Prevalence of diabetes in Malaysia and usefulness of HbA1c as a diagnostic criterion

Leveraging Dental Visits for Systemic Health: Diabetes Screening and Referral Compliance in Periodontitis Patients in Malaysia

Background/Objectives: Opportunistic diabetes screening in dental clinics is an innovative strategy with significant public health implications. Methods: This prospective observational study assessed diabetes risk and referral compliance among periodontitis patients using the Finnish Diabetes Risk Score (FINDRISC) and capillary fasting blood glucose (cFBG). Patients with FINDRISC ≥ 11 and/or cFBG ≥ 5.6 mmol/L were classified as high-risk and referred for further medical evaluation, with compliance tracked through medical practitioner feedback. Results: A total of 142 participants were recruited by 20 general dental practitioners (GDPs). Of these, 36.4% (n = 47) had a FINDRISC ≥ 11, with a mean score of 7.7 ± 4.5, and 26.3% (n = 34/129) had cFBG levels ≥ 5.6 mmol/L. There was no significant difference between periodontal status and FINDRISC (p = 0.291) or between periodontal status and cFBG (p = 0.129). Overall, 54 patients (41.8%) were referred for follow-up, with 33 (61.1%) completing the process. Among those who completed referrals, 10 (30.3%) were diagnosed with prediabetes and seven (21.2%) with diabetes. Non-compliance was more common among patients from lower socioeconomic backgrounds. Conclusions: This study shows the feasibility of integrating diabetes risk screening into private dental practice and its potential to identify high-risk individuals. Shared care models and policy adaptations are essential to improve interdisciplinary collaboration and overcome referral compliance barriers.

Genetics and epigenetics of diabetes and its complications in India

Diabetes mellitus (DM) has become a significant health concern with an increasing rate of morbidity and mortality worldwide. India ranks second in the number of diabetes cases in the world. The increasing burden of DM can be explained by genetic predisposition of Indians to type 2 diabetes mellitus (T2DM) coupled with rapid urbanization and socio-economic development in the last 3 decades leading to drastic changes in lifestyle. Environment and lifestyle changes contribute to T2DM development by altering epigenetic processes such as DNA methylation, histone post-translational modifications, and long non-coding RNAs, all of which regulate chromatin structure and gene expression. Although the genetic predisposition of Indians to T2DM is well established, how environmental and genetic factors interact and lead to T2DM is not well understood. In this review, we discuss the prevalence of diabetes and its complications across different states in India and how various risk factors contribute to its pathogenesis. The review also highlights the role of genetic predisposition among the Indian population and epigenetic factors involved in the etiology of diabetes. Lastly, we review current treatments and emphasize the knowledge gap with respect to genetic and epigenetic factors in the Indian context. Further understanding of the genetic and epigenetic determinants will help in risk prediction and prevention as well as therapeutic interventions, which will improve the clinical management of diabetes and associated macro- and micro-vascular complications.

Family Involvement to Stop the Conversion of Prediabetes to Diabetes

Prediabetes is a condition associated with an increased risk of developing diabetes, in which blood glucose levels are high but not high enough to be diagnosed as diabetes. The rapid increase in the prevalence of prediabetes is a major global health challenge. The incidence of prediabetes has increased to pandemic levels and can lead to serious consequences. Unfortunately, nearly 90% of prediabetic individuals are unaware of their ailment. A quarter of prediabetic individuals develop type 2 diabetes mellitus (T2DM) within 3-5 years. Although prediabetes is a reversible condition, the prevention of diabetes has received little attention. It is essential for prediabetic individuals to implement new health-improvement techniques. Focusing on family systems is one strategy to promote health, which is determined by health patterns that are often taught, established, and adjusted within family contexts. For disease prevention, a family-based approach may be beneficial. Family support is essential for the metabolic control of the disease. This study aimed to show several strategies for involving the patient's family members in preventing the conversion of prediabetes to T2DM and to emphasize that the patient's family members are a valuable resource to reduce the incidence of diabetes.

Trends in all-cause mortality among adults with diagnosed type 2 diabetes in West Malaysia: 2010 - 2019

AIMS

We determined 10-year all-cause mortality trends in diagnosed type 2 diabetes (T2D) population in West Malaysia, a middle-income country in the Western-Pacific region.

METHODS

One million T2D people aged 40-79 registered in the National Diabetes Registry (2009-2018) were linked to death records (censored on 31 December 2019). Standardized absolute mortality rates and standardized mortality ratios (SMRs) were estimated relative to the Malaysian general population, and standardized to the 2019 registry population with respect to sex, age group, and disease duration.

RESULTS

Overall all-cause standardized mortality rates were unchanged in both sexes. Rates increased in males aged 40-49 (annual average percent change [AAPC]: 2.46 % [95 % CI 0.42 %, 4.55 %]) and 50-59 (AAPC: 1.91 % [95 % CI 0.73 %, 3.10 %]), and females aged 40-49 (AAPC: 3.39 % [95 % CI 1.32 %, 5.50 %]). In both sexes, rates increased among those with 1) > 15 years disease duration, 2) prior cardiovascular disease, and 3) Bumiputera (Malay/native) ethnicity. The overall SMR was 1.83 (95 % CI 1.80, 1.86) for males and 1.85 (95 % CI 1.82, 1.89) for females, being higher in younger age groups and showed an increasing trend in those with either > 15 years disease duration or prior cardiovascular disease.

CONCLUSIONS

Mortality trends worsened in certain T2D population in Malaysia.

Prevalence and Pattern of Glomerulonephritis: An Experience of Two Tertiary Centers in Malaysia

The prevalence of glomerulonephritis (GN), especially membranous GN (MGN), changes from time to time. This change may be due to genetic predisposition, environmental factors race, age, and indications for a renal biopsy. This study was conducted to evaluate the distribution and changing patterns of GN by further assessing the prevalence of MGN. A 1000, 123 biopsies were performed from January 2012 to October 2019 in Hospital Serdang and Hospital Kuala Lumpur. Electron microscopy, immunohistochemistry, and clinical presentations were used to differentiate primary and secondary MGN, from which 611 and 457 primary and secondary subjects were diagnosed with primary and secondary GN, respectively. Primary MGN accounts for 13% of all the primary GN, while lupus nephritis (LN) accounts for 44.2% of all secondary GN followed by diabetes mellitus (25.6%). The proportions of primary and secondary MGN were 64.8% and 35.2%, respectively, with a male-to-female ratio of 1:1.1 in favor of females. The renal biopsy obtained from the registry of two prominent hospitals in Malaysia provided valuable prevalence and demonstrated changes in the prevalence of GN in Malaysia. Notwithstanding, immunoglobulin A nephropathy and LN remain the most common causes of primary and secondary GN in Malaysia.

