Estimated prevalence of diabetes mellitus in Malaysia was about 2%. Diabetes was most common in Indians especially males and least common in Chinese. There was a slight male preponderance seen in Malays and Indians. Positive family history was obtained in 14% of cases most commonly in Malays, almost 1/3 of whom had more than one family member with diabetes. Familial association was uncommon in Chinese. Over 50% of patients were overweight. Obesity was noted in nearly 70% of female Malays and Indians while the majority of Chinese were not overweight. More than 80% of patients were non insulin requiring. Youth onset diabetes was considered rare; those 10 years and below were estimated to be only 0.4% and below 20 years of age between 2%-4% of the diabetic population. Females were twice as common than males in this type of diabetes and familial association was greater. Malnutrition-related diabetes and pancreatic calcification were not well-documented but youth-onset non insulin requiring diabetics with mild symptoms but strong family history of diabetes were observed. More than half of hospital-based patients had evidence of complications, mainly amongst Malays and Indians. Hypertension was the most frequent associated disease followed by foot ulcers and ischaemic heart disease. Hypertension usually associated with chronic renal failure was most common amongst Malays while gangrenic ulcers and heart diseases were seen mainly in Indians. The major causes of death were chronic renal failure, myocardial infarction, ketoacidosis, stroke and septicaemia related to gangrene.(ABSTRACT TRUNCATED AT 250 WORDS)
Matched MeSH terms: Diabetes Mellitus, Type 1/epidemiology
Insulin-dependent diabetes mellitus (IDDM) is inherited in a multifactorial manner with polygenes and environmental factors contributing to its emergence in a particular individual. The evidence for such a mode of inheritance is reviewed. One of the most important genetic roles is that played by the HLA genes on chromosome 6 and the different alleles which increase or decrease susceptibility in Caucasians, Japanese, Singapore Chinese and Shanghai Chinese are described. It is inferred that these alleles are different in different ethnic groups. The other genes which are important are unknown. The environmental influences are less well known although viral infections may act as triggers. Because the morbidity and mortality are still extremely serious in IDDM patients in spite of insulin therapy, it is proposed that preventive measures should be instituted in families prone to IDDM. The role of prenatal diagnosis is discussed especially in those families with multiple HLA susceptibility genes present. Great care paid to management of hyperglycemia from onset of the disease may reduce future morbidity and mortality.
Matched MeSH terms: Diabetes Mellitus, Type 1/etiology; Diabetes Mellitus, Type 1/genetics; Diabetes Mellitus, Type 1/metabolism; Diabetes Mellitus, Type 1/epidemiology; Diabetes Mellitus, Type 1/prevention & control*
The prevalence, age at diagnosis, clinical characteristics and treatment of young diabetics, younger than 40 years were determined on the basis of a cross-sectional study of medical records of 2 health districts in Pahang, Malaysia. There were only 20 insulin-dependent diabetics (IDDM), prevalence 0.07 per 1000 inhabitants. There were 84 non-insulin-dependent diabetics (NIDDM), prevalence 0.3 per 1000 inhabitants. Three of the NIDDM patients could have malnutrition-related diabetes. Many NIDDM patients were asymptomatic which is an important reason why many of them remain undetected in the community. Seventy-four percent of the patients below the age of 30 years at diagnosis had NIDDM, 56% of the patients below the age of 20 years at diagnosis also had NIDDM and 54% of the NIDDM patients had a strong family history of diabetes. Many NIDDM patients were misdiagnosed as IDDM, especially if they were underweight, leading to considerable overuse of insulin. This study confirms that IDDM is rare in Malaysia, as in other Asian countries. Most young diabetics have NIDDM and have a strong family history. This pattern of diabetes in the young is unlike that seen in the West.
Matched MeSH terms: Diabetes Mellitus, Type 1/diagnosis; Diabetes Mellitus, Type 1/epidemiology*; Diabetes Mellitus, Type 1/therapy
Pseudomonas pseudomallei, a gram negative organism causing melioidosis, is found in tropical and subtropical regions. It may manifest as a pulmonary lesion, osteomyelitis, soft tissue abscesses, abscesses in various organs or in septicaemic form. Melioidosis of the parapharyngeal space has not been reported so far. A case of melioidosis of the parapharyngeal space which was successfully treated by drainage and prolonged antibiotic therapy is reported here. Melioidosis should be suspected in severe forms of deep neck space infection, especially if the patient comes from an endemic area.
