The prevalence of ischemic stroke being 4 times higher than that of hemorrhagic stroke, is not different from another study in an Asian population(11). In addition, the authors found that the prevalence of stroke was 4.4%, which was lower than that of 10% in coronary heart diseases. This finding is the same as found in other Asian populations, but is different from that found in the European populations(12). This may be due to a lower level of HDL-cholesterol in the Asian population. However, it may be due to selection bias of this present study that excluded patients who had a communication disability. Nonetheless, well- established risk factors are quite high such as dys- lipidemia at 73% and hypertension at 63%. They may increase the incidence of diabetic complications in the future. A follow-up study for incident cases of this cohort will give more precise information.
Achievement of glycemic control and meta- bolic derangement is another important issue to men- tion in this present registry. The authors found that glycemic control achieved the target in only 30% of the patients, and LDL-C of being less than 100 mg/dl was achieved in only 38.1% of all patients regardless of any treatment strategies; all of those accounted for macro- vascular diseases. This achievement is similar to the average achievement as studied by the DiabCare Asia that is in between 20 to 30%, according to the coun- tries(13). If the authors regard that annual screening for diabetic complications is an indicator for standard of care, 2300 out of 9419 cases (24.4%) did not undergo eye examinations by ophthalmologists in the past year. The inadequate eye examination is clearly due to a limited number of ophthalmologists as found in a study in Nakhonrajasrima province showing that eye examinations could be done in only 23.5% of diabetic patients(14). Screening for diabetic nephropathy may be more serious in this patient population since nearly a half of the patients in the present registry had not been tested for urinary microalbuminuria and the authors found that 41% of the screened subjects had diabetic nephropathy. The large number of unscreened cases is due to financial limitation.
The present study recruited nearly 10,000 diabetic patients. This is a large enough sample size to see the characteristics and burden of diabetic compli- cations in the Thai population. Even though the present study was done in tertiary care medical centers, thatmay be different from those in a primary care situation, the authors might be able to forecast the magnitude of the problem related to diabetes in Thailand.