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  1. Fulltext A retrospective review of diabetic nephropathy patients during referral to the sub-urban nephrology clinic
    Menon R, Mohd Noor FS, Draman CR, Seman MR, Ghani AS
    Saudi J Kidney Dis Transpl, 2012 Sep;23(5):1109-14.
    PMID: 22982937 DOI: 10.4103/1319-2442.100972
    Diabetic nephropathy (DN) has become the most common cause of end-stage renal failure. Early referral and specific nephrology treatment could delay the disease progression and should reduce the treatment cost, mortality and morbidity rate in these patients. This is a single-center, retrospective review of all DN patients referred to the nephrology clinic in Hospital Sultan Ahmad Shah, Temerloh, from 2000 to 2009, to study and define the clinical characteristics of DN patients at the time of the referral to the nephrology clinic. A total of 75 patient case records were reviewed. Forty-three (57.3%) of them were males, with a median age of 64.3 ± 8.5 years at the time of referral. Only 14.7% of them had blood pressure lower than 125/75 mmHg. Co-morbid and disease-related complications were also commonly diagnosed and 28.4% (n = 21) had ischemic heart disease, 23% (n = 17) had diabetic retinopathy and 20.3% (n = 15) had diabetic neuropathy. The mean serum creatinine at the time of referral was 339.8 ± 2.3 μmol/L, gylcated hemoglobin A 1c (HbA1C) was 8.1 ± 2.0 %, serum fasting glucose was 9.6 ± 4.7 mmol/L, serum cholesterol was 5.4 ± 1.2 mmol/L and hemoglobin level was 10.6 ± 2.9 g/dL. Although female patients were less frequently seen in the early stages of chronic kidney disease (CKD), they comprised at least 72.7% of CKD stage 5 (male:female; 6:16, P <0.05). Twenty-nine percent (n=22) of them were referred at CKD stage 5, 48% (n=36) were at CKD stage 4, 17.3% (n=13) were at CKD stage 3, 4% (n=3) were at CKD stage 2 and 1.3% (n=1) was at CKD stage 1. Advanced CKD patients were frequently prescribed with more antihypertensives. CKD stage 5 patients were prescribed with two-and-half types of antihypertensive as compared to two types of anti-hypertensive in CKD stage 2 and stage 3. Furthermore, ACE-inhibitors (ACE-I) were less frequently prescribed to them. Only 22.7% (n=5) of CKD stage 5 patients received ACE-I and 30% (n=11) in CKD stage 4 patients as compared to 53.4% (n=7) in CKD patients stage 3. This review shows that DN patients were referred late to the nephrologists and the overall disease management was suboptimal. Antihypertensive requirement was also increased and ACEIs were less frequently prescribed in the advanced diabetic nephropathy patients.
    Study site: Nephrology Clinic, Hospital Sultan Ahmad Shah, Temerloh, Pahang, Malaysia
    Matched MeSH terms: Diabetic Retinopathy
  2. Glycaemic control and quality of life among ethnically diverse Malaysian diabetic patients
    Daher AM, AlMashoor SA, Winn T
    Qual Life Res, 2015 Apr;24(4):951-8.
    PMID: 25352036 DOI: 10.1007/s11136-014-0830-5
    PURPOSE: To assess the relationship between glycaemic control and quality of life (QoL) among a sample of Malaysians with type 2 diabetes mellitus.

    METHODS: This study is a cross-sectional hospital-based study involving 256 patients from three major ethnic groups in Malaysia. Data about QoL were collected with the 18-item Audit of Diabetes Dependent QoL questionnaire. Other data about putative predictors of QoL including personal characteristics and disease-related factors were also collected. Hierarchical multiple linear regression was used to determine factors associated with QoL and to control for confounding variables.

    RESULTS: The mean age of participants was 56.79 years. Participants were mostly women, employed and married and had attained secondary education. More than a third of the patients had a disease duration of more than 10 years, and about two-thirds had HbA1c ≥ 6.5 %. Those with desired glycaemic control had poorer QoL than those with less than desired glycaemic control moderated by the use of insulin. Hierarchical multiple linear regression showed that desired glycaemic control (HbA1c), diabetes worry, use of insulin, more than 10 years' duration of diabetes, neuropathy and retinopathy were associated with poor QoL, whereas being satisfied with waiting time for consultation was associated with better QoL.

