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Findings among 100 type 2 diabetics in a clinic in Penang, Malaysia, 1983-84

Merriman A, Ross I

Ann Acad Med Singap, 1985 Apr;14(2):277-85.
PMID: 4037686

A Specialist Clinic was commenced in August 1983, from the Medical School at Universiti Sains Malaysia, Penang, Malaysia to assess: 1) the present control and 2) the incidence of complications in a diabetic population already receiving primary health care at Penang General Hospital. The ethnic groups among the diabetics were Chinese (39%), Malays (26%) and Indian (35%). There was a greater percentage of Indians than would be expected from the ethnic distribution of the population of Penang. The results of the first 100 (43 males and 57 females) non-insulin dependent diabetic patients are reviewed. The mean age was 54 years, 41% had relatives with diabetes, and all were taking oral agents. The diet comprehension and compliance were poor. 65% of the group, 54% of males and 75% of females were obese. The mean blood glucose was 11 m.mols/l (fasting) and 12.8 m.mols/1 (2 hours post prandial). The complications seen in the 100 diabetics were: albuminurea 41, skin infection 37, cataracts 35, hypertension 32, peripheral sensory neuropathy 32, retinopathy 22, ischaemic heart disease 19, autonomic neuropathy 10, impaired renal function 4 (urea or creatinine elevated), foot ulcer 2 and gangrene 1. Urinalysis for glucose at the Clinic showed very little correlation with blood glucose at the same time. Nine out of 43 males admitted to impotence on questioning. Comparisons of findings in Penang were made with recent studies in Singapore and Hong Kong.

Matched MeSH terms: Diabetes Mellitus, Type 2/complications*; Diabetes Mellitus, Type 2/genetics; Diabetes Mellitus, Type 2/therapy
Diabetes mellitus in peninsular Malaysia: ethnic differences in prevalence and complications

Mustaffa BE

Ann Acad Med Singap, 1985 Apr;14(2):272-6.
PMID: 4037685

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 2/epidemiology
Prevalence, age at diagnosis, clinical characteristics and treatment of diabetes in the young in Pahang, Malaysia

Lim TO

Diabetes Res Clin Pract, 1991 Jul;12(3):201-7.
PMID: 1889350 DOI: 10.1016/0168-8227(91)90078-R

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 2/diagnosis; Diabetes Mellitus, Type 2/epidemiology*; Diabetes Mellitus, Type 2/therapy
Fulltext Comparison of serum fructosamine and blood glucose concentrations as indices of glycaemic control in non-insulin dependent diabetic out-patients

Lim TO, Selvan T, Suppiah A, Khan N, Ismail F

Singapore Med J, 1992 Jun;33(3):287-9.
PMID: 1631590

The usefulness and validity of blood glucose measurement as an index of diabetic control were assessed with reference to serum fructosamine. Two hundred and twenty-eight non-insulin dependent diabetic out-patients were studied in the usual clinical setting. Fasting blood glucose (FBG) concentration was positively correlated with serum fructosamine (r = 0.42, t = 6.78 p less than 0.01). On the basis of their serum fructosamine concentrations, patients were divided into 3 groups. They were good control (fructosamine less than or equal to 288 umol/l), acceptable control (fructosamine less than or equal to 320 umol/l) and poor control groups (fructosamine greater than 320 umol/l). The mean fasting blood glucose concentration was significantly higher in the latter than the former 2 groups. However, at each level of control, there was a wide range of FBG concentrations. Thus, the value of FBG in predicting glycaemic control is limited. Its positive predictive value was only 32%, and its overall accuracy as an index of diabetic control was only 58% though its negative predictive value was high (93%). In 162 patients with poor diabetic control as indicated by their serum fructosamine concentrations, 81 (50%) of them had FBG less than 10 mmol/l on their clinic visit day. Fasting blood glucose is therefore not a reliable measure of good diabetic control, though it is useful in predicting poor control. FBG is simple to measure, cheap and rapidly available on clinic day, thus ensuring its continuing use. Doctors should be aware of its limitations and should not rely solely on FBG to assess diabetic control.
Study site: Diabetic clinic, Hospital Mentakab, Pahang, Malaysia

Matched MeSH terms: Diabetes Mellitus, Type 2/blood*; Diabetes Mellitus, Type 2/therapy
Prevalence of NIDDM and impaired glucose tolerance in aborigines and Malays in Malaysia and their relationship to sociodemographic, health, and nutritional factors

Ali O, Tan TT, Sakinah O, Khalid BA, Wu LL, Ng ML

Diabetes Care, 1993 Jan;16(1):68-75.
PMID: 8422835 DOI: 10.2337/diacare.16.1.68

OBJECTIVE: To determine the prevalence of diabetes mellitus and IGT in different ethnic groups living in the same physical environment and to find their relationship to nutritional status and dietary intake.

