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  1. Fulltext Quit rates at 6 months in a pharmacist-led smoking cessation service in Malaysia
    Fai SC, Yen GK, Malik N
    Can Pharm J (Ott), 2016 Sep;149(5):303-312.
    PMID: 27708676
    BACKGROUND: Smoking cessation clinics have been established in Malaysia since 2004, but wide variations in success rates have been observed. This study aimed to evaluate the proposed pharmacist-led Integrated Quit Smoking Service (IQSS) in Sabah, Malaysia, and identify factors associated with successful smoking cessation.
    METHODS: Data from 176 participants were collected from one of the quit-smoking centres in Sabah, Malaysia. Pharmacists, doctors and nurses were involved throughout the study. Any health care provider can refer patients for smoking cessation, and free pharmacotherapy and counselling was provided during the cessation period for up to 3 months. Information on demographic characteristics, smoking behaviours, follow-up and pharmacotherapy were collected. The main outcome measure was the abstinence from smoking, which was verified through carbon monoxide in expired air during the 6-month follow-up.
    RESULTS: A 42.6% success rate was achieved in IQSS. Smoking behaviour such as lower cigarette intake and lower Fagerström score were identified as factors associated with success. On top of that, a longer duration of follow-up and more frequent visits were significantly associated with success in quitting smoking.
    CONCLUSION: Collaboration among health care practitioners should be the main focus, and we need a combination of proven effective modalities in order to create an ideal smoking cessation module.
    Study site: Klinik Kesihatan Luyang, Kota Kinabalu, Sabah, Malaysia
    Matched MeSH terms: Ambulatory Care Facilities
  2. Fulltext Determinants of uncontrolled hypertension in adult type 2 diabetes mellitus: an analysis of the Malaysian diabetes registry 2009
    Chew BH, Mastura I, Shariff-Ghazali S, Lee PY, Cheong AT, Ahmad Z, et al.
    Cardiovasc Diabetol, 2012;11:54.
    PMID: 22607105 DOI: 10.1186/1475-2840-11-54
    BACKGROUND: Uncontrolled blood pressure (BP) is a significant contributor of morbidity and even mortality in type 2 diabetes (T2D) patients. This study was done to determine the significant determinants of uncontrolled blood pressure in T2D patients in Malaysia.
    METHODS: Between 1st January 2009 to 31st December 2009, data from 70 889 patients with Type 2 diabetes was obtained from the Adult Diabetes Control and Management Registry for analysis; 303 centers participated in the study. Their demographic characteristics, the nature of their diabetes, their state of hypertension, treatment modalities, risk factors, and complications are described. Based on their most recent BP values, subjects were divided into controlled BP and uncontrolled BP and their clinical determinants compared. Independent determinants were identified using multivariate logistic regression.
    RESULTS: The mean age of patients at diagnosis of diabetes was 52.3 +/- 11.1 years old. Most were women (59.0 %) and of Malay ethnicity (61.9 %). The mean duration of diabetes was 5.9 +/- 5.6 years. A total of 57.4 % were hypertensive. Of the 56 503 blood pressure (BP) measured, 13 280 (23.5 %) patients had BP <130/80 mmHg. Eighteen percent was on > two anti-hypertensive agents. Health clinics without doctor, older age (>/= 50 years old), shorter duration of diabetes (< 5 years), Malay, overweight were determinants for uncontrolled blood pressure (BP >/=130/80 mmHg). Patients who were on anti-hypertensive agent/s were 2.7 times more likely to have BP >/=130/80 mmHg. Type 2 diabetes patients who had ischaemic heart disease or nephropathy were about 20 % and 15 % more likely to have their blood pressure treated to target respectively.
    CONCLUSIONS: Major independent determinants of uncontrolled BP in our group of T2D patients were Malay ethnicity, older age, recent diagnosis of diabetes, overweight and follow-up at health clinics without a doctor and possibly the improper use of anti hypertensive agent. More effort, education and resources, especially in the primary health care centres are needed to improve hypertensive care among our patients with diabetes.
    Matched MeSH terms: Ambulatory Care Facilities
  3. Candidate gene polymorphisms and their association with hypertension in Malays
