Dyslipidaemia In Patients With Type 2 Diabetes Mellitus.

The aims of the study-were to define the prevalence of dyslipidaemia, its correlation with glycaemic control and contributory factors of dyslipidaemia in type 2 diabetic patients

Psychometric evaluation of blood disaster management questionnaire-(floodDMQ-BM©) : confirmatory factor analysis and item response theory analysis

Background Flood disaster is the commonest natural disaster with a huge impact on health care services in Malaysia. Therefore, the FloodDMQ-BM© questionnaire is developed as a tool to assess the knowledge, attitude, and practice of health care providers regarding patient management during a flood disaster. This work aimed to further validate the FloodDMQ-BM© questionnaire by using Confirmatory Factor Analysis (CFA) and Item Response Theory (IRT) in order to confirm its validity in assessing the knowledge, attitude, and practice of health care providers regarding patient management during a flood disaster. Materials and Methods This observational cross-sectional study involved health care workers in the Emergency Department (ED) of Hospital Universiti Sains Malaysia (HUSM), Hospital Raja Perempuan Zainab II (HRPZ2), and Hospital Kuala Krai (HKK). The completed FloodDMQ-BM© questionnaire was analysed by using CFA and IRT to establish its validity and reliability. Result A total of 209 respondents participated in this study, yielding an 84% response rate. CFA method subjected on the attitude and practice components resulted in good factor loadings (>0.5) in nearly all items and good model fit indices values (CFI = 0.96-0.98, TLI = 0.95- 0.96, SRMR = 0.04-0.05, RMSEA = 0.07). Meanwhile, IRT analysis on the knowledge section showed a good two-way marginal fit based on S-X2, and a good model fit with RMSEA of 0.08. The items had good standardised loadings (>0.3) and marginal reliability of 0.651. Conclusion Our results confirmed that the FloodDMQ-BM© questionnaire displayed valid and reliable psychometric properties

The impact of structured healthy lifestyle program among type 2 diabetic patients in Kelantan

A non-randomised control trial was conducted with the aim to assess the impact of structured healthy life-style program among Type 2 diabetic patients in Kelantan.One hundred and forty Type 2 diabetic patients from Selising Health Centre (inteivention group) and Gaal Health Centre (control group) in Pasir Puteh District were selected using multistage sampling technique.An intervention group was given a structured health education on self-care,dietary advise and exercise.The control group was given conventional health education.Data were collected using a structured questionnaire, anthropometries measurement and blood sampling for random blood sugar and HbAlc. Statistical Package for Social Science (SPSS) version 9.0 was used for analysing the data. The patients in both health centres had a similar sociodemographic distribution (p value > 0.05).Most of them are Malay(99%),females(59% intervention,66%control), married (74% intervention,86% control),and a non-smoker (67% intervention,73% control). Their mean(+SD)age was 56:0 + 10.17 year (intervention) vs 54.2 + 11.75 year (control) and mean (SD) duration of diabetes was 5.6(4.81) year (intervention) vs. 5.4(4.23) year (control).The intervention group showed a significant improvement in mean score of ·knowledge (16.5 (4.49) vs 23.8 {1.42)),practice (14.5(2.13) vs. 15.6 (2.42)), HbAlc (10.3{2.85) vs 8.9(1.93)) and BMI level (26.1(4.08) vs 25.8(3.98)) kgm-2 after the intervention program whereas no significant different seen in the control group.The study showed that the blood glucose control and BW of Type 2 diabetic patients could be improved if they are willing to change their lifestyle.The main challenge in management of these patients is however to sustained their healthy lifestyle

A short term evaluation of the iodized supplementation programme to antenatal mothers in Bachok Kelantan.

Hasil kajian ini dapat memberikan gambaran tentang kejadian masalah kekurangan iodine di kalangan ibu mengandung terutamanya di dalam daerah Bachok, Kelantan dan secara tidak langsung dalam negeri Kelantan secara arnnya. Ia juga dapat memberikan gambaran tentang sejauh mana keberkesanan aktiviti pendidikan kesihatan yang dijalankan oleh pihak Kementerian Kesihatan mengenai rnasalah kekurangan iodine dan juga kesan pemberian garam beriodine kepada ibu-ibu hamil

Analysis of Leptin receptor, Glucocorticoid receptor,B-3 Aderenergic receptor and Tumour Necrosis Factor-a Gene Polymorphism in Type 2 Diabetes Mellitus in Kelantan Malays.

