9 years). The long-DM group was older than the short-DM group (65.5 +/- 10.3 vs. 58.2 +/- 12.6 year-old, p less than 0.0001), and had higher HbA(1c) (8.5 vs. 8.0%, p = 0.009). The prevalence of diabetic complications in the long-DM group was higher than that in the short-DM group (DN 49.4% vs. 33.9%, DR 54.3% vs. 22.8%; MI 9.4% vs. 3.5%, PAD 17.3% vs. 5.5%, foot ulcer 13.4% vs. 5.3%, stroke 9.4% vs. 7.0% and amputation 5.5% vs 2.0%; allp values less than 0.01). The duration of DM significantly affected the risk of diabetic complications after adjustment for age, hypertension, and levels of glycemic control. Conclusion: Diabetic duration was independently associated with increased risk of having diabetes-related complications without threshold. Monitoring of complications in patients having long-standing diabetes is warranted in order to provide appropriate management.
PubMed, Aug 1, 2006
Objective: To determine the prevalence of hypertension, patterns of antihypertensive treatment an... more Objective: To determine the prevalence of hypertension, patterns of antihypertensive treatment and level of blood pressure control in adult Thai type 2 diabetic patients who attended diabetes clinics in university and tertiary-care hospitals. Material and method: A cross-sectional, multi-center, hospital-based diabetes registry of 8884 adults 18 years old and older was carried out from diabetes clinics of 11 tertiary centers. Demographic data, including use of antihypertensive drugs and blood samples were collected and analyzed for prevalence, associated factors, patterns of antihypertensive therapy and level of blood pressure control. Results: The prevalence of hypertension in adult Thai type 2 diabetic patients was 78.4 (6965)%. Antihypertensive drugs were prescribed in 84.4 (5878)% of all hypertensive patients. The achievement of blood pressure control (less than 130/80 mmHg) w as 13.85%. Thepercentage of patients receiving 1, 2, 3, 4, and 5 drugs were 45 (2645)%, 33.4 (1963)%, 16.8 (987)%, 4.4 (259)%, and 0.4 (24)% respectively. Angiotensin-converting enzyme inhibitors were the most commonly prescribed antihypertensive agents (54.6%), followed by diuretics (43.8%), and calcium channel blockers (34.6%). Conclusion: Blood pressure control in hypertensive adults with type 2 diabetes was suboptimal. Strategies to improve awareness and adequacy of blood pressure control in these subjects should be seriously considered.
Diabetologia, 2011
Aims/hypothesis This meta-analysis aimed to compare the renal outcomes between ACE inhibitor (ACE... more Aims/hypothesis This meta-analysis aimed to compare the renal outcomes between ACE inhibitor (ACEI)/angiotensin II receptor blocker (ARB) and other antihypertensive drugs or placebo in type 2 diabetes. Methods Publications were identified from Medline and Embase up to July 2011. Only randomised controlled trials comparing ACEI/ARB monotherapy with other active drugs or placebo were eligible. The outcome of end-stage renal disease, doubling of serum creatinine, microvascular complications, microalbuminuria, macroalbuminuria and albuminuria regression were extracted. Risk ratios were pooled using a random-effects model if heterogeneity was present; a fixedeffects model was used in the absence of heterogeneity. Results Of 673 studies identified, 28 were eligible (n013-4,912). In direct meta-analysis, ACEI/ARB had significantly lower risk of serum creatinine doubling (pooled RR00.66 [95% CI 0.52, 0.83]), macroalbuminuria (pooled RR00.70 [95% CI 0.50, 1.00]) and albuminuria regression (pooled RR 1.16 [95% CI 1.00, 1.39]) than other antihypertensive drugs, mainly calcium channel blockers (CCBs). Although the risks of end-stage renal disease and microalbuminuria were lower in the ACEI/ARB group (pooled RR 0.82 [95% CI 0.64, 1.05] and 0.84 [95% CI 0.61, 1.15], respectively), the differences were not