    Ghazali DM, Rehman A, Abdul Rahman AR
    Clin Chim Acta, 2008 Feb;388(1-2):46-50.
    PMID: 17977523 DOI: 10.1016/j.cca.2007.10.002
    BACKGROUND: Knowledge of candidate gene polymorphisms in a population is useful for a variety of gene-disease association studies, particularly for some complex traits. A single nucleotide variant of the angiotensinogene gene (AGT M235T) and endothelial nitric oxide synthase gene (eNOS G894T) have been associated with hypertension.
    METHOD: A cross-sectional study consisting of 200 hypertensives and 198 age- and sex-matched controls was conducted. Subjects involved in this study were pure Malay for 3 generations. The AGT M235T and eNOS G894T polymorphisms were determined by PCR-RFLP method.
    RESULTS: The distribution of M235T genotype in the population was 3.5% for MM, 30.4% for MT and 66.1% for TT. No significant difference was observed in genotype (chi(2)=1.30, p=0.52) and allele (chi(2)=0.87, p=0.35) frequencies among the 2 study group. In contrast, the distribution of genotypes for G894T was 74.1% for GG, 24.6% for GT and 1.3% for TT, respectively. Similarly, no significant difference was observed in genotype (chi(2)=0.94, p=0.33) and allele (chi(2)=0.60, p=0.44) frequencies between both study groups.
    CONCLUSION: The AGT M235T and eNOS G894T polymorphisms are unlikely to play an important role in the pathogenesis of hypertension in Malays.
    Study site: Outpatient clinic, Hospital Universiti Sains Malaysia (HUSM); government clinics, Kelantan, Malaysia.
    Matched MeSH terms: Ambulatory Care Facilities
  4. Fulltext Effect of petroleum derivatives and solvents on colour perception
    Sharanjeet-Kaur, Mursyid A, Kamaruddin A, Ariffin A
    Clin Exp Optom, 2004 Jul;87(4-5):339-43.
    PMID: 15312037 DOI: 10.1111/j.1444-0938.2004.tb05064.x
    BACKGROUND: Occupational exposure to various neurotoxic chemicals has been shown to be associated with colour vision impairment. It seems that this can occur at low exposure levels, sometimes well below the recommended occupational threshold limits. This study was undertaken to determine the effect of exposure to petroleum derivatives (polyethylene, polystyrene) and solvents (perchloroethylene) on colour perception.
    METHODS: Colour vision was assessed using the Ishihara plates, the D-15 test and the Farnsworth Munsell 100 Hue test. Two factories using petroleum derivatives and three dry cleaning premises were chosen at random. A total of 93 apparently healthy employees were recruited from the five workplaces. Two age-matched control groups comprising 56 people, who were support staff of the university with no exposure to petroleum, solvents or their derivatives, were also recruited.
    RESULTS: All subjects passed the Ishihara test, showing that none had a congenital red-green defect. Some of the exposed employees failed the D-15 and had abnormally high FM100 Hue scores. All control subjects passed all the colour vision tests. The D-15 test showed that 28 per cent (26 of 93) of exposed employees had a colour vision defect whereas the FM 100 Hue test found that 63 per cent (59 of 93) had a colour vision defect. Most defects were of the blue-yellow type (22.6 per cent) when using the D-15 test. However, with the FM 100 Hue test, most defects were of the non-polar type with no specific axis (50.5 per cent). Mean total error scores calculated from the FM100 Hue test for exposed employees were statistically significantly higher than those of the control subjects.
    CONCLUSION: Employees directly exposed to petroleum derivatives and solvents have a higher risk of acquiring colour vision defects compared to subjects who are not.
    Study sites: Factories; the control subjects were tested at the Optometry Clinic in Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
    Matched MeSH terms: Ambulatory Care Facilities
  5. Profile of a low vision clinic population
    Mohidin N, Yusoff S
    Clin Exp Optom, 2002 12 17;81(5):198-202.
    PMID: 12482319
