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Fulltext Cyclophilin A as a target in the treatment of cytomegalovirus infections

A Abdullah A, Abdullah R, A Nazariah Z, N Balakrishnan K, Firdaus J Abdullah F, A Bala J, et al.

Antivir Chem Chemother, 2018;26:2040206618811413.
PMID: 30449131 DOI: 10.1177/2040206618811413

BACKGROUND: Viruses are obligate parasites that depend on the cellular machinery of the host to regenerate and manufacture their proteins. Most antiviral drugs on the market today target viral proteins. However, the more recent strategies involve targeting the host cell proteins or pathways that mediate viral replication. This new approach would be effective for most viruses while minimizing drug resistance and toxicity.
METHODS: Cytomegalovirus replication, latency, and immune response are mediated by the intermediate early protein 2, the main protein that determines the effectiveness of drugs in cytomegalovirus inhibition. This review explains how intermediate early protein 2 can modify the action of cyclosporin A, an immunosuppressive, and antiviral drug. It also links all the pathways mediated by cyclosporin A, cytomegalovirus replication, and its encoded proteins.
RESULTS: Intermediate early protein 2 can influence the cellular cyclophilin A pathway, affecting cyclosporin A as a mediator of viral replication or anti-cytomegalovirus drug.
CONCLUSION: Cyclosporin A has a dual function in cytomegalovirus pathogenesis. It has the immunosuppressive effect that establishes virus replication through the inhibition of T-cell function. It also has an anti-cytomegalovirus effect mediated by intermediate early protein 2. Both of these functions involve cyclophilin A pathway.
Identification of metabolic pathways using pathfinding approaches: a systematic review

Abd Algfoor Z, Shahrizal Sunar M, Abdullah A, Kolivand H

Brief Funct Genomics, 2017 03 01;16(2):87-98.
PMID: 26969656 DOI: 10.1093/bfgp/elw002

Metabolic pathways have become increasingly available for various microorganisms. Such pathways have spurred the development of a wide array of computational tools, in particular, mathematical pathfinding approaches. This article can facilitate the understanding of computational analysis of metabolic pathways in genomics. Moreover, stoichiometric and pathfinding approaches in metabolic pathway analysis are discussed. Three major types of studies are elaborated: stoichiometric identification models, pathway-based graph analysis and pathfinding approaches in cellular metabolism. Furthermore, evaluation of the outcomes of the pathways with mathematical benchmarking metrics is provided. This review would lead to better comprehension of metabolism behaviors in living cells, in terms of computed pathfinding approaches.
Enhanced photodegradation of o-cresol in aqueous Mn(1%)-doped ZnO suspensions

Abdollahi Y, Abdullah AH, Gaya UI, Zainal Z, Yusof NA

Environ Technol, 2012 Jun;33(10-12):1183-9.
PMID: 22856288

The effective removal of o-cresol is currently both an environmental and economic challenge. ZnO is not only an efficient photocatalyst but is also cost effective, as its photoabsorption can extend from the ultraviolet (UV) to the visible range thereby allowing the use of inexpensive visible light sources, such as sunlight. The principal objective of the present work is to investigate the visible light-driven removal of o-cresol from aqueous solution in the presence of 1.0 wt% Mn-doped ZnO. To measure the efficiency ofphotodegradation, the variables studied included the amount ofphotocatalyst, concentration of o-cresol, pH and irradiation time. The concentration ofo-cresol and residual organic carbon was monitored using a UV-visible spectrophotometer, ultra high-pressure liquid chromatography and a total organic carbon analyser. The optimum conditions under which the photodegradation of o-cresol was most favourable corresponded to 1.5 g/l ZnO, 35 ppm o-cresol and pH 9. The ZnO-1 wt% Mn photoprocess has demonstrated reusability for more than three times, which warrants its scale-up from laboratory- to in industrial-scale application.
Fulltext The decision-making journey of Malaysian women with early breast cancer: a qualitative study

