Metabolic control in type 2 diabetes correlates weakly with patient adherence to oral hypoglycaemic treatment.

Introduction: Patient adherence to treatment is viewed as essential to good metabolic control in diabetes. Our primary objective was to determine if self-reported patient adherence correlated strongly with metabolic control. Our secondary objective was to determine the natural grouping of factors which influence adherence. Materials and Methods: Data were collected using a questionnaire set with 5-point Likert scales. Primary analysis was done using Spearman's correlation coefficient between self-reported composite adherence scores and HbA1c. Secondary analysis was done using exploratory factor analysis. Results: The primary analysis suggests that patient adherence to the treatment regime is weakly correlated to metabolic control. Calculated Spearman's rho was 0.197, with a two-tailed P value of 0.027. The secondary analysis demonstrates the natural clustering of factors that influence patient adherence to treatment. A 6-factor solution was found to account for most of the variance in the data. We also found that feelings of frustration, anxiety, and depression were associated with a lack of knowledge about diabetes treatment. In addition, belief in traditional medicine correlated strongly with ethnicity. Conclusion: A good treatment regime for type 2 diabetes mellitus influences metabolic outcome far more than patient adherence

Colesevelam for type 2 diabetes mellitus (Protocol).

Colesevelam was originally approved for the treatment of hyperlipidaemia (high blood lipids) in the 2000s but has been shown to improve blood sugar as well. Therefore, we investigated its role in the management of type 2 diabetes mellitus. A total of 1450 patients took part in six studies investigating colesevelam. These studies lasted 8 to 26 weeks. Only one small study compared colesevelam directly to placebo, the other five studies investigated a combination of colesevelam with other antidiabetic agents versus a combination of placebo with other antidiabetic agents. There were no two studies with the same intervention and comparison group. When added to other antidiabetic agents colesevelam showed improvements in the control of blood glucose and blood lipids. However, it is difficult to disentangle the effects of colesevelam from the other antidiabetic agents used because only one study compared colesevelam to placebo. The same is true for adverse effects: three studies reported on just a few non-severe hypoglycaemic episodes, no other serious side effects were observed. No study investigated mortality; complications of type 2 diabetes such as eye disease, kidney disease, heart attack and stroke; health-related quality of life; functional outcomes and costs of treatment. Therefore, long-term data on the efficacy and safety of colesevelam are necessary

Efficacy of Progressive Resistance Tube Training in Community Dwelling Older Adults: A Pilot Study

SummaryBackground/objectiveFalls are known to be one of the most prevalent public health problems in older adults. Currently, the aging population is growing fast. It is essential to use low cost, time-efficient exercise intervention programs for increasing strength, functional mobility, and balance in older adults, and subsequently decrease the risk of falls. This is a pilot study to assess the effects of a 12-week progressive resistance tube training session on the lower limb muscle strength, dynamic balance, and functional mobility in elderly people.MethodsSeventeen community dwelling older adults with a mean age of 69.2 ± 4.62 years were recruited among residents of a senior day care center in Malaysia to participate in this pilot study. Eight out of 17 participants completed their lower extremity resistance tube training sessions three times per week for 12 weeks. Lower limb muscle strength and functional mobility were tested by five times sit to stand test (FRSTST), and timed up and go test (TUG), respectively. Functional reach test (FRT) and four square step test (FSST) were applied to measure dynamic balance.ResultsThe results revealed significant increases in lower limb strength (30.3%), dynamic balance (29.6% in FRT and 15.3% in FSST), and functional mobility (27.1%) (all significant at p < 0.05).ConclusionIt was concluded that the use of a simple and inexpensive strength training program may improve leg muscle strength and consequently dynamic balance and mobility in elderly people and make them independent in their daily activities

Carbohydrates for improving the cognitive performance of independent-living older adults with normal cognition or mild cognitive impairment.

Mild cognitive impairment (MCI) is an intermediate state between normal cognition and dementia in which daily function is largely intact. This condition may present an opportunity for research into the prevention of dementia. Carbohydrate is an essential and easily accessible macronutrient which influences cognitive performance. A better understanding of carbohydrate-driven cognitive changes in normal cognition and mild cognitive impairment may suggest ways to prevent or reduce cognitive decline

Andrographolide induces cell cycle arrest and apoptosis in PC-3 prostate cancer cells.

