AIM: To determine the relationships between maternal and fetal outcomes and gestational diabetes mellitus (GDM), impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), respectively.
METHODS: A retrospective cohort study design was used with 149 patients with abnormal oral glucose tolerance test (OGTT) and 149 normal patients. Statistical analysis used was the chi-squared test, Fisher's exact test or the Student's t-test, as appropriate. P < 0.05 was considered significant.
RESULTS: The level of hyperglycemia according to the OGTT (World Health Organization criteria) was associated with pre-eclampsia, polyhydramnios and macrosomia in GDM patients. There was no increase in the complications of preterm labor and premature rupture of membranes, despite the increased risk of polyhydramnios. Although treated with insulin, macrosomia still occurred in patients with GDM, but there was no shoulder dystocia as there was an increase in the incidence of cesarean section (CS). The IGT group was not associated with adverse fetal or maternal outcomes, but there was an increase in intervention and the incidence of CS. The IFG group was associated with a significantly increased risk of pre-eclampsia and macrosomia. These findings challenge the concept of IFG being a lesser pathology than GDM. Further prospective studies with a larger number of patients are needed to ascertain the significance of these findings.
CONCLUSION: There was an increased risk of pre-eclampsia and macrosomia in both the GDM and IFG patients, but IGT was not associated with adverse fetal or maternal outcomes.
Study site: Maternity Hospital Kuala Lumpur (MHKL), Kuala Lumpur, Malaysia
This study was conducted to compare the treatment efficacy between a prandial glucose regulator, repaglinide and a new sulphonylurea, glimepiride in Muslim Type 2 diabetic patients who practice Ramadan fasting. Forty-one patients, previously treated with a sulphonylurea or metformin, were divided to receive either repaglinide (n=20, preprandially three-times daily) or glimepiride (n=21, preprandially once daily) 3 months before the month of Ramadan. During Ramadan, patients modified their eating pattern to two meals daily, and the triple doses of repaglinide were redistributed to two preprandial doses. Four point blood glucose monitoring were performed weekly during the month of Ramadan and the subsequent month. Measurements of the 4-point blood glucose were significantly lower in the glimepiride group compared to the repaglinide group both during and after Ramadan. The glycaemic excursion was better in the morning for the repaglinide group and better in the afternoon and evening for the glimepiride group during the Ramadan period. There was no statistically significant difference in the incidence of hypoglycaemia between the two groups during and after Ramadan. There was no difference in the glycaemic excursion post-Ramadan. The longer duration of action of glimepiride may offer an advantage over repaglinide during the 13.5 hours of fast in Ramadan for diabetic patients.
This study was done to determine the correlation between glucose monitoring by fasting blood glucose or 2 hours postprandial blood glucose with HbA1c and fructosamine in type 2 diabetic patients. A total of 82 patients from the Primary Care Clinic were enrolled in the study. Fasting blood was drawn for fasting plasma glucose (FPG), glycated haemoglobin (HbA1c) and fructosamine. Two hours after a standard breakfast, blood was again drawn for prandial plasma glucose (PPG). Both PPG and FPG significantly correlated with both HbA1c and fructosamine but PPG showed better correlation to HbA1c than FPG (r= 0.604 vs.0.575) whereas that of FPG and PPG were equally correlated to fructosamine (r= 0.566 vs. 0.551). In predicting good glycaemic control (HbA1c < 7.0%), the sensitivity, specificity and positive predictive value of PPG were 75.0%, 80.6% and 82.5% whereas FPG were 81.8%, 58.3% and 70.6% respectively. These results show that PPG correlated better than FPG to HbA1c and both equally correlated to fructosamine levels. Thus, PPG predicted overall glycaemic control better than FPG. Compared to HbA1c, fructosamine correlated least well with mean glucose profiles. Hence, using HbAlc in monitoring overall glycaemic control is better than fructosamine.
