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@#Introduction: In the recent years, there is remarkable increased in the prevalence of Type 2 Diabetes Mellitus (T2DM) in Middle East countries including Oman. There is good evidence that Mediterranean Diet (MedDiet) is effective over diabetes control and several cardiovascular risk factors in different populations, with little compelling evidence among Omanis. This paper describes the protocol of a wait-list, open labelled, randomized control trial, with its main objective aimed to determine the effectiveness of Mediterranean Diet intervention on glycaemic control and cardiovascular risks among T2DM patients in Oman. Methods: A total of 140 eligible T2DM patients will be recruited. Participants in the intervention group will undergo a six-month MedDiet program comprising of different activities (individual dietary counseling, cooking classes, phone calls and social media messages) while the control group will continue with standard diabetes care. Data collection will be conducted at baseline, after three and six months. The 2 x 3 mixed-design ANOVA will be used to determine the mean changes in outcome variables over the full study period between the two groups. Discussion: Epidemiology studies on nutrition and health had focused on dietary pattern, which provides an opportunity to account for nutrient-nutrient interactions lately. Mediterranean Diet has produced consistent findings on its protective role in diabetes management, with little information on its effectiveness in population outside of Mediterranean basin, including Oman. The outcomes of current study will be used to inform community and health care professionals on the effectiveness and practically of MedDiet on diabetes management.
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La principal causa de muerte en personas con diabetes mellitus tipo 1 (DM1) es de origen cardiovascular (CV). La duración de la DM1 es uno de los predictores más importantes para infarto agudo de miocardio (IAM), junto con el colesterol de lipoproteínas de baja densidad (cLDL) y HbA1c. El desarrollo de DM1 antes de los 10 años de edad se asocia con un riesgo 90 veces mayor de IAM en mujeres. En la DM1 habría una mayor contribución de un estado de inflamación sistémica de bajo de grado. La combinación de electrocardiograma de ejercicio y una técnica de imagen proporciona valor diagnóstico para la detección de isquemia miocárdica y pronóstico. La evaluación del riesgo CV en el adulto mayor debe ser individualizado y categorizarlo según funcionalidad y comorbilidades a fin de fijar objetivos de control de factores glucémicos y no glucémicos personalizados. Las personas con enfermedad cardíaca conocida o múltiples factores de riesgo cardiovascular (FRCV) deben tener recomendaciones de ejercicio personalizadas; se recomienda el tratamiento intensificado de la glucemia y de los FRCV asociados. En la población pediátrica y adolescentes con DM1 es esencial la detección y tratamiento precoz de los FRCV a fin de prevenir o retrasar el inicio y progresión de eventos CV
The leading cause of death in type 1 diabetes mellitus (T1DM) is cardiovascular. The duration of diabetes is one of the most important predictors for acute myocardial infarction (AMI), along with low-density lipoprotein cholesterol (cLDL) and HbA1c. Being diagnosed of T1DM before age 10 is been associated with a 90 times higher risk of AMI in women. It has been proposed, that a low-grade systemic inflammation state to be great prompt contributor. The combination of exercise electrocardiogram and an imaging technique provides diagnostic value for myocardial ischemia detection and future prognosis. Cardiovascular risk assessment in the older adult should be individualized by categorizing it, according to functionality and patient's co morbidity and customized glycaemic and non-glycaemic targets. People with known heart disease or multiple cardiovascular risk factors should have personalized exercise recommendations, blood glucose intensified treatment and associated risk factors. In paediatric and adolescent population with T1DM, cardiovascular risk factors early screening, recognition and treatment has become essential to prevent or delay the onset and progression of cardiovascular events.
