Prevalence and factors associated with prediabetes and diabetes in fishing communities in penang, Malaysia: A cross-sectional study

Transform diabetes care with precision medicine

Background and Aims

Diabetes is a global concern. This article took a closer look at diabetes and precision medicine.

Methods

A literature search of studies related to the use of precision medicine in diabetes care was conducted in various databases (PubMed, Google Scholar, and Scopus).

Results

Precision medicine encompasses the integration of a wide array of personal data, including clinical, lifestyle, genetic, and various biomarker information. Its goal is to facilitate tailored treatment approaches using contemporary diagnostic and therapeutic techniques that specifically target patients based on their genetic makeup, molecular markers, phenotypic traits, or psychosocial characteristics. This article not only highlights significant advancements but also addresses key challenges, particularly focusing on the technologies that contribute to the realization of personalized and precise diabetes care.

Conclusion

For the successful implementation of precision diabetes medicine, collaboration and coordination among multiple stakeholders are crucial.

Prevalence and associated factors of prediabetes in adult East African population: A systematic review and meta-analysis

Introduction

Diabetes mellitus is a major public health problem with serious consequences, and more than three-fourths of diabetes live in low- and middle-income countries. According to a recent study, people with prediabetes have nearly six times the risk of developing diabetes than those with normal glucose levels. However, due to the inconsistency and absence of representative data, this study aimed to estimate the prevalence of prediabetes and its associated factors in the adult East African population.

Methods

Databases were systematically searched for articles published between January 1, 2013, and December 30, 2022. All observational community-based studies that reported prediabetes prevalence and/or associated factors in adult East African populations were included in the meta-analyses. Three authors independently extracted all required data using the Excel data extraction format and analyzed using Stata™ Version 11. An I2 test was conducted to determine significant heterogeneity. Finally, a random effects model was used to determine the overall prevalence of prediabetes and its associated factors. The study was registered with Prospero number CRD42023389745.

Results

The search strategy identified 267 articles. After screening for full-text review, twenty-one articles were included in the final analysis. The overall prevalence of prediabetes was 12.58 % (95 % CI:10.30, 14.86 %) in the adult East African population. Furthermore, the subgroup analysis revealed that prediabetes in the urban population 20 % (95 % CI: 1.60, 38.37) was twice as prevalent as in rural 10.0 % (95 % CI: 5.52, 14.48) populations. The prevalence of prediabetes by the ADA diagnostic criteria was 21.45 % (95 % CI: 15.54, 27.35) three times higher than the WHO 7.20 % (95 % CI: 5.70, 8.69). Moreover, prediabetes was significantly associated with old age (OR = 1.64, 95 %, CI: 1.07, 2.53), hypertension (OR = 2.43, 95 %, CI: 1.02-5.79), obesity and overweight (OR = 1.70, 95 %, CI: 1.09,2.65).

Conclusion

This study showed a high prevalence of prediabetes, which was significantly associated with old age, hypertension, and high BMI. This study suggests that health policymakers should pay attention to the prevention and control strategies that is targeted at those with obesity, hypertension, and old age.

Effectiveness of acupuncture as adjunctive therapy in type 2 diabetic: Study protocol for a randomized controlled trial

INTRODUCTION

The incidence of type 2 diabetes mellitus is increasing worldwide. The literature suggests that acupuncture is a possible complementary therapy for type 2 diabetes mellitus. This study aims to determine the effectiveness of acupuncture as an adjunctive therapy on homeostasis model assessment-insulin resistance (HOMA-IR), and health-related quality of life (HRQoL) in patients with type 2 diabetes mellitus.

MATERIALS AND METHODS

This randomized, double-blind, placebo controlled, and parallel design trial will be carried out in a public university teaching hospitals in Malaysia. Eligible type 2 diabetes mellitus subjects will be randomly assigned to receive either acupuncture (n = 30) or a placebo (n = 30). The intervention is carried out using press needle or press placebo on abdomen area (10 sessions of treatment). Both groups will continue with their routine diabetes care. Primary outcome of HOMA-IR will be measured at the time of recruitment (-week 0), and after completion of 10 sessions (week 7) of the treatment. Additionally, secondary outcome of HRQoL will be measured at the time of recruitment (-week 0), after completion of 5 sessions (week 3/4), and 10 sessions (week 7) of the treatment. Any adverse event will be recorded at every visit.

DISCUSSION

The findings of this study will provide important clinical evidence for the effect of acupuncture as adjunctive therapy on HOMA-IR, adiposity and HRQoL of type 2 diabetes mellitus.

TRIAL REGISTRATION NUMBER

NCT04829045.

Trends in the Cost of Medicines, Consultation Fees and Clinic Visits in Malaysia's Private Primary Healthcare System: Employer Health Insurance Coverage

Objective

To examine trends in the cost of medicines, consultation fees and clinic visits among the employees covered by the employer health insurance in Malaysia's private primary healthcare system in Malaysia.