    BACKGROUND: Causes of low vision and types of low vision devices (LVDs) prescribed in other low vision clinics have been studied extensively. Similar studies have not been conducted in Malaysia. This paper reports the results of a retrospective study of 573 patients seen at the Universiti Kebangsaan Malaysia-Malaysian Association for the Blind (UKM-MAB) low vision clinic in Kuala Lumpur. METHODS: The record cards of 573 patients seen at the UKM-MAB clinic over 10 years were examined and the following information extracted: date of first consultation, age, sex, cause of visual impairment as diagnosed by an ophthalmologist and types of low vision devices (LVDs) prescribed. RESULTS: The majority of patients were from the younger age groups with 423 (73.8 per cent) less than 50 years of age. Three hundred and ninety-five (68.9 per cent) of the subjects were males and 178 (31.1 per cent) female. The main causes of low vision were congenital structural defects including nystagmus among patients in the zero to 29 years age group, retinitis pigmentosa among the 30 to 59 years age group and age-related macular degeneration (ARM) among those over 60 years of age. CONCLUSIONS: Since the majority of the patients were from the younger age group the main causes of low vision were congenital and hereditary diseases. Three hundred and forty-one (59.5 per cent) patients seen at the low vision clinic accepted the use of LVDs.
    Matched MeSH terms: Ambulatory Care Facilities
  6. Fulltext Dyadic effects of attitude toward aging on psychological well-being of older Malaysian couples: an actor-partner interdependence model
    Momtaz YA, Hamid TA, Masud J, Haron SA, Ibrahim R
    Clin Interv Aging, 2013;8:1413-20.
    PMID: 24174873 DOI: 10.2147/CIA.S51877
    BACKGROUND: There is a growing body of literature indicating that attitudes toward aging significantly affect older adults' psychological well-being. However, there is a paucity of scientific investigations examining the role of older adults' attitudes toward aging on their spouses' psychological well-being. Therefore, the present study aimed to examine the dyadic effects of attitude toward aging on the psychological well-being of older couples.
    METHODS: Data for the present study, consisting of 300 couples aged 50 years and older, were drawn from a community-based survey entitled "Poverty among Elderly Women: Case Study of Amanah Ikhtiar" conducted in Peninsular Malaysia. An actor-partner interdependence model using AMOS version 20 (Europress Software, Cheshire, UK) was used to analyze the dyadic data.
    RESULTS: The mean ages of the husbands and wives in this sample were 60.37 years (±6.55) and 56.33 years (±5.32), respectively. Interdependence analyses revealed significant association between older adults' attitudes toward aging and the attitudes of their spouses (intraclass correlation =0.59; P<0.001), and similar interdependence was found for psychological well-being (intraclass correlation =0.57; P<0.001). The findings from AMOS revealed that the proposed model fits the data (CMIN/degrees of freedom =3.23; goodness-of-fit index =0.90; confirmatory fit index =0.91; root mean square error of approximation =0.08). Results of the actor-partner independence model indicated that older adults' psychological well-being is significantly predicted by their spouses' attitudes toward aging, both among older men (critical ratio =2.92; P<0.01) and women (critical ratio =2.70; P<0.01). Husbands' and wives' own reports of their attitudes toward aging were significantly correlated with their own and their spouses' psychological well-being.
    CONCLUSION: The findings from this study supported the proposed Spousal Attitude-Well-Being Model, where older adults' attitudes toward aging significantly affected their own and their spouses' psychological well-being. The theoretical and practical implications of the findings are discussed.
    KEYWORDS: aged; attitude toward aging; psychological well-being
    Matched MeSH terms: Ambulatory Care Facilities
  7. Preliminary validation of the Malay Yale Food Addiction Scale: Factor structure and item analysis in an obese population
    Swarna Nantha Y, Abd Patah NA, Ponnusamy Pillai M
    Clin Nutr ESPEN, 2016 Dec;16:42-47.
    PMID: 28531454 DOI: 10.1016/j.clnesp.2016.08.001
    BACKGROUND AND AIMS: Researchers suggest that the rise in obesity rates may be explained by the addictive properties of certain types of food. In view of the growing obesity epidemic in South-East Asia, there is a need for a psychometric tool to assess the concept of food addiction amongst high-risk populations. The objective of this study is to translate the Yale Food Addiction Scale (YFAS) into the Malay language and subsequently validate its use in an obese population.