Matched MeSH terms: Diabetes Mellitus, Type 1/complications*
Growth hormone (GH) levels were measured after a 75g oral glucose load (OGTT) in normal adults, patients with impaired glucose tolerance (IGT), insulin-dependent diabetes mellitus (IDDM) and acromegaly. Nadir GH levels at 2-hour post-OGTT in normal subjects ranged from 0.4 to 8.4 mIU/L, the 95% confidence interval being 0.4-4.4 mIU/L. In IGT and IDDM subjects basal fasting GH levels were not significantly different from normal and did not alter during OGTT. The high fasting GH level measured in one each of the IGT and IDDM patients was suppressible at 1-hour after glucose intake. In contrast, acromegalic patients had elevated fasting GH levels (11.8-178 mIU/L) although in 3 patients, the levels were mildly elevated and overlapped with normal. OGTT failed or only partially suppressed GH secretion in all acromegalics. Therefore, elevated fasting GH levels are not diagnostic and OGTT is required for accurate diagnosis and assessment of treatment of acromegalic patients.
Matched MeSH terms: Diabetes Mellitus, Type 1/blood; Diabetes Mellitus, Type 1/metabolism*
Fasting serum growth hormone (GH) levels of different groups of diabetic patients were measured and compared to age-matched normal subjects. Insulin-dependent diabetes mellitus (IDDM) children (aged 12-17 years) were found to have significantly lower fasting GH levels than age-matched normal children (p < 0.001). In the adult age groups of 18-44 and 45-76 years, the IDDM patients showed increased fasting GH levels compared to age-matched normal subjects (p < 0.06 and p < 0.001 respectively) and non-insulin-dependent diabetes mellitus (NIDDM) patients (p < 0.05 and p < 0.001 respectively). The fasting GH levels of IDDM patients of the age group 18-44 years also showed significant correlations with glycated haemoglobin (r = 0.510, p = 0.002) and fasting blood sugar levels (r = 0.571, p = 0.01).
Matched MeSH terms: Diabetes Mellitus, Type 1/blood
A 35-year-old Chinese man who was known to have insulin-dependent diabetes mellitus was admitted for fever and weight loss. During his hospital stay, he fell to his death from his ward at the twelfth floor. The clinical features, radiological findings and gross organ changes at autopsy closely simulated miliary tuberculosis. Histology, however, revealed extensive necrosis of the adrenal glands, lungs, spleen, kidneys and thyroid associated with the presence of Histoplasma capsulatum organisms. This case highlights the similarity both clinically and pathologically between histoplasmosis and tuberculosis and emphasizes the need to be aware of this infection in a nonendemic area among patients with a compromised immune system.
Matched MeSH terms: Diabetes Mellitus, Type 1/immunology*
There is an increasing prevalence of diabetes mellitus around the world associated with rapid sociocultural development and changing lifestyles. Increased prevalence of obesity, with a higher consumption of animal products and lower consumption of fruits and vegetables, increases the risk of diabetes mellitus and other chronic degenerative diseases. Insulin-dependent diabetes (IDD) is caused by insulin deficiency, whereas the main feature of non-insulin-dependent diabetes (NIDD) which accounts for more than 90% of diabetics, is hyperinsulinemia and insulin resistance, which may eventually lead to actual insulin deficiency. Hyperinsulinemia is undesirable because it increases the risk of developing vascular disease. In Malaysia, the prevalence of NIDD in some communities now exceeds 5%, and of impaired glucose tolerance 10%. Along with these increases in prevalence of hyperglycemia are increases in prevalence of overweight (BMI>25) and almost certainly abdominal fatness. In terms of management, nutrition is given priority. Insulin and hypoglycemic drugs (sulphonylureas or biguanides), where required, may adversely affect body composition if overused. Newer therapeutic strategies require greater attention to the underlying problem in NIDD of abdominal fatness by attention to the relevant nutritional factors, physical activity and other lifestyle factors like cigarette smoking and alcohol. The greater impact of obesity and diabetes on Malaysian women as opposed to men also needs to be addressed.