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Humans , Diabetes Mellitus, Type 1 , Therapeutics , Blood Glucose , Cardiovascular Diseases , DiagnosisABSTRACT
Aims: To determine the prevalence, pattern and presentation of the diabetic foot ulcer.Background: A diabetic foot ulcer is a major complication in diabetes mellitusand probably the major component of diabetic foot. It occurs in 15% of all patients with diabetes and precedes 84% of all lower leg amputations.Poverty, low economic status and ignorance have resulted in this devastating disease. It may worsen in the next decade.There are multiple risk factors that predispose an individual to DM foot ulcer; they include age, gender(male), type of DM, glycaemic (HbA1c) or FBG level, duration of DM (>10yrs) occupational status particular habits of self-foot care and infection.Patients and Methods: This consists of 69 diabetic patients; male and female included done between the monthsof January 2019 to March 2019. A demographic data questionnaire and social history were obtained. Overnight fasting serum glucose was obtained. Serum glucose was determined by enzymatic glucose oxidase method. Data obtained were subjected to Stata Version 11 Software to determine the graphical representation, mean, standard deviation of the analysis. Results: Thirty-Five 35 were male and 34 were female had type 2 diabetes. Forty-Three 43 patients had foot ulcer, 21 patients had gangrene and 5 had infection. The number of patients with peak glucose values 10mmol/L and least glucose at 20-25mmol/L. Those of duration 4-6years were the mostaffected the age group most affected is between 40-59yrs.Discussion and Conclusion: Risk factors for foot ulceration discovered among a host other factors identified in this study, were the infection, low socioeconomic status, improper footwear, poor glycaemic control, structural foot deformity and untreated gangrene. The role of poor glycaemic control in the genesis of diabetic complications cannot be overemphasized as the mean FPG was noted to be considerably higher in patients with foot ulcerationAspart of a comprehensive foot care programme, education on foot care should be directed at patients, family members and healthcare providers.Not less than 85% of all diabetic foot-related problems are preventable. This can be achieved through a combination of good care of foot, provided by an inter-professional diabetes care team, and appropriate education for people with diabetes.
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Background: Carotid Intima Media Thickness (CIMT) andCRP (C Reactive Protein) are have been used for measuringAtherosclerotic Risk in Diabetics. However there is paucity ofdata regarding their importance in Statin Naïve Diabetics.Aim: To study Correlation of CIMT with glycaemic control andhsCRP in Statin Naïve Diabetics.Materials and Methods: 80 Cases (Patient suffering from type2 Diabetes Mellitus) and 20 controls (non- diabetic healthpatients) presenting in outpatient department of a tertiaryHospital were included in this observational cross sectionalobservational study. Complete Blood Count, urine Routine andMicroscopy, urine for microalbuminuria, fasting plasma glucose(FPG), postprandial plasma glucose (PPPG), glycatedhaemoglobin (HbA1C), lipid profile, renal function test, hs-CRPand CIMT were evaluated in each individual. Independentsamples T-test was used to compare CIMT and hs-CRP bothcases and controls. Test of proportion and chi-square test wasused for association between categorical variables.Spearman’s method was used to assess correlation betweenhsCRP and CIMT.Results: 80 cases (Statin naïve and Non-smoker Diabeticpatients and 20 healthy controls were included in this study.Average CIMT in cases was significantly higher in Diabeticcases than Control (0.66 + 0.14 vs 0.56±0.05, difference= 0.10 mm, 95% C.I. (0.1 - 0.17), p < 0.0001). HsCRP wassignificantly correlated with average CIMT in Diabetic cases.(r=0.512, 95% C.I. 0.33-0.658, p<0.0001). Fasting Blood Sugarwas correlated with average CIMT in Diabetic cases. (r=0.234,95% C.I. 0.015-0.432, p=0.0366). Post Prandial Blood Sugarwas also correlated with average CIMT (r=0.300, 95% C.I.0.086-0.488, p=0.00677).Conclusion: Cardiovascular risk factors like glycaemic controland inflammatory markers like hsCRP are significantlyassociated with CIMT even in non-smoking and statin naïveDiabetics.