Diabetes Prevalence and Associated Risk Factors among Women in a Rural District of Nepal Using HbA1c as a Diagnostic Tool: A Population-Based Study

Given the scarcity of data on diabetes prevalence and associated risk factors among women in rural Nepal, we aimed to examine this, using glycated hemoglobin (HbA1c) as a diagnostic tool. A cross-sectional survey addressing reproductive health and non-communicable diseases was conducted in 2012–2013 among non-pregnant, married women in Bolde, a rural district of Nepal. HbA1c ≥ 6.5% (48 mmol/mol) was used as diagnostic criterion for diabetes, a cut-off of 7.0% (53 mmol/mol) was used to increase the specificity. HbA1c was measured in 757 women (17–86 years). The prevalence of diabetes and prediabetes was 13.5% and 38.5%, respectively. When using 7.0% as a cut-off, the prevalence of diabetes was 5.8%. Aging, intake of instant noodles and milk and vegetarian food (ns) were associated with increased risk for diabetes. Waist circumference was higher among women with diabetes, although not significant. The women were uneducated (87.6%), and only 12% had heard about diabetes. In conclusion, we observed a higher prevalence of diabetes and prediabetes than anticipated among rural, Nepalese women. The increased risk was mainly attributed to dietary factors. In contrast to most previous studies in Nepal, we used HbA1c as diagnostic criterion.

Prevalence of type-2 diabetes and prediabetes in Malaysia: A systematic review and meta-analysis

OBJECTIVE

The main purpose of this study was to investigate the pooled prevalence of prediabetes and type-2 diabetes in the general population of Malaysia.

METHOD

We systematically searched Medline (PubMed), Embase, Web of Science, Google Scholar and Malaysian Journals Online to identify relevant studies published between January 1, 1995, and November 30, 2021, on the prevalence of type-2 diabetes in Malaysia. Random-effects meta-analyses were used to obtain the pooled prevalence of diabetes and prediabetes. Subgroup analyses also used to analyze to the potential sources of heterogeneity. Meta- regression was carried to assess associations between study characteristics and diabetes prevalence. Three independent authors selected studies and conducted the quality assessment. The quality of the final evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

RESULTS

Of 2689 potentially relevant studies, 786 titles and abstract were screened. Fifteen studies with 103063 individuals were eligible to be included in the meta-analyses. The pooled prevalence of diabetes was 14.39% (95% CI, 12.51%-16.38%; I2 = 98.4%, 103063 participants from 15 studies). The pooled prevalence of prediabetes was 11.62% (95% CI, 7.17%-16.97%; I2 = 99.8, 88702 participants from 9 studies). The subgroup analysis showed statistically significant differences in diabetes prevalence by the ethical sub-populations with highest in Indians (25.10%; 95% CI, 20.19%-30.35%), followed by Malays (15.25%; 95% CI, 11.59%-19.29%), Chinese (12.87%; 95% CI, 9.73%-16.37%), Bumiputeras (8.62%; 95% CI, 5.41%-12.47%) and others (6.91%; 95% CI, 5.71%-8.19%). There was no evidence of publication bias, although heterogeneity was high (I2 ranged from 0.00% to 99·8%). The quality of evidence based on GRADE was low.

CONCLUSIONS

Results of this study suggest that a high prevalence of prediabetes and diabetes in Malaysia. The diabetes prevalence is associated with time period and increasing age. The Malaysian government should develop a comprehensive approach and strategy to enhance diabetes awareness, control, prevention, and treatment.

TRIAL REGISTRATION

Trial registration no. PROSPERO CRD42021255894; https://clinicaltrials.gov/.

Phase angle and diabetes in community-dwelling older adults: cross-sectional analysis from the Malaysian elders longitudinal research (MELoR) study

OBJECTIVE

To evaluate the role of PhA in diabetes in a large population of older adults with a high prevalence of diabetes in order to gain new insights on the potential diagnostic and prognostic role of PhA in individuals with diabetes.

DESIGN

Cross-sectional study.

SETTING

Teaching Hospital.

PARTICIPANTS

1085 individuals aged 55 years or over.

MEASUREMENTS

Phase Angle was obtained using bioimpedance analysis with the Bodystat QuadScan^® 4000. Diabetes mellitus was considered present with fasting hyperglycaemia (serum fasting glucose >6.66 mmol/l), HbA1c > 42 mmol/mol (6.1%), or self-reported Diabetes or the consumption of glucose-lowering agents.

RESULTS

The mean age of the (standard deviation) of the 1,085 participants was 68.11 (7.12) years and 60.7% were women. Among male participants, individuals with PhA within the lowest quartile (PhA ≤4.9) were significantly more likely to have diabetes mellitus [odds Ratio (95% confidence interval, CI), 2.02 (1.17-3.47)] following adjustments for age, body mass index and other comorbidities. The above relationship was attenuated following further adjustment hypoglycaemic medications. Men on oral hypoglycaemic agents had significantly reduced PhA [mean difference (95% CI), -0.44 (-0.67 to -0.22)]. No significant relationship between PhA and diabetes existed among women.

CONCLUSION

The association between lower PhA (≤4.9) in men aged 55 and over and diabetes which is accounted for by oral hypoglycaemic agents. The mechanisms underlying this relationship remain unclear. This relationship should also be evaluated further to determine the potential of PhA as a prognostic tool for diabetes.

Review of the management of sight-threatening diabetic retinopathy during pregnancy

Diabetes mellitus (DM) is a noncommunicable disease reaching epidemic proportions around the world. It affects younger individuals, including women of childbearing age. Diabetes can cause diabetic retinopathy (DR), which is potentially sight threatening when severe nonproliferative DR (NPDR), proliferative DR (PDR), or sight-threatening diabetic macular oedema (STDME) develops. Pregnancy is an independent risk factor for the progression of DR. Baseline DR at the onset of pregnancy is an important indicator of progression, with up to 10% of women with baseline NPDR progressing to PDR. Progression to sight-threatening DR (STDR) during pregnancy causes distress to the patient and often necessitates ocular treatment, which may have a systemic effect. Management includes prepregnancy counselling and, when possible, conventional treatment prior to pregnancy. During pregnancy, closer follow-up is required for those with a long duration of DM, poor baseline control of blood sugar and blood pressure, and worse DR, as these are risk factors for progression to STDR. Conventional treatment with anti-vascular endothelial growth factor agents for STDME can potentially lead to foetal loss. Treatment with laser photocoagulation may be preferred, and surgery under general anaesthesia should be avoided. This review provides a management plan for STDR from the perspective of practising ophthalmologists. A review of strategies for maintaining the eyesight of diabetic women with STDR with emphasis on prepregnancy counselling and planning, monitoring and safe treatment during pregnancy, and management of complications is presented.

Nutritional Status and Health-Related Quality of Life among Knee and Hip Osteoarthritis Patients under Rehabilitation Care in Kuala Nerus, Terengganu, Malaysia

Introduction:

The World Health Organisation (WHO) has estimated that 80% of people with osteoarthritis (OA) have movement limitations while 25% of them cannot perform their major daily activities, thus resulting in a decline of their nutritional status and quality of life (QOL). Therefore, this study aimed to compare the nutritional status and health-related quality of life (HRQOL) of OA patients between gender and age group.

Material and Methods:

A cross-sectional study was conducted on 131 OA patients in Rehabilitation Health Organisation, Terengganu. Socio-demographic, clinical, lifestyle histories, 24-hour dietary intake and HRQOL were assessed using a structured questionnaire.