    CONCLUSIONS: The results of this study show that diabetes was associated with negative impact on quality of life. The use of insulin to achieve desired glycaemic control was particularly associated with negative impact on QoL.
    Matched MeSH terms: Diabetic Retinopathy
  3. Fulltext Diabetes control and complications in public hospitals in Malaysia
    Mafauzy M
    Med J Malaysia, 2006 Oct;61(4):477-83.
    PMID: 17243527 MyJurnal
    The Diabcare-Asia project was initiated to study the status of diabetes care and prevalence of diabetic complications in Asia and this study was done to evaluate the above in public hospitals in Malaysia and compare to a similar study done in 1998. A total of 19 public hospitals participated in this study from which a total of 1099 patients were included and analysed. The majority of patients (94.8%) had type 2 diabetes mellitus and 66.5% were overweight or obese. As for glycaemic control only 41.0% of the patients had HbA1c < 7% and 18% had FPG < 6.1 mmol/L. As for lipid levels, only 32.0% of the patients had total cholesterol < 4.8 mmol/L; 59.6% had HDL-cholesterol > 1.1 mmol/L and 51.1% had triglycerides < 1.7 mmol/L. Despite the high proportion of patients having dyslipidaemia, only 52.8% of the patients were on lipid lowering therapy. As for blood pressure, 15.0% of the patients had blood pressure < 130/80 mmHg. Although 75.9% of the patients were on antihypertensive medication only 11.3% had blood pressure < 130/80 mmHg. Only 54.8% of patients admitted to adhering to a diabetic diet regularly and 38.9% exercised regularly. As for glucose monitoring, only 26.8% of the patients did home blood glucose monitoring and 1.8% did home urine glucose testing. There was also a high complication rate with the commonest being neuropathy (19.0%) followed by albuminuria (15.7%), background retinopathy (11.1%) and microalbuminuria (6.6%). Compared to the 1998 study, there was some improvement in the percentage of patients achieving target levels and a reduction in the prevalence of complications. In conclusion, the majority of diabetic patients treated at the public hospitals were still not satisfactorily controlled and this was still associated with a high prevalence of complications. There is still an urgent need to educate both patients and health care personnel on the importance of achieving the clinical targets and greater effort must be made to achieve these targets.
    Matched MeSH terms: Diabetic Retinopathy
  4. Fulltext Blood glucose control and diabetic microangiopathy
    Cheah JS
    Med J Malaysia, 1981 Dec;36(4):220-6.
    PMID: 7334957
    There is overwhelming evidence that the microangiopathic complications (retinopathy, nephropathy and neuropathy) of diabetes can be minimised, prevented or improved by optimal blood glucose control. There is little evidence to show otherwise. This paper reviews evidences to demonstrate that poor diabetic control predisposes to diabetic microangiopathy. The only way to minimise diabetic microangiopathy is to avoid hyperglycaemia and achieve euglycaemia for most part of the day. In doing so the dangers of hypoglycaemia must be clearly recognized and avoided.
    Matched MeSH terms: Diabetic Retinopathy
  5. Fulltext Transient Cortical Blindness After Coronary Angiography, Bypass Graft Angiography, and Coronary Angioplasty
    Lee ZV, Arjan Singh RS
    Cureus, 2021 Jan 07;13(1):e12542.
    PMID: 33425567 DOI: 10.7759/cureus.12542
    Transient cortical blindness after coronary angiography has long been reported in the literature; however, this condition remains rare until today. We report a case of transient cortical blindness after coronary angiography, bypass graft angiography, and coronary angioplasty, which was deemed to be secondary to contrast agent. A 60-year-old man who underwent prior coronary artery bypass grafting (CABG) started to experience recurrence of exertional and resting chest pain one year after CABG. In addition to coronary artery disease, he has underlying type 2 diabetes mellitus, hypertension, and dyslipidemia. Due to technical reasons, he was unable to undergo a computed tomography (CT) angiography of the coronary arteries and bypass grafts. Invasive coronary and bypass graft angiography were done, followed by stenting of the left circumflex artery. Thirty minutes after completion of the procedure, the patient had bilateral blurring of vision, which worsened drastically to only being able to perceive light bilaterally. The patient otherwise did not have any other neurological deficits. Binocular indirect ophthalmoscopy revealed no significant abnormalities apart from mild non-proliferative diabetic retinopathy of the left eye. A non-contrasted CT scan of the brain revealed acute subarachnoid bleed in both occipital lobes, but a subsequent magnetic resonance imaging scan of the brain revealed no evidence of intracranial bleed. The patient's vision gradually improved eight hours after the index event, and his vision completely normalized 12 hours later. The patient was discharged well two days later, and at one-month, three-month, and six-month follow-up, the patient remained angina-free, and his vision had remained stable bilaterally.
    Matched MeSH terms: Diabetic Retinopathy
  6. Evaluating the toxic and beneficial effects of jering beans (Archidendron jiringa) in normal and diabetic rats
    Shukri R, Mohamed S, Mustapha NM, Hamid AA
    J Sci Food Agric, 2011 Nov;91(14):2697-706.
    PMID: 21744354 DOI: 10.1002/jsfa.4516
    Jering (Archidendron jiringa) is eaten in the tropics and traditionally extolled for treating diabetes, high blood pressure and eliminating bladder stones. Jering contains an unusual amino acid-djenkolic acid (S,S'-methylenebiscysteine)-which may form sharp crystals in the urinary tract, causing pain and haematuria. This study evaluates the beneficial and toxic effects of dietary jering on tissues and organs in normal and diabetic rats.
    Matched MeSH terms: Diabetic Retinopathy/prevention & control
  7. Fulltext Effects of a Technology-Assisted Integrated Diabetes Care Program on Cardiometabolic Risk Factors Among Patients With Type 2 Diabetes in the Asia-Pacific Region: The JADE Program Randomized Clinical Trial
    Lim LL, Lau ESH, Fu AWC, Ray S, Hung YJ, Tan ATB, et al.
    JAMA Netw Open, 2021 04 01;4(4):e217557.
    PMID: 33929522 DOI: 10.1001/jamanetworkopen.2021.7557
    Importance: Many health care systems lack the efficiency, preparedness, or resources needed to address the increasing number of patients with type 2 diabetes, especially in low- and middle-income countries.