This study was conducted for 3 main purposes: 1) to determine if there was blue colour deficiency amongst diabetes mellitus (IDDM and NIDDM) patients without retinopathy, 2) to determine if the Dl5 test could be used to detect any colour vision defects amongst diabetics without retinopathy (all previous workers have used FM 100-Hue), and 3) to assess the performance of diabetics without retinopathy in detecting correct colour changes with the urine strip test. Thirty eight non-insulin dependent diabetes mellitus (NIDDM) and 30 insulin-dependent diabetes mellitus (IDDM) patients without retinopathy participated in this study. A control group of 23 normal subjects were also included in the study. Dl5 colour vision test was performed under daylight conditions. Colour dependent urine glucose test (Glukotest) was also performed on all subjects. The study showed that 47.1% of diabetics (47.4% NIDDM and 46.7% IDDM patients) without retinopathy had a blue colour deficiency. Amongst the diabetics with a blue colour deficiency, 25% of diabetics (22% of NIDDM and 28.6% of IDDM patients) failed to accurately match the strip colour with the comparison chart on the bottle.
Kajian ini dilakukan untuk 3 tujuan: I) untuk menentukan samada terdapat gangguan penglihatan warna biru dalam pesakit diabetes mellitus (IDDM dan NIDDM) tanpa retinopati, 2) untuk menentukan samada ujian penglihatan warna Dl5 boleh digunakan untuk mengesan defek penglihatan warna dalam pesakit diabetes tanpa retinopati (kesemua kajian terdahulu menggunakan ujian FM 100-Hue). dan 3) untuk menilaikan prestasi pesakit diabetik tanpa retinopati dalam mengesan perubahan warna yang betul dengan menggunakan ujian strip urin. Tiga puluh lapan pesakit dengan non-insulin dependent diabetes (NIDDM) dan 30 pesakit dengan insulin dependent diabetes (IDDM) tanpa retinopati menyertai kajian ini. Kumpulan kawalan mengandungi 23 orang subjek yang normal juga terlibat di dalam kajian ini. Ujian penglihatan warna Dl5 dilakukan di bawah cahaya daylight. Ujian glukos urin berasaskan warna (Glukotest) dilakukan ke atas semua subjek. Kajian menunjukkan 47.1% pesakit diabetes (47.4% pesakit NIDDM dan 46.7% pesakit IDDM) tanpa retinopati mengalami defisiensi warna biru. Dalam kumpulan diabetik dengan defisiensi warna biru, 25% pesakit diabetes (22.2% adalah pesakit NIDDM dan 28.6% adalah pesakit IDDM) gagal untuk memadankan dengan tepat warna strip dengan carta perbandingan warna di atas botol.
To determine the incidence of insulin dependent diabetes mellitus (IDDM) in children 0-12 years of age in Singapore, which has a population of 2.9 million.
Matched MeSH terms: Diabetes Mellitus, Type 1/genetics; Diabetes Mellitus, Type 1/epidemiology*
We successfully developed an in-house, competitive enzyme immunoassay to measure advanced glycosylation end-products (AGE) in serum. The assay involved coating microtitre wells with AGE-BSA at 8 micrograms/ml for 4 hours, followed by overnight incubation of 20 microliters sample (prediluted at 1:6) with 80 microliters antiserum (1:8000). HRP-labelled goat anti-rabbit was used as the second antibody and 3,5',5,5'-tetramethylbenzidine dihydrochloride as the substrate. Incubation was carried out at 4 degrees C. As suggested in an earlier study, we standardised the AGE units against normal human serum (NHS). Thus, one AGE unit was defined as the inhibition that resulted when the 1:6 diluted NHS was assayed. Mean (+/- SD) AGE level in normal subjects (n = 37) was significantly lower than in diabetes subjects with microalbuminuria (n = 57) (6.0 +/- 0.7 versus 10.2 +/- 4.7 units/ml, p = 0.0001). With the availability of in-house assay and by standardising the AGE unit with the other laboratories, more studies could be undertaken and results compared, and possibly, further elucidate the roles of AGE in the pathogenesis of diabetic complications.