Abdullah A, Abdullah KL, Yip CH, Teo SH, Taib NA, Ng CJ

Asian Pac J Cancer Prev, 2013;14(12):7143-7.
PMID: 24460266

BACKGROUND: The survival outcomes for women presenting with early breast cancer are influenced by treatment decisions. In Malaysia, survival outcome is generally poor due to late presentation. Of those who present early, many refuse treatment for complementary therapy.
OBJECTIVE: This study aimed to explore the decision making experiences of women with early breast cancer.
MATERIALS AND METHODS: A qualitative study using individual in-depth interviews was conducted to capture the decision making process of women with early breast cancer in Malaysia. We used purposive sampling to recruit women yet to undergo surgical treatment. A total of eight participants consented and were interviewed using a semi-structured interview guide. These women were recruited from a period of one week after they were informed of their diagnoses. A topic guide, based on the Ottawa decision support framework (ODSF), was used to facilitate the interviews, which were audio recorded, transcribed and analysed using a thematic approach.
RESULTS: We identified four phases in the decision-making process of women with early breast cancer: discovery (pre-diagnosis); confirmatory ('receiving bad news'); deliberation; and decision (making a decision). These phases ranged from when women first discovered abnormalities in their breasts to them making final surgical treatment decisions. Information was vital in guiding these women. Support from family members, friends, healthcare professionals as well as survivors also has an influencing role. However, the final say on treatment decision was from themselves.
CONCLUSIONS: The treatment decision for women with early breast cancer in Malaysia is a result of information they gather on their decision making journey. This journey starts with diagnosis. The women's spouses, friends, family members and healthcare professionals play different roles as information providers and supporters at different stages of treatment decisions. However, the final treatment decision is influenced mainly by women's own experiences, knowledge and understanding.
Study site: Breast surgical units, Klang Valley, Malaysia
Fulltext The influence of self-owned home blood pressure monitoring (HBPM) on primary care patients with hypertension: a qualitative study

Abdullah A, Othman S

BMC Fam Pract, 2011;12:143.
PMID: 22208768 DOI: 10.1186/1471-2296-12-143

BACKGROUND:
Home blood pressure monitoring (HBPM) is gaining popularity among hypertensive patients. This study aimed to explore the influence of self-initiated HBPM on primary care patients with hypertension.
METHODS:
Six in-depth interviews and two focus group discussions were conducted, taking into consideration the experiences of 24 primary care patients with hypertension. These patients had been using HBPM as part of their hypertension management. The overriding influences were grouped under themes which emerged from analyzing the data using the grounded theory approach.
RESULTS:
There are both positive and negative influences of self-initiated HBPM. Patients used the readings of their HBPM to decide on many aspects of their hypertension management. The HBPM readings both influenced their adherence to diet and exercise and provided certain reassurance when they experienced symptoms. In addition, the act of discussing their HBPM readings with their health care providers resulted in an enhanced doctor-patient therapeutic relationship. Nevertheless, HBPM created confusion at times in some patients, particularly with regard to the target blood pressure level and the need for medication. This led to some patients making their own medical decisions based on their own standards.
CONCLUSIONS:
HBPM is becoming an integral part of hypertension management. Primary care patients who self-initiated HBPM reported being more self-efficacious, but lack of participation and guidance from their doctors created confusion, and hindered the true benefit of HBPM.

Study site: urban primary care clinic, located within the University Malaya Medical Centre
Fulltext Massive epistaxis secondary to pseudoaneurysm of internal carotid artery

Abdullah A, Putra SH, Saim L

Med J Malaysia, 2006 Mar;61(1):84-7.
PMID: 16708739 MyJurnal

Post-traumatic pseudoaneurysms of internal carotid arteries are uncommon. The patients may present with massive epistaxis due to rupture of the aneurysm into the sphenoid sinus. Early diagnosis and treatment is mandatory as the likelihood of exsanguinations increases with each subsequent episode of epistaxis. The clinical features of unilateral blindness and massive epistaxis after head injury should indicate the diagnosis. The high mortality of this entity underlines the importance of early angiography in these patients to confirm this diagnosis. We present 3 cases of post-traumatic aneurysm of the ICA.
Fulltext Management of congenital choanal atresia (CCA) after multiple failures: A Case Report

Abdullah A, Abdul Rahman R, Aziz S, Abu Bakar S, AbAziz AA

Med J Malaysia, 2013;68(1):76-8.
PMID: 23466775 MyJurnal

Nasal obstruction in neonates is a potentially fatal condition because neonates are obligatory nasal breathers. Bilateral choanal atresia is therefore a neonatal emergency. Several approaches for corrections of choanal atresia are available including the helium laser: YAG. A 5-year-old Chinese girl born with bilateral choanal atresia, had birth asphyxia that required intubation. She underwent multiple surgeries for correction of choanal atresia at other hospitals but failed to improve. She was referred to Universiti Kebangsaan Malaysia Medical Center (UKMMC) after presenting with intermittent respiratory distress and cyanosis following an upper respiratory tract infection. A repeat computed tomography (CT) scan done preoperatively showed complete bony stenosis over the left choana and finding was confirmed by examination under general anesthesia. She underwent endoscopic transnasal removal of left bony atretic plate. There was no intra or postoperative complications. During follow up 10 years later, the airway on both sides remains patent.
Fulltext An evolutionary firefly algorithm for the estimation of nonlinear biological model parameters