    Objective: To examine the effects of a quality improvement intervention comprising information and communications technology and contact with nonphysician personnel on the care and cardiometabolic risk factors of patients with type 2 diabetes in 8 Asia-Pacific countries.

    Design, Setting, and Participants: This 12-month multinational open-label randomized clinical trial was conducted from June 28, 2012, to April 28, 2016, at 50 primary care or hospital-based diabetes centers in 8 Asia-Pacific countries (India, Indonesia, Malaysia, the Philippines, Singapore, Taiwan, Thailand, and Vietnam). Six countries were low and middle income, and 2 countries were high income. The study was conducted in 2 phases; phase 1 enrolled 7537 participants, and phase 2 enrolled 13 297 participants. Participants in both phases were randomized on a 1:1 ratio to intervention or control groups. Data were analyzed by intention to treat and per protocol from July 3, 2019, to July 21, 2020.

    Interventions: In both phases, the intervention group received 3 care components: a nurse-led Joint Asia Diabetes Evaluation (JADE) technology-guided structured evaluation, automated personalized reports to encourage patient empowerment, and 2 or more telephone or face-to-face contacts by nurses to increase patient engagement. In phase 1, the control group received the JADE technology-guided structured evaluation and automated personalized reports. In phase 2, the control group received the JADE technology-guided structured evaluation only.

    Main Outcomes and Measures: The primary outcome was the incidence of a composite of diabetes-associated end points, including cardiovascular disease, chronic kidney disease, visual impairment or eye surgery, lower extremity amputation or foot ulcers requiring hospitalization, all-site cancers, and death. The secondary outcomes were the attainment of 2 or more primary diabetes-associated targets (glycated hemoglobin A1c <7.0%, blood pressure <130/80 mm Hg, and low-density lipoprotein cholesterol <100 mg/dL) and/or 2 or more key performance indices (reduction in glycated hemoglobin A1c≥0.5%, reduction in systolic blood pressure ≥5 mm Hg, reduction in low-density lipoprotein cholesterol ≥19 mg/dL, and reduction in body weight ≥3.0%).