Results:

Knee and/or hip OA patients recruited consisted of 19.1% of men and 80.9 % of women collectively with a mean age of 61.81 (9.28) years ranging from 38 to 83 years. The percentages of underweight, normal, overweight, and obese patients were 1.5%, 12.2%, 36.7%, and 49.6%, respectively. Further assessment of HRQOL showed that the highest mean score was obtained by the social functioning (SF) domain of 41.25 (27.16), while the mental domain scored the least mean score of 21.15 (20.92). In terms of gender breakdown, the males had significantly greater weight and height but lower body fat (BF) compared to their female counterparts, as well as a significantly higher energy, carbohydrate and protein intake. According to the age group, patients aged < 60 years had significantly greater weight, height, and BF than those aged ≥ 60 years.

Conclusion:

This study is an important baseline reference for proper OA management and prevention by providing crucial nutritional status and HRQOL information.

Discordance between Fasting Plasma Glucose (FPG) and HbA1c in Diagnosing Diabetes and Pre-diabetes in The Malaysian Cohort

OBJECTIVE

In this present study, we aim to evaluate the accuracy of the HbA1c relative to fasting plasma glucose (FPG) in the diagnosis of diabetes and pre-diabetes among The Malaysian Cohort (TMC) participants.

METHODOLOGY

FPG and HbA1c were taken from 40,667 eligible TMC participants that have no previous history of diabetes, aged between 35-70 years and were recruited from 2006 - 2012. Participants were classified as normal, diabetes and pre-diabetes based on the 2006 World Health Organization (WHO) criteria. Statistical analyses were performed using ANOVA and Chi-square test, while Pearson correlation and Cohen's kappa were used to examine the concordance rate between FPG and HbA1c.

RESULTS

The study samples consisted of 16,224 men and 24,443 women. The prevalence of diabetes among the participants was 5.7% and 7.5% according to the FPG and HbA1c level, respectively. Based on FPG, 10.6% of the participants had pre-diabetes but this increased to 14.2% based on HbA1c (r=0.86; P<0.001). HbA1c had a sensitivity of 58.20 (95% CI: 56.43, 59.96) and a specificity of 98.59 (95% CI: 98.46, 98.70).

CONCLUSION

A higher prevalence of pre-diabetes and diabetes was observed when using HbA1c as a diagnosis tool, suggesting that it could possibly be more useful for early detection. However, given that HbA1c may also have lower sensitivity and higher false positive rate, several diagnostic criteria should be used to diagnose diabetes accurately.

Performance of the Finnish Diabetes Risk Score (FINDRISC) and Modified Asian FINDRISC (ModAsian FINDRISC) for screening of undiagnosed type 2 diabetes mellitus and dysglycaemia in primary care

AIMS

To evaluate the performance of FINDRISC and ModAsian FINDRISC for the screening of undiagnosed diabetes and dysglycaemia in primary care. To compare the performance of FINDRISC with the recommendations of the American Diabetes Association (ADA) and US Preventive Services Task Force (USPSTF) guidelines.

METHODS

This cross-sectional study was carried out on 293 patients without a prior history of diabetes at a primary care clinic in Malaysia. Questions on body mass index and waist circumference were modified based on the Asian standard in ModAsian FINDRISC. Haemoglobin A1c of ≥6.5% (48 mmol/mol) was used to diagnose diabetes. Areas under the receiver operating curve (ROC-AUC) for FINDRISC and ModAsian FINDRISC were analyzed.

RESULTS

The prevalence of undiagnosed diabetes was 7.5% and prediabetes was 32.8%. The ROC-AUC of FINDRISC was 0.76 (undiagnosed diabetes) and 0.79 (dysglycaemia). There was no statistical difference between FINDRISC and ModAsian FINDRISC. The recommended optimal FINDRISC cut-off point for undiagnosed diabetes was ≥11 (Sensitivity 86.4%, Specificity 48.7%). FINDRISC ≥11 point has higher sensitivity compared to USPSTF criteria (72.7%) and higher specificity compared to the ADA (9.6%).

CONCLUSIONS

FINDRISC is a useful diabetes screening tool to identify those at risk of diabetes in primary care in Malaysia.

The Effects of Wet Cupping Therapy on Fasting Blood Sugar, Renal Function Parameters, and Endothelial Function: A Single-arm Intervention Study

Objectives

Despite being recognized worldwide as an alternative therapy in treating various chronic diseases and pain, the mechanism of wet cupping is still not well understood. The purpose of this study was to evaluate fasting blood sugar (FBS), renal function parameters, and endothelial function changes following wet cupping in healthy individuals.

Methods

We conducted a single-arm intervention study at the Clinical Lab of Community Medicine, Universiti Sains Malaysia, and included 31 healthy individuals aged between 30 and 60 years old. Wet cupping therapy was performed at five treatment points at the beginning of the study and repeated after three months. Health outcomes at baseline, one, three, and four months were assessed for FBS, renal function parameters (urea, creatinine, and uric acid), systolic blood pressure (SBP), and von Willebrand factor (vWF).

Results

Forty-five percent of participants were female, and the mean age of study participants was 44.9±6.4 years. Wet cupping therapy significantly reduced FBS, serum urea, and serum creatinine at one, three, and four months compared with baseline values. Serum uric acid and SBP showed a significant reduction at one and four months compared with baseline. The vWF (a measure of endothelial function) had a 4.0% reduction at four months compared to baseline, with a mean difference of 5.3 (95% confidence interval (CI): 2.20 = 8.55; p = 0.002).

Conclusions

This study provides preliminary support that repeated wet cupping therapy enhances body health status; thus, it could be an effective complementary medicine in disease prevention.

Ethnic differences in the prevalence, socioeconomic and health related risk factors of knee pain and osteoarthritis symptoms in older Malaysians

Knee pain is often underreported, underestimated and undertreated. This study was conducted to estimate the prevalence, burden and further identify socioeconomic factors influencing ethnic differences in knee pain and symptoms of OA among older adults aged 55 years and over in Greater Kuala Lumpur (the capital city of Malaysia). The sample for the Malaysian Elders Longitudinal Research (MELoR) was selected using stratified random sampling, by age and ethnicity from the electoral rolls of three parliamentary constituencies. Information on knee pain was available in 1226 participants, mean age (SD) 68.96 (1.57) years (409 Malay, 416 Chinese, 401 Indian). The crude and weighted prevalence of knee pain and self-reported knee OA symptoms were 33.3% and 30.8% respectively. There were significant ethnic differences in knee pain (crude prevalence: Malays 44.6%, Chinese 23.5% and Indians 31.9%, p<0.001). The presence of two or more non-communicable diseases (NCD) attenuated the increased risk of knee pain among the ethnic Indians compared to the ethnic Chinese. The prevalence of knee pain remained significantly higher among the ethnic Malays after adjustment for confounders. While the prevalence of knee pain in our older population appears similar to that reported in other published studies in Asia, the higher prevalence among the ethnic Malays has not previously been reported. Further research to determine potential genetic susceptibility to knee pain among the ethnic Malays is recommended.

