Factors Associated with Treatment Response to Antidiabetic Agents in Compliant Type 2 Diabetes Mellitus Patients: A Brief Summary of 5-Year Data

Purpose: To evaluate the response to diabetic medications and factors influencing drug response in compliant type 2 diabetes mellitus (T2DM) patients.Methods: A cross-sectional, retrospective study was performed on 100 T2DM patients at the University Malaya Medical Centre (UMMC) who were prescribed with at least one antidiabetic medication between January 2007 and December 2011.Results: Using data from their medical records, it was determined that both fasting plasma glucose (FPG) and glycated hemoglobin (A1c) levels among all subjects were lower than baseline values. However, the reductions were not significant (p = 0.239 and p = 0.093). Factors that were significantlyassociated with the response to diabetic medications, include hypertension (p = 0.011), sulfonylureas (p = 0.041), beta-blockers (p = 0.005), and baseline A1c levels (p < 0.001).Conclusion: Treatment of T2DM can be further optimized to ensure that diabetes is well-controlled.Keywords: Treatment response; Antidiabetics; Type 2 Diabetes Mellitus, Hypertension, Beta-blocker

A Prospective Cohort Study on IRS Gene Polymorphisms in Type 2 Diabetes Mellitus Patients during Severe/Acute Hyperglycemia Phase 1: Association with Insulin Resistance

Purpose: To investigate the genetic polymorphisms that may contribute to the worsening of insulin resistance in type 2 diabetes mellitus (T2DM) with severe or acute hyperglycemia.Methods: This is a prospective cohort study involving 156 T2DM patients with severe or acute hyperglycemia from all medical wards of the National University of Malaysia Medical Centre (UKMMC) that were placed on insulin therapy. The polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was used to determine the genetic association of insulin receptor substrate (IRS) gene with insulin resistance. Insulin resistance status was determined using the homeostatic model assessment for insulin resistance (HOMA-IR) index.Results: IRS1 polymorphisms were associated with increased insulin resistance (X2 = 5.09, p = 0.023) in T2DM patients with severe/acute hyperglycemia. IRS2 polymorphisms were not associated with insulin resistance (X2 = 0.69, p = 0.406) in this group of patients.Conclusion: IRS1 genetic factor alone may be a significant genetic determinant for insulin resistance in T2DM patients during severe/acute phase hyperglycemia.Keywords: Insulin receptor substrate, Genetic, Polymorphism, Diabetes, Insulin resistance, Hyperglycemia, IRS1, IRS

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

Hasniza Zaman Huri,1,2 Doris Yew Hui Ling,1 Wan Azman Wan Ahmad2,3 1Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; 2Clinical Investigation Centre, University Malaya Medical Centre, Lembah Pantai, Kuala Lumpur, Malaysia; 3Cardiology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia 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. Keywords: glycemic control, antidiabetic drugs, type 2 diabetes mellitus, cardiovascular disease&nbsp

Drug-related problems in patients with erectile dysfunctions and multiple comorbidities

Hasniza Zaman Huri,1,2 Chui Fang Ling,1 Azad Hassan Abdul Razack3 1Department of Pharmacy, Faculty of Medicine, University of Malaya, 2Clinical Investigation Centre, University Malaya Medical Centre, 3Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia Abstract: This study was conducted in a tertiary medical center in Kuala Lumpur, Malaysia. A total of 200 erectile dysfunction (ED) patients with 499 cases who had received pharmacological treatments for their ED participated in this study. Types, causes and factors associated with drug-related problems (DRPs) in ED patients with multiple comorbidities were assessed. A total of 244 DRPs with an average of 1.2±2.1 DRPs per patient were identified. Drug interaction contributed the most to DRPs occurrence. There was a significant higher risk of DRPs in patients with benign prostatic hyperplasia, lower urinary tract infection and elderly and end-stage renal disease. Early identification of types of DRPs and factors associated may enhance their prevention and management. Keywords: ED drugs, DRPs, factors associated, prevention and managemen

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

Hasniza Zaman Huri,1,2 Lay Peng Lim,1 Soo Kun Lim3 1Department of Pharmacy, Faculty of Medicine, University of Malaya, 2Clinical Investigation Centre, University Malaya Medical Centre, 3Renal Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia 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), a-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. Keywords: glycemic control, type 2 diabetes, antidiabetic regimens, renal complication

Association of psychological factors, patients’ knowledge, and management among patients with erectile dysfunction

