Development and validation of a carbohydrate and insulin dosing knowledge quiz in adults with diabetes mellitus / Journal of the ASEAN Federation of Endocrine Societies

@#<b>OBJECTIVES</b>: We aimed to develop and validate a carbohydrate and insulin dosing knowledge quiz for adult Asian patients with diabetes mellitus. <br /><br /><b>METHODOLOGY</b>: A self-administered quiz was developed to test carbohydrate recognition; single food carbohydrate estimation; meal carbohydrate estimation and food label reading; and insulin dosing calculation for carbohydrate, blood glucose and for a meal in a multi-ethnic Asian population. The subjects’ carbohydrate knowledge and insulin dosing ability were rated by the study dietitian and the subjects’ primary physicians, respectively. We compared the quiz scores with the dietitians’ and physician ratings and the subjects’ HbA1c. Reliability of the quiz was tested by measuring internal consistency and split half reliability. <br /><br /><b>RESULTS</b>: Seventy-five subjects completed the study. Median (inter-quartile range) quiz score was 71.9 (60.2 to 83.6)%. The quiz score was found to be correlated with the healthcare provider assessments (r=0.652, p<0.001) and the subjects’ HbA1c (r=-0.375, p=0.001). Cronbach alpha was 0.897 and Guttman split half coefficient was 0.930. <br /><br /><b>CONCLUSIONS</b>: Our analysis suggested that this newly developed quiz had good reliability and validity for testing carbohydrate and insulin dosing knowledge in a group of Asian subjects with diabetes mellitus. This can be a useful screening tool in clinical practice.

Coronary artery calcification across ethnic groups in Singapore

<p><b>INTRODUCTION</b>In Singapore, the age-standardised event rates of myocardial infarction (MI) are 2- and 3-fold higher for Malays and Indians respectively compared to the Chinese. The objectives of this study were to determine the prevalence and quantity of coronary artery calcification (CAC) and non-calcified plaques across these 3 ethnic groups.</p><p><b>MATERIALS AND METHODS</b>This was a retrospective descriptive study. We identified 1041 patients (810 Chinese, 139 Malays, 92 Indians) without previous history of cardiovascular disease who underwent cardiac computed tomography for atypical chest pain evaluation. A cardiologist, who was blinded to the patients' clinical demographics, reviewed all scans. We retrospectively analysed all their case records.</p><p><b>RESULTS</b>Overall, Malays were most likely to be active smokers (P = 0.02), Indians had the highest prevalence of diabetes mellitus (P = 0.01) and Chinese had the highest mean age (P <0.0001). The overall prevalence of patients with non-calcified plaques as the only manifestation of sub-clinical coronary artery disease was 2.1%. There was no significant difference in the prevalence of CAC, mean CAC score or prevalence of non-calcified plaques among the 3 ethnic groups. Active smoking, age and hypertension were independent predictors of CAC. Non-calcified plaques were positively associated with male gender, age, dyslipidaemia and diabetes mellitus.</p><p><b>CONCLUSION</b>The higher MI rates in Malays and Indians in Singapore cannot be explained by any difference in CAC or non-calcified plaque. More research with prospective follow-up of larger patient populations is necessary to establish if ethnic-specific calibration of CAC measures is needed to adjust for differences among ethnic groups.</p>