    Results: A total of 20 834 patients with type 2 diabetes were randomized in phases 1 and 2. In phase 1, 7537 participants (mean [SD] age, 60.0 [11.3] years; 3914 men [51.9%]; 4855 patients [64.4%] from low- and middle-income countries) were randomized, with 3732 patients allocated to the intervention group and 3805 patients allocated to the control group. In phase 2, 13 297 participants (mean [SD] age, 54.0 [11.1] years; 7754 men [58.3%]; 13 297 patients [100%] from low- and middle-income countries) were randomized, with 6645 patients allocated to the intervention group and 6652 patients allocated to the control group. In phase 1, compared with the control group, the intervention group had a similar risk of experiencing any of the primary outcomes (odds ratio [OR], 0.94; 95% CI, 0.74-1.21) but had an increased likelihood of attaining 2 or more primary targets (OR, 1.34; 95% CI, 1.21-1.49) and 2 or more key performance indices (OR, 1.18; 95% CI, 1.04-1.34). In phase 2, the intervention group also had a similar risk of experiencing any of the primary outcomes (OR, 1.02; 95% CI, 0.83-1.25) and had a greater likelihood of attaining 2 or more primary targets (OR, 1.25; 95% CI, 1.14-1.37) and 2 or more key performance indices (OR, 1.50; 95% CI, 1.33-1.68) compared with the control group. For attainment of 2 or more primary targets, larger effects were observed among patients in low- and middle-income countries (OR, 1.50; 95% CI, 1.29-1.74) compared with high-income countries (OR, 1.20; 95% CI, 1.03-1.39) (P = .04).

    Conclusions and Relevance: In this 12-month clinical trial, the use of information and communications technology and nurses to empower and engage patients did not change the number of clinical events but did reduce cardiometabolic risk factors among patients with type 2 diabetes, especially those in low- and middle-income countries in the Asia-Pacific region.

    Trial Registration: ClinicalTrials.gov Identifier: NCT01631084.

    Matched MeSH terms: Diabetic Retinopathy/epidemiology
  8. Fulltext Prevalence of eye diseases and visual impairment in urban population - a study from University of Malaya Medical Centre
    Reddy S, Tajunisah I, Low K, Karmila A
    Malays Fam Physician, 2008;3(1):25-8.
    PMID: 25606108 MyJurnal
    One thousand one hundred and sixty-nine (1169) patients were examined in the Eye Clinic of University of Malaya Medical Centre over a period of three weeks to determine the prevalence of eye diseases and visual impairment. Age, gender, race, visual acuity and diagnosis of patients were noted from the case records. Cataract (385, 32.9%) was the most common eye disease seen in our study followed by glaucoma (274, 23.4%). Refractive errors were seen in 126 (10.8%) while diabetic retinopathy was noted in 113 (9.7%) patients. One hundred and fifteen (9.6%) patients had visual impairment and 11 (0.9%) had blindness in our study according to WHO classification of visual impairment. Refractive errors are the most common causes of visual impairment in children, while cataract, glaucoma and diabetic retinopathy account for visual impairment in elderly people. All these eye diseases are treatable and the severe eye conditions may be potentially preventable with early diagnosis.
    Study site: Eye Clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
    Matched MeSH terms: Diabetic Retinopathy
  9. Fulltext Prevalence and causes of visual impairment and blindness in a rural population in Sepang district, Selangor
    Reddy SC, Rampal L, Nurulaini O
    Med J Malaysia, 2004 Jun;59(2):212-7.
    PMID: 15559172 MyJurnal
    A community based cross-sectional study was carried out to determine the prevalence and causes of visual impairment and blindness in residents aged forty years and above in kampung Jenderam Hilir of Sepang district, Selangor state. A total of 311 out of 341 (91.3%) respondents participated in this study. The prevalence of visual impairment and blindness observed was 18.9% and 2.9% respectively. The prevalence of visual impairment and blindness increased significantly with age. Amongst the 159 respondents who agreed for eye checkup, refractive errors (56%), cataract (20.1%), glaucoma (4.4%) and diabetic retinopathy (1.3%) were found to be causing visual impairment and blindness.
    Matched MeSH terms: Diabetic Retinopathy
  10. Fulltext Diabetes care: is it adequate?--An audit of diabetes care in a hospital
    Lim TO
    Med J Malaysia, 1990 Mar;45(1):18-22.
    PMID: 2152064
    An audit of diabetes care was done in a hospital to assess its effectiveness. The results revealed that diabetic patients received less than adequate care. Only 9% of the patients achieved good glycaemic control; 39% had hypertriglyceridemia and 65% had undesirable weight gain while on treatment. The average duration of diabetes in this group of young diabetic patients under study was only 4.5 years, yet 12% of them had evidence of diabetic retinopathy. Few patients possessed adequate knowledge and skills of diabetes self-care. No patients could draw up and mix insulin adequately. Only one patient could self-inject insulin correctly. Few understood the nature of hypoglycaemia, hence few took adequate precaution against it. Patients had frequent hypoglycaemia; 61% had at least one episode per week and 56% of the diabetic drivers admitted to occurrence of hypoglycaemia while driving. No patient understood the principle of diabetic diet therapy, nor did they carry out regular home-monitoring of their diabetes. Good diabetes care requires organisation with supportive patient education. The less than adequate standard of care achieved by the hospital under study is probably explained by the absence of both.
    Study site: Outpatient clinic, Hospital Mentakab, Pahang, Malaysia
    Matched MeSH terms: Diabetic Retinopathy
  11. Prevalence and risk factors of dual sensory impairment among community-dwelling older adults in Selangor: A secondary data analysis
    Mah HY, Ishak WS, Abd Rahman MH
    Geriatr Gerontol Int, 2020 Oct;20(10):911-916.
    PMID: 32820857 DOI: 10.1111/ggi.14011
    The present study aimed to examine the prevalence of dual sensory impairment, and to identify its risk factors among community-dwelling older adults in Selangor.