Matched MeSH terms: Diabetes Mellitus, Type 1/blood; Diabetes Mellitus, Type 1/urine
This cross-sectional study looked at the prevalence of microalbuminuria and retinopathy in a cohort of 926 young, Type 1 and Type 2 diabetes mellitus (DM) patients, and determined the factors which were associated with these microvascular complications. The prevalence of microalbuminuria, defined as the albumin:creatinine ratio > or = 2.5 (for males) or > or = 3.5 mg/mmol (for females), was 13.4% in Type 1 DM, 69.5% in insulin-requiring Type 2 DM and 16% in Type 2 DM treated only with oral hypoglycemic agents. Compared to those with normal renal functions, these patients were older (P < or = 0.01), had significantly elevated blood pressures (P < 0.01 or P = 0.0001), and in the case of Type 1 DM, with a higher body mass index (P = 0.0001) and waist-hip ratio (P < 0.01). The prevalence of diabetic retinopathy in Type 1 DM was found to increase with the duration of diabetes, from 1.4% in the newly-onset (< 5 years), to 9.9% in those with 5-10 years disease, to 35% among patients with more than 10 years of diabetes (P < 0.0001). In this study, it was also observed that 10% of the Type 2 DM patients already had retinopathy within 5 years of diagnosis, and the prevalence increased significantly to 42.9% (P < 0.0001) among patients who had been diabetics for more than 10 years. Stepwise multiple regression analysis showed that besides the disease duration, systolic blood pressure was the most common and significant determinant for both microalbuminuria and retinopathy in both types of DM, thus implying that in order to reduce the risk of microvascular complications in diabetes mellitus, systolic and not just the diastolic blood pressure, should be effectively controlled.
Matched MeSH terms: Diabetes Mellitus, Type 1/complications; Diabetes Mellitus, Type 1/urine
Recent studies have shown that good glycaemic control can prevent the development of diabetic complications in type 1 and type 2 diabetes. We wished to observe the glycaemic control in patients from different centres in Peninsular Malaysia and the factors that determine it. We recruited 926 patients with diabetes diagnosed before age 40 years from seven different centres, with proportionate representation from the three main ethnic groups. Clinical history and physical examination were done and blood taken for HbA1c and fasting glucose. The overall glycaemic control was poor with geometric mean HbA1c of 8.6% whilst 61.1% of the patients had HbA1c greater than 8%. Glycaemic control in patients with type 2 diabetes varied between various centres and ethnic groups, with the best control obtained in Chinese patients. Significant predictors of HbA1c in both type 1 and type 2 diabetes include access to nurse educators, ethnic background and WHR. In type 2 diabetes, use of insulin was a significant predictor, while in type 1 diabetes, household income was a significant predictor. Socioeconomic status did not have a significant effect in type 2 diabetes. There were no significant differences in the glycaemic control in patients with different educational status. In conclusion, glycaemic control in big hospitals in Malaysia was poor, and was closely related to the availability of diabetes care facilities and ethnic group, rather than socioeconomic status.
Matched MeSH terms: Diabetes Mellitus, Type 1/epidemiology*; Diabetes Mellitus, Type 1/therapy*
This study determined the prevalence and significance of autoantibodies to GAD65 (GAD Ab), insulin (IAA), tyrosine-like phosphatase (IA2) and islet-cell (ICA) in a group of 213 young Malaysian Type 1 diabetics, diagnosed before the age of 40 years. Venous blood was taken at fasting, and at 6 minutes post-glucagon (1 mg i.v.). IAA was detected in 47.4%, GAD Ab in 33.8%, IA2 in 8.9% and ICA in 1.4% of the subjects. When based on post-glucagon C-peptide level of 600 pmol/L, 172 (80.7%) patients had inadequate pancreatic reserve, while the remainder 41(19.3%) showed normal response. The autoantibodies, either alone or in combination, were detectable in both groups of patients; higher prevalence in those with poor or no beta-cell function (73.3% versus 46.3%, p = 0.0001). Although the prevalence of GAD Ab was highest in newly diagnosed patients (< 5 years), unlike IA2 and ICA, the marker remained detectable in 24-25% of those patients with long-standing disease. Nineteen patients could probably belong to the "latent autoimmune diabetes in adults (LADA)" subset, where pancreatic reserve was adequate but patients had detectable autoantibodies and insulin-requiring. On the other hand, 68 of the 213 patients (32%) were seronegative, but presented with near or total beta-cell destruction. Thus, as has also been suggested by others, there is indeed etiological differences between the Asian and the Caucasian Type 1 diabetics, and, there is also the possibility that other, but unknown autoantigens are involved in causing the pancreatic damage.