statistically significant. The ACEI/ARB benefit over placebo was significant for all outcomes except microalbuminuria. A network meta-analysis detected significant treatment effects across all outcomes for both active drugs and placebo comparisons. Conclusions/interpretation Our review suggests a consistent reno-protective effect of ACEI/ARB over other antihypertensive drugs, mainly CCBs, and placebo in type 2 diabetes. The lack of any differences in BP decrease between ACEI/ARB and active comparators suggest this benefit is not due simply to the antihypertensive effect. Keywords Albuminuria regression. Angiotensin receptor blockers. Angiotensin-converting enzyme inhibitors. Doubling of serum creatinine. End-stage renal disease. Macroalbuminuria. Meta-analysis. Microalbuminuria. Renin-angiotensin system blockade. Reno-protective effect. Systematic review. Type 2 diabetes Electronic supplementary material The online version of this article
Journal of Diabetes Investigation, 2021
AIMS/INTRODUCTION There are lack of current information regarding young-onset diabetes in Thailan... more AIMS/INTRODUCTION There are lack of current information regarding young-onset diabetes in Thailand. Thus, the objectives of this study were to describe the types of diabetes, the clinical characteristics, the treatment regimens, and achievement of glycemic control in Thai patients with young-onset diabetes. MATERIALS AND METHODS Data of 2,844 patients with diabetes onset before 30 years of age were retrospectively reviewed from a diabetes registry comprising 31 hospitals in Thailand. Gestational diabetes was excluded. RESULTS Based on clinical criteria, type 1 diabetes (T1D) was identified in 62.6%, type 2 diabetes (T2D) 30.7%, neonatal diabetes 0.8%, other monogenic diabetes 1.7%, secondary diabetes 3.0%, genetic syndromes associated with diabetes 0.9%, and other types of diabetes 0.4%. T1D accounted for 72.3% of patients with age of onset <20 years. The proportion of T2D was 61.0% of patients with age of onset from 20 to <30 years. Intensive insulin treatment was prescribed in 55.2% of T1D. Oral antidiabetic agent alone was used in 50.8% of T2D, while 44.1% received insulin treatment. Most monogenic diabetes, secondary diabetes, and genetic syndromes associated with diabetes required insulin treatment. Achievement of glycemic control was identified in 12.4% of T1D, 30% of T2D, 36.4% of neonatal diabetes, 28.3% of other monogenic diabetes, 45.6% of secondary diabetes, and 28% of genetic syndromes associated with diabetes. CONCLUSION In this registry, T1D remains the most common type and the prevalence of T2D increases with age. The majority of patients did not achieve glycemic target, especially T1D.
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2006
To determine the pattern of hyperglycemic agent usage in Thai type 2 diabetics (T2 DM) who attend... more To determine the pattern of hyperglycemic agent usage in Thai type 2 diabetics (T2 DM) who attended the diabetes clinic in university and tertiary-care hospitals. The achievement oftarget glycemic control by various modalities of treatment was also analyzed. A cross-sectional, hospital-based diabetes registry of 8913 type 2 diabetic patients in 11 tertiary care hospitals and medical schools was carried out from April to December 2003. Demographic data, usage of hypoglycemic agents and level of glycemic control were collected to determine the pattern ofuse, associated factors, and achievement of glycemic control. Overall, 2342 (26.3%) of T2 DM achieved HbA1C less than 7%. The percentage of patients treated with metformin was 70.8%, sulfonylureas (SU) was 68.7% and insulin was 25.3%. Only 7.0% of patients received alpha-Glucosidase Inhibitor (AGI), 5.7% received ThaiZoliDinediones (TZD), 1.1% received repaglinide, and 3.2% was on diet control alone. Target glycemic control was achieve...
