Management of diabetes in pregnancy in primary care

@#Diabetes in pregnancy is associated with risks to the woman and her developing fetus. Management of the condition at the primary care level includes pre-conception care, screening, diagnosis, as well as antenatal and postpartum care. A multidisciplinary approach is essential in ensuring its holistic management.

Validation of the Malay version of Diabetes Quality of Life (DQOL) Questionnaire for Adult Population with Type 2 Diabetes Mellitus

Objective: We aimed to validate the Malay version of Diabetes Quality of Life (DQOL) questionnaire for Malaysian adult population with type 2 diabetes mellitus (DM). Methods: This is a cross-sectional study to validate Malay version of DQOL among the adult diabetic patients. DQOL questionnaire has 46 items consist of three domains, namely Satisfaction Domain, Impact Domain and Worry Domain. Both forward and backward translations from the English version of DQOL into Malay version were performed. After the face validity of the Malay version was established, it was then pilot-tested. Finally, the validity and reliability of the final Malay version of DQOL questionnaire were evaluated. Results: There were 290 patients participated in this study with a mean (SD) age of 53.1 (10.0) years. The Cronbach's alpha coefficients of the overall items and the main domains were between 0.846 and 0.941. The Pearson's correlation coefficients for the three domains were between 0.228 and 0.451. HbA1C was found to be positively correlated with Impact Domain (P = 0.006). The Worry Domain was associated with diabetic retinopathy (P = 0.014) and nephropathy (P = 0.033). Conclusion: The Malay version of diabetes quality of life (DQOL) questionnaire was found to be a valid and reliable survey instrument to be used for Malaysian adult patients with diabetes mellitus.

Prevalence of Oral Mucosal Lesions in Patients with Type 2 Diabetes Attending Hospital Universiti Sains Malaysia

Objectives: Diabetes mellitus is associated with a greater likelihood of developing certain oral mucosal disorders. This study was aimed at assessing the prevalence of oral mucosal lesions (OMLs) in patients with type 2 diabetes (DM2) and to investigate the association of such lesions with metabolic control of the disease. Methods: This cross-sectional study involved 391 patients with DM2 and 391 non-diabetic control subjects. Demographic information and data on the duration and type of diabetes, glycosylated hemoglobin (HbA1c) values, medical history, and current use of medication were obtained from medical records. Detailed oral examination was performed in accordance with international criteria. Results: The prevalence of OMLs was significantly higher among diabetic patients (45.5%) than among control subjects (38.4%) (P = 0.042). Patients with diabetes had a higher prevalence of geographic tongue (GT) (P = 0.017), denture stomatitis (P = 0.018), and angular cheilitis (P = 0.006) than controls. Overall, diabetic patients with poor metabolic control had a significantly higher prevalence of OMLs and xerostomia than patients with moderately and well-controlled disease (P < 0.05). Conclusions: The prevalence of OMLs was significantly higher in diabetic patients than in control subjects. Higher occurrence of OMLs was significantly associated with poor metabolic control.

Usage of glucometer is associated with improved glycaemic control in type 2 diabetes mellitus patients in Malaysian public primary care clinics: an open-label, randomised controlled trial

<p><b>INTRODUCTION</b>Self-monitoring of blood glucose (SMBG) has been underutilised. We conducted an open-label, randomised controlled trial to assess the feasibility of introducing SMBG in primary care clinics in Malaysia.</p><p><b>METHODS</b>This was an open-label, randomised controlled trial conducted in five public primary care clinics in Malaysia. Patients with type 2 diabetes mellitus (age range 35-65 years) not performing SMBG at the time of the study were randomised to receive either a glucometer for SMBG or usual care. Both groups of patients received similar diabetes care from the clinics.</p><p><b>RESULTS</b>A total of 105 patients with type 2 diabetes mellitus were enrolled. Of these, 58 and 47 were randomised to intervention and control groups, respectively. After six months, the glycated haemoglobin (HbA1c) level in the intervention group showed a statistically significant improvement of 1.3% (p = 0.001; 95% confidence interval 0.6-2.0), relative to the control group that underwent usual care. The percentages of patients that reached the HbA1c treatment target of ≤ 7% were 14.0% and 32.1% in the control and intervention groups (p = 0.036), respectively.</p><p><b>CONCLUSION</b>The usage of a glucometer improved glycaemic control, possibly due to the encouragement of greater self-care in the intervention group.</p>