    METHODS: Between the year 2014 and 2015, a total of 250 obese adults were assessed for food addiction utilizing the Malay version of the YFAS at a primary care clinic. An assessment of the psychometric properties of the scale was performed to determine the factor structure, item statistics and internal consistency of the scale.

    RESULTS: A one factorial structure of YFAS was confirmed in this study through factor analysis. All items except 4 (items 19, 22, 24 and 25) had factor loadings >0.42. The internal reliability (KR-20) coefficient of the one-factor solution was α = 0.76. The mean YFAS symptom count was M = 2.74 (SD = 1.57) with 10.4% (N = 26) of the participants received the diagnosis of food addiction.

    CONCLUSIONS: The determination of construct validity and the identification of other latent variables in the Malay food addiction model is necessary prior to the formal utilization of the scale as a tool to detect addictive eating patterns in the community.
    Matched MeSH terms: Ambulatory Care Facilities
  8. Fulltext Periodontal referral pattern in periodontal specialist clinic in faculty of dentistry, Universiti Teknologi Mara (UiTM): a retrospective pilot study
    Erni Noor, Nur Azielyana Noor Kamaruzaman, Nur Syahira Mohd Jeffri, Nik Nazurah Nik Eezammudden, Nur Zety Mohd Noh
    Compendium of Oral Science, 2018;5(1):37-45.
    MyJurnal
    Objectives: Periodontitis is a chronic disease which remain undiagnosed and untreated without proper examination and referral to specialist clinic for further management Therefore, this study was conducted to evaluate the pattern of referrals to Universiti Teknologi MARA (UiTM) Periodontal Specialist Clinic. Materials and methods: A total of 176 periodontal cases referred to UiTM Periodontal Specialist Clinic in year 2011 and 2016 were identified and patient’s referral forms were collected. The data obtained were the referred cases from undergraduate student clinics, other specialist clinics, UiTM primary dental care clinic and private dental clinics. Descriptive data analysis was conducted using frequency distribution by SPSS. Chi square analysis was used to evaluate the association of source of referral, diagnosis and reason for referrals to Periodontal Specialist Clinic. Results: There was increased referral cases to Periodontal Specialist Clinic in 2016 (86.9%) compared to 2011 (13.1%). Most referral to Periodontal Specialist Clinic were received from faculty’s undergraduate student clinic in both 2011 and 2016 (46%), followed by other specialists (27.3%), primary care clinic (25.6%) and private practice (1.1%). 96% of cases were referred for intervention by periodontist as more than half of the cases were referred for the non-surgical periodontal treatment. Chi square analysis showed the association between source of referral and reason for referral was statistically significant (p value=0.000). Conclusion: Proper periodontal screening in all patients and necessary referral to specialist clinic is crucial to prevent undiagnosed periodontal disease.
    Matched MeSH terms: Ambulatory Care Facilities
  9. Hypertensive patients' preferences for complementary and alternative medicine and the influence of these preferences on the adherence to prescribed medication
    Lee K, Mokhtar HH, Krauss SE, Ong BK
    Complement Ther Clin Pract, 2014 May;20(2):99-105.
    PMID: 24767954 DOI: 10.1016/j.ctcp.2014.03.001
    PURPOSE: This study aimed to understand hypertensive patients' perceptions of and adherence to prescribed medication.
    METHODS: A qualitative research study based on 23 purposely selected participants from a community health clinic in Malaysia. The participants underwent in-depth semi-structured interviews, and the data were analyzed using qualitative content analysis method.
    RESULTS: The participants were presented with six types of perceptions of medication. The majority of the participants had negative perceptions of Western medicine (WM), self-adjusted their prescribed medication with complementary and alternative medicine (CAM) and concealed their self-adjusting habits from their doctors. Participants who thought positively of WM took their prescribed medication regularly. Most of the participants perceived the nature of WM as not being curative because of its side effects. Patients have the right to choose their preferred medication when they understand their illness.
    CONCLUSION: Local health care systems should provide patients with alternative health services that suit their requests.
    KEYWORDS: Adherence; Complementary and alternative medicine; Hypertension; Qualitative research
    Study site: Klinik kesihatan, Selangor, Malaysia
    Matched MeSH terms: Ambulatory Care Facilities
  10. Pregnancy complications, mental health-related problems and type 2 diabetes mellitus in Malaysian women
    Hasan SS, Thiruchelvam K, Ahmed SI, Clavarino AM, Mamun AA, Kairuz T
    Diabetes Metab Syndr, 2013;7(4):191-7.
    PMID: 24290082 DOI: 10.1016/j.dsx.2013.10.023
    AIMS: The aim of this study was to investigate the association between pregnancy complications, mental health-related problems, and type 2 diabetes mellitus (T2DM) in Malaysian women.
    MATERIALS AND METHODS: A case-control study of women with T2DM (n=160) matched by age range to controls without T2DM (n=160). Data were collected in the Negeri Sembilan and PutraJaya regions in Malaysia, from two hospital outpatient clinics, PutraJaya Hospital and Tuanku Jaa'far Hospital Seremban, and one health clinic at Seremban. Validated, interviewer-administered questionnaires were used to obtain the data. The unadjusted and adjusted estimates were calculated using the Mantel-Haenszel method.
    RESULTS: Neither depression (RR 0.74, 95% CI: 0.39-1.41) nor anxiety (RR 1.00, 95% CI: 0.53-1.88) symptoms increased the risk of T2DM significantly. However, gestational diabetes (RR 1.35, 95% CI: 1.02-1.79), and ≥3 pregnancies (RR 1.39, 95% CI: 1.08-1.79) were significant risk factors for the development of T2DM. T2DM was not a significant risk factor for either depression (RR 1.26, 95% CI: 0.91-1.74) or anxiety symptoms (RR 1.13, 95% CI: 0.59-2.19).
    CONCLUSION: In this study, T2DM is not a significant risk factor for depression and anxiety; similarly, neither are depression and anxiety significant risk factors for T2DM. Although prevalence of depression and anxiety is not alarming, the findings reported here should alert clinicians to screen and treat anxiety and depression in people with diabetes and also note the importance of monitoring women with complications in pregnancy for risk of later T2DM.