Matched MeSH terms: Diabetes Mellitus, Type 1/immunology*
Population studies all over the world have clearly showed that the prevalence of Type 2 diabetes mellitus (DM) is escalating at phenomenal scale and very likely we are heading towards epidemic proportions. In 1985, the estimated population of diabetic individuals in the world was 30 million but by 1995 this figure soared to 135 million. Based on current trends, epidemiologists predict that the population of diabetic individuals will swell up to a staggering 300 million by the year 2025. Almost half of that will be in the Asia Oceania region alone. Dr Hilary King of WHO pointed out that there will be a projected rise of about 42% in developed countries whereas the developing countries will see an escalation to the magnitude of 170% (H. King, R.E. Aubert, W.H. Herman, Global burden of diabetes, 1995-2025: prevalence, numerical estimates and projections, Diabetes Care 21 (1998) 1414-1431; WHO Health Report 1997, WHO Switzerland). There will be a 3-fold rise of the disease in Asia and much of these will be seen in China (40 million) and India (55 million) by virtue of the massive population of these countries. Nevertheless, the other rapidly developing Asian nations like Singapore, Malaysia, Thailand and those making up Indochina will experience the surge. At the same time the prevalence and incidence of diabetes complications will also increase. Based on recent WHO prediction (WHO Newsletter, The global burden of diabetes 1995-2025. World Diabetes 3 (1997) 5-6), it is estimated that by the year 2000 the following figures will be seen:Diabetes complications are major causes of premature death all over the world and most of these are avoidable. DCCT and UKPDS are landmark studies showing strong evidence that major complications can be drastically reduced by maintaining to near normoglycaemic control.
Matched MeSH terms: Diabetes Mellitus, Type 1/epidemiology*
Diabetes mellitus has been on the rise in Singapore, while Singaporeans are becoming more affluent, our lifestyles are more sedentary and our population is ageing rapidly. The prevalence of diabetes mellitus rose from 2% in 1975 to 4.7% in 1984, 8.6% in 1992 and 9.0% of adults 18-69 years old in 1998. Malay and Indian women and Indian men were at higher risk, with 14.3, 14.9 and 16.7% prevalence rates, respectively. A further 15% of the adult population have impaired glucose tolerance (IGT). Diabetes was a factor in 39.7% of strokes and in 9.3% of all deaths in Singapore, and is the sixth most common cause of death. In the Diabcare Singapore 1998 Study, 91% of participants were diagnosed with Type 2 diabetes, with mean BMI of 25.1+/-4.4 kg/m(2). The incidence of Type 1 diabetes in childhood is 2.46 per 100000 children 0-12 years of age, while Type 2 diabetes in childhood is an emerging problem. The prevalence of obesity (BMI >30 kg/m(2)) among persons aged 18-69 years rose to 6% in 1998, up from 5.1% in 1992. The prevalence of obesity was highest among the Malays (16.2%) followed by the Indians (12.2%) and the Chinese (3.8%). About 12% of schoolchildren are obese. Increased efforts must be made to change lifestyle and eating patterns in our society, reduce childhood obesity and encourage adults to make lifelong sports and exercise part of the Singaporean way of life. Singapore has one of the world's fastest ageing populations, and even now, 32.4% of Singaporeans 60-69 years of age have diabetes. We should consider screening for diabetes in obese schoolchildren and seek to improve quality of care for people with diabetes, including enlisting the aid of community organisations to improve access to diabetes education, monitoring, support and complications screening services.