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@#The growing prevalence of type 2 diabetes mellitus (T2DM) and the parallel increase in the prevalence of obesity warrants for effective intervention strategies. Overweight/obese patients with T2DM who attempt weight reduction often face considerable challenges. A recent study in Malaysia conducted among overweight/obese patients with T2DM showed that weight reduction and improved glycaemic control could be achieved with structured lifestyle intervention and the incorporation of behavioural counselling. The structured lifestyle recommendations in this study consisted of 1) a fixed low-calorie diet plan of 1200 kcal/day for female and 1500 kcal/day for male patients; 2) incorporation of one or two servings/day of diabetes-specific formula as a meal replacement; 3) a 14-day structured meal plan consisting of the ingredients list, cooking methods and nutrition facts; and the 4) healthy low-calorie snack options. Exercise prescription of ≥150 min/week of moderate-intensity was also encouraged. Behavioural counselling such as motivational interviewing not only facilitated adherence to the lifestyle recommendations but also further enhanced weight loss and glycaemic control in these patients. This article outlines the localisation of the structured lifestyle recommendations and its effectiveness in achieving weight loss and good glycaemic control in overweight/obese patients with T2DM.
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@#Introduction: In Malaysia, Diabetes Medication Therapy Adherence Clinic (DMTAC) in hospital settings significantly improved patients' glycaemic control and cardiovascular risk. Until now no randomised controlled trial of DMTAC has been done in a primary care setting where the access to subspecialist services (endocrinologists, expensive medication, etc.) is limited. The objective of this research is to compare the glycaemic control among diabetes mellitus (DM) patients between those received additional DMTAC service and those received normal clinic service in primary care settings. Materials and Method: This was a parallel, randomised controlled study. The selected participants were patients aged 18 to 70 years with type 2 DM on diabetic medication who were being treated in Kota Samarahan Health Clinic with HbA1c above 8% and who never attended any education of DM prior to the study. The control group received normal clinic visits with consultations by a medical officer. The intervention group received four or more DMTAC visits in addition to normal clinic visits. The primary outcomes were HbA1c while the secondary outcomes were the occurrence of severe hypoglycaemia, weight gain and medication compliance of patients. The subjects were randomised by numbered envelope opened chronologically by the investigator during the initial assessment. All health care professionals (nurse, lab staff and medical officer) except DMTAC pharmacist managing the subjects were blinded as there were no markings on the patients notes indicating that they were in this study. The demographic data was collected during screening while health data including glycated haemoglobin (HbA1c) levels were collected at baseline, sixth month and one year. Results: In all, 100 patients were randomised into control and intervention groups (n=50 per arm). The change of HbA1c in the intervention group (mean=-1.58) was significantly more than the control group (mean=-0.48) at 12 months with a mean difference of -1.10% (p=0.005, Cohen's d=0.627). Both study groups had similar significant changes of subjects from non-compliance to compliance (control group, n=11 vs. intervention group, n=10). The changes of BMI after 12 months between control group (0.24 kg/m2 ) and intervention group (0.24 kg/m2 ) was not significant (p=0.910). There were no episodes of severe hypoglycaemia detected in both groups. Conclusion: The addition of DMTAC service in primary care can improve glycaemic control among patients. The study was registered in the National Medical Research Register (Malaysia): NMRR-13-1449-18955 FUNDING: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. All blood test was done in our setting.
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Introduction: This study assumes significance as it compareshead on DPP-IV inhibitors along with other oral hypoglycemicagents with respect to glycemic and non-glycemic targets.Study was done to evaluate the DPP-IV inhibitors andother oral hypoglycemic agents (OHA) either alone or incombination, with reference to glycemic targets like fastingplasma glucose (FPG), post prandial glucose (PPG) andglycosylated hemoglobin (HbA1c) in type 2 diabetes mellitus.Material and Methods: This was an open labelledcomparative study and included 90 patients with Type 2 DM.These patients were divided into 3groups: Each group wascontaining 30 patients i.e. Group A: DPP-IV inhibitors (n=30); Group B: Oral hypoglycemic agents other than DPP-IVinhibitors (n= 30) and Group C: DPP-IV inhibitors + other oralhypoglycemic agents (n= 30). The patients were given drugson the basis of physician’s discretion, depending upon theglycemic of the patients at the time of presentation. A detailedhistory regarding age, sex, profession, duration of disease,treatment history, family history and personal history wastaken for each patient. After stabilization patients observed at0 weeks, 6 weeks, 12 weeks and 24 weeks.Results: Mean duration of diabetes was 5.35±0.53 years, andthe mean age of onset of diabetes was 46.98±0.91years. Therewas no significant difference between the study groups withrespect to FPG, PPG, and HbA1c levels. The HbA1c showedsignificant improvement in each group at the end of studyperiod.Conclusion: In summary, this study showed that treatmentwith sitagliptin, either alone or in combination with other oralhypoglycemic agent led to clinically meaningful reductionsin HbA1c, FPG and PPG over a 24 week period. Sitagliptinpresents an alternative therapeutic strategy for patientswith type 2 diabetes and, in general, showed significantimprovements in glycemic control and is well tolerated,particularly with regard to weight change and hypoglycemia.