Effectiveness of Diabetes Community Sharp Disposal Education Module in Primary Care: An Experimental Study in North-East Peninsular Malaysia

Background: Structured education is needed to cultivate safe sharp disposal behavior among diabetic patients. Thus, this study aimed to assess the effectiveness of the Diabetes Community Sharp Disposal Education Module in improving knowledge and sharp disposal practice among Malaysian Type 2 diabetic patients. Methods: This quasi-experimental study was conducted at primary health clinics in two districts in Kelantan, a state in the North-East Region of Peninsular Malaysia. A total of 132 Type 2 diabetic patients on insulin therapy were involved, with 68 participants in each control and intervention group. The health education intervention was based on the validated Diabetes Community Sharp Disposal Education Module. The knowledge and practices were measured using a validated questionnaire at baseline, one month, and three months after the intervention. Results: There was a significant increment in the mean knowledge score for intervention group; from baseline to one month follow up and from baseline to three months follow up [Greenhouse-Geisser; F(1.5, 199.7) = 62.38, p < 0.001; effect size (η²) = 0.318]. Intervention group had significantly higher mean knowledge score as compared to control group; at one month and three months follow up [F(1, 134) = 17.38, p < 0.001; effect size (η²) = 0.115]. There was a statistically significant increment in the proportion of participants in the intervention group who practiced the proper community sharp disposal method over time, X²(2) = 52.061, p < 0.001. Conclusions: The Diabetes Community Sharp Disposal Education Module was an effective health education tool to improve knowledge and encourage Malaysian diabetic patients to engage with proper sharp disposal practices.

CNDP1, NOS3, and MnSOD Polymorphisms as Risk Factors for Diabetic Nephropathy among Type 2 Diabetic Patients in Malaysia

Type 2 diabetes mellitus (T2DM) is associated with a high incidence of nephropathy. The aim of this study was to investigate the association of a genetic polymorphism of carnosinase (CNDP1-D18S880 and -rs2346061), endothelial nitric oxide synthase (NOS3-rs1799983), and manganese superoxide dismutase (MnSOD-rs4880) genes with the development of diabetic nephropathy among Malaysian type 2 diabetic patients. A case-control association study was performed using 652 T2DM patients comprising 227 Malays (without nephropathy = 96 and nephropathy = 131), 203 Chinese (without nephropathy = 95 and nephropathy = 108), and 222 Indians (without nephropathy = 136 and nephropathy = 86). DNA sequencing was performed for the D18S880 of CNDP1, while the rest were tested using DNA Sequenom MassARRAY to identify the polymorphisms. DNA was extracted from the secondary blood samples taken from the T2DM patients. The alleles and genotypes were tested using four genetic models, and the best mode of inheritance was chosen based on the least p value. The rs2346061 of CNDP1 was significantly associated with diabetic nephropathy among the Indians only with OR = 1.94 and 95% CI = (1.76–3.20) and fitted best the multiplicative model, while D18S880 was associated among all the three major races with the Malays having the strongest association with OR = 2.46 and 95% CI = (1.48–4.10), Chinese with OR = 2.26 and 95% CI = (1.34–3.83), and Indians with OR = 1.77 and 95% CI = (1.18–2.65) in the genotypic multiplicative model. The best mode of inheritance for both MnSOD and NOS3 was the additive model. For MnSOD-rs4880, the Chinese had OR = 2.8 and 95% CI = (0.53–14.94), Indians had OR = 2.4 and 95% CI = (0.69–2.84), and Malays had OR = 2.16 and 95% CI = (0.54–8.65), while for NOS3-rs1799983, the Indians had the highest risk with OR = 3.16 and 95% CI = (0.52–17.56), followed by the Chinese with OR = 3.55 and 95% CI = (0.36–35.03) and the Malays with OR = 2.89 and 95% CI = (0.29–28.32). The four oxidative stress-related polymorphisms have significant effects on the development of nephropathy in type 2 diabetes patients. The genes may, therefore, be considered as risk factors for Malaysian subjects who are predisposed to T2DM nephropathy.

Re-examining the sensitivity of HbA1c to screen for diabetes mellitus

BACKGROUND

One of the laboratory tests recommended by the American Diabetes Association (ADA) to screen for diabetes mellitus (DM) is HbA1c, and it is particularly suitable for segments of the population that cannot or are unwilling to fast for a screening test. The aim of this study was to determine whether HbA1c would be a useful tool to screen for DM in a real-world setting if ADA guidelines for repeat testing to confirm the diagnosis of DM are strictly adhered to.

METHODS

A retrospective database study was performed by extracting demographic and laboratory data from a chronic disease registry that collects data on adults from three tertiary hospitals and nine large primary care clinics in Singapore. Data were extracted and analyzed for adults not previously known to have DM whose data was captured in the registry between 2005 and 2016 with HbA1c and at least two diagnostic tests for DM (fasting plasma glucose or 2-h plasma glucose) performed within 4 weeks after HbA1c determination.

RESULTS

In all, 3928 adults were included in this study. The sensitivity, specificity, and area under the receiver operating characteristic curve for HbA1c at a threshold of 6.5% were 85.2%, 82.3%, and 0.914, respectively. A higher sensitivity was found in female adults, younger adults, and those of non-Chinese ethnicity.

CONCLUSIONS

The sensitivity of HbA1c as a screening test for DM in this study was significantly higher than that reported previously. This work provides additional evidence supporting the inclusion of HbA1c as one of the screening tests for DM.

Prevalence of Diabetes and Relationship with Socioeconomic Status in the Thai Population: National Health Examination Survey, 2004-2014

OBJECTIVE

To determine the prevalence and trend of diabetes, related glycemic control, and influential socioeconomic (SES) factors in the Thai population aged ≥20 years during 2004-2014.

METHODS

Data from the Thai National Health Examination Survey 2004, 2009, and 2014 were used. Age-adjusted prevalence was calculated, and the associations of education levels with prevalence of diabetes and glycemic control were examined using logistic regression.

RESULTS

Age-adjusted prevalence of diabetes increased from 7.7% in 2004 to 7.8% in 2009 and 9.9% in 2014 (8.9% among men and 10.8% among women). Proportions of undiagnosed diabetes were slightly decreased but remained high in 2014 (51.2% for men and 41.3% for women). Diabetes prevalence was higher among those with primary education in both sexes; however, undiagnosed diabetes was higher among women with secondary and university educations. The percentages of those treated and controlled slightly improved among men (45.9%) but not among women (36.4%). Unmet glycemic control was also higher among women with secondary education levels and among men with university-level educations.

CONCLUSIONS

Epidemic diabetes continues to grow in the Thai population, particularly in individuals with lower educational attainment. Measures to detect new cases and strengthen glycemic control should be scaled up.

Use of HbA1c to diagnose type 2 diabetes mellitus among high risk Sri Lankan adults

AIM

Even though, glycosylated hemoglobin (HbA1c) was found to be effective in predicting diabetes especially in Caucasians there is limited evidence of its diagnostic utility in high risk Sri Lankan adults. This study aimed to determine the optimal HbA1c cut-off points for detecting diabetes in a high risk population in Sri Lanka.

MATERIALS AND METHODS

This community based study consisted of 254 previously healthy adults with history of diabetes in one or more first-degree relatives. Fasting plasma glucose (FPG) , glucose tolerance test (GTT) and HbA1c were measured in all and GTT was used as a reference to diagnose diabetes. Receiver operating characteristic curve was created to find the optimum HbA1c cut-off value to predict diabetes.

RESULTS

Prevalence of diabetes was 12.2% (n=31) with FPG and 16.1% (n=41) with GTT. Prevalence rose to 27.6% (P<0.01) when HbA1c with cut-off of ≥6.5% was used as the diagnostic test. The ROC curves showed the HbA1c threshold of 6.3% provided the optimum balance between sensitivity (80.5%) and specificity (79%). In compared to GTT, FPG had only a modest sensitivity (65%) in diagnosing diabetes in this high risk population.