Designs

Retrospective cross-sectional study.

Setting

PMCare claims database from January 2016 to August 2019.

Participants

A total of 83,556 outpatient clinic visits involving 10,150 IIUM employees of the International Islamic University Malaysia (IIUM) to private general practitioners (GPs). During the study period, IIUM adopts the incentive structure of capping coverage at Ringgit Malaysia (RM) 45/outpatient visit (USD 10.58) to cover for consultation fees and medicine costs.

Main Outcome Measures

The monthly percentage change in the number of clinic visits, medicine costs, consultation fees and total costs between January 2016 and August 2019. A simple linear regression using Stata v15.1 was also performed to measure the association between the characteristics of the prescribed medicines and medicine charges.

Results

The number of clinic visits per patient increased by 17% from January 2016 to August 2019, with consultation fees increasing by 113.9% and total costs by 7.9% per clinic visit per patient. Conversely, the cost of medicines and the number of medicines prescribed per clinic visit per patient decreased by 39.7% and 6.3%, respectively.

Conclusion

Within the incentive structure of capping the total amount of coverage per clinic visit, medicine costs were reduced by decreasing the number of medicines prescribed, to offset the increased consultation fees. This may create perverse incentives that affect medicine use with negative consequences for the health system and health insurers.

Changes in Mitochondrial Epigenome in Type 2 Diabetes Mellitus

Type 2 Diabetes Mellitus is a major chronic metabolic disorder in public health. Due to mitochondria's indispensable role in the body, its dysfunction has been implicated in the development and progression of multiple diseases, including Type 2 Diabetes mellitus. Thus, factors that can regulate mitochondrial function, like mtDNA methylation, are of significant interest in managing T2DM. In this paper, the overview of epigenetics and the mechanism of nuclear and mitochondrial DNA methylation were briefly discussed, followed by other mitochondrial epigenetics. Subsequently, the association between mtDNA methylation with T2DM and the challenges of mtDNA methylation studies were also reviewed. This review will aid in understanding the impact of mtDNA methylation on T2DM and future advancements in T2DM treatment.

Pattern of macronutrients intake among type-2 diabetes mellitus (T2DM) patients in Malaysia

BACKGROUND

The incidence of type 2 diabetes mellitus (T2DM) is rising rapidly in Malaysia. Modifying dietary intake is key to both the prevention and treatment of T2DM. This study aims to investigate the pattern of macronutrient intake among T2DM patients in Malaysia.

METHODS

This study was carried out on adults aged between 35 and 70 years, residing in urban and rural Malaysian communities. A series of standardised questionnaires was used to assess the sociodemographic information, dietary intake and physical activity level of 15,353 respondents who provided informed consent to participate in this study. Blood sampling (finger prick test) and physical examination were performed to obtain blood glucose and anthropometric data, respectively. The Chi-square test was used to assess differences in the trends of macronutrient intake among T2DM patients.

RESULTS

The total number of participants diagnosed with T2DM in this study was 2254. Of these, 453 (20.1%) were newly diagnosed, 1156 (51.3%) were diagnosed for ≤5 years and 645 (28.6%) were diagnosed for > 5 years. Male patients show that there were significant differences among the three groups of T2DM according to the following variables: age, BMI, residency, participant comorbidity of hypertension, family history of T2DM and hypertension, and active smoker. Meanwhile, female patients show significant differences among the three groups of T2DM according to the following variables: age, BMI, marital status, education level, residency, participant comorbidity of hypertension and family history of T2DM. Most of the male patients consumed appropriate proportions of carbohydrate (458, 60.7%) and protein (618, 81.9%). However, female patients did not show any significant differences of the macronutrients intake among the three groups of T2DM patients.

CONCLUSIONS

The pattern of dietary intake among T2DM patients in this study showed consumption of carbohydrate and protein within the range of Malaysian RNI, coupled with high fat intake. Compliance with the Recommended Nutrient Intake (RNI) was satisfactory for both carbohydrate and protein but not for fat. The pattern indicated a preference for fat rather than protein when carbohydrate intake was restricted.

Lipohypertrophy prevalence and its associated risk factors in insulin-treated patients with type 2 diabetes in North Borneo, Malaysia

Background

Insulin-treated diabetes patients are at high risk of developing lipohypertrophy, which can negatively impact treatment outcomes. Early detection of lipohypertrophy is crucial to preventing blood glucose fluctuation. Unfortunately, this clinical issue is often overlooked by nurses, causing the development of vascular complications, which leads to an increase in the morbidity and mortality of the type 2 diabetes mellitus population.

Objective

This study was conducted to identify lipohypertrophy prevalence and to establish the association between the presence of lipohypertrophy and its associated risk factors, including years on injection, total injection in a day, total insulin unit per day, often change needle, insulin injection site and move to a different area.