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Background: Anaemia is one of the world’s most common preventable condition yet it is often overlooked especially in people with Diabetes Mellitus. Anaemia is a common finding in patients with diabetes. Anaemia in patients with diabetes mellitus might contribute to the pathogenesis and progression of cardiovascular disease and aggravate diabetic nephropathy and retinopathy. This aims to study the correlation between HbA1c and blood glucose levels in anaemic diabetics in order to assess the influence of anaemia on HbA1c and the effect of severity and type of anaemia on HbA1c.Methods: It’s a case control study, 200 Diabetic subjects were divided into two groups of 100 each based on their HbA1c levels group A, with good glycaemic control (HbA1c<7) and group B with poor glycaemic control (HbA1c>7), incidence of anaemia was measured and compared among them and also with 100 age and sex matched healthy non Diabetic controls. Results: In this study, it was found that high incidence of anaemia was found significantly higher in diabetics group with poor glycaemic control. Anemia was detected in 55% of patients among diabetic patients. Anaemia was seen in 71% of patients in group B with poor glycaemic control as compared to group A with good glycaemic control, in which only 39% of patients had anaemia. Mean haemoglobin was significantly lower that is, 10.81±3.0 in group with poor glycaemic control as compared to group with good glycaemic control i.e. 13.04±2.02. There was a statistically significant negative correllation between Haemoglobin percentage and HbA1c.Conclusion: Anaemia is a common finding in patients with diabetes. Diabetes related chronic hyperglycaemia can lead to a hypoxic environment in the renal interstitium which results in impaired production of erythropoietin by the peritubular fibroblasts and subsequently anaemia occurs. Anaemia in patients with diabetes mellitus might contribute to pathogenesis and progression of cardiovascular disease and aggravate diabetic nephropathy and retinopathy. However, an emphasis on regular screening for anaemia, alongside that for other diabetes related complications, might help to delay the progression of vascular complication in these patients.
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Background: Diastolic heart failure, otherwise called as heart failure with preserved ejection fraction, is common finding of hypertensive heart disease, but various studies report a high incidence of diastolic heart failure in patients with type 2 diabetes mellitus in spite of the absence of coronary artery heart disease and hypertension. The objectives of the study were to determine the prevalence of dysfunction of left ventricle in diastole in type 2 diabetes mellitus patients and to compare with the non-diabetic individuals with that of asymptomatic type II diabetes patients. To assess the correlation of diastolic dysfunction in diabetes with age of patients, HbA1c levels, duration of diabetes, retinopathy, autonomic neuropathy.Methods: A prospective cross sectional among them 50 patients were diabetics and 50 were non-diabetic controls. Diastolic dysfunction was measured with standard echocardiographic parameters and the results were computed with corresponding variables of the patients. All the variables and their data were analysed for percentage, mean, standard deviation ‘t’ test and chi square test. The ‘t’-test was used to study the quantitative data while chi square test was used to study the qualitative data.Results: Among the study population 60% had diastolic dysfunction and 14% had diastolic dysfunction among cases and control group respectively. Diastolic dysfunction was present among 23.3% and the 76.7% of the age group groups of less than 45 and more than 45 years of age respectively. In this study poor glycaemic status was significantly associated with diastolic dysfunction, whereas duration of diabetes, retinopathy and autonomic neuropathy were not statistically significant.Conclusions: Present study reveals moderately high incidence of diastolic dysfunction in asymptomatic diabetic; subjects and, this finding was correlated with the HBA1C levels but not with retinopathy and autonomic neuropathy.