Abdullah A, Deris S, Anwar S, Arjunan SN

PLoS One, 2013;8(3):e56310.
PMID: 23469172 DOI: 10.1371/journal.pone.0056310

The development of accurate computational models of biological processes is fundamental to computational systems biology. These models are usually represented by mathematical expressions that rely heavily on the system parameters. The measurement of these parameters is often difficult. Therefore, they are commonly estimated by fitting the predicted model to the experimental data using optimization methods. The complexity and nonlinearity of the biological processes pose a significant challenge, however, to the development of accurate and fast optimization methods. We introduce a new hybrid optimization method incorporating the Firefly Algorithm and the evolutionary operation of the Differential Evolution method. The proposed method improves solutions by neighbourhood search using evolutionary procedures. Testing our method on models for the arginine catabolism and the negative feedback loop of the p53 signalling pathway, we found that it estimated the parameters with high accuracy and within a reasonable computation time compared to well-known approaches, including Particle Swarm Optimization, Nelder-Mead, and Firefly Algorithm. We have also verified the reliability of the parameters estimated by the method using an a posteriori practical identifiability test.
Fulltext Sensitivity and specificity of portable transient otoacoustic emission (TEOAE) in newborn hearing screening

Abdullah A, Long CW, Saim L, Mukari SZM

Med J Malaysia, 2005 Mar;60(1):21-7.
PMID: 16250276 MyJurnal

Early identification and management of hearing impairment is very valuable. The goal standard measurement of hearing loss is by brainstem evoked response (BSER). This prospective study was conducted in Hospital University Kebangsaan Malaysia (HUKM) to determine the sensitivity and specificity of transient evoked otoacoustic emission (TEOAE) as a screening tool for hearing impairment from February 1999 to February 2000. One hundred and thirty-three newborns from postnatal ward and seventy-eight newborns from neonatal intensive care unit (NICU) were screened for possible hearing loss using portable TEOAE. This study showed that TEOAE is a very sensitive but moderately specific screening tool.
Fulltext What influences patients' acceptance of a blood pressure telemonitoring service in primary care? A qualitative study

Abdullah A, Liew SM, Hanafi NS, Ng CJ, Lai PS, Chia YC, et al.

Patient Prefer Adherence, 2016;10:99-106.
PMID: 26869773 DOI: 10.2147/PPA.S94687

BACKGROUND: Telemonitoring of home blood pressure (BP) is found to have a positive effect on BP control. Delivering a BP telemonitoring service in primary care offers primary care physicians an innovative approach toward management of their patients with hypertension. However, little is known about patients' acceptance of such service in routine clinical care.
OBJECTIVE: This study aimed to explore patients' acceptance of a BP telemonitoring service delivered in primary care based on the technology acceptance model (TAM).
METHODS: A qualitative study design was used. Primary care patients with uncontrolled office BP who fulfilled the inclusion criteria were enrolled into a BP telemonitoring service offered between the period August 2012 and September 2012. This service was delivered at an urban primary care clinic in Kuala Lumpur, Malaysia. Twenty patients used the BP telemonitoring service. Of these, 17 patients consented to share their views and experiences through five in-depth interviews and two focus group discussions. An interview guide was developed based on the TAM. The interviews were audio-recorded and transcribed verbatim. Thematic analysis was used for analysis.
RESULTS: Patients found the BP telemonitoring service easy to use but struggled with the perceived usefulness of doing so. They expressed confusion in making sense of the monitored home BP readings. They often thought about the implications of these readings to their hypertension management and overall health. Patients wanted more feedback from their doctors and suggested improvement to the BP telemonitoring functionalities to improve interactions. Patients cited being involved in research as the main reason for their intention to use the service. They felt that patients with limited experience with the internet and information technology, who worked out of town, or who had an outdoor hobby would not be able to benefit from such a service.
CONCLUSION: Patients found BP telemonitoring service in primary care easy to use but needed help to interpret the meanings of monitored BP readings. Implementations of BP telemonitoring service must tackle these issues to maximize the patients' acceptance of a BP telemonitoring service.
Preoperative high resolution CT and MR imaging in cochlear implantation