Hasniza Zaman Huri,1,2 Nurul Diyana Mat Sanusi,1 Azad Hassan Abdul Razack,3 Raymond Mark1 1Department of Pharmacy, 2Clinical Investigation Center, University of Malaya Medical Centre, 3Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia Background: Erectile dysfunction (ED) is one of the most common health problems in men. ED can significantly affect a man’s psychological well-being and overall health. Purpose: To investigate the association of psychological factors, patients’ knowledge, and management among ED patients. Patients and methods: A total of 93 patients with an age range from 31 to 81 years who have undergone treatment for ED were included in this study. Results: It was found that the feeling of blame (P=0.001), guilt (P=0.001), anger or bitterness (P=0.001), depression (P=0.001), feeling like a failure (P=0.001), and the feeling of letting down a partner during intercourse (P=0.001) were significantly associated with ED. Age was also found to be significantly associated with patients’ psychological scale (P=0.004). In addition, the majority of patients in this study practice the right method of administration of ED therapy. However, no significant correlation was found between patients’ knowledge of ED therapy and demographic characteristics. Conclusion: This study concluded that ED does affect psychological well-being of people. In addition, patient’s knowledge about ED and its management is also crucial in ensuring that the patient achieves optimal therapeutic outcomes from ED therapy. Keywords: erectile dysfunction, psychological factors, patients’ knowledge, managemen

Effectiveness and prescription pattern of lipid-lowering therapy and its associated factors among patients with type 2 diabetes mellitus in Malaysian primary care settings

Mohamed Hassan Elnaem,1 Mohamad Haniki Nik Mohamed,1 Hasniza Zaman Huri,2 Azarisman Shah Mohd Shah3 1Department of Pharmacy Practice, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia; 2Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; 3Department of Internal Medicine, Faculty of Medicine, International Islamic University Malaysia, Kuantan, Pahang, Malaysia Background: Cardiovascular diseases (CVDs) are the main complication leading to morbidity and mortality among patients with type 2 diabetes mellitus (T2DM). There is a large amount of evidence to support the use of lipid-lowering therapy (LLT) for the prevention of CVD. This study aimed to assess the effectiveness and prescription quality of LLT among T2DM patients and to identify its associated factors.Methods: A multicenter cross-sectional study included 816 T2DM patients from four different primary care centers in Pahang, Malaysia. We involved LLT-eligible T2DM patients as per the national clinical practice guidelines (CPG). The assessment of therapy effectiveness focused on the attainment of target lipid measures stated in the CPG. Evaluation of the prescription quality was classified into appropriate, potentially inappropriate, and inappropriate, based on the compliance with guidelines and existence of potential safety concerns. Binomial logistic regression was employed to identify the predictors of LLT effectiveness and prescription quality.Results: The overall percentage of T2DM patients receiving statin therapy was 87.6% (715/816). Statin therapy was appropriately prescribed in 71.5% of the cases. About 17.5% of the LLT prescriptions have at least one significant drug interaction with co-prescribed medications. The achievement of the primary target of low-density lipoprotein cholesterol (LDL-C) levels was observed in only 37% of T2DM patients. The LLT indication and appropriateness of prescription were significantly associated with the attainment of LDL-C treatment goals. Primary prevention, Malay race, and hypertension were identified as predictors for appropriate prescribing of LLT among T2DM subjects.Conclusion: There is a need to enhance the quality of LLT prescribing in the primary care setting to cover all eligible high-risk patients and ensure patient safety. Strategies to improve the achievement of LDL-C goals among patients with T2DM, such as investigating the potential role of the combination therapy and high-intensity statin therapy, are required. Keywords: primary care, statin therapy, diabetes, dyslipidemia, Malaysi

Effect of Interaction between Polymorphisms in Insulin Receptor Substrate Genes in Type 2 Diabetes Mellitus Patients with Severe/Acute Hyperglycemia

Purpose: To investigate whether there are interactions between insulin receptor substrate 1 (IRS1) and insulin receptor substrate 2 (IRS2) that are associated with increased insulin resistance during such episodes.Methods: Testing Haplotype EffectS in Association Studies (THESIAS) software was used to investigate allelic and haplotype interactions between the polymorphisms in 156 T2DM patients with severe or acute hyperglycemia.Results: Binary analysis showed there were significant differences in the haplotype frequencies for the IRS1 and IRS2 polymorphisms based on the insulin resistance status. Nevertheless, estimation of haplotype effects by equality analysis showed no significant interactions (likelihood ratio tests: all p > 0.05) in increased insulin resistance in T2DM patients with severe/acute hyperglycemia.Conclusion: There are no interactions between IRS1 rs1801278 (p.Gly972Arg) and IRS2 rs1805097 (p.Gly1057Asp) polymorphisms that would affect insulin resistance in T2DM patients with severe/acute hyperglycemia.Keywords: Insulin receptor substrate, Proteins, Insulin resistance, Diabetes mellitus, Hyperglycemia, Haplotype, Genetic polymorphis