CONCLUSION

Our study showed that optimum HbA1C cut-off for detecting diabetes was 6.3% and it had better sensitivity, but lower specificity than FPG. This study further showed that the prevalence of diabetes would become double if HbA1c is used over FPG to screen this high risk population.

Provision of Prosthetic Services Following Lower Limb Amputation in Malaysia

The incidence of lower limb amputation is high across the globe and continues to be a major threat to morbidity and mortality. Consequently, the provision of high quality and effective prosthetics services have been known as an essential component for a successful rehabilitation outcome. In Malaysia, amputation prevalence has been increasing in which several main components of service delivering aspects (such as service intervention, prosthetic personnel) should be anticipated to accommodate for the increasing demand. This article highlights the hurdles experienced in providing prosthetic services in Malaysia from multiple aspects such as financial burden to acquire the prosthesis and lack of expertise to produce quality prosthesis. This paramount issues consequently justify for the urgency to carry out national level survey on the current statistics of lower limb amputation and to ascertain the available workforce to provide a quality prosthetics services. Only with accurate and current information from the national survey, strategies and policies aimed at enhancing the outcome from prosthetics services can be achieved.

A Consensus of Key Opinion Leaders on the Management of Pre-diabetes in the Asia-Pacific Region

The Asia-Pacific region carries a high disease burden, with over half of the global diabetic population residing in this region. Increasing evidence shows that without targeted intervention, the progression from impaired glucose tolerance (IGT) to type 2 diabetes occurs more frequently in Asians compared with Caucasians. Furthermore, IGT is independently associated with an increased risk of cardiovascular disease, and should be managed as early as possible. Because diabetes is now a major public health issue, strategies aimed at prevention and treatment are urgently required. Lifestyle modification, including weight loss, dietary changes and increased physical activity, play a major role in controlling the disease. Significant evidence also supports the effectiveness of a combination of lifestyle modification and pharmacologic therapy, such as metformin, in delaying the onset of diabetes. Although the importance of lifestyle interventions is well recognized throughout Asia, many countries do not have formal recommendations to guide the diagnosis and management of individuals at risk of progression to diabetes. At a recent regional meeting, experts from the Asian region convened to develop consensus recommendations to guide clinicians in the management of Asian patients with pre-diabetes. These consensus recommendations provide a clear and concise approach to the management of individuals with IGT based on the available evidence and current best clinical practice.

Usability and utility evaluation of the web-based "Should I Start Insulin?" patient decision aid for patients with type 2 diabetes among older people

This study aimed to evaluate the usability (ease of use) and utility (impact on user's decision-making process) of a web-based patient decision aid (PDA) among older-age users. A pragmatic, qualitative research design was used. We recruited patients with type 2 diabetes who were at the point of making a decision about starting insulin from a tertiary teaching hospital in Malaysia in 2014. Computer screen recording software was used to record the website browsing session and in-depth interviews were conducted while playing back the website recording. The interviews were analyzed using the framework approach to identify usability and utility issues. Three cycles of iteration were conducted until no more major issues emerged. Thirteen patients participated: median age 65 years old, 10 men, and nine had secondary education/diploma, four were graduates/had postgraduate degree. Four usability issues were identified (navigation between pages and sections, a layout with open display, simple language, and equipment preferences). For utility, participants commented that the website influenced their decision about insulin in three ways: it had provided information about insulin, it helped them deliberate choices using the option-attribute matrix, and it allowed them to involve others in their decision making by sharing the PDA summary printout.

Damage in the Multiethnic Malaysian Systemic Lupus Erythematosus (SLE) Cohort: Comparison with Other Cohorts Worldwide

Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease and despite the improvement in the survival in the past few decades, the morbidity due to disease damage remains significant. The objectives of this study were to investigate the disease damagepattern and determine the associated factors of damage in the multi-ethnic Malaysian SLE patients. We consecutively 424SLE patients who attended a consistent follow-up at the National University of Malaysia Medical Centre and Putrajaya Hospital were recruited. Disease damage was assessed using the SLICC/ACR (Systemic Lupus International Collaborating Clinics/American College of Rheumatology) Damage Index (SDI) scores. Information on their demographics and disease characteristics were obtained from the clinical record. Univariate analysis was performed and the best model of independent predictors of disease damage was determined by multivariate logistic regression analysis. A total of 182 patients (42.9%) had disease damage (SDI ≥1). A significantly higher number of Indian patients had disease/organ damage and they predominantly developed steroid-induced diabetes mellitus (SDM). Patients with corticosteroid-induced osteoporosis (CIOP) were more likely to be Malayswhile majority of patients who developed malignancy were Chinese (p<0.05). In the univariate and multivariate analyses, disease damage was significantly associated with age, Indian ethnicity, lower mean cumulative C3 level, neuropsychiatry lupus (NPSLE), and antiphospholipid syndrome (APLS). Patients who had ever and early treatment with hydroxychloroquine(HCQ)were less likely to develop disease damage while more patients who had received oral prednisolone ≥1mg/kg daily over 2 weeks had disease damage (p<0.05). In conclusion, there were inter-ethnic differences in the damage pattern and risks among SLE patients.

Diabetes mellitus and its complications in India

India is one of the epicentres of the global diabetes mellitus pandemic. Rapid socioeconomic development and demographic changes, along with increased susceptibility for Indian individuals, have led to the explosive increase in the prevalence of diabetes mellitus in India over the past four decades. Type 2 diabetes mellitus in Asian Indian people is characterized by a young age of onset and occurrence at low levels of BMI. Available data also suggest that the susceptibility of Asian Indian people to the complications of diabetes mellitus differs from that of white populations. Management of this disease in India faces multiple challenges, such as low levels of awareness, paucity of trained medical and paramedical staff and unaffordability of medications and services. Novel interventions using readily available resources and technology promise to revolutionise the care of patients with diabetes mellitus in India. As many of these challenges are common to most developing countries of the world, the lessons learnt from India's experience with diabetes mellitus are likely to be of immense global relevance. In this Review, we discuss the epidemiology of diabetes mellitus and its complications in India and outline the advances made in the country to ensure adequate care. We make specific references to novel, cost-effective interventions, which might be of relevance to other low-income and middle-income countries of the world.

The SAD-MEN questionnaire: a new and reliable questionnaire for assessing sexual dysfunction in Asians with diabetes

AIM

The aim of this study is to construct a new tool for the assessment of sexual dysfunction among men with diabetes that is valid and reliable across different ethnicities, languages and socio-economic backgrounds in South East Asia.

METHODS

Focus group interviews were conducted to determine the construct of the questionnaire. Content and face validity were assessed by a panel of experts. A pilot study was conducted to validate the Sexual Dysfunction in Asian Men with Diabetes (SAD-MEN) questionnaire in English and Malay. The International Index of Erectile Function-5 (IIEF-5) was used for comparison. Construct validity was assessed using exploratory factor analysis, reliability was determined using Cronbach's α (> 0.700), and test-retest reliability using Spearman's rank correlation coefficient.