Abdullah A, Mahmud MR, Maimunah A, Zulfiqar MA, Saim L, Mazlan R

Ann Acad Med Singap, 2003 Jul;32(4):442-5.
PMID: 12968546

INTRODUCTION: Accurate preoperative imaging of the temporal bone in patients receiving cochlear implants is important. High resolution computed tomography (HRCT) and magnetic resonance (MR) imaging are the 2 preoperative imaging modalities that provide critical information on abnormalities of the otic capsule, pneumatisation of the mastoid, middle ear abnormalities, cochlear ducts patency and presence of cochlear nerve.
MATERIALS AND METHODS: The HRCT and MR imaging in 46 cochlear implant patients in our department were reviewed.
RESULTS: Majority of our patients [34 patients (73.9%)] showed normal HRCT of the temporal bone; 5 (10.9%) patients had labyrinthitis ossificans, 2 (4.3%) had Mondini's abnormality and 2 (4.3%) had middle ear effusion. One patient each had high jugular bulb, hypoplasia of the internal auditory canal and single cochlear cavity, respectively.
CONCLUSION: The above findings contribute significantly to our surgical decisions regarding candidacy for surgery, side selection and surgical technique in cochlear implantation.
Maternal mortality rate in the Obstetric Unit of University Kebangsaan Malaysia: 1981-1990

Abdullah A, Mahmood JH, Adeeb N

J Obstet Gynaecol (Tokyo 1995), 1995 Jun;21(3):299-303.
PMID: 8590370

This paper analyses maternal mortality as seen in the Obstetric Unit of the University Kebangsaan Malaysia. During the 10 year study period, the maternal mortality rate was 74/100,000 total births. Women who were non-booked, aged above 40 years, gradmultiparous and of India ethnicity were at the highest risk of maternal death. The commonest causes of death were hemorrhage, hypertension, embolism and sepsis. Post-mortem examinations were performed in only 8.2% of women who died.
Fulltext The different faces of facial nerve schwannomas

Abdullah A, Mahmud MR, Sabir HA, Saim L

Med J Malaysia, 2003 Aug;58(3):450-3.
PMID: 14750390

Facial nerve schwannomas are rare benign tumors. The tumor can arise anywhere along the course of the facial nerve. The most common presentation for this tumor is a slowly progressive facial nerve paralysis. Sensorineural hearing loss (SNHL) and tinnitus are later symptoms. The symptoms and signs depend on the site of tumor along the nerve. We report three cases of facial nerve schwannomas with different clinical presentations. Appropriate management of a facial nerve schwannoma should be based on the site and extent of the tumor and status of the nerve function.
Fulltext The Effects of Various Concentrations of NaOH on the Inter-Particle Gelation of a Fly Ash Geopolymer Aggregate

Abdullah A, Hussin K, Abdullah MMAB, Yahya Z, Sochacki W, Razak RA, et al.

Materials (Basel), 2021 Feb 27;14(5).
PMID: 33673522 DOI: 10.3390/ma14051111

Aggregates can be categorized into natural and artificial aggregates. Preserving natural resources is crucial to ensuring the constant supply of natural aggregates. In order to preserve these natural resources, the production of artificial aggregates is beginning to gain the attention of researchers worldwide. One of the methods involves using geopolymer technology. On this basis, this current research focuses on the inter-particle effect on the properties of fly ash geopolymer aggregates with different molarities of sodium hydroxide (NaOH). The effects of synthesis parameters (6, 8, 10, 12, and 14 M) on the mechanical and microstructural properties of the fly ash geopolymer aggregate were studied. The fly ash geopolymer aggregate was palletized manually by using a hand to form a sphere-shaped aggregate where the ratio of NaOH/Na2SiO3 used was constant at 2.5. The results indicated that the NaOH molarity has a significant effect on the impact strength of a fly ash geopolymer aggregate. The highest aggregate impact value (AIV) was obtained for samples with 6 M NaOH molarity (26.95%), indicating the lowest strength among other molarities studied and the lowest density of 2150 kg/m3. The low concentration of sodium hydroxide in the alkali activator solution resulted in the dissolution of fly ash being limited; thus, the inter-particle volume cannot be fully filled by the precipitated gels.
The Prevalence of Hearing Loss Among Babies in the Neonatal Intensive Care Unit in a Tertiary Hospital in Malaysia