RESEARCH DESIGN AND METHODS: The study was conducted among Malays and Orang Asli in six rural and urban locations in Malaysia. OGTTs were performed on 706 adult subjects > or = 18 yr of age. WHO criteria were used for diagnosing diabetes mellitus and IGT.

RESULTS: The overall prevalence of diabetes mellitus and IGT among Orang Asli was 0.3 and 4.4% compared with 4.7 and 11.3%, respectively, among Malays. This increased prevalence of glucose intolerance among Malays was associated with higher levels of social development. Among rural Malays, the crude prevalence of diabetes in a traditional village was 2.8% and in the land scheme was 6.7%, whereas urban Malays had a prevalence of 8.2%. In contrast, the prevalence of IGT (10.5-14.8%) was higher among rural Malays, compared with 9.6% among urban Malays. Ethnic group, > or = 40 yr of age, an income > M$250, fewer daily activity, and obesity were associated with a higher prevalence of diabetes.

CONCLUSIONS: Diabetes mellitus and IGT, which were more common among Malays than Orang Asli, were associated with more affluent life-styles and modernization.

Matched MeSH terms: Diabetes Mellitus, Type 2/epidemiology*
Fasting growth hormone levels in diabetes mellitus

Nazaimoon WM, Ng ML, Khalid BA

Ann Acad Med Singap, 1993 Nov;22(6):861-3.
PMID: 8129344

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 2/blood
Fulltext Body composition in the pathogenesis and management of diabetes: a Malaysian perspective

Osman A, Khalid BA

Asia Pac J Clin Nutr, 1994 Mar;3(1):33-9.
PMID: 24351204

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.

Matched MeSH terms: Diabetes Mellitus, Type 2
Factors associated with diabetic control

Ruzita AT, Osman A, Khalid AK

Family Physician, 1994;6:12-14.

The aim of the study was to determine the factors associated with diabetic control among Non Insulin Dependent Diabetes Mellitus (NIDDM) in a Felda settlement area. METHODS: We analyzed the anthropometric and metabolic data of sixty three NIDDM patients in Felda Sg Koyan, Raub, Pahang. Diabetic control, was measured by glycated hemoglobin (HbA1) and fructosamine; it showed a strong correlation (r=12.8 and p-0.001). With the use of a multivariate regression model, which was adjusted for sex, age, dhration of diabetes, body mass index (BMI) and systolic blood pressure, we found that the occurrence of higher fructosamine was associated with significantly higher HbA1 (F =7.8, p=0.01). RESULTS: Obesity was present in 72% of diabetic patients with BMI>25 and had a mean duration of diabetes of 6+4 years. Mean HbAl among males (6.8 + 1.6%) were significantly different (p 0.05) to diabetic control. CONCLUSIONS: The study showed that males have a better diabetic control than females. Poor control was observed among diabetics who had diabetes for more than five years.

Matched MeSH terms: Diabetes Mellitus, Type 2
Fulltext Diabetic control among NIDDM patients in urban and rural areas in Malaysia

Ruzita AT, Osman A, Fatimah A, Khalid BA

Med J Malaysia, 1996 Mar;51(1):48-51.
PMID: 10967979

Sixty three and fifty nine non-insulin dependent diabetes mellitus (NIDDM) patients in rural (land resettlement scheme) and urban areas respectively were studied to determine factors associated with diabetic control. The anthropometric and metabolic data (HbA1 and fructosamine levels) were analysed. After adjusting for gender, age, body mass index (BMI) and food intake, the fructosamine level which correlates with short term diabetic control, was significantly lower among patients in urban areas compared to patients in rural areas (p < 0.05). However, for longer term diabetic control (HbA1 level) the difference was not statistically significant (p > 0.05). The socio-economic status, level of education, BMI and types of food did not correlate with diabetic control in either group of patients. More diabetes education is needed together with socio-economic development and changes in lifestyles to enhance compliance towards health and dietary regimens and to achieve better metabolic control.