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2006
To explore the nature of diabetic complications in type 2 diabetic patients who had had diabetes ... more To explore the nature of diabetic complications in type 2 diabetic patients who had had diabetes for longer than 15 years (long-DM), compared to those with duration of less than 15 years (short-DM). Patients studied were adult type 2 diabetic patients registered to the Diabetes Registry Project, a nationwide cross-sectional study of diabetes mellitus in Thailand. Information collected included demographic data, age at diagnosis of diabetes, blood pressure, body mass index, fasting plasma glucose, HbA(1c), serum creatinine, and major diabetic vascular complications, including diabetic retinopathy (DR), albuminuria or renal insufficiency (diabetic nephropathy; DN), myocardial infarction (MI), stroke, peripheral arterial disease (PAD), foot ulcer and amputation. There were 9284 patients, consisting of 2244 (24.17%) subjects with long-DM (mean +/- SD, mean duration of DM21.3 +/- 5.8 years), and 7040 subjects with short-DM (mean duration 7.0 +/- 3.9 years). The long-DM group was older th...
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2006
The primary objectives of the Thailand Diabetes Registry project were to identify the characteris... more The primary objectives of the Thailand Diabetes Registry project were to identify the characteristics of Thai diabetic patients in tertiary care medical centers and to determine the extent of long term diabetic complications. The secondary objective aimed at building up and strengthening clinical research network among Thai experts in diabetes mellitus and collection of baseline data for future follow-up study. A cross-sectional, multi-center, hospital-based diabetes registry was carried out from diabetes clinics of 11 tertiary centers. Demographic data, clinical status of diabetes and its complications were collected and analyzed for the prevalence of complications and risk factors. Nine-thousand-four-hundred-and-nineteen patients were registered for the project and 94.6% were type 2 diabetes. Mean +/- SD of age was 59.4 +/- 13.5 and duration of diabetes was and 10 +/- 7.6 years. Only 38.2% of the subjects achieved glycemic control of FPG under 130 mg/dl in only 30.7% had an HbA lc...
Brain Research, 2001
The ventromedial hypothalamus (VMH) has been proposed to be a glucose sensor within the brain and... more The ventromedial hypothalamus (VMH) has been proposed to be a glucose sensor within the brain and appears to play a critical role in initiating the counterregulatory response to hypoglycemia. Transport of glucose across the brain capillaries and into neurons in this region is mediated by different isoforms of the sodium-independent glucose transporter gene family. The objective of the present study was to identify the specific glucose transporter isoforms present, as well as their cellular localization, within the VMH. Immunohistochemistry was performed for GLUT1, GLUT2 and GLUT4 in frozen sections of hypothalami from normal rats. GLUT1 was present on the endothelial cells of the blood-brain barrier (BBB) of the VMH. GLUT2 immunoreactivity was seen in the ependymal cells of the third ventricle and in scattered cells in the arcuate and periventricular nuclei. There was no GLUT2 expression in the VMH. The insulin-sensitive GLUT4 isoform was localized to vascular structures within the VMH. Double-labeled immunohistochemistry demonstrated co-localization of GLUT4 with GLUT1 and with the tight junction protein ZO-1 in the VMH and suggested that VMH GLUT4 expression was restricted to the BBB. The role of GLUT4 in the brain and within the VMH is unknown, but given its location on the BBB, it may participate in brain sensing of blood glucose concentrations.
American Journal of Physiology-Endocrinology and Metabolism, 2001
Aldosterone is the most important circulating mineralocorticoid. It is secreted by the zona glome... more Aldosterone is the most important circulating mineralocorticoid. It is secreted by the zona glomerulosa of the adrenal gland and plays a major role in sodium and potassium metabolism by binding to epithelial mineralocorticoid receptors (MR) in the renal collecting duct, promoting sodium resorption and potassium excretion. The action of aldosterone on its classic target epithelia has been extensively studied, and many of the signaling events that mediate its effects have been described. Recently, there has been increased interest in aldosterone actions on the cardiovascular system, which are mediated through nonclassical actions. These include local tissue production, nongenomic actions, and effects on nonepithelial targets. In this review article, we focus on the effects of aldosterone in nonepithelial tissues that are mediated through MR, especially cardiovascular effects.