Strobilanthes crispus (Acanthaceae) has been used traditionally as antidiabetic, diuretic, antilytic, and laxative and has been proven scientifically to possess high antioxidant activity, anti-AIDS, and anticancer properties. It is commonly consumed in the form of herbal tea. The ethnopharmacological value of this plant, such as the development of nutraceutical S. crispus herbal tea (fermented and unfermented) and assessment of their antihyperglycemic properties were investigated. The antidiabetic properties of S. crispus fermented and unfermented tea was carried out in normal and streptozotocin-induced hyperglycaemic rats for 21 days. Glucose and lipid profile (total cholesterol, triglyceride, HDL-cholesterol, LDL-cholesterol) were determined at day 0 (baseline), day 7, and day 21. The results showed that the hot water extract of both fermented and unfermented S. crispus tea reduced blood glucose in hyperglycaemic rats. S. crispus unfermented tea also reduced glucose level in normal rat. Both fermented and unfermented S. crispus tea also showed to improve lipid profile. Antioxidant and polyphenol content that present in the extracts might contribute to the antihyperglycemic and antilipidemic properties. Further study is needed to be carried out in pre-clinical and clinical environment to prove its efficacy in human.
We studied the efficacy of four different treatment regimens (sulphonylurea and metformin+/-acarbose versus glimepiride and rosiglitazone versus glimepiride and bedtime NPH insulin versus multiple actrapid and NPH insulin injections) in poorly controlled type 2 diabetes subjects on hs-CRP, VCAM-1 and AGE at 4, 8 and 12 weeks of treatment. Multiple insulin injections rapidly improved HbA(1c) by 0.6+/-0.9% (p<0.005), 1.2+/-1.3% (p<0.0005) and 1.3+/-1.4% (p<0.0005) at week 4, at week 8 and week 12, respectively. Subjects who continued their existing combination treatment of sulphonylurea, metformin+/-acarbose also showed a significant reduction in HbA(1c) (p<0.05). Although effective in reducing glycemic parameters, there was no reduction in CRP levels in either treatment group. The treatment regimen consisting of rosiglitazone and glimepiride significantly lowered hs-CRP by -2.6 (3.9) mg/L (p<0.05) at week 12 in spite of no improvement in blood glucose. AGE improved in all groups irrespective of type of treatment, glycaemic control and CRP levels. Our data indicate rapid glycaemic control alone does not necessarily result in improvement in markers of inflammation in type 2 diabetes patients.
OBJECTIVE: To describe the glycaemic control, diabetes care and prevalence of complications in youth with type 2 diabetes from the Western Pacific Region.
RESEARCH DESIGN AND METHODS: Cross-sectional, clinic-based audit of 331 patients aged < 18 years from 56 centres in Australia, China-Beijing, China-Shanghai, China-Hong Kong, Indonesia, Japan, South Korea, Malaysia, Philippines, Singapore, Taiwan and Thailand. Clinical and management data were recorded along with glycated haemoglobin (HbA(1c)), lipids and complication rates.
MAIN OUTCOME MEASURES: Glycaemic control, complications, diabetes management.
RESULTS: Median age was 14.9 years (interquartile range 13.2-16.4 years) and median diabetes duration 2.3 years (1.4-3.6 years). Median HbA(1c) was 7% (5.9-9.9%) and HbA(1c) was > 7.5% in 40% of patients. In multiple regression analysis, glycaemic control varied significantly between countries (p = 0.02); higher HbA(1c) was associated with fewer home blood glucose measurements (p = 0.005) and higher insulin dose/kg (p < 0.0001). Blood glucose monitoring was performed by 65% of patients (range 33-96% by country). In 25% of patients, management consisted of diet alone or no treatment (range 0-53% by country); oral anti-diabetic drugs alone were used in 49%, insulin alone in 11% and both in 15%. Microalbuminuria was found in 8% and hypertension in 24%. The risk of hypertension increased with higher BMI (OR 1.16, 95% CI 1.09-1.24, p < 0.0001); antihypertensive agents were used in 4% of patients.
CONCLUSIONS: The management of type 2 diabetes in youth from the Western Pacific Region varies widely. Hypertension and microalbuminuria were frequent, but not commonly treated. Further investigation into the natural history and risk factors for complications in youth with type 2 diabetes is required to assist in developing evidence based management guidelines.