Methods

This cross-sectional study included 128 patients with type 2 diabetes mellitus who received insulin therapy in an outpatient diabetic clinic. Questionnaires on socio-demographic and lipohypertrophy-associated risk factors were distributed among patients, and lipohypertrophy-assessment was done using a checklist. Descriptive statistics and Pearson Chi-square were used for statistical analysis.

Results

The prevalence of lipohypertrophy was 51.6% (95% CI: 42.6, 60.5). Swelling on fatty tissue (46.1%) exhibited the highest percentage of lipohypertrophy features during the assessment. Pearson Chi-Square revealed a significant relationship between the presence of LH and BMI categories (χ2 = 10.059, df = 3, p = 0.018), duration of injection (χ2 = 15.001, df = 3, p = 0.002), frequency of needle replacement (χ2 = 9.525, df = 3, p = 0.023) and rotation of injection site (χ2 = 5.914, df = 1, p = 0.015).

Conclusion

The high prevalence of lipohypertrophy indicates a need for a prevention strategy. Thus, nurses should play an important role in educating patients regarding the proper administration of insulin injections and performing a routine lipohypertrophy assessment and health education on the correct method of insulin injection.

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/.

The Prevalence of Diabetes, Prediabetes and Associated Risk Factors in Hangzhou, Zhejiang Province: A Community-Based Cross-Sectional Study

OBJECTIVE

Little information is available on the prevalence and associated risk factors of diabetes and prediabetes in the community located in Hangzhou city, Zhejiang Province, southeast China. This study aims to investigate the prevalence of adult diabetes and prediabetes and their associated risk factors among a community population in Hangzhou.

METHODS

A multistage sampling method was used in this study. Ten communities located in Shangcheng district of Hangzhou city were selected, and 3096 permanent residents (resident for ≥6 months) aged 18 years and above were enrolled into this study. Finally, a total of 2986 participants were included. A questionnaire interview and physical examination were conducted for all participants by trained investigators in a local medical center. Anthropometric measurements covered height, weight, waist circumference (WC) and blood pressure, while the blood tests included fasting blood glucose, an oral glucose tolerance test and fasting lipid profiles. The American Diabetes Association diabetes diagnosis criteria were used to discriminate among normal blood glucose, diabetes and prediabetes. The Rao-Scott adjusted χ ² test and complex sampling design-based unconditional multivariate logistic regression analysis were used to evaluate factors associated with diabetes and prediabetes. Descriptive and inferential statistics were calculated in Stata version 15. P-values <0.05 indicate statistical significance.

RESULTS

The overall prevalence of diabetes was 13.97%, of which 81.54% had prediagnosed diabetes and 18.46% were newly diagnosed with diabetes in the present study. The prevalence of prediabetes was 18.89%. Multivariable logistic regression analysis showed that age, education, once smoking, family history of diabetes, obesity, central obesity and hypertension were factors associated with diabetes, while age, smoking, drinking, central obesity and hypertension were significant factors related to prediabetes.

CONCLUSION

The prevalence of diabetes and prediabetes in adults in Hangzhou city remains high. Interventions aiming to modify risk factors such as drinking, obesity, central obesity and hypertension are urgently required.

Current utilization patterns for long-acting insulin analogues including biosimilars among selected Asian countries and the implications for the future

INTRODUCTION

Prevalence rates for diabetes mellitus continue to rise, which, coupled with increasing costs of complications, has appreciably increased expenditure in recent years. Poor glycaemic control including hypoglycaemia enhances complication rates and associated morbidity, mortality and costs. Consequently, this needs to be addressed. Whilst the majority of patients with diabetes have type-2 diabetes, a considerable number of patients with diabetes require insulin to help control their diabetes. Long-acting insulin analogues were developed to reduce hypoglycaemia associated with insulin and help improve adherence, which can be a concern. However, their considerably higher costs have impacted on their funding and use, especially in countries with affordability issues. Biosimilars can help reduce the costs of long-acting insulin analogues thereby increasing available choices. However, the availability and use of long-acting insulin analogues can be affected by limited price reductions versus originators and limited demand-side initiatives to encourage their use. Consequently, we wanted to assess current utilisation rates for long-acting insulin analogues, especially biosimilars, and the rationale for patterns seen, across multiple Asian countries ranging from Japan (high-income) to Pakistan (lower-income) to inform future strategies.

METHODOLOGY

Multiple approaches including assessing utilization and prices of insulins including biosimilars among six Asian countries and comparing the findings especially with other middle-income countries.