Matched MeSH terms: Diabetes Mellitus, Type 2/blood*; Diabetes Mellitus, Type 2/pathology
Glycaemic and insulin responses of diabetic patients to traditional Malaysian meals and the effect of guar gum

Khalid BA, Lee LF, Samad AH, Ng ML

Asia Pac J Clin Nutr, 1996 Dec;5(4):239-43.
PMID: 24394617

The aims of the project were to determine the glycaemic and insulin responses of non-insulin dependent diabetic patients (NIDDM) to 3 traditional Malaysian meals compared to oral glucose, and to determine whether guar gum would affect these responses. Patients with NIDDM were tested with 75 g oral glucose and three common breakfast meals of the three main ethnic groups of Malaysia. When compared with the oral glucose group, significantly by lower blood glucose responses were seen at 90 and 120 minutes post prandial for nasi lemak (p<0.05) and at 60, 75 and 90 minutes for mee sup (p<0.05). No significant difference was seen for roti telur. There was no significant difference in plasma glucose at any time point of the study when the three test meals were compared with each other. Addition of 5g granulated guar gum mixed with water taken prior to the glucose significantly lowered the plasma glucose at 60, 120 and 150 minutes postprandially (p<0.05). Similarly for the test meals, guar gum significantly lowered plasma glucose concentration between 15 and 45 minutes (p<0.03) postprandial for nasi lemak and between 15 and 30 minutes (p<0.03) for mee sup but not with roti telur. With addition of guar gum, there was no significant change of insulin responses with the three meals but a significant increase was seen at 30 minutes (p<0.02) after ingestion of glucose.

Matched MeSH terms: Diabetes Mellitus, Type 2
Blue deficiency in patients with diabetes mellitus without retinopathy - its clinical implications

Kaur S

Sains Malaysiana, 1996;25(2):41-49.

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.

Matched MeSH terms: Diabetes Mellitus, Type 2
Fulltext HbA1c as an indicator of diabetic control in the Family Practice Clinic

Wong KC, Teng CL, Krishnan R

Family Physician, 1996;9(3):3-6.

A quality assurance exercise for non-insulin dependent diabetes mellitus in the Family Practice Clinic, University Hospital Kuala Lumpur, was conducted using HbA1c as an indicator. We found that about 60% of the 163 patients with non-insulin dependent diabetes mellitus had fair to optimal control. The HbA1c correlated well with fasting and post-prandial blood glucose level (r=0.79 and r=0.54, respectively, p<0.001). The mean HbA1c was significantly higher in Malay compared to the other races, in those with longer duration of diabetes and in patients on two types of oral hypoglycaemic agent.
Study site: Family Practice Clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia

Matched MeSH terms: Diabetes Mellitus, Type 2
Fulltext The effectiveness of group dietary counselling among non insulin dependent diabetes mellitus (NIDDM) patients in resettlement scheme areas in Malaysia

Talib R, Ali O, Arshad F, Kadir KA

Asia Pac J Clin Nutr, 1997 Jun;6(2):84-7.
PMID: 24394705

A study was undertaken in FELDA (Federal Land Development Authority) resettlement scheme areas in Pahang, Malaysia, to determine the effectiveness of group dietary counselling in motivating diabetic patients to achieve good dietary habits, and weight and diabetes control. Sixty-one non-insulin dependent diabetes mellitus (NIDDM) patients were randomly assigned to either the experimental or control group. The experimental group received six sessions of group dietary counselling over 5 months and the control group received mass media diabetes-educational program during the same period. The one hour group dietary counselling sessions discussed general knowledge of diabetes, food groups for meal planning, the importance of dietary fibre-rich foods, types of fat in food, exercise and weight control. The experimental group met monthly with a dietitian as a counsellor. Effectiveness was assessed by improvement in food choice, and decline in percentage glycated haemoglobin (total HbA1) or body mass index (BMI). Measurements were made at a baseline visit, every two months during the six month program, and six months afterwards. Patients in the experimental group improved their food choices, resulting in a healthier diet high in unrefined carbohydrates and dietary fibre rich foods, and low in fat. There were significant reductions of their percentage total HbA1 levels and BMI following the counselling sessions, which decreased further six months after the program compared with patients in the control group. Thus group dietary counselling is effective in motivating NIDDM patients to achieve better food choice, and related weight and glycaemic control in a Malaysian setting.