Diabetes is a complex disease with both genetics and environmental component in the pathogenesis. Progress in the human genetic has allowed a better understanding in the search for either specific or multiple affliction of the candidate gene susceptible for the disease. Since the past 3 years studies showed that several genes including the Leptin receptor, f33-adrenergic receptor, Tumour necrosis factor alpha (Tnf-a.) and Glucocorticoid receptor have been linked and their polymorphism associated to diabetes. However, the prevalence involvement and polymorphic variations differ markedly among the ethnic groups. In this initial project the choice of these candidate genes markers were selected from the biological pathway likely to the development and the progression of the NIDDM. Future research will include other known and related gene susceptible to the disease. The potential role of identification of these variant not only contribute to better understanding of the pathogenesis of the disease but it also provide a research tool for the studies to assess the association of the multiple genetics markers with the disease. We expect to define the association of these genes polymorphism to the pathogenesis of diabetes in the local population. Research Methodology Subject and control 50 patients clinically confirm as diabetes and attending the Diabetes Clinics in the HUSM were selected. The clinical characteristics including sex, age, body mass index, blood pressure measurements and biochemical analysis of HbA 1 c and fasting blood sugar were analyzed. 50 controls are normal individual who do not have diabetes. A total 10 ml blood were collectedin the EDTA container from each patients and normal individual for DNA extraction and further genetic analysis. Genetic determination Genomic DNA was extracted from the above sample using standard non-phenol extraction procedure. The genomic DNA were amplified using specific primers and polymerase chain reaction (PCR) conditions for each specific gene of interest according to published works with modification. The Restriction Fragment Length Polymorphism (RFLP) was applied for mutation analysis. Both PCR and RFLP products were subjected to electrophoresis on either agarose or polyacrylamide gel for allele identifications. Statistical analysis The chi-square test was carried out for comparison of the genotype frequency and level of the variable between the genotype groups was compared using analysis of variance (ANOVA). P values of less than 0.05 were considered as statistically significant.Results From the whole sample studied, genotype frequency for mutant allele in these four genes are ranging from 8.0% to 29.2%. The highest genotype frequency for mutant allele is the Pentanucleotide Insertion/Deletion Polymorphism of the 3' -UTR of Leptin receptor gene (17.0%), followed by Trp64Arg polymorphism of the p3-adrenergic receptor gene (10.0%), followed by Asn363Ser polymorphism of the Glucocorticoid receptor gene (4.0%) and the lowest is G-308A polymorphism of the Tumour necrosis factor alpha (Tnf-a.) gene (3.0°Al). While in normal control samples, the result shows genotype frequency for mutant genes are 16.0% (Lepr), 7.0% (Tnf-a), 3.0% (GRL) and 2.0% (~3-AR). All genes are not associated with the incidence of type 2 diabetes in Kelantan Malay subjects (p <0.05).Conclusion We suggested that all genes are not likely to be the major predispose in the incidence of type 2 diabetes in Kelantan Malay population except for f33-adrenergic receptor gene. Future studies should be done to screen for other polymorphism in same genes and also in other genes which have been reported in other populations to have significant association with the pathogenesis of type 2 diabetes

An interventive and kap study on healthy lifestyle of overweight and uncontrolled diabetic patients in Kota Bharu, Kelantan

OBJECTIVES: To assess the effects of a regular exercise programme on metabolic control and also knowledge, attitude and practice (KAP) of exercise and physical activity among Type 2 diabetes mellitus patients. MATERIAL AND MET{{ ODS: Forty two Type 2 diabetes patients from the community medicine and medical specialist clinics in USM were assigned . to two groups; The interventive group consisted of 13 males and 14 females, mean age 52.6(8.7) (mean (SD)), body mass index 27.2 (3.9) participated in regular group exercise sessions (3 times a week, 1 hour sessions) for 7 weeks. Exercise intensity was predetermined based on the predicted target heart rate for each subject. The control group consisted of 7 males and 8 females, mean age 56.5(11.1), body mass index 25.8(2.73). Pre and post-intervention anthropometric measurements and blood investigations were done. These include height, weight, body mass index, body fat percentage and fat free mass (FFM), blood pressure, cardiorespiratory fitness level, fasting plasma glucose level (FPG), HbA I c level, fasting lipid profile, insulin and Cpeptidelevel. RESULTS:, In the intervention group, FFM increased from 45.98(9.71) to 47.93(10.53) kg,; percentage body fat decreased from 32.37(11.02) to 30.14(10.73)%. Diastolic pressure reduced from 91(11.2) to 83.3(7.5) mmHg, cholesterol level decreased from 6.23(1.03) to 5.74(1.23) mmoVI, HDL level increased from 0.97(0.31) to 1.19(0.28) mmolll. Estimated V02max increased from 21.6(7.04) to 27.7(8.72) mllkg/min. Resting heart rate declined significantly from 80(7) to 73( II) bpm. There was no improvement in body mass index (BMI), fasting plasma glucose, insulin and C-peptide levels. Knowledge and attitude scores were higher than practice scores. CONCLUSION: Seven weeks of exercise intervention among type 2 diabetes patients resulted in an improvement in body composition, cardiorespiratory fitness, lipid profile and a reduction in blood pressure. However there is a disparity between knowledge and practice of exercise and physical activity