Insulin insensitivity is a common finding in several metabolic disorders including glucose intolerance, dyslipidemia, hyperuricemia and hypertension. Most of the previous studies on insulin sensitivity were performed on diabetic or obese population. So our knowledge about insulin sensitivity of healthy population remains limited. Rising prevalence of obesity, diabetes and metabolic syndrome is a serious issue in Malaysia and some other rapidly developing countries. So it is important to look at the insulin sensitivity status of healthy Malaysian subjects and to compare it in future with those of diabetic, obese or metabolic syndrome patients. In this study we sampled subjects who were independent of confounding factors such as obesity (including abdominal obesity), hypertension and glucose intolerance (diabetes, IGT or IFG) which may influence insulin sensitivity. Fasting plasma glucose, fasting insulin and lipid profile were determined. Insulin sensitivity and secretory status were calculated using the homeostasis model assessment (HOMA) software (HOMA%S, HOMA%B and HOMA-IR). The insulin sensitivity (HOMA%S) of healthy Malay subjects aged between 30-60 years was 155.17%, HOMA-IR was 1.05 and HOMA%B was 116.65% (values adjusted for age, sex, BMI and waist circumference). It was seen that non-obese Malaysians can prevent age related lowering of insulin sensitivity if they can retain their BMI within limit.
Study site: 7 schools and 2 public offices in Kota Bharu, Kelantan, Malaysia
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.
Significant hypertension in adolescence is defined according to Blood Pressure (BP) distribution among general population. The present study was conducted to determine the BP distribution in Iranian adolescents. In a population-based study held in Tehran, BP data for 2560 participants aged 10-17 years (1247 boys and 1313 girls) were collected. The 90th and 95th percentiles of systolic (SBP) and diastolic BP (DBP) were obtained for different age and height subgroups of boys and girls. While the 90th and 95th percentiles of SBP obtained in our study were generally lower than international guidelines, the corresponding percentiles of DBP were higher. Significant associations were found between BP and age, height, weight and BMI. According to our findings, it is necessary to prepare BP reference tables according to regional surveys.
There is concern that shift workers are at higher risk for metabolic syndrome (MS) . The syndrome is characterized by a constellation of metabolic risk factors in one individual. A cross-sectional study of 148 workers in one factory in Kota Bharu, Kelarttan was conducted to examine relationships between shift work and five of the MS rnk factors namely high blood pressure, hyperglycemia, hypertriglyceridaemia, hypo·I·IDL-cholesterolaemia and high body mass index (BMI) . Data was collected through a questionnaire on psychosocial and life-style factors, anthropometric and blood pressure measurements, fasting blood sugar and fasting lipid profile. The National Cholesterol Education Program’s Adult Treatment Panel III Report (NCEPATP III) with some modifications was used to determine the presence of risk factors for the metabolic syndrome, The prevalence of high blood pressure, hypertriglyceridaemia and high BMI were significantly higher among shift workers compared to day workers. There was no difference in the prevalence of hyperglycemia and hypo-HDL-cholesterolaemia. When the shift workers were compared with the
day workers, the proportion of workers having three or more risk factors for the syndrome was higher among shift workers which were 15.8% and 5.6% respectively.
Patient understanding and perception of diabetes control is important if clinicians were to allow diabetes patients to play a central role in management of their illness. We conducted a survey to see what diabetic patients generally thought of their understanding of disease and glycemic control; if these perceptions were accurate and related to complications.
One hundred and eight consecutive patients (mean age 52.7± 13 years, BMI 27±5.2 kg/m2, HbA1c 9.2±2.2 %) attending diabetes clinic participated including 63% women, 60% primary or no education, and 47% duration of diabetes >10 years. 54% claimed to have a good understanding although nearly half answered questions on diabetes management and targets wrongly. 32% perceived their glycemic control to be good and were found to have lower baseline HbA1c (p
Fifty Non Insulin Dependent Diabetes Mellitus (NIDDM) patients undergoing surgery under epidural anaesthesia were studied. All patients received dextrose 5% infusion at 100 ml/hr from the period of fasting until upon arrival to the operation room. Patients were randomly divided into two groups. Patients in Group 1 (n=25) received normal saline while patients in Group 2 (n=25) were given Ringer’s lactate. Both groups received their infusion throughout the operative period up to four hours postoperatively. Blood glucose level was measured at baseline, 45 minutes intra operatively and postoperatively at 30 minutes and four hours by using a glucometer. Patients in Group 2 has a larger mean increase in blood glucose level of 1.5 mmol/L between 4 hours postoperatively and baseline compared to 0.96 mmol/L in Group 1. However, this was not statistically significant. There was no difference in the increase of mean glucose level at 30 minutes when compared to baseline. There was a significant increase in mean blood glucose level in both groups in the postoperative period when compared to baseline. This study demonstrated that patients with NIDDM receiving Ringer’s lactate has a larger increase in mean blood glucose level compared to those receiving normal saline, but the magnitude is not statistically significant.