    METHODS: Secondary analysis was carried out on data collected by the Grand Challenge Project among older adults aged ≥65 years from Selangor. Data on sociodemographic information, medical history, cognitive function and functional performance were obtained through face-to-face interviews using standardized questionnaires. Visual acuity was measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) chart while hearing was assessed using pure-tone audiometry. Descriptive analysis was used to measure the prevalence of the impairments, and logistic regression analysis was used to identify the risk factors.

    RESULTS: The prevalence of dual sensory impairment and hearing impairment were at 10.5% and 76.2% respectively. Multivariate logistic regression analysis revealed that participants with lower cognitive scores were associated with dual sensory impairment (odds ratio, 0.90; 95% confidence interval, 0.83-0.98), while smoking was found associated with hearing impairment (odds ratio, 6.58; 95% confidence interval, 1.51-28.65).

    CONCLUSION: Dual sensory impairment is common among older adults in Selangor. The association between dual sensory impairment and cognitive function suggests the need to have visual and hearing screening on older adults for early detection particularly those at risk of cognitive impairment. The prevalence of hearing impairment was reported high among older adults and smokers appeared to be at higher risk of the impairment. Geriatr Gerontol Int 2020; 20: 911-916.

    Matched MeSH terms: Diabetic Retinopathy
  12. Fulltext Prevalence of diabetic retinopathy and its associated factors among diabetic patients in primary care clinics, Kuantan, Pahang
    Mohd Aznan MA, Khairidzan MK, Razman MR, Fa’iza A
    International Medical Journal Malaysia, 2018;17(2):11-16.
    MyJurnal
    Introduction: Diabetic retinopathy (DR) is one of the commonest complications of diabetes mellitus. This study was to determine the prevalence of DR and its association with chronic kidney disease (CKD), high HbA1c and dyslipidemia among diabetic patients in government primary care clinics.
    Materials and Methods: A cross sectional study was carried out. The respondents were selected from diabetic registry at two government primary care clinics in Kuantan, Pahang via stratified random sampling method during the study period from May 2010 to April 2011. The respondents were interviewed and assessed clinically using a structured questionnaire. Retinal examination was performed by accredited staff using non-mydratic retinal imaging and DR was classified according to the International Clinical Diabetic Retinopathy Disease Severity Scale.
    Results: Out of 400 respondents, 58.8% were diagnosed with diabetes less than 5 years and 51.0% had uncontrolled blood pressure (>130/80 mmHg). The prevalence of DR and maculopathy were 33.5% and of 17.8% respectively. Most of these patients (22.3%) had mild non-proliferative DR. DR patients had higher percentages CKD (17.9% vs. 6.8%; p<0.001) and a higher mean of HbA1C (8.69 vs. 8.11; p=0.015) compared to non-DR patients. The study revealed that DR was independently associated with CKD {OR: 3.46, 95% CI (1.76, 6.80)} and high HbA1c {OR: 1.12, 95% CI (1.02, 1.23)}. Those with dyslipidemia however, has 39% less risk of DR {OR: 0.61, 95% CI (0.39, 0.94)}.
    Conclusion: This study showed that diabetic patients with CKD and high HbA1c have greater risks to develop DR but has protective risk with dyslipidemia.
    KEYWORDS: diabetic retinopathy (DR), non-mydratic retinal camera, primary care clinic
    Matched MeSH terms: Diabetic Retinopathy
  13. Fulltext Risk factors for diabetic retinopathy in diabetic screened using fundus photography at a primary health care setting in East Malaysia
    Mallika PS, Lee PY, Cheah WL, Wong JS, Syed Alwi SAR, Nor Hayati H, et al.
    Malays Fam Physician, 2011;6(2):60-65.
    MyJurnal
    Introduction: This study reports on the prevalence of diabetic retinopathy (DR) and risk factors among diabetic patients, who underwent fundus photography screening in a primary care setting of Borneo Islands, East Malaysia. We aimed to explore the preliminary data to help in the planning of more effective preventive strategies of DR at the primary health care setting.
    Materials and Methods: A cross-sectional study on 738 known diabetic patients aged 19-82 years was conducted in 2004. Eye examination consists of visual acuity testing followed by fundus photography for DR assessment. The fundus pictures were reviewed by a family physician and an ophthalmologist. Fundus photographs were graded as having no DR, NPDR, PDR and maculopathy. The data of other parameters was retrieved from patient’s record. Bi-variate and multivariate analysis was used to elucidate the factors associated with DR.