    Study site: two hospital outpatient clinics, PutraJaya Hospital and Tuanku Jaa'far Hospital Seremban, and one health clinic at Seremban, Negeri Sembilan, Malaysia
    Matched MeSH terms: Ambulatory Care Facilities
  11. Prevalence and determinants of restless leg syndrome in type 2 diabetes mellitus (T2DM) in Pakistan
    Nawaz MS, Nawaz MS, Shah KU, Mustafa ZU, Ahmed A, Sajjad Ahmed H, et al.
    Diabetes Metab Syndr, 2021 Feb 13;15(2):525-528.
    PMID: 33668002 DOI: 10.1016/j.dsx.2021.02.013
    BACKGROUND AND AIMS: Restless legs syndromes (RLS) are intrinsic sleeping disorder and its prevalence rate is 10-15% in general population but it is observed that prevalence rate is different in diabetes patients. Current study aims to find prevalence and determinants of RLS in people living with type 2 diabetes mellitus in Pakistan.

    METHOD: A multicenter cross-sectional observational study was conducted in 388 diabetes patients attending daily diabetes clinics and teaching hospitals in Pakistan's twin city between August 2019 and February 2020. The chi-square test and linear regression were used to detect RLS-related factors in type 2 diabetes mellitus.

    RESULTS: The prevalence of RLS found was; 3.1% patients with diabetes were suffering from very severe RLS, 23.5% from severe RLS, 34% from moderate RLS, 21.1% from mild RLS and 18.3% from non-RLS. Gender, age, education, blood glucose fasting (BSF), blood glucose random (BSR) and HBA1c were found to be significant predictors of RLS in patients with diabetes.

    CONCLUSION: Policy makers can develop local interventions to curb the growing RLS prevalence by keeping in control the risk factors of RLS in people living with type 2 diabetes.

    Matched MeSH terms: Ambulatory Care Facilities
  12. Renin angiotensin-aldosterone system (RAAS) blockers usage among type II diabetes mellitus patients-A Retrospective Study
    Ng YP, Balasubramanian GP, Heng YP, Kalaiselvan M, Teh YW, Cheong KM, et al.
    Diabetes Metab Syndr, 2018 May;12(3):305-308.
    PMID: 29279269 DOI: 10.1016/j.dsx.2017.12.005
    AIMS: Recent data showed an alarming rise of new dialysis cases secondary to diabetic nephropathy despite the growing usage of RAAS blockers. Primary objective of this study is to explore the prevalence of RAAS blockers usage among type II diabetic patients, secondary objectives are to compare the prescribing pattern of RAAS blocker between primary and tertiary care center and to explore if the dose of RAAS blocker prescribed was at optimal dose as suggested by trials.

    MATERIALS AND METHODS: This is a retrospective study conducted at one public tertiary referral hospital and one public health clinic in Sungai Petani, Kedah, Malaysia.

    RESULTS: RAAS blockers in T2DM patients was found to be 65%. In primary care, 14.3% of the RAAS blockers prescribed was ARB. Tertiary care had higher utilization of ARB, which was 42.9%. In primary care setting, the most commonly used ACEI were perindopril (92.4%) followed by enalapril (7.6%), meanwhile perindopril was the only ACEI being prescribed in tertiary care. The most prescribed ARB was irbesartan (63.6%) and telmisartan (54.2%) respectively in primary and tertiary care. Overall, 64.9% of RAAS blockers prescribed by both levels of care were found to be achieving the target dose as recommended in landmark trials. Crude odd ratio of prescribing RAAS blocker in primary care versus tertiary care was reported as 2.70 (95% CI: 1.49 to 4.91).