RESULTS

The SAD-MEN questionnaire yielded moderate face and content validity, with high reliability as shown by Cronbach's α values of 0.949 for sexual performance and 0.775 for sexual desire for the English version. The Malay language questionnaire had a Cronbach's α value of 0.945 for sexual performance and 0.750 for sexual desire. Test-retest reliability using Spearman's test gave correlation coefficients of r = 0.853, P = 0.000 for the English language questionnaire and r = 0.908, P = 0.000 for the Malay language questionnaire.

CONCLUSION

The SAD-MEN questionnaire is a valid and reliable tool by which to assess sexual dysfunction in English- and Malay-speaking Malaysian and South East Asian men with diabetes.

An Application of Bayesian Approach in Modeling Risk of Death in an Intensive Care Unit

Background and Objectives

There are not many studies that attempt to model intensive care unit (ICU) risk of death in developing countries, especially in South East Asia. The aim of this study was to propose and describe application of a Bayesian approach in modeling in-ICU deaths in a Malaysian ICU.

Methods

This was a prospective study in a mixed medical-surgery ICU in a multidisciplinary tertiary referral hospital in Malaysia. Data collection included variables that were defined in Acute Physiology and Chronic Health Evaluation IV (APACHE IV) model. Bayesian Markov Chain Monte Carlo (MCMC) simulation approach was applied in the development of four multivariate logistic regression predictive models for the ICU, where the main outcome measure was in-ICU mortality risk. The performance of the models were assessed through overall model fit, discrimination and calibration measures. Results from the Bayesian models were also compared against results obtained using frequentist maximum likelihood method.

Results

The study involved 1,286 consecutive ICU admissions between January 1, 2009 and June 30, 2010, of which 1,111 met the inclusion criteria. Patients who were admitted to the ICU were generally younger, predominantly male, with low co-morbidity load and mostly under mechanical ventilation. The overall in-ICU mortality rate was 18.5% and the overall mean Acute Physiology Score (APS) was 68.5. All four models exhibited good discrimination, with area under receiver operating characteristic curve (AUC) values approximately 0.8. Calibration was acceptable (Hosmer-Lemeshow p-values > 0.05) for all models, except for model M3. Model M1 was identified as the model with the best overall performance in this study.

Conclusion

Four prediction models were proposed, where the best model was chosen based on its overall performance in this study. This study has also demonstrated the promising potential of the Bayesian MCMC approach as an alternative in the analysis and modeling of in-ICU mortality outcomes.

Diabetes in Asia and the Pacific: Implications for the Global Epidemic

The last three decades have witnessed an epidemic rise in the number of people with diabetes, especially type 2 diabetes, and particularly in developing countries, where more than 80% of the people with diabetes live. The rise of type 2 diabetes in South Asia is estimated to be more than 150% between 2000 and 2035. Although aging, urbanization, and associated lifestyle changes are the major determinants for the rapid increase, an adverse intrauterine environment and the resulting epigenetic changes could also contribute in many developing countries. The International Diabetes Federation estimated that there were 382 million people with diabetes in 2013, a number surpassing its earlier predictions. More than 60% of the people with diabetes live in Asia, with almost one-half in China and India combined. The Western Pacific, the world's most populous region, has more than 138.2 million people with diabetes, and the number may rise to 201.8 million by 2035. The scenario poses huge social and economic problems to most nations in the region and could impede national and, indeed, global development. More action is required to understand the drivers of the epidemic to provide a rationale for prevention strategies to address the rising global public health "tsunami." Unless drastic steps are taken through national prevention programs to curb the escalating trends in all of the countries, the social, economic, and health care challenges are likely to be insurmountable.

Association between glycemic control and antidiabetic drugs in type 2 diabetes mellitus patients with cardiovascular complications

PURPOSE

Cardiovascular disease (CVD) is a macrovascular complication in patients with type 2 diabetes mellitus (T2DM). To date, glycemic control profiles of antidiabetic drugs in cardiovascular (CV) complications have not been clearly elucidated. Therefore, this study was conducted retrospectively to assess the association of antidiabetic drugs and glycemic control with CV profiles in T2DM patients. The association of concurrent medications and comorbidities with glycemic control was also investigated.

METHODS

A total of 220 T2DM patients from the University of Malaya Medical Centre, Malaysia, who had at least one CV complication and who had been taking at least one antidiabetic drug for at least 3 months, were included. The associations of antidiabetics, cardiovascular diseases, laboratory parameters, concurrent medications, comorbidities, demographics, and clinical characteristics with glycemic control were investigated.

RESULTS

Sulfonylureas in combination (P=0.002) and sulfonylurea monotherapy (P<0.001) were found to be associated with good glycemic control, whereas insulin in combination (P=0.051), and combination biguanides and insulin therapy (P=0.012) were found to be associated with poor glycemic control. Stroke (P=0.044) was the only type of CVD that seemed to be significantly associated with good glycemic control. Other factors such as benign prostatic hyperplasia (P=0.026), elderly patients (P=0.018), low-density lipoprotein cholesterol levels (P=0.021), and fasting plasma glucose (P<0.001) were found to be significantly correlated with good glycemic control.

CONCLUSION

Individualized treatment in T2DM patients with CVDs can be supported through a better understanding of the association between glycemic control and CV profiles in T2DM patients.

Glycemic control and antidiabetic drugs in type 2 diabetes mellitus patients with renal complications

BACKGROUND

Good glycemic control can delay the progression of kidney diseases in type 2 diabetes mellitus (T2DM) patients with renal complications. To date, the association between antidiabetic agents and glycemic control in this specific patient population is not well established.

PURPOSE

This study aimed to identify antidiabetic regimens as well as other factors that associated with glycemic control in T2DM patients with different stages of chronic kidney disease (CKD).

PATIENTS AND METHODS

This retrospective, cross-sectional study involved 242 T2DM inpatients and outpatients with renal complications from January 2009 to March 2014 and was conducted in a tertiary teaching hospital in Malaysia. Glycated hemoglobin (A1C) was used as main parameter to assess patients' glycemic status. Patients were classified to have good (A1C <7%) or poor glycemic control (A1C ≥7%) based on the recommendations of the American Diabetes Association.

RESULTS

Majority of the patients presented with CKD stage 4 (43.4%). Approximately 55.4% of patients were categorized to have poor glycemic control. Insulin (57.9%) was the most commonly prescribed antidiabetic medication, followed by sulfonylureas (43%). Of all antidiabetic regimens, sulfonylureas monotherapy (P<0.001), insulin therapy (P=0.005), and combination of biguanides with insulin (P=0.038) were found to be significantly associated with glycemic control. Other factors including duration of T2DM (P=0.004), comorbidities such as anemia (P=0.024) and retinopathy (P=0.033), concurrent medications such as erythropoietin therapy (P=0.047), α-blockers (P=0.033), and antigouts (P=0.003) were also correlated with A1C.

CONCLUSION

Identification of factors that are associated with glycemic control is important to help in optimization of glucose control in T2DM patients with renal complication.

The Malaysian Cataract Surgery Registry: Profile of Patients Presenting for Cataract Surgery

PURPOSE

To investigate the change in the profile of patients who had cataract surgery at Ministry of Health (MOH) hospitals in Malaysia.

DESIGN

Secondary analysis on Malaysian Cataract Surgery Registry data.