    Results: Any DR was detected in 23.7% (95% CI=21 to 27%) of the patients and 3.2% had proliferative DR. The risk factors associated with any DR was duration of DM (OR =2.5, CI=1.6 to 3.9 for duration of five to 10 years when compared to <5 years) and lower BMI (OR=1.8, CI=1.1 to 3.0). Moderate visual loss was associated with DR (OR=2.1, CI=1.2 to 3.7).
    Conclusions: This study confirms associations of DR with diabetic duration, body mass index and visual loss. Our data provide preliminary findings to help to improve the screening and preventive strategies of DR at the primary health care setting.
    Keywords: Diabetic retinopathy, epidemiology, screening, primary health care, Malaysia
    Study site: Klinik Kesihatan Jalan Masjid, Kuching, Sarawak, Malaysia
    Matched MeSH terms: Diabetic Retinopathy
  14. Fulltext Prevalence of dyslipidaemia in type 2 diabetes mellitus patients and Its association to diabetic retinopathy in a Malaysian tertiary hospital
    Samsudin IN, Md Saleh R, Thambiah SC, Mohamad Amir Hamzah AS, Wan Khalik WNF, George E
    Malaysian Journal of Medicine and Health Sciences, 2014;10(2):47-51.
    MyJurnal
    Background: Diabetic retinopathy (DR) is a microvascular complication of diabetes, which is a cause of visual impairment and blindness. Its development and progression have been linked to dyslipidaemia, although the link remains inconclusive.
    Aim: This study aimed to determine the prevalence of dyslipidaemia among type 2 diabetic patients with DR in a tertiary setting and to determine the association between dyslipidaemia and DR severity.
    Materials and methods: This was a cross sectional study using retrospective data of type 2 diabetic patients attending the opthalmology clinic of a tertiary centre from January 2007 to June 2014. Results of their fasting lipid profile and clinical data were retrieved from the hospital information system.
    Results: A total of 178 patient’s data were collected. 120 (n=67.4%) patients had non-proliferative diabetic retinopathy (NDPR) with moderate NPDR being the most prevalent. Dyslipidaemia was noted in 151 (84.8%) of the patients. Patients had a combination of more than one abnormality in the lipid profile with increased LDL-cholesterol being the main abnormality. Dyslipidaemia was however, not significantly associated with DR severity.
    Conclusion: Dyslipidaemia was highly prevalent in DR patients. The dyslipidaemia was however not associated with severity of DR.
    Study site: Ophthalmology clinic, Hospital (?name), Malaysia
    Matched MeSH terms: Diabetic Retinopathy
  15. Fulltext Dramatic response of iris and retinal neovascularisation following usage of intravitreal ranibizumab as pre-operative adjunct in vitrectomy for advanced proliferative diabetic retinopathy
    Malisa, A., Mae-Lynn, C.B.
    Journal of Surgical Academia, 2011;1(1):61-64.
    MyJurnal
    A 37-year-old Malay woman presented with progressive deterioration in vision and was diagnosed with advanced proliferative diabetic retinopathy with neovascular glaucoma. Intravitreal ranibizumab injection (an anti-vascular endothelial growth factor) was administered prior to vitrectomy. Slit lamp assessment 2 days post-injection revealed significant regression of both iris and retinal neovascularisation. This resulted in adequate reduction of intra-ocular pressure prior to surgery. In addition, the regression of retinal vessels reduced the risk of intra-operative haemorrhage, thus aiding the surgical excision of the fibrovascular membranes. Periodic post-operative assessment in the first 3 weeks showed minimal inflammation and no recurrence of vitreous haemorrhage. This case illustrates that intravitreal ranibizumab has a role as an adjunct therapy prior to diabetic vitrectomy to significantly reduce the risk of intra-ocular haemorrhage.
    Matched MeSH terms: Diabetic Retinopathy
  16. Fulltext Predictive factors of visual outcome of Malaysian cataract patients: a retrospective study
    Thevi T, Godinho MA
    Int J Ophthalmol, 2017;10(9):1452-1459.
    PMID: 28944207 DOI: 10.18240/ijo.2017.09.19
    AIM: To explore the associations between various characteristics of Malaysian cataract patients and their management, and their post-operative visual outcomes, to inform relevant bodies to reduce cataract-related blindness.