    CONCLUSION: RAAS blockers usage among T2DM patients was higher in primary care versus tertiary care settings. Majority of the patients did not receive optimal dose of RAAS blockers.
    Matched MeSH terms: Ambulatory Care Facilities
  13. Fulltext Determinants of uncontrolled dyslipidaemia among adult type 2 diabetes in Malaysia: the Malaysian Diabetes Registry 2009
    Chew BH, Ismail M, Lee PY, Taher SW, Haniff J, Mustapha FI, et al.
    Diabetes Res Clin Pract, 2012 Jun;96(3):339-47.
    PMID: 22305940 DOI: 10.1016/j.diabres.2012.01.017
    Numerous studies with compelling evidence had shown a clear relationship between dyslipidaemia and cardiovascular (CV) events in patients with diabetes mellitus. This was an observational study based on secondary data from the online registry database Adult Diabetes Control and Management (ADCM) looking into the determinants of uncontrolled dyslipidaemia in type 2 diabetes mellitus patients. Independent predictors were identified using multivariate logistic regression. A total of 303 centres (289 health clinics, 14 hospitals) contributed a total of 70,889 patients (1972 or 2.8% patients were from hospital). About thirty eight percent were reported to have dyslipidaemia. There were 40.7% patients on lipid-lowering agents and of those above age 40 years old, only 38.1% of them were on a statin. Malay ethnicity and younger age groups (<50 years old) were two major determinants of uncontrolled LDL-C, TG and HDL-C. Female gender and uncontrolled blood pressure were determinants of uncontrolled LDL-C, and poor glycaemic control was related independently to high TG. This study has highlighted the suboptimal management of diabetic dyslipidaemia in Malaysia. Pharmacological treatment of dyslipidaemia could be more effective. Healthcare stakeholders in this country, especially in the primary care, have to recognize these shortfalls and take immediate remedial measures.
    Matched MeSH terms: Ambulatory Care Facilities
  14. Effectiveness of a colour coded HbA1c graphical record in improving diabetes control in people with type 2 diabetes: a randomized control trial
    Wong SS, Ng CJ, Liew SM, Hussein N
    Diabetes Res Clin Pract, 2012 Feb;95(2):e41-4.
    PMID: 22119614 DOI: 10.1016/j.diabres.2011.11.001
    We conducted a six-month randomized-controlled-trial to evaluate the effectiveness of a colour-coded HbA1c-graphical record in improving HbA1c level among type 2 diabetes patients. There was an improvement in the mean HbA1c knowledge score but the usage of the colour-coded HbA1c-graphical record did not produce reduction in the HbA1c level.
    Study site: Primary care clinic, University Malaya Medical Centre, Kuala Lumpur, Malaysia
    Matched MeSH terms: Ambulatory Care Facilities
  15. The relationship of health beliefs and complication prevention behaviors of Chinese individuals with type 2 diabetes mellitus
    Tan MY
    Diabetes Res Clin Pract, 2004 Oct;66(1):71-7.
    PMID: 15364164 DOI: 10.1016/j.diabres.2004.02.021
    This study aimed to identify the relationship of health beliefs and complication prevention behaviors among Chinese individuals with Type 2 Diabetes Mellitus in Malaysia. A correlation study using the Health Belief Model (HBM) framework was undertaken with 128 Chinese subjects with Type 2 Diabetes of both gender, mean age 60.5 +/- 8.42 years from one urban hospital and four rural health centers. Research tool was a 60-item questionnaire with responses recorded on 5-point Likert scale. Data was analyzed with descriptive statistics, Spearmen correlation and Mann-Whitney U-test. The majority of the subjects had less than 6 years of education. Seventy-two percent of them were aware of diabetes complications and its risk factors. However, few subjects practiced complication preventive measures because of lack of perceived seriousness of diabetes and lack of perceived susceptibility to diabetes complications. There were significant correlations between complication prevention behaviors and perceived severity (P < 0.05), perceived susceptibility (P < 0.05 ) and perceived barrier (P < 0.05 ); subjects' education level and perceived severity (P < 0.05), perceived susceptibility (P < 0.05) and complication prevention behavior (P < 0.05). There was no significant correlation between health beliefs and settings; genders; disease duration and treatment mode. In conclusion, poor complication preventive behavior among the subjects was associated with lack of perceived seriousness of diabetes and lack of perceived susceptibility to diabetes complications.
    Matched MeSH terms: Ambulatory Care Facilities
  16. The associations between diabetes distress and self-efficacy, medication adherence, self-care activities and disease control depend on the way diabetes distress is measured: Comparing the DDS-17, DDS-2 and the PAID-5
    Chew BH, Vos RC, Pouwer F, Rutten GEHM
    Diabetes Res Clin Pract, 2018 Aug;142:74-84.
    PMID: 29802952 DOI: 10.1016/j.diabres.2018.05.021
    AIMS: To examine whether diabetes distress (DD), when measured by three different instruments, was associated differently with self-efficacy, self-care activity, medication adherence and disease control in people with Type 2 diabetes mellitus.
    METHODS: A cross-sectional study in three health clinics. DD was assessed with the 17-item Diabetes Distress Scale, the 2-item DDS-2 (DDS-2) and the 5-item Problem Areas in Diabetes Scale (PAID-5). Dependent variables included self-efficacy, self-care activities, medication adherence, HbA1c, systolic and diastolic blood pressure (SBP, DBP). Multiple linear and logistic regression were used in analyses.
    RESULTS: In total 338 participants (56% women), with a mean age of 61 years and diabetes duration of 9.8 years, were included. DDS-2 was an independent determinant of SBP (β = 1.89, 95% CI 0.14, 3.64), DBP (β = 1.19, 95% CI 0.16, 2.21) and blood pressure target (OR = 2.09, 95% CI 1.12, 3.83). PAID-5 was an independent determinant of medication adherence (adjusted β = -0.05, 95% CI -0.08, -0.01) and self-care activities (OR = 0.50, 95% CI 0.26, 0.99).
    CONCLUSIONS: Associations of DD with important aspects of diabetes care are substantially influenced by confounders and depend on the way DD is measured. Our findings call for a judicious use of different DD measures in clinical practice and research. The study is registered on ClinicalTrials.gov (NCT02730754).
    Matched MeSH terms: Ambulatory Care Facilities
  17. Fulltext Hypoglycemia awareness among insulin-treated patients with diabetes in Malaysia: A cohort subanalysis of the HAT study
    Hussein Z, Kamaruddin NA, Chan SP, Jain A, Uppal S, Bebakar WMW, et al.
    Diabetes Res Clin Pract, 2017 Nov;133:40-49.
    PMID: 28888148 DOI: 10.1016/j.diabres.2017.08.007
    AIMS: The present Malaysian cohort analysis determined the prevalence of hypoglycemia among patients with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) attending primary care- or hospital-based diabetes clinics in Malaysia and their awareness of the symptoms of hypoglycemia.