Nutritional status and early childhood caries among preschool children in Pasir Mas,Kelantan, Malaysia

This is a cross-sectional study in a representative sample of preschool children from 12 preschools (TADIKA KEMAS) Pasir Mas, Kelantan, Malaysia. Data on socioeconomic status and sources of water supply at home were collected through interview with mothers. Children’s anthropometric data (height and weight) and body-mass-index-for-age (BMI-for-age) was calculated. Oral examinations of ECC status was based on the dmft index (WHO, 1997). The results showed mean carious teeth were very high (dmft 11.1±4.8) and almost every preschool child was affected with ECC (prevalence 98.1%). The majority were in “high caries” category (i.e. dmft >7) and about 51.4% of preschoolers was underweight and only a few was overweight/obese. Preschool children with high caries mostly were underweight and normal of BMI. The BMI-for-age, household income and household expenditure for food were significant correlation with ECC experience (p<0.05). However, logistic regression showed only family income was a significant factor to ECC.

The study of tooth wear patterns and their associated aetiologies in adults in Kelantan, Malaysia

Tooth wear is the loss of tooth tissue and structures not due to caries. It can occur in various forms either attrition, abrasion, erosion, noncaries cervical lesion (NCCL) or a combination of two or more forms. The objective of this study was to determine the patterns and associated aetiologies of tooth wear among adults in Kelantan, Malaysia. This crosssectional study involved 81 adults with tooth wear which was visually assessed using the Smith and Knight Tooth Wear Index (TWI). A questionnaire was used to seek putative aetiologies of the wear. Data were analyzed and the results were expressed as frequencies and percentages. Six thousand three hundred and eighty four tooth surfaces were examined in 1596 teeth. 17.4% surfaces had tooth wear; 80% scored 1, 18% scored 2 and 2% scored 3. Among the 81 cases of tooth wear, 29 (35.8%) had abrasion; 25 (30.9%) had attrition; 1(1.2%) had erosion while 26 (32.1%) had the combined type. Among those with abrasion, majority had the habit of eating freshwater clams (Corbicula fluminea) as local delicacy where most of the times people use their teeth to pry open the clam shells. Erosion was related to the pooling of carbonated drinks or beverages in the mouth before swallowing. In conclusion, most adults experienced abrasion and the most common possible associated aetiology is the way of eating clams.

Tooth wear prevalence and sample size determination: A pilot study

Tooth wear is the non-carious loss of tooth tissue, which results from three processes namely attrition, erosion and abrasion. These can occur in isolation or simultaneously. Very mild tooth wear is a physiological effect of aging. This study aims to estimate the prevalence of tooth wear among 16-year old Malay school children and determine a feasible sample size for further study. Fifty-five subjects were examined clinically, followed by the completion of self-administered questionnaires. Questionnaires consisted of socio-demographic and associated variables for tooth wear obtained from the literature. The Smith and Knight tooth wear index was used to chart tooth wear. Other oral findings were recorded using the WHO criteria. A software programme was used to determine pathological tooth wear. About equal ratio of male to female were involved. It was found that 18.2% of subjects have no tooth wear, 63.6% had very mild tooth wear, 10.9% mild tooth wear, 5.5% moderate tooth wear and 1.8 % severe tooth wear. In conclusion 18.2% of subjects were deemed to have pathological tooth wear (mild, moderate & severe). Exploration with all associated variables gave a sample size ranging from 560 – 1715. The final sample size for further study greatly depends on available time and resources.