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Background: Poorly controlled diabetes mellitus as indicated by elevated glycated haemoglobin (HbA1c) levels is associated with increased cardiovascular risk. C–reactive protein (CRP), an important cardiovascular risk factor, is elevated in diabetics with poor glycaemic control than those with good control. The present study assessed the correlation between HbA1c and CRP levels.Methods: A prospective study was conducted in thirty type 2 diabetic patients irrespective of the disease duration and treatment; those with established target organ damage were excluded. HbA1c and hsCRP levels were measured at baseline; sugars were monitored monthly and medications optimised; at the end of six months HbA1c and hsCRP levels were measured.Results: Mean age of the study subjects was 58.7±8.6 years; At the baseline, all had poor glycaemic control (HbA1c >7%); 15 had hsCRP >3 mg/L. At the end of 6 months, 5 achieved good glycaemic control (HbA1c <7%); 10 had hsCRP >3 mg/L. Baseline median hsCRP was 3.33 mg/L (0.68, 15.9) and at the end of 6 months it was 2.08 mg/L (0.48, 9.12). Mean HbA1c at baseline and end line was 10.6±1.55% and 8.43±1.84% respectively. There was significant reduction in both the mean HbA1c and median hsCRP at the end of 6 months (p <0.001). Positive correlation was observed between HbA1c and CRP at baseline (r=0.32, p=0.10). However, this was not observed at the end of 6 months.Conclusions: There is positive correlation between the level of glycaemic control (HbA1c) and CRP levels; Better glycaemic control results in significant reduction in the hsCRP levels.
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Background: Diabetes mellitus (DM) is a global pandemic affecting almost every organ in the body. Peripheral nervous system involvement in diabetes is well known but there are not many studies on central nervous system involvement. Visual evoked potential (VEP) is a sensitive, non-invasive test to detect central demyelination of optic nerve. The objective was to compare the visual evoked potentials in type-2 DM patients with that of healthy controls and to find out if any correlation is there with the duration and glycaemic control of the disease and to compare incidence of peripheral and central neuropathy in DM patients.Methods: Author included 50 DM patients and 50 age and sex matched controls. Patients with previous stroke, demyelination, diabetic retinopathy and other ophthalmological disorders were excluded. VEP was recorded using pattern reversal stimulation with EMG RMS MARK II machine and p100 latency was measured.Results: P100 latencies (ms) was significantly prolonged in diabetics with mean±SD of (111.24±5.28 ms) as compared to controls (101.30±1.66 ms) with p value <0.003. Also, there was significant correlation between duration of DM and P100 latency prolongation, but no significant correlation was present when compared with glycaemic control.Conclusions: Central neuropathy is very common in DM. It is related to duration of DM and not HbA1c unlike PNP which is related to both. Central neuropathy occurs even prior to development of retinopathy or PNP. Hence, VEP is a non-invasive and sensitive screening tool for early neurological involvement in DM.
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Background: Porphyromonas gingivalis is a major periodontal pathogen. Saliva is the most easy, non-invasive microbiological sample for detection of periodontal pathogens. Aim and Objectives: A prospective study on 37 diabetic patients was grouped into well-controlled diabetes with/without periodontitis and uncontrolled diabetic with periodontitis. PCR and sequencing of P. gingivalis was performed in saliva samples. Materials and Methods: DNA was extracted from saliva using Triton X-100 and 16s rRNA gene (404 bp) was amplified by polymerase chain reaction. DNA sequencing was performed for two samples. Results:P. gingivalis was detected in 27.03% (n = 10), of which 30% (n = 9) were diabetic with periodontal disease and 14.3% (n = 1) were diabetic without periodontal disease. The percentage of poor oral hygiene was 50% and 20% in uncontrolled and controlled glycaemic patients, respectively. DNA sequencing of two samples showed 100% identity with the sequences in the GenBank database (Gen Bank accession no: KX640913-KX640914). Conclusion: Type 2 diabetes mellitus and periodontitis are interlinked. Early detection of P. gingivalis and appropriate treatment with doxycycline will also assist in controlling the glycaemic status.