    METHODS: The Hypoglycemia Assessment Tool (HAT) study was a non-interventional, 6-month retrospective and 4-week prospective analysis of hypoglycemic events in 24 countries, using self-assessment questionnaires and diaries among patients with T1DM/T2DM aged ≥18years, using insulin for >12months. This report focuses on prospective data, as they are less prone to recall bias.

    RESULTS: There were 1153 participants in the Malaysian cohort (114 T1DM; 1039 T2DM). In the prospective period, 50.4% and 33.4% of patients reported ≥1 hypoglycemic events, with estimated rates of 20.3 and 13.1 events per patient-year of exposure in patients with T1DM and T2DM, respectively. 24.8% and 16.1% of patients with T1DM or T2DM, respectively, reported ≥1 nocturnal hypoglycemic event. The majority of patients (96.5%, T1DM; 91.8%, T2DM) knew what hypoglycemia was prior to the study. Impaired awareness was present in 48.0% (T1DM) and 36.9% (T2DM) of patients. In the prospective period, 50% of patients with T1DM or T2DM consulted a doctor or nurse following a hypoglycemia episode.

    CONCLUSIONS: Half of patients with T1DM and a third of patients with T2DM reported ≥1 hypoglycemic event during the prospective period. Although the majority of patients knew the typical features of hypoglycemia, many reported impaired ability to recognize symptoms in real life. The present findings highlight the importance of patient education and physician awareness in dealing with hypoglycemia, in particular the burden of hypoglycemic unawareness.

    CLINICAL TRIAL NUMBER: This trial was registered at www.clinicaltrials.gov as NCT01696266 on 26 September 2012.
    Matched MeSH terms: Ambulatory Care Facilities
  18. Fulltext The effectiveness of an emotion-focused educational programme in reducing diabetes distress in adults with type 2 diabetes mellitus (VEMOFIT): a cluster randomized controlled trial
    Chew BH, Vos RC, Stellato RK, Ismail M, Rutten GEHM
    Diabet Med, 2018 06;35(6):750-759.
    PMID: 29505098 DOI: 10.1111/dme.13615
    AIMS: To evaluate the effectiveness of a brief, value-based emotion-focused educational programme (VEMOFIT) in Malay adults with Type 2 diabetes mellitus compared with a programme of active listening to participants' emotional experiences, social support and their opinion on the health clinic diabetes care services (attention control).

    METHODS: Malay adults with severe diabetes distress [Diabetes Distress Scale (DDS-17) mean score ≥ 3] were included. VEMOFIT consisted of four biweekly group sessions, a booster session after 3 months and a follow-up 6 months post intervention. The attention control programme consisted of three sessions over the same period. Outcomes included diabetes distress, depressive symptoms, self-efficacy and disease control. Required total sample size was 165.

    RESULTS: Participants (n = 124) were randomized to either VEMOFIT (n = 53) or the attention control programme (n = 71). Participants had a mean (sd) age of 55.7 (9.7) years, median diabetes duration of 7.0 (8.0) years and mean HbA1c level of 82 mmol/mol (9.7%). The mean DDS-17 level decreased significantly in both the VEMOFIT and the attention control programmes (3.4 to 2.9 vs. 3.1 to 2.7, respectively). The adjusted between-group DDS-17 difference was not significant [-0.01, 95% confidence interval (CI) -0.38, 0.35]. The proportion of individuals with severe diabetes distress decreased in both groups, from 89% to 47% vs. 69% to 39% (odds ratio 0.88; 95% CI 0.26, 2.90). Other outcomes did not differ between groups.