RESULTS

Typically, there was increasing use of long-acting insulin analogues among the selected Asian countries. This was especially the case enhanced by biosimilars in Bangladesh, India, and Malaysia reflecting their perceived benefits. However, there was limited use in Pakistan due to issues of affordability similar to a number of African countries. The high use of biosimilars in Bangladesh, India and Malaysia was helped by issues of affordability and local production. The limited use of biosimilars in Japan and Korea reflects limited price reductions and demand-side initiatives similar to a number of European countries.

CONCLUSIONS

Increasing use of long-acting insulin analogues across countries is welcomed, adding to the range of insulins available, which increasingly includes biosimilars. A number of activities are needed to enhance the use of long-acting insulin analogue biosimilars in Japan, Korea and Pakistan.

Rapid Assessment of Price Instability and Paucity of Medicines and Protection for COVID-19 Across Asia: Findings and Public Health Implications for the Future

Background: Countries have introduced a variety of measures to prevent and treat COVID-19 with medicines and personal protective equipment (PPE), with some countries adopting preventative strategies earlier than others. However, there has been considerable controversy surrounding some treatments. This includes hydroxychloroquine where the initial hype and misinformation lead to shortages, price rises and suicides. Price rises and shortages have also been seen for PPE. Such activities can have catastrophic effects on patients where there are high co-payment levels and issues of affordability. Consequently, there is a need to investigate this further. Objective: Assess changes in the availability, utilization and prices of relevant medicines and PPE during the pandemic among a range of Asian countries. Our approach: Narrative literature review combined with interviews among community pharmacists to assess changes in consumption, prices and shortages of medicines and PPE from the beginning of March 2020 until end of May 2020. In addition, suggestions on ways to reduce misinformation. Results: 308 pharmacists took part from five Asian countries. There was an appreciable increase in the utilization of antimicrobials in Pakistan (in over 88% of pharmacies), with lower increases or no change in Bangladesh, India, Malaysia and Vietnam. Encouragingly, there was increased use of vitamins/immune boosters and PPE across the countries, as well as limited price rises for antimicrobials in India, Malaysia and Vietnam, although greater price rises seen for analgesics and vitamin C/immune boosters. Appreciable price increases were also seen for PPE across some countries. Conclusion: Encouraging to see increases in utilization of vitamins/immune boosters and PPE. However, increases in the utilization and prices of antimicrobials is a concern that needs addressing alongside misinformation and any unintended consequences from the pandemic. Community pharmacists can play a key role in providing evidence-based advice, helping to moderate prices, as well as helping address some of the unintended consequences of the pandemic.

Factors associated with undiagnosed type 2 diabetes in Germany: results from German Health Interview and Examination Survey for Adults 2008-2011

INTRODUCTION

To identify characteristics of people with undiagnosed type 2 diabetes (T2D) among adults in Germany.

RESEARCH DESIGN AND METHODS

The study population comprised participants aged 40-79 years of the German Health Interview and Examination Survey for Adults 2008-2011. Glycemic status was categorized as undiagnosed T2D (glycated hemoglobin A1c (HbA1c) ≥48 mmol/mol (6.5%), n=135), diagnosed T2D (n=518) and normoglycemia (HbA1c<48 mmol/mol (6.5%), n=4451). Multinomial logistic regression models including glycemic status as the outcome variable and sociodemographic characteristics, living alone, diabetes risk factors and healthcare services utilization as independent variables were used to identify factors associated with undiagnosed T2D compared with normoglycemia and diagnosed T2D. Odds ratios (ORs) and 95% confidence intervals (CIs) are reported as measure of association between the outcome and independent variables.

RESULTS

The prevalence of undiagnosed T2D was 2.9% (95% CI 2.2% to 3.9%) at an overall prevalence of 12.3% (11.0% to 13.6%) of persons with undiagnosed or diagnosed T2D. In multivariable analyses, factors associated with undiagnosed as well as diagnosed T2D in comparison to normoglycemia were older age (OR 1.04, 95% CI 1.01 to 1.06, per year, for undiagnosed T2D; OR 1.08, 1.07 to 1.10 for diagnosed T2D), male sex (3.33, 2.18 to 5.07; 1.91, 1.43 to 2.56), obesity (3.47, 2.17 to 5.56; 2.68, 2.04 to 3.52), hypertension (1.66, 1.09 to 2.53; 2.04, 1.42 to 2.95) and parental history of diabetes (2.04, 1.24 to 3.35; 3.16, 2.30 to 4.34). Variables independently associated with undiagnosed T2D but not diagnosed T2D included living alone (2.20; 1.36 to 3.56) and not seeing a doctor within the past year (2.57; 1.34 to 4.93). People with undiagnosed T2D were further younger and more likely to be male sex and reside in the western part of Germany than people with diagnosed T2D.

CONCLUSION

Apart from major known risk factors of diabetes, characteristics specific to undiagnosed diabetes among adults in Germany will serve to inform the national education and communication strategy on diabetes mellitus in Germany.