Matched MeSH terms: Diabetes Mellitus, Type 2
Cardiovascular risk factors in non-insulin-dependent diabetics compared to non-diabetic controls: a population-based survey among Asians in Singapore

Hughes K, Choo M, Kuperan P, Ong CN, Aw TC

Atherosclerosis, 1998 Jan;136(1):25-31.
PMID: 9544728

Cardiovascular risk factors were compared between 126 people with non-insulin-dependent diabetes mellitus (NIDDM) and 530 non-diabetics (controls), in a random sample of people (Chinese, Malays, and Asian Indians) aged 40-69 years from the general population of Singapore. Data were adjusted for age and ethnicity. For both genders, people with NIDDM had higher mean body mass indices, waist-hip ratios and abdominal diameters. They also had a higher prevalence of hypertension, higher mean levels of fasting serum triglyceride, slightly lower mean levels of serum high-density-lipoprotein cholesterol, and higher mean levels of plasma plasminogen activator inhibitor-1 and tissue plasminogen activator (antigen). These factors are components of syndrome X (metabolic syndrome) and increase the risk of atherosclerosis and thrombosis. In contrast, there were no important differences for cigarette smoking, serum total and low-density-lipoprotein cholesterol, serum apolipoproteins A1 and B, plasma factor VIIc and plasma prothrombin fragment 1 + 2. Females with NIDDM, but not males, had a higher mean serum fibrinogen level than non-diabetics, which could explain why NIDDM has a greater cardiovascular effect in females than males. Serum lipoprotein(a) concentrations were lower in people with NIDDM. Mean levels of serum ferritin, a pro-oxidant, were higher in people with NIDDM than controls, but there were no important differences for plasma vitamins A, C and E, and serum selenium, which are anti-oxidants.

Matched MeSH terms: Diabetes Mellitus, Type 2/complications*
Ethnic differences in correlates of microalbuminuria in NIDDM. The role of the acute-phase response

Islam N, Kazmi F, Chusney GD, Mattock MB, Zaini A, Pickup JC

Diabetes Care, 1998 Mar;21(3):385-8.
PMID: 9540020

OBJECTIVE: To investigate whether microalbuminuria is associated with markers of the acute-phase response in NIDDM and whether there are ethnic differences in this association among the three main racial groups in Malaysia.
RESEARCH DESIGN AND METHODS: NIDDM patients of Chinese, Indian, and Malay origin attending a diabetic clinic in Kuala Lumpur, Malaysia, were matched for age, sex, diabetes duration, and glycemic control (n = 34 in each group). Urinary albumin-to-creatinine ratio was measured in an early morning urine sample. Biochemical measurements included markers of the acute-phase response: serum sialic acid, triglyceride, and (lowered) HDL cholesterol.
RESULTS: The frequency of microalbuminuria did not differ among the Chinese, Indian, and Malay patients (44, 41, and 47%, respectively). In Chinese patients, those with microalbuminuria had evidence of an augmented acute-phase response, with higher serum sialic acid and triglyceride and lower HDL cholesterol levels; and urinary albumin-to-creatinine ratio was correlated with serum sialic acid and triglyceride. The acute-phase response markers were not different in Indians, with microalbuminuria being high in even the normoalbuminuric Indians; only the mean arterial blood pressure was correlated with urinary albumin-to-creatinine ratio in the Indians. Malay NIDDM subjects had an association of microalbuminuria with acute-phase markers, but this was weaker than in the Chinese subjects.
CONCLUSIONS: Microalbuminuria is associated with an acute-phase response in Chinese NIDDM patients in Malaysia, as previously found in Caucasian NIDDM subjects. Elevated urinary albumin excretion has different correlates in other racial groups, such as those originating from the Indian subcontinent. The acute-phase response may have an etiological role in microalbuminuria.

Matched MeSH terms: Diabetes Mellitus, Type 2/blood; Diabetes Mellitus, Type 2/ethnology*; Diabetes Mellitus, Type 2/urine
Age: the most significant risk for diabetes in Indian populations

Rao PV, Ahuja MM, Trivedi BB, Ramachandran M, Samal KC, Zain AZ, et al.

J Indian Med Assoc, 1998 May;96(5):155-7.
PMID: 9828573
Matched MeSH terms: Diabetes Mellitus, Type 2/ethnology; Diabetes Mellitus, Type 2/epidemiology
Systolic hypertension and duration of diabetes mellitus are important determinants of retinopathy and microalbuminuria in young diabetics

Wan Nazaimoon WM, Letchuman R, Noraini N, Ropilah AR, Zainal M, Ismail IS, et al.

Diabetes Res Clin Pract, 1999 Dec;46(3):213-21.
PMID: 10624787 DOI: 10.1016/s0168-8227(99)00095-9

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 2/complications; Diabetes Mellitus, Type 2/urine
Sociodemographic determinants of glycaemic control in young diabetic patients in peninsular Malaysia

Ismail IS, Nazaimoon WM, Mohamad WB, Letchuman R, Singaraveloo M, Pendek R, et al.