Matched MeSH terms: Diabetes Mellitus, Type 1/epidemiology
Detection of microalbuminuria is important in the management of diabetic patients since it is predictive of development of proteinuria and nephropathy. Two sensitive and specific in-house ELISAs for microalbuminuria were established and validated. One of the ELISAs was based on antigen coating while the other employed antibody coating. Recovery and linearity experiments gave acceptable results of 100 +/- 10%, while precision results were <10% for intra-assay and <12% for inter-assay coefficients of variation (CVs). The standard curve ranged from 10-625 ug/l, equivalent to 0.2-12.5 mg/l for urine samples diluted 1:20 fold. When the antibody coated ELISA was compared to antigen coated ELISA, a correlation of r=0.996 was obtained. When compared to commercial kits, the in-house ELISAs gave good correlations of r=0.961 versus the Boehringer Mannheim Micral Test strips and r=0.940 versus Ames Microalb Turbidimetry. The normal microalbumin reference ranges determined for 12h, first morning and random urine samples were 0.7-5.3 mg, 0.1-10.2 mg/l and 0.8-26.1 mg/l respectively. The normal albumin excretion rate (AER) was 1.0-7.3 ug/min while untimed urine samples gave results of 0.1-0.9 and 0.2-1.6 mg/mmol after dividing by creatinine concentrations. The ELISAs were used to detect microalbuminuria in 338 random urine samples from diabetic patients. A high percentage 47.9% was found to be positive for microalbuminuria and 18.0% had macroalbuminuria >25 mg/mmol. Thus screening for microalbuminuria together with creatinine measurements using random urine samples can be used for management of diabetic patients.
Matched MeSH terms: Diabetes Mellitus, Type 1/physiopathology; Diabetes Mellitus, Type 1/urine*
AIMS: To define the prevalence of dyslipidaemia in young diabetic patients in Peninsular Malaysia and the contributory factors of dyslipidaemia in these subjects.
METHODS: This is a cross-sectional study involving 848 young diabetic patients from seven different centres, with representation from the three main ethnic groups. Clinical history and physical examination was done and blood taken for HbA1c, fasting glucose, total cholesterol, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol and triglycerides.
RESULTS: The overall lipids were suboptimal, worse in Type 2 diabetes mellitus (DM) patients compared with Type 1 DM patients. Of the Type 2 patients, 73.2% had total cholesterol > 5.20 mmol/l, 90.9% had LDL-cholesterol > 2.60 mmol/l, 52.6% had HDL-cholesterol < 1.15 mmol/l and 27.3% had serum triglycerides > 2.30 mmol/l. There were ethnic differences in the lipid levels with the Malays having the highest total cholesterol (mean 6.19 mmol/l), and the highest LDL-cholesterol (mean 4.16 mmol/l), while the Chinese had the highest HDL-cholesterol (geometric mean 1.24 mmol/l). Ethnicity was an important determinant of total, LDL- and HDL-cholesterol in Type 2 DM, and LDL- and HDL-cholesterol and triglycerides in Type 1 DM. Glycaemic control was an important determinant of total, LDL-cholesterol and triglycerides in both Type 1 and Type 2 DM. Waist-hip ratio (WHR) was an important determinant of HDL-cholesterol and triglycerides in both types of DM. Gender was an important determinant of HDL-cholesterol in Type 2 DM, but not in Type 1 DM. Socioeconomic factors and diabetes care facilities did not have any effect on the dyslipidaemia.
CONCLUSIONS: The prevalence of dyslipidaemia was high especially in Type 2 DM patients. Ethnicity, glycaemic control, WHR, and gender were important determinants of dyslipidaemia in young diabetic patients. Diabet. Med. 18, 501-508 (2001)
Matched MeSH terms: Diabetes Mellitus, Type 1/blood; Diabetes Mellitus, Type 1/complications
This cross-sectional study compared serum lipoprotein (a) [Lp(a)] concentrations in type 1 and type 2 diabetic subjects and examined the determinants of Lp(a) concentrations in both types of diabetes. Serum Lp(a) was measured in 26 type 1 and 107 type 2 diabetic patients and 126 non-diabetic controls. HbA(1c), fasting lipids and urinary albumin were also assayed. Lp(a) concentrations were higher in both type 1 and type 2 diabetic patients compared with controls (P<0.0001 and P<0.0001, respectively), and were higher in type 1 than type 2 diabetic patients (P<0.05). Waist-hip ratio (WHR) was an independent determinant of Lp(a) concentrations in both type 1 and type 2 diabetes.
Matched MeSH terms: Diabetes Mellitus, Type 1/blood*; Diabetes Mellitus, Type 1/physiopathology