    METHODS: We conducted a descriptive secondary data analysis of cataract surgery patients in Melaka Hospital, from 2007 to 2014 using the National Eye Database (NED). Patient-related factors (demographic features, systemic and ocular comorbidities) and management-related factors (surgical duration, type of surgery, type of lens) were analysed for their association with visual outcome (acuity).

    RESULTS: Most patients were Malays (48.23%) and Chinese (38.55%) aged 60-79y (range 0-100y). Hypertension (58.61%) and diabetes (44.89%) were major systemic comorbidities. Glaucoma (6.71%) and diabetic retinopathy (10.12%) were the main ocular comorbidities. Other comorbidities were age-related macular degeneration, pterygium, corneal opacities, macula diseases, vitreous haemorrhage, retinal detachment and pseudoexfoliation (0.70%-1.60%). Preoperatively 7150 (55.03%) eyes presented with poor vision. Uncomplicated phacoemulsification performed quickly with foldable lenses gave good results.

    CONCLUSION: Primary care physicians should initiate early detection to prevent late presentation of cataracts causing poor vision and should discuss the risks and benefits of cataract surgery while emphasizing the role of pre-existing comorbidities which may affect the visual outcomes. For good results, phacoemulsification should be done within 30min, without complications, using foldable posterior chamber intraocular lens.
    Matched MeSH terms: Diabetic Retinopathy
  17. The Malaysian cataract surgery registry: incidence and risk factors of postoperative infectious endophthalmitis over a 7-year period
    Wai YZ, Fiona Chew LM, Mohamad AS, Ang CL, Chong YY, Adnan TH, et al.
    Int J Ophthalmol, 2018;11(10):1685-1690.
    PMID: 30364221 DOI: 10.18240/ijo.2018.10.17
    AIM: To report the incidence, risk factors and visual outcomes for postoperative endophthalmitis (POE) based on 7-year data from the Malaysian Ministry of Health Cataract Surgery Registry (MOH CSR).

    METHODS: Data was collected from the web-based MOH CSR. All consecutive cataract surgery patients from 1st June 2008 to 31st December 2014 were identified. Exclusion criteria were traumatic cataract or previous ocular surgery. Demographic data, ocular co-morbidities, intraoperative details and postoperative visual acuity (VA) at final ophthalmological follow-up were noted. All eyes were taken for analysis. Subjects with POE were compared against subjects with no POE for risk factor assessment using multiple logistic regressions.

    RESULTS: A total of 163 503 subjects were screened. The incidence of POE was 0.08% (131/163 503). Demographic POE risk factors included male gender (OR: 2.121, 95%CI: 1.464-3.015) and renal disease (OR: 2.867, 95%CI: 1.503-5.467). POE risk increased with secondary causes of cataract (OR: 3.562, 95%CI: 1.740-7.288), uveitis (OR: 11.663, 95%CI: 4.292-31.693) and diabetic retinopathy (OR: 1.720, 95%CI: 1.078-2.744). Intraoperative factors reducing POE were shorter surgical time (OR: 2.114, 95%CI: 1.473-3.032), topical or intracameral anaesthesia (OR: 1.823, 95%CI: 1.278-2.602), posterior chamber intraocular lens (PCIOL; OR: 4.992, 95%CI: 2.689-9.266) and foldable IOL (OR: 2.276, 95%CI: 1.498-3.457). POE risk increased with posterior capsule rupture (OR: 3.773, 95%CI: 1.915-7.432) and vitreous loss (OR: 3.907, 95%CI: 1.720-8.873). Postoperative VA of 6/12 or better was achieved in 15.27% (20/131) subjects with POE.