A new implantable electrocatalytic glucose sensor for subcutaneous glucose monitoring has been fabricated by immobilizing glucose oxidase on a chemically modified carbon fiber. The sensor was inserted subcutaneously on a male spraguely rat without any incision after dipping the microsensor in the rat's serum for 3 days. The so called "stained" microsensor, operated in the amperometric mode with an applied potential of +0.23 V versus Ag|AgCl, was able to directly measure the glucose concentration upon infusion of glucose. The results obtained were encouraging, with the response time was less than 2s and the apparent Michaelis-Menten value at 5.1+/-0.5mM. The "stained" microsensor shows good stability and reproducibility with constant response spanned over 25 days. Most common interferences in glucose analysis were minimized by the outerlayer Nafion. Hematology examinations showed minimal material-tissue interaction. Use of such mechanical devices will allow a more refined understanding towards glucose control in diabetic patients as the implanted microsensor was not effected by biocompatibility failures.
Diabetes prevalence is increasing rapidly in Asian populations but the influence of a family history of diabetes on cardiovascular risk is unknown. To assess this relationship, 120 urban-dwelling Malays were recruited to a cross-sectional case-control study. Sixty were pre-pubertal children, 30 of diabetic parentage (Group 1) and 30 with no diabetes family history (Group 2). Group 1 and 2 subjects were the offspring of adults with (Group 3) or without (Group 4) type 2 diabetes. Subjects were assessed for clinical and biochemical variables defining cardiovascular risk. Principal component analysis assessed clustering of variables in the children. Group 1 subjects had a higher mean waist:hip ratio, diastolic blood pressure and HbA(1c) than those in Group 2, and a lower HDL:total cholesterol ratio (P<0.03). Although there were no correlations between Group 1 and 3 subjects for cardiovascular risk variables, significant associations were found in Groups 2 and 4, especially HbA(1c) and insulin sensitivity (P< or =0.004). Of five separate clusters of variables (factors) identified amongst the children, the strongest comprised diabetic parentage, HbA(1c), insulin sensitivity and blood pressure. Features of the metabolic syndrome are becoming evident in the young non-obese children of diabetic Malays, suggesting that lifestyle factors merit particular attention in this group.
The aims of this study were (i) to determine the prevalence of self-monitoring of blood glucose (SMBG) among Type 2 diabetes patients attending government health clinics and (ii) to ascertain the factors influencing SMBG. Five hundred and fifty-six Type 2 diabetes patients from two government health clinics in Selangor and Negeri Sembilan were interviewed using a structured questionnaire. The total subjects of the study were 556 patients. Eighty-five patients (15.3%) of patients; performed SMBG. However, 170 subjects were included in the statistical analysis, 85 patients who were not self-monitoring were randomly selected and was compared with 85 patients who were self-monitoring. Among those who performed SMBG, the majority (83.5%) monitored less than once per day and only 16.5% monitored at least once a day. One-third of patients adjusted their medications based on their SMBG results. The higher patient's level of education (p= 0.024, CI 1.29 - 35.3); the higher total family income (p= 0.041, CI 1.26 - 4.79); the longer duration of diabetes (p<0.01, CI 2.22 - 7.29); and treatment regime which includes insulin (p< 0.001, CI 2.05 -9.24) were significant predictors of SMBG practice. Although SMBG is recognised to be useful and effective in achieving diabetes control, this study has found that only a minority of patients with diabetes performed SMBG. Hence healthcare personnel must increase awareness on the importance of SMBG and strongly promote the practice among diabetic patients.
AIM: To determine the effects of lipid lowering by TLC on insulin sensitivity and secretory status of non-obese normoglycemic hyperlipidemic subjects.
METHODS: An intervention study was undertaken on 16 non-obese normoglycemic hyperlipidemic subjects. They underwent 6 months of a TLC regimen. Their insulin sensitivity and lipid status were assessed at baseline and after six months. A control group containing 16 age, sex and body mass index (BMI) matched normolipidemic subjects was also enrolled to compare the change in lipid levels and insulin sensitivity in the hyperlipidemic subjects.