Disease characteristics and treatment of patients with diabetes mellitus attending government health services in Indonesia, Peru, Romania and South Africa.

OBJECTIVE: To describe the characteristics and management of Diabetes mellitus (DM) patients from low- and middle-income countries (LMIC). METHODS: We systematically characterized consecutive DM patients attending public health services in urban settings in Indonesia, Peru, Romania and South Africa, collecting data on DM treatment history, complications, drug treatment, obesity, HbA1c, and cardiovascular risk profile; and assessing treatment gaps against relevant national guidelines. RESULTS: Patients (median 59 years, 62.9% female) mostly had type 2 diabetes (96%), half for >5 years (48.6%). Obesity (45.5%) and central obesity (females 84.8%; males 62.7%) were common. The median HbA1c was 8.7% (72 mmol/mol), ranging from 7.7% (61 mmol/mol; Peru) to 10.4% (90 mmol/mol; South Africa). Antidiabetes treatment included metformin (62.6%), insulin (37.8%), and other oral glucose-lowering drugs (34.8%). Disease complications included eyesight problems (50.4%), EGFR <60 ml/min (18.9%), heart disease (16.5%), and proteinuria (14.7%). Many had an elevated cardiovascular risk with elevated blood pressure (36%), LDL (71.0%), and smoking (13%), but few were taking antihypertensive drugs (47.1%), statins (28.5%) and aspirin (30.0%) when indicated. Few patients on insulin (8.0%), statins (8.4%) and antihypertensives (39.5%) reached treatment targets according to national guidelines. There were large differences between countries in terms of disease profile and medication use. CONCLUSION: DM patients in government clinics in four LMIC with considerable growth of DM have insufficient glycemic control, frequent macrovascular and other complications, and insufficient preventive measures for cardiovascular disease. These findings underline the need to identify treatment barriers and secure optimal DM care in such settings. This article is protected by copyright. All rights reserved

Practical guide in using insulin degludec/insulin aspart: A multidisciplinary approach in Malaysia

Insulin degludec/insulin aspart (IDegAsp) co-formulation provides both basal and mealtime glycaemic control in a single injection. The glucose level-lowering efficacy of IDegAsp is reported to be superior or non-inferior to that of the currently available insulin therapies with a lower rate of overall hypoglycaemia and nocturnal hypoglycaemia. An expert panel from Malaysia aims to provide insights into the utilisation of IDegAsp across a broad range of patients with type 2 diabetes mellitus (i.e. treatment-naïve or insulin-naïve patients or patients receiving treatment intensification from basal-only regimens, premixed insulin and basal–bolus insulin therapy). IDegAsp can be initiated as once-daily dosing for the main meal with the largest carbohydrate content with weekly dose adjustments based on patient response. A lower starting dose is recommended for patients with cardiac or renal comorbidities. Dose intensification with IDegAsp may warrant splitting into twice-daily dosing. IDegAsp twice-daily dosing does not need to be split at a 50:50 ratio but should be adjusted to match the carbohydrate content of meals. The treatment of patients choosing to fast during Ramadan should be switched to IDegAsp early before Ramadan, as a longer duration of titration leads to better glycated haemoglobin level reductions. The pre-Ramadan breakfast/lunch insulin dose can be reduced by 30%–50% and taken during sahur, while the pre-Ramadan dinner dose can be taken without any change during iftar. Education on the main meal concept is important, as carbohydrates are present in almost all meals. Patients should not have a misconception of consuming more carbohydrates while taking IDegAsp