Abdullah A, Dahari KASA, Tamil AM, Rohana J, Razif MYM, Shareena I

Medeni Med J, 2020;35(2):116-120.
PMID: 32733760 DOI: 10.5222/MMJ.2020.68466

Objective: To study the prevalence of hearing loss (HL) and to identify the possible risk factors causing HL.
Methods: This retrospective study was conducted from January 2014-December 2016 at a tertiary hospital in Malaysia. All neonates admitted to the neonatal intensive care unit (NICU), Universiti Kebangsaan Malaysia Medical Centre (UKMMC) were screened with a two-step protocol using an automated auditory brain response (AABR) and/or Otoacoustic Emission and auditory brain response (ABR). Descriptive analysis was used for the prevalence of HL, degree of HL and number of risk factors per infant.
Results: A total of 2713 babies underwent hearing screening in NICU was enrolled in this study. Two thousand six hundred eight (96%) babies passed the screening test and 214 (4%) babies required further diagnostic test. Only 105 (49%) babies completed diagnostic tests. Out of 105 babies, 40 (38.1%) babies had HL. Mild HL was the commonest HL with 22 (55%), moderate HL was in seven babies (17.5%), severe HL in two babies (5%), and profound HL in nine babies (22.5%). The presence of craniofacial anomalies was the only significant independent risk factor for HL with p<0.05 with an odds ratio of 0.105 CI 95% [0.028-0.389]. Of Babies with the presence of three or more risk factors, 100% of them had HL.There was an increased risk of hearing loss in those with craniofacial anomalies up to 11 times higher compared to those without such anomalies.
Conclusion: The prevalence of HL among the NICU babies was 1.5% and mild HL was the commonest degree of HL (55%).
Giant cell tumor of the tendon sheath in the knee of an 11-year-old girl

Abdullah A, Abdullah S, Haflah NH, Ibrahim S

J Chin Med Assoc, 2010 Jan;73(1):47-51.
PMID: 20103492

Giant cell tumors are commonly found over the flexor tendon sheath of the hand and wrist. However, giant cell tumors in the knee joint are rare, especially in children. We report an interesting case of an 11-year-old girl who presented with a painful lump on her right knee that enlarged over time. Clinically, she had fullness over the anterolateral part of her knee. Magnetic resonance imaging revealed an encapsulated mass inferior to the patella. The tumor measured 3 x 3.5 x 1.5 cm. Histopathological findings confirmed that it was a tenosynovial giant cell tumor. Because of initial mild symptoms, there was a delay of 2 years from the initial symptoms until tumor excision. Her follow-up period was 35 months, and her health to date is excellent with no recurrence. We believe that reporting this rare case will help clinicians update their knowledge on possible causes of lumps in the knee, and avoid diagnostic delay. It could also prove to be beneficial in arriving at a diagnosis in future cases.
Fulltext Health literacy experiences of multi-ethnic patients and their health-care providers in the management of type 2 diabetes in Malaysia: A qualitative study

Abdullah A, Liew SM, Ng CJ, Ambigapathy S, V Paranthaman PV

Health Expect, 2020 10;23(5):1166-1176.
PMID: 32686277 DOI: 10.1111/hex.13095

BACKGROUND: Patients with type 2 diabetes mellitus (T2DM) require adequate health literacy to understand the disease and learn self-management skills to optimize their health. However, the prevalence of limited health literacy is high in patients with T2DM, especially in Asian countries.
OBJECTIVE: This study aimed to explore experiences related to health literacy in Asian patients with T2DM.
DESIGN: This is a qualitative study using in-depth interviews and focus group discussions. A framework analysis was used to analyse the data.
SETTING AND PARTICIPANTS: articipants (n = 24) were multi-ethnic patients with T2DM (n = 18) and their primary health-care providers (n = 6). This study was conducted in four primary health-care clinics in Malaysia.
RESULTS: Nine subthemes were identified within the four dimensions of health literacy: accessing, understanding, appraising and applying information.
DISCUSSION: Motivated patients actively sought information, while others passively received information shared by family members, friends or even strangers. Language and communication skills played important roles in helping patients understand this information. Information appraisal was lacking, with patients just proceeding to apply the information obtained. Patients' use of information was influenced by their self-efficacy, and internal and external barriers.
CONCLUSION: In conclusion, the experiences of multi-ethnic patients with T2DM regarding health literacy were varied and heavily influenced by their cultures.
Antioxidant Modulation of mTOR and Sirtuin Pathways in Age-Related Neurodegenerative Diseases