METHODS

The Malaysian Cataract Surgery Registry, a MOH-initiated registry, collects data on patients who had cataract surgery at the 36 MOH ophthalmology departments including demography, causes of cataract, systemic and ocular comorbidity, preoperative visual acuity (VA), operative details, and postoperative outcomes. This article reviews data on patient profiles from 2002 to 2004 and 2007 to 2011.

RESULTS

The coverage of cataract surgery was 91.5% (171,482/185,388). Mean patient age was 64.5 years, and 51.6% were women. A high proportion of patients had hypertension (48.9%), diabetes mellitus (37.1%), and diabetic retinopathy (10.7%). Most had senile cataract (93.4%) and one third had second eye surgery. Most patients (82.0%) had preoperative unaided VA of worse than 6/12. Eyes presenting with unaided VA of worse than 3/60 decreased from 62.6% in 2002 to 47.7% in 2011, whereas those with 6/18 to 3/60 increased from 35.2% to 48.5% (P < 0.001). Patients who had extracapsular cataract extraction had worse preoperative VA than those who had phacoemulsification (81.3% vs 40% had vision worse than 3/60).

CONCLUSIONS

The obvious change in patient profiles was the decreasing number of eyes presenting with worse than 3/60 vision. Compared with developed countries, patients who had cataract surgery at MOH hospitals in Malaysia were younger and had higher associations with diabetes mellitus and diabetic retinopathy.

A comparative drug utilisation study of the treatment of diabetes in Malaysia and Australia

BACKGROUND

Once a disease of developed countries, type 2 diabetes mellitus (T2DM) has become widespread worldwide. For people with T2DM, achievement of therapeutic outcomes demands the rational and quality use of medicine.

AIMS

The primary aim of this study was to examine the prevalence of diabetes and prescribing patterns of anti-diabetic medications in Australia and Malaysia.

METHODS

The most recent, publicly available, statistical reports (2004-2008) on the use of medicines published in Australia and in Malaysia were evaluated. Defined daily doses (DDDs/1,000 population/day) were derived from the reports and used to rank and compare individual drug use.

RESULTS

There was an increasing trend in the prevalence of diabetes in Australia, although there is a greater predicted increase in prevalence for Malaysia. While drugs used for the treatment of diabetes were not the most highly used drugs in Australia, their use increased during the study period, from 42.64 to 48.61 DDD/1,000/day. Anti-diabetic drugs were the most frequently dispensed class of drugs in Malaysia. Although the total consumption of anti-diabetic drugs in Malaysia decreased between 2006 and 2007 (from 40.30 to 39.72), this was followed by a marked increase to 46.69 in 2008. There was a marked reduction in the dispensing of insulin in Malaysia from 2004 to 2007 (7.77 to 3.23).

CONCLUSION

The use of drugs to treat diabetes does not reflect the usage patterns found in Australia. Effective drug use reviews are required to ensure impartial access in middle- and low-income countries.

Development and validation of the Asian Diabetes Quality of Life (AsianDQOL) Questionnaire

AIM

To construct a type-2 diabetes specific quality of life (QOL) tool for Asian populations that is valid and reliable across different ethnicities, languages, and socio-economic backgrounds.

METHODS

A focus group determined the domains affecting QOL in consultation with an expert group. A pilot study was conducted to validate the Asian Diabetes QOL (AsianDQOL) in English, Malay and Chinese-Mandarin. The World Health Organization Brief Quality of Life Questionnaire (WHOQOL-BREF) was used for comparison. Exploratory factor analysis (EFA), reliability analysis (RA) using Cronbach's alpha, test-retest reliability, and confirmatory factor analysis (CFA) using structural equation modeling (SEM) was undertaken using the statistical software IBM SPSS Statistics version 20.

RESULTS

EFA with eigenvalues (>1) and factor loadings ≥0.3 for English and Malay language demonstrated 21 items (5 components). CFA (English version) confirmed the model (CMIN 201.08, p-value 0.071, GFI 0.88, RMSEA 0.036, CFI 0.978). CFA (Malay version) confirmed the 5-factor model (CMIN 189.39, p-value 0.085, GFI 0.937, RMSEA 0.025, CFI 0.987). The Cronbach's alpha scores (English version) were 0.917, 0.818, 0.816, 0.749 and 0.719, respectively. The Malay version scored 0.833, 0.819, 0.816, 0.775, 0.673, respectively, whilst the Chinese/Mandarin version scored 0.890, 0.719, 0.826, 0.862 and 0.759, respectively. Test-retest reliability showed Pearson correlation of 0.600 (English version), 0.700 (Malay version) and 0.500 (Chinese-Mandarin version). A scoring system was generated based on the 25th, 50th and 75th centiles for all the three languages.

CONCLUSION

The AsianDQOL is a valid, reliable and stable tool for assessing QOL in multi-ethnic and multi-lingual T2DM Asian populations.

Cardio-metabolic health risks in indigenous populations of Southeast Asia and the influence of urbanization

Background

South East Asia (SEA) is home to over 30 tribes of indigenous population groups who are currently facing rapid socio-economic change. Epidemiological transition and increased prevalence of non-communicable diseases (NCD) has occured. In Peninsular Malaysia, the Orang Asli (OA) indigenous people comprise 0 · 6% (150,000) of the population and live in various settlements. OA comprise three distinct large tribes with smaller sub-tribes. The three large tribes include Proto-Malay (sub-tribes: Orang Seletar and Jakun), Senoi (sub-tribes: Mahmeri and Semai), and Negrito (sub-tribes: Jehai, Mendriq and Batek).

Methods

We studied the health of 636 OA from seven sub-tribes in the Peninsular. Parameters that were assessed included height, weight, BMI and waist circumference whilst blood pressure, cholesterols, fasting blood glucose and HbA1c levels were recorded. We then analysed cardio-metabolic risk factor prevalences and performed multiple pair-wise comparisons among different sub-tribes and socio-economic clusters.

Results

Cardio-metabolic risk factors were recorded in the seven sub-tribes.. Prevalence for general and abdominal obesity were highest in the urbanized Orang Seletar (31 · 6 ± 5 · 7%; 66 · 1 ± 5 · 9%). Notably, hunter gatherer Jehai and Batek tribes displayed the highest prevalence for hypertension (43 · 8 ± 9 · 29% and 51 · 2 ± 15 · 3%) despite being the leanest and most remote, while the Mendriq sub-tribe, living in the same jungle area with access to similar resources as the Batek were less hypertensive (16.3 ± 11.0%), but displayed higher prevalence of abdominal obesity (27.30 ± 13.16%).

Conclusions

We describe the cardio-metabolic risk factors of seven indigenous communities in Malaysia. We report variable prevalence of obesity, cholesterol, hypertension and diabetes in the OA in contrast to the larger ethnic majorities such as Malays, Chinese and Indians in Malaysia These differences are likely to be due to socio-economic effects and lifestyle changes. In some sub-tribes, other factors including genetic predisposition may also play a role. It is expected that the cardio-metabolic risk factors may worsen with further urbanization, increase the health burden of these communities and strain the government’s resources.

Sitagliptin: Is It Effective in Routine Clinical Practice?