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@#Patients with type 2 diabetes mellitus (DM2) are recognised to have a higher risk of fragility fractures. With the increasing prevalence of DM2 in Singapore and an ageing population, the impact of DM2 on fragility fracture is expected to rise. The aim of this article is to review updated information on bone fragility and fracture risk in DM2 patients, to discuss the impact of diabetes treatment on bone metabolism, as well as the efficacy of anti-osteoporosis treatments for this population. An algorithm is proposed for the identification and management of DM2 patients at increased fracture risk.
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Abstract@#Introduction: The objective of this study was to determine the factors and predictors of good glycaemic control among patients with Type 2 Diabetes Mellitus (T2DM) in two rural government health clinics in Kuala Selangor. Methods: This cross-sectional study involved 200 patients selected through systematic random sampling from a list of T2DM patients in two government health clinics in Kuala Selangor. Data was collected using a self-administered questionnaire while glycosylated haemoglobin (HbA1c) results were obtained from the patients’ blood results record at the clinic. HbA1c of 6.5 % and below was categorized as good glycaemic control. The factors studied were socio-demographic characteristics (age, gender, ethnicity, level of education, occupation and household income), T2DM medical history (T2DM duration and type of treatment), diabetes knowledge, health literacy, adherence to treatment, body mass index (BMI) and physical activity. Pearson’s chi square test was used to test for associations and multiple logistic regressions were used to determine the predictors. Results: The response rate was 86.9%. The proportion of good glycaemic control was 34.0%. Level of glycaemic control was significantly associated with duration of being diagnosed with T2DM (p=0.006) and type of treatment (p=0.009). The probability of having good glycaemic control was 2.5 times more likely among respondents diagnosed with T2DM for less than 10 years (AOR=2.458, 95% of CI=1.504-14.282, p=0.037). Conclusion: Shorter duration of being diagnosed with T2DM has been found to be a predictor of good glycaemic control in this study population, thus warranting stricter monitoring among patients who have been diagnosed for a longer period.
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@#Type 2 Diabetes Mellitus is a complex disorder which has many associated comorbidities besides hyperglycaemia. Micro and macrovascular complications develop as a result of poor risk factor control and contribute to the disability, reduced quality of life and reduced life expectancy associated with the disease. Intensive glucose control and, more importantly, comprehensive care involving treatment of all modifiable cardiovascular risk factors over a sustained period decreases the risk of morbidity and mortality especially in people newly diagnosed with Type 2 Diabetes Mellitus. The need to recognise subgroups of people with diabetes with increased risks of complications and the importance of individualised treatment are also discussed. Early intensive treatment and control of risk factors provides the opportunity for greatest accrual of benefit over the longer term.
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Objective: To assess the safety and efficacy of herbal formulation rich in standardized fenugreek seed extract (IND-2) add-on therapy in type 2 diabetes mellitus (T2DM) patients who were on insulin treatment in prospective, single arm, open-label, uncontrolled, multicentre trial. Methods: T2DM patients (n=30) with aged 18-80 years who were stabilized on insulin treatment with fasting blood sugar (FBS) level between 100-140 mg/dL received IND-2 capsules (700 mg, thrice a day) for 16 weeks. The primary endpoints were an assessment of FBS at week 2, 4, 6, 8, 12 and 16. Secondary end-points include post-prandial blood sugar level, glycosylated Hb (HbA1c), reduction in the dose of insulin and number of hypoglycemic attacks, and improvement in lipid profile at various weeks. Safety and adverse events (AEs) were also assessed during the study. Results: Study was completed in twenty T2DM patients, and there was no significant reduction in FBS and post-prandial blood sugar level after add-on therapy of IND-2. However, add-on therapy of IND-2 significantly reduced (P<0.01) the HbA1c values, requirements of insulin and hypoglycemic events as compared with baseline. Total cholesterol, high-density lipoproteins-cholesterol, and low-density lipoprotein-cholesterol levels were significantly increased (P<0.01) after IND-2 add-on therapy. Body weight and safety outcomes did not differ significantly in IND-2 add-on therapy group at week 16. Additionally, add-on therapy of IND-2 did not produce any serious adverse events. Conclusions: The results of present investigation suggest that add-on therapy of IND-2 with insulin in T2DM patients improves glycaemic control through a decrease in levels of HbA1c and number of insulin doses needed per day without an increase in body weight and risk of hypoglycemia. Thus, IND-2 may provide a safe and well-tolerated add-on therapy option for the management of T2DM.