Abdullah A, Mohd Murshid N, Makpol S

Mol Neurobiol, 2020 Dec;57(12):5193-5207.
PMID: 32865663 DOI: 10.1007/s12035-020-02083-1

In the human body, cell division and metabolism are expected to transpire uneventfully for approximately 25 years. Then, secondary metabolism and cell damage products accumulate, and ageing phenotypes are acquired, causing the progression of disease. Among these age-related diseases, neurodegenerative diseases have attracted considerable attention because of their irreversibility, the absence of effective treatment and their relationship with social and economic pressures. Mechanistic (formerly mammalian) target of rapamycin (mTOR), sirtuin (SIRT) and insulin/insulin growth factor 1 (IGF1) signalling pathways are among the most important pathways in ageing-associated conditions, such as neurodegeneration. These longevity-related pathways are associated with a diversity of various processes, including metabolism, cognition, stress reaction and brain plasticity. In this review, we discuss the roles of sirtuin and mTOR in ageing and neurodegeneration, with an emphasis on their regulation of autophagy, apoptosis and mitochondrial energy metabolism. The intervention of neurodegeneration using potential antioxidants, including vitamins, phytochemicals, resveratrol, herbals, curcumin, coenzyme Q10 and minerals, specifically aimed at retaining mitochondrial function in the treatment of Alzheimer's disease, Parkinson's disease and Huntington's disease is highlighted.
First detection of tilapia lake virus (TiLV) in wild river carp (Barbonymus schwanenfeldii) at Timah Tasoh Lake, Malaysia

Abdullah A, Ramly R, Mohammad Ridzwan MS, Sudirwan F, Abas A, Ahmad K, et al.

J Fish Dis, 2018 Sep;41(9):1459-1462.
PMID: 30027657 DOI: 10.1111/jfd.12843
Fulltext Prevalence of limited health literacy among patients with type 2 diabetes mellitus: A systematic review

Abdullah A, Liew SM, Salim H, Ng CJ, Chinna K

PLoS One, 2019;14(5):e0216402.
PMID: 31063470 DOI: 10.1371/journal.pone.0216402

BACKGROUND: Health literacy (HL) skills are essential to enable self-management and shared decision-making in patients with type 2 diabetes mellitus (T2DM). Limited HL in these patients is associated with poorer outcomes. It is not clear what the burden of limited HL in patients with T2DM across countries and what factors influence it.
METHODS: A systematic review was conducted according to the PRISMA guidelines. The study protocol was registered with PROSPERO (CRD42017056150). We searched MEDLINE, EMBASE, PsycINFO, CINAHL and ERIC for articles published up to January 2017. Articles that measured HL levels in adult patients with T2DM; that used validated HL tools; and that were reported in English were included. Two reviewers assessed studies for eligibility and quality, and extracted the data. Prevalence of limited HL is calculated from the number of patients with less than adequate HL over the total number of patients with T2DM in the study. Meta-analysis and meta-regression analysis were conducted using the Open Meta-analyst software.
RESULTS: Twenty-nine studies involving 13,457 patients with T2DM from seven countries were included. In total, seven different HL measurement tools were used. The prevalence of limited HL ranged from 7.3% to 82%, lowest in Switzerland and the highest in Taiwan. Meta-regression analysis of all included studies showed the country of study (p<0.001), HL tool used (p = 0.002), and the country's region (p<0.001) contributed to the variation findings. Thirteen studies in the USA measured functional HL. The pooled prevalence of inadequate functional HL among patients with T2DM in the USA was 28.9% (95% CI: 20.4-37.3), with high heterogeneity (I2 = 97.9%, p <0.001). Studies were done in the community as opposed to a hospital or primary care (p = 0.005) and populations with education level lower than high school education (p = 0.009) reported a higher prevalence of limited HL.
CONCLUSION: The prevalence of limited HL in patients with T2DM varied widely between countries, HL tools used and the country's region. Pooled prevalence showed nearly one in three patients with T2DM in the USA had limited functional HL. Interactions with healthcare providers and educational attainment were associated with reported of prevalence in the USA.

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