Aim. The present study was conducted to determine the glycaemic effects of sitagliptin in type 2 diabetes patients. Methods. Data was collected from patient medical records of a major teaching hospital in Malaysia, from 2009 to 2012. Glycated hemoglobin (HbA1c) values prior to and up to 12 months after the initiation of sitagliptin were analysed. The change in HbA1c values was accounted for based on a generalized linear model generated using the Generalized Estimating Equations (GEE) method. Results and Discussion. Of the 457 patients, 53.6% were elderly and 81.4% were overweight. The mean HbA1c (standard deviation) before initiation of sitagliptin was 8.5 (1.4)%. This dropped to 7.7 (1.4)%, 3 to 6 months after initiation of sitagliptin, with a mean difference of 0.8% (95% confidence interval (CI): 0.7-1.0; P < 0.001). However, this value increased to 8.0 (1.7)% after 7 to 12 months on sitagliptin (P = 0.002) with a mean difference from baseline of 0.6% (95% CI: 0.4-0.7; P < 0.001). Conclusion. In routine clinical practice, sitagliptin produces a significant reduction in mean HbA1c (0.8%) within the first 6 months of use which corresponds to efficacy data obtained in controlled clinical trials. However, this reduction was lesser, 7 to 12 month later.

Diabetes quality of life perception in a multiethnic population

AIM

The aim of this study was to determine ethnic differences and predictors of the perception of quality of life (QOL) in a multiethnic Malaysian population with type 2 diabetes.

METHODS

A population-based cross-sectional study was done in three different states in Malaysia. The Asian Diabetes Quality of Life (AsianDQOL) tool specific for type 2 diabetes is the primary outcome tool. One-way analysis of covariance was undertaken to examine ethnic differences on the total and component AsianDQOL scores controlling for important covariates. Stepwise multiple linear regression models were used for selecting predictors for the AsianDQOL score with stratification for ethnicity and language.

RESULTS

A total of 647 subjects (338 Malays, 160 Chinese and 149 Indians) were recruited. Chinese scored significantly lower (78.1 ± 11.6) on the AsianDQOL (total) score compared to Malays (81.4 ± 9.0) and Indians (81.5 ± 9.2) (F = 3.060, p = 0.049, η (2) = 0.02). Likewise, Chinese scored significantly lower (21.0 ± 4.3) on the AsianDQOL (diet) score compared to Malays (22.8 ± 3.6) and Indians (22.5 ± 3.7) (F = 4.96, p = 0.008, η (2) = 0.04). The main predictors of AsianDQOL (total) score for the English language group of different ethnicities were sexual dysfunction (-4.5), having visual problems (-3.7), female (-2.8) and glycemic control (-1.6). Sexual dysfunction was negatively correlated with QOL in Malay, Chinese ethnic group and Indian ethnic groups.

CONCLUSION

The perception of AsianDQOL is different across ethnic groups and languages spoken. Significant differences in the English-speaking group and the non-English-speaking group are detected within the same ethnicity. Sexual dysfunction severely impacts AsianDQOL in a multiethnic Asian population and remains an important determinant regardless of ethnicity and language.

The changing pattern of cataract surgery indications: a 5-year study of 2 cataract surgery databases

PURPOSE

The aim of this study was to describe changes over time in the indications and outcomes of cataract surgery and to discuss optimal timing for the surgery.

DESIGN

Database study.

PARTICIPANTS

Patients who had undergone cataract extraction in the Netherlands, Sweden, or Malaysia from 2008 through 2012.

METHODS

We analyzed preoperative, surgical, and postoperative data from 2 databases: the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO) and the Malaysian National Cataract Registry. The EUREQUO contains complete data from the national cataract registries in the Netherlands and Sweden.

MAIN OUTCOME MEASURES

Preoperative and postoperative corrected distance visual acuity, preoperative ocular comorbidity in the surgery eye, and capsule complications during surgery.

RESULTS

There were substantial differences in indication for surgery between the 3 national data sets. The percentage of eyes with a preoperative best-corrected visual acuity of 20/200 or worse varied from 7.1% to 72%. In all 3 data sets, the visual thresholds for cataract surgery decreased over time by 6% to 28% of the baseline values. The frequency of capsule complications varied between the 3 data sets, from 1.1% to 3.7% in 2008 and from 0.6% to 2.7% in 2012. An increasing postoperative visual acuity was also seen for all 3 data sets. A high frequency of capsule complication was related significantly to poor preoperative visual acuity, and a high frequency of decreased visual acuity after surgery was related significantly to excellent preoperative visual acuity.

CONCLUSIONS

The 5-year trend in all 3 national data sets showed decreasing visual thresholds for surgery, decreasing surgical complication rates, and increasing visual outcomes regardless of the initial preoperative visual level. Cataract surgery on eyes with poor preoperative visual acuity was related to surgical complications, and cataract surgery on eyes with excellent preoperative visual acuity was related to adverse visual results.

A descriptive study of the factors associated with damage in Malaysian patients with lupus nephritis

Introduction

Renal involvement is the most common serious complication in patients with systemic lupus erythematosus (SLE).

Objective

The objective of this article is to investigate and determine the associated factors of disease damage among lupus nephritis (LN) patients.

Methods

Medical records of LN patients who attended regular follow-up for at least one year in the Nephrology/SLE Clinic, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), were reviewed. Their Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index scores were noted. Univariate analysis and multivariable regression analysis were performed to determine the independent factors of disease damage in LN.

Results

A total of 150 patients were included and their follow-up duration ranged from one to 20 years. Sixty (40%) LN patients had disease damage (SDI ≥1). In the univariate analysis, it was associated with age, longer disease duration, antiphospholipid syndrome (APS), higher maximum daily oral prednisolone dose (mg/day), lower mean C3 and C4, higher chronicity index and global sclerosis on renal biopsies ( p < 0.05). Patients who received early (≤3 months after the SLE diagnosis) hydroxychloroquine (HCQ), optimum HCQ dose at 6.5 mg/kg/day and achieved early complete remission (CR) were less likely to have disease damage ( p < 0.05). After adjustment for age, gender, disease duration and severity, multivariable regression analysis revealed that a higher maximum daily dose of oral prednisolone was independently associated with disease damage while early HCQ and CR were associated with lower disease damage.

Conclusion

Higher maximum daily prednisolone dose predicted disease damage whereas treatment with early HCQ and early CR had a protective role against disease damage.

Haemoglobin A1c: comparing performance of two point of care devices with laboratory analyser

BACKGROUND

Measurement of HbA1c has been widely used for long-term monitoring and management of diabetes control. There is increasing use of point-of-care (POC) devices for measuring HbA1c where quicker results would allow immediate clinical management decisions to be made. Therefore, it is important to evaluate and compare the performance of such devices to the reference laboratory method.

FINDINGS

A total of 274 venous blood was collected from normal healthy adults during the community screening programmes. The performance of POC devices, Afinion and Quo-test were compared to central laboratory HPLC method; Adams A1c HA 8160. Both POC devices showed good correlation to HA 8160 with r = 0.94 (p < 0.001) and r = 0.95 (p < 0.001) for Afinion and Quo-test respectively. The means difference were statistically higher between POC and HA 8160 with 0.23% (95% CI 0.19-0.26, p < 0.001) and 0.29% (95% CI 0.24-0.34, p < 0.001) for Afinion and Quo-test respectively.

CONCLUSIONS

Both POC devices could be considered in health clinics for diabetes management but not to be used for the diagnostic purposes.