American journal of hypertension, 2005
Sympathetic activity and renal norepinephrine spillover are increased in obese individuals. We ha... more Sympathetic activity and renal norepinephrine spillover are increased in obese individuals. We have reported that infusion of nonesterified fatty acids increases blood pressure in animals through stimulation of the sympathetic nervous system. In this study, we assessed the effect of increasing circulating nonesterified fatty acids on systemic and renal norepinephrine kinetics in healthy adults by infusing fat emulsion and heparin for 4 h. (3)H-norepinephrine was infused for 60 min before and again during the last hour of the fatty acid infusion to assess norepinephrine kinetics. Renal venous blood samples were obtained to calculate renal norepinephrine spillover. Nonesterified fatty acid levels increased threefold during the first hour and remained elevated throughout the study. Arterial and renal venous plasma norepinephrine levels fell by 15% and 20%, respectively, during the infusion (P < .05 for both). Kinetic analysis indicated that systemic release of norepinephrine into an...
Ramathibodi Medical Journal
Background: Diabetes mellitus (DM) is a chronic metabolic disorder. Previous studies reported the... more Background: Diabetes mellitus (DM) is a chronic metabolic disorder. Previous studies reported the hearing impairment of diabetes patients as a progressive bilateral symmetrical sensorineural hearing loss (SNHL) of gradual onset which predominantly affected the higher frequencies, and found that diabetic patients had unsatisfactory hearing thresholds than nondiabetics in the same age group. For the use of evoked otoacoustic emissions (EOAEs) as a clinical test of hearing, EOAEs are sound which can be recorded in the outer ear canal and give objective information about preneural, mechanical elements of the cochlear function. Objective: To compare the otoacoustic emissions of asymptomatic DM patients with a normal hearing control group. Methods: All subjects received a routine audiologic evaluation which consisted of pure-tone air-bone conduction tests, tympanograms, and stapedius acoustic reflex tests. OAEs were measured in 30 asymptomatic diabetic patients with a mean age of 55.73 ye...
Ramathibodi Nursing Journal, 2008
The Southeast Asian journal of tropical medicine and public health, 2015
This study was conducted in order to determine the impact of education on mortality due cardiovas... more This study was conducted in order to determine the impact of education on mortality due cardiovascular, infectious and renal disease, and cancer among Thai diabetics using data from the Thailand diabetes registry cohort prospected and conducted between April 2003 and February 2006. The study population consisted of 9,370 registered diabetic patients attending ten diabetes clinics at tertiary medical centers in Bangkok and major provinces. The population was classified by education level: those who had not yet attained a bachelor's degree classified as having "lower education" (7,684: 82%) and those with a bachelor's degree or higher classified as having "higher education" (1,686:18%). The overall mortality rate among those in the higher education group was lower than those in the lower education group (8.9 vs 20.5 per 1,000 patient-years, respectively) with a hazard ratio (HR) of 0.43 (0.31-0.61). The higher education group also had lower mortality rates ...
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2006
To determine the prevalence of dyslipidemia in adult Thai type 2 diabetes who attended diabetes c... more To determine the prevalence of dyslipidemia in adult Thai type 2 diabetes who attended diabetes clinics in university and tertiary-care hospitals. A cross-sectional, multi-center, hospital-based diabetes registry was conducted in 11 diabetic clinics in tertiary medical centers in Bangkok and major provinces between April and December 2003. A group of 9419 diabetic patients were registered. Individual Demographic data including education and socioeconomic status were collected. The results of the physical examination for complications, history screening and laboratory results were recorded. The prevalence of the various complications of diabetes was analyzed and the percentage achievement of metabolic control calculated. Of the 9419 diabetic patients registered 8769 had complete demographic and plasma lipid data. Mean age was 59.5 +/- 13.3 years. The percentage of male patients was 33.9%. In the present study, there were 8464 type 2 diabetes and 383 type I diabetes. History of corona...
