Citation: Quality of Diabetes Care at MOH Healthcare Facilities: SIQ Investigation Guideline, Fifth Edition. Putrajaya: Ministry of Health, Malaysia; 2011
The effect of ambient temperature on the analytical and clinical performance of a glucose meter was examined. A total of 114 venous whole blood samples were analysed for glucose by a reference method, and by a glucose meter at 21-22 degrees C, room temperatures, 26-27 degrees C and 33-34 degrees C. Glucose meter readings at each temperature were compared with the reference values and evaluated by analysis of variance, Spearman's correlation, the percentage of glucose meter readings within +/- 10% of the reference value and error grid analysis. Analysis of covariance was used to determine the effect of temperature on glucose meter readings. There were no significant differences in the glucose meter readings and in accuracy of the meter readings between different temperatures. Temperature was not a significant independent determinant of the glucose meter readings. For each glucose concentration, the precision of the meter and clinical performance were comparable between the different temperatures. In conclusion, ambient temperature does not affect the accuracy, precision and clinical performance of the Omnitest Sensor.
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.
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
A study was undertaken to determine the extent of morbidity associated with asthma and to audit the management of asthma in two out-patient clinics of two district hospitals. Patients were recruited for the study during a 3-month period from December 1990 to February 1991. Seventy asthmatic patients were studied. Eighty-six percent of the patients had their sleep disturbed by asthma, 77% took daily medication regularly, 63% felt that their activities were restricted by asthma, 60% had at least one acute exacerbation in the preceding six months. Of those who had their peak expiratory flow rate (PEFR) measured, 40% had a PEFR below 50% predicted, and only 11% had normal PEFR (greater than 80% predicted). The morbidity of asthma was thus considerable. On the other hand, the drug treatment of these asthmatics was grossly inadequate. They were prescribed on average 2.1 item of drugs, which for most patients comprised an oral beta agonist and a theophylline. Only 43% of the patients received inhaler therapy, but no patients were given steroids, inhaled or oral. The drug treatment was unrelated to the severity of patients' asthma. Further, objective measurement of severity was under-used in the assessment of asthma, only 8.5% of patients ever had their PEFR recorded. This study has found that asthma is poorly managed in out-patient clinics. We need to improve the training of doctors in the optimal management of asthma.
Study site: General outpatient clinics, district hospitals, Pahang, Malaysia
Poor compliance with drug treatment is a barrier to effective management of hypertension. Drug compliance behaviour of 168 patients were studied, their drug compliance was measured by the pill-counting method. The prevalence of non-compliance with medication was 26%. Thirteen variables were examined for their association with compliance; these were age, sex, duration of hypertension since diagnosis, adequacy of blood pressure control, complexity of drug regimen and side-effect of drug, history of previous admission for hypertension related reason, patient's knowledge of hypertensive complications, patient's belief that drug was 'panas' or 'san', previous use of traditional treatment for hypertension, patient's fatalistic attitude, their social support and satisfaction with the health services. None of these variables were significantly related to compliance (p greater than 0.05) except adequacy of blood pressure control. The performance of patient self-report was compared with pill-count as a measure of drug compliance; it was poorly predictive of non-compliance (sensitivity = 71%, specificity = 50%). An inverse relationship was found between non-compliance with medication and patient subsequent drop-out rate. Patients who were compliant were more likely to remain on treatment and vice versa. As a measure of drug compliance, detection of drop-out compared well with pill-count (sensitivity 97%, specificity 66%, positive predictive value 89%, negative predictive value 88%).
Study site: outpatient clinic, Hospital Mentakab, Pahang, Malaysia
Consecutive hypertensives admitted with cardiovascular complications were studied. One hundred and eight complicated hypertensives (10%) out of 1,066 medical admissions were seen in the three month study. Thirty three per cent had cerebrovascular disease, 30% ischaemic heart disease, 2% had malignant hypertension and 85% had hypertensive heart disease. All patients had uncontrolled hypertension at admission (mean blood pressure 184/115 mmHg). Twenty-four patients (22%) were newly diagnosed; of the rest of previously diagnosed hypertensives (78%), 3% had never been on treatment and 56% had dropped out of treatment, which explained their ineffective blood pressure control. However, 18% of patients had apparently been on regular follow up and treatment, and yet their blood pressure control was poor. Many patients had evidence of renal disease. The prevalence of cardiovascular risk factors was also high; 56% had hypercholesterolaemia; 46% had hypertriglyceridaemia; 44% smoked, 38% were overweight or obese, and 18% were diabetic. This indicates that hypertension is best regarded as an ingredient of a cardiovascular risk profile and its management requires multifactorial correction of all risk factors identified.