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Objective: To assess the safety and efficacy of herbal formulation rich in standardized fenugreek seed extract (IND-2) add-on therapy in type 2 diabetes mellitus (T2DM) patients who were on insulin treatment in prospective, single arm, open-label, uncontrolled, multicentre trial. Methods: T2DM patients (n=30) with aged 18-80 years who were stabilized on insulin treatment with fasting blood sugar (FBS) level between 100-140 mg/dL received IND-2 capsules (700 mg, thrice a day) for 16 weeks. The primary endpoints were an assessment of FBS at week 2, 4, 6, 8, 12 and 16. Secondary end-points include post-prandial blood sugar level, glycosylated Hb (HbA1c), reduction in the dose of insulin and number of hypoglycemic attacks, and improvement in lipid profile at various weeks. Safety and adverse events (AEs) were also assessed during the study. Results: Study was completed in twenty T2DM patients, and there was no significant reduction in FBS and post-prandial blood sugar level after addon therapy of IND-2. However, add-on therapy of IND-2 significantly reduced (P<0.01) the HbA1c values, requirements of insulin and hypoglycemic events as compared with baseline. Total cholesterol, high-density lipoproteins-cholesterol, and low-density lipoproteincholesterol levels were significantly increased (P<0.01) after IND-2 add-on therapy. Body weight and safety outcomes did not differ significantly in IND-2 add-on therapy group at week 16. Additionally, add-on therapy of IND-2 did not produce any serious adverse events. Conclusions: The results of present investigation suggest that add-on therapy of IND-2 with insulin in T2DM patients improves glycaemic control through a decrease in levels of HbA1c and number of insulin doses needed per day without an increase in body weight and risk of hypoglycemia. Thus, IND-2 may provide a safe and well-tolerated add-on therapy option for the management of T2DM.
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@#The practice of diabetes self-care plays an important role in achieving and maintaining good glycaemic control. However, not all patients with insulin-treated diabetes engage in their self-care activities. There is some evidence that self-care practices in patients with insulin-treated diabetes can be understood and predicted by their health beliefs, although studies are often hampered by methodological weaknesses, and the fact that less is known about adults with insulin-treated diabetes in Malaysia. This study was conducted to examine whether health beliefs (as specified in the Health Belief Model: HBM) can predict self-care practices and glycaemic control in patients with insulin-treated diabetes in Malaysia. Longitudinal design with self-reported questionnaire measures was administered at baseline (Time 1:T1) and six months later (Time 2: T2). Participants were recruited from three endocrinology clinics in Malaysia. The measures included self-care practices (diet, insulin intake, exercise and self-blood glucose monitoring: SMBG), health beliefs and diabetes knowledge. Participants’ glycaemic control was examined based on their glycated hemoglobin (HbA1c) results. Data analysis was performed at different points of the study times; T1, T1-T2 and T2. Diabetes knowledge and demographic data were controlled for in predictive statistical analyses. A total of 159 patients with insulin-treated diabetes (aged 18-40 years) completed the measures at T1. Of these, only 108 (67.9%) completed follow-up measures at T2. However, demographic characteristics were not significantly different between those who completed and dropped out of the study (p>0.05). The HBM was significantly predictive of diet self-care at T2, insulin intake practice at T1 and HbA1c at T1-T2 andT2. Of the HBM constructs, perceived benefits significantly predicted good dietary habits at T1 (OR 1.92) and T2 (OR .23) and adherence to insulin injection at T1 (OR 3.17) and T1-T2 (OR 2.68). With the exception of perceived severity, all other HBM constructs significantly predicted HbA1c [perceived susceptibility (β .169) at T1, perceived barriers (β -.206) and perceived benefits (β -.397) at T2 and cues to action (β -.233) at T1-T2]. Health beliefs predict self-care practices and glycaemic control in young to middle-aged adults with insulin-treated diabetes in Malaysia. Diabetes educators could use this knowledge in their efforts to improve diabetes self-care in this patient groupby modifying those beliefs through their diabetes education.