    CONCLUSIONS: Both interventions decreased diabetes distress significantly. The theory-based VEMOFIT programme was not superior to the attention control programme. The latter approach is a simpler way to decrease severe diabetes distress (Trial registration: NCT02730078; NMRR-15-1144-24803).

    Study site: Klinik Kesihatan, Negeri Sembilan, Malaysia
    Matched MeSH terms: Ambulatory Care Facilities
  19. Treatment of Type 2 diabetes mellitus in Chongqing of China: unaffordable care for the poor
    Long Q, He M, Tang X, Allotey P, Tang S
    Diabet Med, 2017 01;34(1):120-126.
    PMID: 27472098 DOI: 10.1111/dme.13193
    AIM: This study aims to investigate the medical expenditure of people with type 2 diabetes mellitus in Chongqing, China; to explore factors that contribute to the expenditure; and to examine the financial burden placed on households, particularly poor households.
    METHODS: A cross sectional survey was conducted with a sample of people diagnosed with Type 2 diabetes mellitus in 2014. Of the 664 people eligible, 76% were interviewed. Descriptive statistics and log-linear regression were used to examine respondents' age, sex and level education, location of residence, income and type of health insurance associated with out-of-pocket expenditure on accessing diabetes mellitus care.
    RESULTS: In a year, average out-of-pocket expenditure on the purchase of drugs from pharmacies and having outpatient care were US $333 and US $310, respectively. The average out-of-pocket expenditure on accessing inpatient care was 3.7 times (US $1159) that of accessing outpatient care. After adjusting for age and sex, out-of-pocket expenditure on diabetes care was significantly higher for people covered by the Urban Employee Basic Medical Insurance programme and those enrolled in the identified priority diseases reimbursement programme, which provided higher reimbursement rates for outpatient and (or) inpatient care. Out-of-pocket expenditures on the purchase of drugs from pharmacies, having outpatient and inpatient care, respectively, were 9.8%, 16.2% and 62.6% of annual household income in low-income group.
    CONCLUSION: Even with health insurance coverage, poor people with Type 2 diabetes mellitus suffered from significant financial hardship. This has significant implications for models of care and healthcare financing in China with the growing burden of diabetes.
    Study site: Township or community health centres, Chongqing, China
    Matched MeSH terms: Ambulatory Care Facilities
  20. Fulltext Statins use is associated with poorer glycaemic control in a cohort of hypertensive patients with diabetes and without diabetes
    Liew SM, Lee PY, Hanafi NS, Ng CJ, Wong SS, Chia YC, et al.
    Diabetol Metab Syndr, 2014;6:53.
    PMID: 24782916 DOI: 10.1186/1758-5996-6-53
    BACKGROUND:The US Federal and Drug Administration (FDA) recently revised statin drug labels to include the information that increases in fasting serum glucose and glycated haemoglobin levels have been reported with the use of statins. Yet in a survey, 87% of the doctors stated that they had never or infrequently observed increases in glucose or HbA1c levels in patients on statin. In this study we would like to determine the association between the use of statins and glycaemic control in a retrospective cohort of patients with hypertension.
    METHODS: A retrospective review of 1060 medical records of patients with hypertension at a primary care clinic was conducted. These records were selected using systematic random sampling (1:4). Data on patient socio-demographic factors; clinical profile; investigation results and prescribed medications were collected. Independent t-test was used for continuous variables while Pearson's χ2 test was used for categorical variables. Logistic regression was done to adjust for confounders.
    RESULTS: 810 (76.4%) patients with hypertension were on statins, out of which 792 (97.8%) were taking simvastatin 10 mg or 20 mg daily. Analysis of the whole group regardless of diabetes status showed that the statin user group had higher HbA1c and fasting blood glucose values. The difference in HbA1c levels remained significant (adjusted OR = 1.290, p = 0.044, 95% CI 1.006, 1.654) after adjustment for diabetes, diabetic medication and fasting blood glucose. In the study population who had diabetes, statin users again had significantly higher HbA1c level compared to statin non-users. This difference remained significant (adjusted OR 1.208, p = 0.037, 95% CI 1.012, 1.441) after adjustment for age and diabetic medications.
    CONCLUSIONS:Stat ins use is associated with increased HbA1c levels among hypertensive patients and hypertensive patients with diabetes. Clinicians managing hypertensive patients on statins should consider monitoring the HbA1c level and ensure that those with diabetes have their hyperglycaemia kept under control.
    KEYWORDS: Diabetes mellitus; HbA1c; Hypertension; Statin
    Study site: primary care clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
    Matched MeSH terms: Ambulatory Care Facilities
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