    CONCLUSION: This study concurs with other studies regarding POE risk factors. Further strengthening of MOH CSR data collection process will enable deeper analysis and optimization of POE treatment.

    Matched MeSH terms: Diabetic Retinopathy
  18. Fulltext Validation of the malay version of Diabetes Quality of Life (DQOL) questionnaire for adult population with type 2 diabetes mellitus
    Bujang MA, Ismail M, Hatta NKBM, Othman SH, Baharum N, Lazim SSM
    Malays J Med Sci, 2017 Aug;24(4):86-96.
    PMID: 28951693 MyJurnal DOI: 10.21315/mjms2017.24.4.10
    OBJECTIVE: We aimed to validate the Malay version of Diabetes Quality of Life (DQOL) questionnaire for Malaysian adult population with type 2 diabetes mellitus (DM).
    METHODS: This is a cross-sectional study to validate Malay version of DQOL among the adult diabetic patients. DQOL questionnaire has 46 items consist of three domains, namely Satisfaction Domain, Impact Domain and Worry Domain. Both forward and backward translations from the English version of DQOL into Malay version were performed. After the face validity of the Malay version was established, it was then pilot-tested. Finally, the validity and reliability of the final Malay version of DQOL questionnaire were evaluated.
    RESULTS: There were 290 patients participated in this study with a mean (SD) age of 53.1 (10.0) years. The Cronbach's alpha coefficients of the overall items and the main domains were between 0.846 and 0.941. The Pearson's correlation coefficients for the three domains were between 0.228 and 0.451. HbA1C was found to be positively correlated with Impact Domain (P = 0.006). The Worry Domain was associated with diabetic retinopathy (P = 0.014) and nephropathy (P = 0.033).
    CONCLUSION: The Malay version of diabetes quality of life (DQOL) questionnaire was found to be a valid and reliable survey instrument to be used for Malaysian adult patients with diabetes mellitus.
    Study site: Klinik Kesihatan Seremban 2, Seremban, Negeri Sembilan, Malaysia
    Matched MeSH terms: Diabetic Retinopathy
  19. Fulltext Soluble receptor for advanced glycation end-product (sRAGE)/pentosidine ratio: a potential risk factor determinant for type 2 diabetic retinopathy
    Ng ZX, Chua KH, Iqbal T, Kuppusamy UR
    Int J Mol Sci, 2013;14(4):7480-91.
    PMID: 23552832 DOI: 10.3390/ijms14047480
    This study aims to investigate potential diabetic retinopathy (DR) risk factors by evaluating the circulating levels of pentosidine, soluble receptor for advanced glycation end-product (sRAGE), advanced oxidation protein product (AOPP) as well as glutathione peroxidase (GPx) and superoxide dismutase (SOD) activities in DR patients. A total of 235 healthy controls, 171 type 2 diabetic without retinopathy (DNR) and 200 diabetic retinopathy (DR) patients were recruited. Plasma was extracted for the estimation of pentosidine, sRAGE, AOPP levels and GPx activity whereas peripheral blood mononuclear cells were disrupted for SOD activity measurement. DNR and DR patients showed significantly higher levels of plasma pentosidine, sRAGE and AOPP but lower GPx and SOD activities when compared to healthy controls. The sRAGE/pentosidine ratio in DR patients was significantly lower than the ratio detected in DNR patients. Proliferative DR patients had significantly higher levels of plasma pentosidine, sRAGE, AOPP and sRAGE/pentosidine ratio than non-proliferative DR patients. High HbA1c level, long duration of diabetes and low sRAGE/pentosidine ratio were determined as the risk factors for DR. This study suggests that sRAGE/pentosidine ratio could serve as a risk factor determinant for type 2 DR as it has a positive correlation with the severity of DR.
    Matched MeSH terms: Diabetic Retinopathy/blood*
  20. 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: Diabetic Retinopathy/etiology*
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