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Health Belief Model , Self Care , Diet , ExerciseABSTRACT
<p><b>INTRODUCTION</b>Perioperative glycaemic control is an important aspect of clinical management in diabetic patients undergoing cataract surgery under local anaesthesia. While poor long-term glycaemic control has significant implications for surgery, perioperative hypoglycaemia or hyperglycaemia may also compromise patient safety and surgical outcomes. We aimed to survey ophthalmologists and anaesthesiologists on their approach and to identify the prevalent practice patterns in Singapore.</p><p><b>METHODS</b>This was a cross-sectional questionnaire-based survey conducted in four public hospitals in Singapore with established ophthalmology and anaesthesia units. Respondents were approached individually, and the self-administered questionnaires comprised questions related to practice patterns, clinical scenarios and awareness of pre-existing guidelines.</p><p><b>RESULTS</b>A total of 129 doctors responded to the questionnaire survey. 76 (58.9%) were from ophthalmology departments and 53 (41.1%) were from anaesthesia departments. The majority chose to withhold oral hypoglycaemic agents (82.9%) and/or insulin (69.8%), and keep the patient fasted preoperatively. A blood glucose level ≥ 17 mmol/L prompted 86.0%-93.8% of respondents to adopt a treat-and-defer strategy, while a level ≥ 23 mmol/L prompted 86.0%-96.9% of respondents to cancel the cataract surgery. The respondents were consistently more concerned about perioperative hyperglycaemia (n = 99, 76.7%) than intraoperative hypoglycaemia (n = 83, 64.3%).</p><p><b>CONCLUSION</b>The current study presented the prevalent practice patterns of ophthalmologists and anaesthesiologists in the perioperative management of diabetic patients undergoing cataract surgery in four public hospitals in Singapore. Further research in this field is required, and may be useful for the future formulation of formal guidelines and protocols.</p>
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Adult , Female , Humans , Male , Middle Aged , Anesthesia, Local , Methods , Anesthesiologists , Blood Glucose , Cataract Extraction , Cross-Sectional Studies , Diabetes Mellitus , Blood , Epidemiology , Incidence , Ophthalmologists , Perioperative Care , Methods , Singapore , Epidemiology , Surveys and QuestionnairesABSTRACT
Diabetes Mellitus is a disease due to reduced insulin sensitivity and secretion in the body which associated with obesity and hypertension. This study aimed to determine the influence of family support and self-motivation towards dietary compliance and glycaemic control among Type 2 Diabetes Mellitus (T2DM) outpatients. This cross-sectional study involved 35 subjects selected from Universiti Kebangsaan Malaysia Medical Centre (UKMMC) in Cheras and Ampangan Health Clinic in Seremban. Anthropometric measurements and fasting blood glucose have been obtained. Face-to-face interview session was done to obtain socio-demographic and diet intake. Further, dietary compliance, social support and self-motivation were assessed using Summary Diabetes Self Care Activities (SDSCA), Diabetes Social Support Questionnaire Family version (DSSQ-Fa) and Treatment Self-Regulation Questionnaire (TSRQ), respectively. Only 8.6% of subjects complied with dietary counselling. Fasting blood glucose for both men (7.93 ± 1.99 mmol/L) and women (8.77 ± 3.08 mmol/L) were higher than normal range. Self-motivation (r = 0.358, p < 0.05) and family support (r = 0.460, p < 0.01) significantly correlated with dietary compliance. Self-motivation and family support are important factors which can increase compliance towards dietary counseling. Further investigation should be carried out to determine factors that may influence dietary compliance and family support towards achieving desirable glycaemic control among T2DM patients.