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2006
To determine the etiology, glycemic control and prevalence of microvascular complications in Thai... more To determine the etiology, glycemic control and prevalence of microvascular complications in Thai diabetic patients who were diagnosed at the age of less than 18 years and who attended diabetes clinics in university or tertiary care hospitals. A cross-sectional, multi-center, hospital-based diabetes registry was carried out from diabetes clinics of 11 tertiary centers. Demographic data including laboratory results and microvascular complications were recorded. Two-hundred-and-fifty out of the 9419 (2.66%) diabetic patients were diagnosed before the age of 18 years, 78% had Type 1 diabetes (T1DM), 18.4% had Type2 diabetes (T2DM) and 3.6% had other types of diabetes. Mean +/- SD HbAlc of T1DM was 9.3 +/- 2.5, T2DM was 9.7 +/- 2.6 and other types of diabetes were 8.6 +/- 4%. The majority of patients had poor glycemic control according to ADA and WHO guidelines. The percentage of patients who had diabetes for more than 5 years but had not been screened for nephropathy and retinopathy we...
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2013
To determine the impact of smoking and quit smoking on mortality rate. This prospective cohort wa... more To determine the impact of smoking and quit smoking on mortality rate. This prospective cohort was a three-year follow-up of Thai Diabetes Registry project that registered 9,370 diabetic patients from 10 diabetic clinics in tertiary medical centers in Bangkok and major provinces between April 2003 and February 2006. The groups of 7,487 (80%), 1,315 (14%), and 568 (6%) patients were classified as non-smokers, ex-smokers, and current smokers. The crude death rate of ex-smokers (Hazard Ratio (HR) 1.52 (95% CI 1.19-1.95)) and current smokers (HR 1.55 (1.10-2.19)) were higher than death rate of non-smokers. After control for covariates, the HR comparing ex-smokers with non-smokers was not different (1.10 (0.81-1.50)), while the HR comparing current smokers with non-smokers remained statistical significant (1.74 (1.17-2.61)). Smoking increases mortality rate in diabetic patients by about 74%. Quitting smoking decreased mortality rate to the same rate as of diabetic non-smokers.
The Southeast Asian journal of tropical medicine and public health, 2011
Adrenal histoplasmosis is an uncommon mycotic disease typically caused by Histoplasma capsulatum.... more Adrenal histoplasmosis is an uncommon mycotic disease typically caused by Histoplasma capsulatum. The objective was to determine the clinicopathological findings in adrenal histoplasmosis. Pathological records were searched from the database at the Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University from 1993 to 2008 for cases of adrenal histoplasmosis. The keywords were "histoplasmosis" and "adrenal gland". Adrenal histoplasmosis was diagnosed by histopathology and Gomori-Grocott methenamine silver staining. Histoplasma capsulatum was confirmed by tissue culture and/or serology. The authors report seven cases of adrenal histoplasmosis in immunocompetent patients. The mean age at diagnosis was 67 years. All patients presented as chronic fatigue syndrome. The onset of symptoms ranged from one to three months. Addison's disease was found in adrenal histoplasmosis in one case (14.3%). The computed tomography revealed adrenal nod...
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2010
The prevalence of type 2 diabetes in Thailand is 9.8 percent which is double the number forecast ... more The prevalence of type 2 diabetes in Thailand is 9.8 percent which is double the number forecast by World Health Organization. There is inadequate information to statistically represent all Thai diabetic patients for their causes of death. To determine the clinical characteristics that predicted death and causes of death in Thai diabetic patients. This prospective cohort was a 3-year follow-up study of the Thai Diabetes Registry project done between April, 2003, and February, 2006, which registered 9,419 diabetic patients attending 11 diabetic clinics in tertiary medical centers in Bangkok and major provinces of Thailand. The dead or alive status (99.5%) was determined. The causes of death were defined by reviewing the medical records. Of the 9,370 diabetic patients registered, 425 patients died, 1.84 percent per year. There was an increased risk of death associated with age, type of healthcare plan, lower education, insulin use, smoking, history of coronary artery disease and cereb...
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Papers by Chardpraorn Ngarmukos