Andrographolide (AGP), the major phytoconstituent isolated from Andrographis paniculata was found to exhibit growth inhibition and cytotoxicity against the hormone-independent (PC-3 and DU-145) and hormone-dependent (LNCaP) prostate cancer cell lines via the microculture tetrazolium (MTT) assay. Due to its greater cytotoxic potency and selectivity towards PC-3 cells, flow cytometry was used to analyze the cell cycle distribution of control and treated PC-3 cells whereas Annexin V-FITC/PI flow cytometry analysis was carried out to confirm apoptosis induced by AGP in PC-3 cells. Cell cycle and apoptotic regulatory proteins were determined by western blot analysis. AGP was found to induce G2/M cell cycle arrest which led to predominantly apoptotic mode of cell death. Mechanistically, AGP was found to downregulate CDK1 without affecting the levels of CDK4 and cyclin D1. Induction of apoptosis was associated with an increase in activation and expression of caspase 8 which then is believed to have induced cleavage of Bid into tBid. In addition, activation and enhancement of executioner caspase 9 and Bax proteins without affecting Bcl-2 protein levels were observed

Research and Policy to Achieve Healthy Aging in Asia: Recommendations from an Expert Workshop

Open Longevity Science71-1

Examining the disability model from the International Classification of Functioning, Disability, and Health using a large data set of community-dwelling Malaysian older adults

Objective: This study examines the International Classification of Functioning, Disability, and Health model (ICF) using a data set of 2,563 community-dwelling elderly with disease-independent measures of mobility, physical activity, and social networking, to represent ICF constructs. Method: The relationship between chronic disease and disability (independent and dependent variables) was examined using logistic regression. To demonstrate variability in activity performance with functional impairment, graphing was used. The relationship between functional impairment, activity performance, and social participation was examined graphically and using ANOVA. The impact of cognitive deficits was quantified through stratifying by dementia. Results: Disability is strongly related to chronic disease (Wald 25.5, p < .001), functional impairment with activity performance (F = 34.2, p < .001), and social participation (F= 43.6, p < .001). With good function, there is considerable variability in activity performance (inter-quartile range [IQR] = 2.00), but diminishes with high impairment (IQR = 0.00) especially with cognitive deficits. Discussion: Environment modification benefits those with moderate functional impairment, but not with higher grades of functional loss

Factors Associated with Dietary Diversity Score among Individuals with Type 2 Diabetes Mellitus

Studies on diet quality among individuals with type 2 diabetes mellitus (T2DM) are scarce. This crosssectional study aimed to assess the diet quality and to determine its associated factors among individuals with T2DM at the Medical Outpatients Department, Serdang Hospital, Selangor, Malaysia, from July 2010 to March 2011. Subjects were interviewed for sociodemographic data. Diabetes history was retrieved from the hospital\u2019s e-database. Usual dietary intake was measured using a food frequency questionnaire, from which a dietary diversity score was obtained with two measures: Food Group Score and Serving Score were constructed based on the Malaysian Dietary Guidelines. Food Group Score was computed from the number of food groups consumed from five major food groups (grains, vegetables, fruits, meat, and dairy products) whereas Serving Score was computed from the number of servings consumed from the various food groups. Anthropometric measures, including weight, height, waist- and hip-circumference were examined. For data analyses, descriptive statistics, simple and multiple linear regression were conducted using IBM SPSS Statistics 20.0. A total of 113 subjects (50.4% female), with mean\ub1SD age of 54.05\ub110.30 years and duration of diabetes of 11.25\ub19.05 years were studied. The mean Food Group Score and Serving Score were 4.12\ub10.79 and 12.75\ub13.50 respectively. Slightly more than one-third of the subjects achieved five food groups a day while less than 2% consumed a desirable number of servings from all food groups. Among the five food groups, dairy, and fruits were the least-frequently consumed foods. Lower education, lower personal income, working, non-insulin, overweight and obese subjects had significantly lower Food Group Score than their counterparts [F (6,106)=4.924, p&lt;0.0001] whereas lower education, lower waist-to-hip ratio, overweight and obese subjects had significantly lower Serving Score than their counterparts [F (4,108)=7.520, p&lt;0.0001]. There was a high proportion of individuals with T2DM, who failed to adhere to the national dietary guidelines. The importance of taking a well-balanced diet in accordance with the guidelines should be emphasized, especially among those with lower educational level through a simple and easy-to-understand approach

A prospective cohort study on the effect of various risk factors on hypoglycaemia in diabetics who fast during Ramadan

Muslim diabetics who fast during Ramadan are at risk of hypoglycaemia, and previous consensus guidelines have highlighted certain risk factors. This prospective cohort study aims to determine the relative risk (RR) of hypoglycaemia during Ramadan fasting compared with a non-fasting period of equivalent length, and to ascertain which risk factors are clinically significant. From the results, Ramadan fasting carries a RR of hypoglycaemia of 1.60 (95% CI 1.05 to 2.43). Good metabolic control (HbAlc 60 years) increased RR more than twice, while taking breakfast prior to fasting reduces RR to less than half