Diabetes Res Clin Pract, 2000 Jan;47(1):57-69.
PMID: 10660222 DOI: 10.1016/s0168-8227(99)00104-7

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 2/epidemiology*; Diabetes Mellitus, Type 2/therapy*
Fulltext Acute effects of acarbose on post-prandial glucose and triglycerides in type 2 diabetics following intake of different Malaysian foods

Nawawi HM, Yazid TN, Ismail F, Khalid BA

Asia Pac J Clin Nutr, 2000 Mar;9(1):41-5.
PMID: 24394314

Acarbose inhibits intestinal alpha-glucosidases resulting in diminished and delayed postprandial hyperglycaemia (PPH). Studies on effects of acarbose on postprandial lipaemia (PPL) have been inconclusive. Little is known about the effects of acarbose on PPH and PPL following intake of a polysaccharide diet. We studied 30 type 2 diabetic patients on dietary and/or oral hypoglycaemic agent(s). Thirty patients were recruited for food A (nasi lemak), 28 for food B (mee goreng) and 28 for food C (roti telur), which represent the typical diets of the three main races in Malaysia. Serial blood samples were taken at 15 min before and up to 240 min after each food intake, without acarbose. Subsequently, three doses of 50 mg acarbose were given orally and the same procedure was repeated the following day. There were significantly lower mean increments in plasma glucose levels after compared to before acarbose treatment 30, 45 and 60 min for food A and at 30, 45, 60, 120, 180 and 240 min for food C, but no significant difference was noted for food B. There was a significantly lower mean fasting glucose level after compared with before acarbose treatment following intake of food A and C but not food B. Short-term treatment with acarbose caused significant diminished and delayed PPH response with food A and C but not with food B. Acarbose was more effective in reducing PPH response in polysaccharide foods with a higher and earlier postprandial glucose peak than in those with a lower and lagged peak. There were no significant differences in the mean fasting or postprandial triglyceride levels before and after acarbose treatment, following intake of all three foods for up to 4 hours. Depending on the food absorption pattern, overnight low dose treatment with acarbose leads to diminished fasting and peak plasma glucose levels, and delayed PPH but insignificant reduction in postprandial lipaemia in poorly controlled type 2 diabetics following intake of racially different Malaysian food.

Matched MeSH terms: Diabetes Mellitus, Type 2
Fulltext Urine protein excretion among Chinese patients with type 2 diabetes mellitus

Hong CY, Chia KS, Ling SL

Med J Malaysia, 2000 Jun;55(2):220-9.
PMID: 19839150

Background: Urinary excreton of low molecular weight proteins such as beta2-microglobulin and retinol binding protein (RBP), and enzymes such as N-acetyl-beta-D-glucosaminidase (NAG), may be useful as indicators of renal tubular dysfunction in diabetes mellitus.
Objective: To describe the profile of urinary protein and enzyme excretion in 240 Chinese patients with type 2 diabetes mellitus in Singapore.
Materials and Methodology: Cross-sectional study of consecutive patients presenting for follow-up at a Government primary care clinic. Information was obtained from interview, physical examination and laboratory analysis. Data analysis included descriptive statistics on urinary protein and enzyme excretion, comparison of unadjusted and adjusted means of these among patient subgroups, as well as correlation with control of diabetes and other clinical parameters.
Results: Albuminuria correlated with urine B2-microglobulin (r=0.34, p<0.01) and RBP (r=0.46,p<0.01). hypertensive patients had significantly higher mean urine albumin (geometric mean 15.13mg/gCr) and B2-microglobulin (363.18ug/gCr) levels compared to patients without hypertension (7.07mg/gCR; 219,20ug/gCr; p<0.05). Patients with complications of diabetes also had higher albumin (15.55 vs 6.20mg/gCr), B2-microglobulin (344.47 vs 288.83ug/gCr) and RBP excretion (152.02 vs 94.54mg/gCr). Two-hour postprandial sugar correlated with B2-microglobulin (r=0.33, p<0.01), RBP (r=0.35, p<0.01) and NAG (r=0.28, p<0.01). Urinary protein excretion did not correlate with HbA1c, fasting blood sugar, age of patient or duration since diagnosis.
Conclusion: These results among 240 Chinese patients in Singapore were consistent with reports from other study populations.

Matched MeSH terms: Diabetes Mellitus, Type 2/physiopathology*

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