RESULTS: The intervention showed significant reductions in insulin resistance (HOMA-IR reduced from 3.8 to 1.4, p<0.001) and improvement of insulin sensitivity (HOMA%S increased from 50.1% to 121.2%, p=0.004) in hyperlipidemic subjects with associated reductions in lipid levels.
CONCLUSION: Lipid lowering in non-obese hyperlipidemic subjects may be associated with improvement of insulin sensitivity.
Study site: Staff of university and offices, Kelantan, Malaysia
Background: The best method of screening for gestational diabetes (GDM) remains unsettled. The 50-g glucose challenge test (GCT) is used in a two-stage screening process but its best threshold value can vary according to population.
Aims: To evaluate the role of risk factors in conjunction with GCT and to determine an appropriate threshold for the one-hour venous plasma glucose with the GCT.
Method: In a prospective study, 1600 women at antenatal booking without a history of diabetes mellitus or GDM filled a form on risk factors before GCT. Women who had GCT >or= 7.2 mmol/L underwent the 75-g oral glucose tolerance test (OGTT). GDM was diagnosed according to WHO (1999) criteria.
Result: Thirty-five per cent had GCT >or= 7.2 mmol/L, 32.6% underwent OGTT and 34.5% of OGTT confirmed GDM. The GDM rate in our population was at least 11.4%. Examination of the receiver operator characteristic curve suggested that the best threshold value for the GCT in our population was >or= 7.6 mmol/L. Multivariable logistic regression demonstrated that only GCT >or= 7.6 mmol/L was an independent predictor for GDM (adjusted odds ratio 3.7: P < 0.001). After GCT, maternal age and anthropometry, OGTT during the third trimester, family history, obstetric history and glycosuria were not independent predictors of GDM.
Conclusions: Risk factors were not independent predictors of GDM in women with GCT >or= 7.2 mmol/L. GCT threshold value >or= 7.6 mmol is appropriate for the Malaysian population at high risk of GDM.
The present work examined the effect of chronic oral administration of quercetin, a flavonoid antioxidant, on blood glucose, vascular function and oxidative stress in STZ-induced diabetic rats. Male Wistar-Kyoto (WKY) rats were randomized into euglycemic, untreated diabetic, vehicle (1% w/v methylcellulose)-treated diabetic, which served as control, or quercetin (10mgkg(-1) body weight)-treated diabetic groups and treated orally for 6 weeks. Quercetin treatment reduced blood glucose level in diabetic rats. Impaired relaxations to endothelium-dependent vasodilator acetylcholine (ACh) and enhanced vasoconstriction responses to alpha(1)-adrenoceptor agonist phenylephrine (PE) in diabetic rat aortic rings were restored to euglycemic levels by quercetin treatment. Pretreatment with N(omega)-nitro-l-arginine methyl ester (l-NAME, 10microM) or methylene blue (10microM) completely blocked but indomethacin (10microM) did not affect relaxations to ACh in aortic rings from vehicle- or quercetin-treated diabetic rats. PE-induced vasoconstriction with an essentially similar magnitude in vehicle- or quercetin-treated diabetic rat aortic rings pretreated with l-NAME (10microM) plus indomethacin (10microM). Quercetin treatment reduced plasma malonaldehyde (MDA) plus 4-hydroxyalkenals (4-HNE) content as well as increased superoxide dismutase activity and total antioxidant capacity in diabetic rats. From the present study, it can be concluded that quercetin administration to diabetic rats restores vascular function, probably through enhancement in the bioavailability of endothelium-derived nitric oxide coupled to reduced blood glucose level and oxidative stress.
This is a cross-sectional study to determine the prevalence of insulin resistance and its associated factors in Hospital UKM patients with schizophrenia using the Homeostatic Model Assessment (HOMA) model. Fasting glucose and insulin from 85 patients were obtained. Fasting glucose revealed 15% of the patients were diabetic, while another 15% had impaired fasting glucose. Using the HOMA model, 68% of the patients had insulin resistance. Univariate analyses found BMI (p < 0.001) and waist circumference (p < 0.001) to be associated with insulin resistance. The statistical significance disappeared after multivariate analyses. All patients with schizophrenia should be screened and managed as a group at high risk for development of diabetes with emphasis on body weight management.
Study site: inpatient and outpatients, Psychiatric department, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia