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Fulltext Evaluation of a commercial dengue NS1 antigen-capture ELISA for laboratory diagnosis of acute dengue virus infection

Kumarasamy V, Wahab AH, Chua SK, Hassan Z, Chem YK, Mohamad M, et al.

J Virol Methods, 2007 Mar;140(1-2):75-9.
PMID: 17140671

A commercial dengue NS1 antigen-capture ELISA was evaluated to demonstrate its potential application for early laboratory diagnosis of acute dengue virus infection. Dengue virus NS1 antigen was detected in 199 of 213 acute serum samples from patients with laboratory confirmation of acute dengue virus infection but none of the 354 healthy blood donors' serum specimens. The dengue NS1 antigen-capture ELISA gave an overall sensitivity of 93.4% (199/213) and a specificity of 100% (354/354). The sensitivity was significantly higher in acute primary dengue (97.3%) than in acute secondary dengue (70.0%). The positive predictive value of the dengue NS1 antigen-capture ELISA was 100% and negative predictive value was 97.3%. Comparatively, virus isolation gave an overall positive isolation rate of 68.1% with a positive isolation rate of 73.9 and 31.0% for acute primary dengue and acute secondary dengue, respectively. Molecular detection of dengue RNA by RT-PCR gave an overall positive detection rate of 66.7% with a detection rate of 65.2 and 75.9% for acute primary dengue and acute secondary dengue, respectively. The results indicate that the commercial dengue NS1 antigen-capture ELISA may be superior to virus isolation and RT-PCR for the laboratory diagnosis of acute dengue infection based on a single serum sample.

Matched MeSH terms: Antigens, Viral/blood*; Dengue/blood*; Viral Nonstructural Proteins/blood*
Nutrition and immunity: the effects of the combination of arginine and tryptophan on growth performance, serum parameters and immune response in broiler chickens challenged with infectious bursal disease vaccine

Emadi M, Jahanshiri F, Kaveh K, Hair-Bejo M, Ideris A, Alimon AR

Avian Pathol, 2011 Feb;40(1):63-72.
PMID: 21331949 DOI: 10.1080/03079457.2010.539590

To explore the effects of the combination of tryptophan (Trp) and arginine (Arg) on growth performance, serum parameters and immune response of broiler chickens challenged with intermediate plus strain of infectious bursal disease virus vaccine, an in vivo experiment was conducted. A corn-soybean meal-based diet containing different levels of Arg and Trp was used. Cobb500 male broiler chickens from 0 to 49 days of age were subjected to a diet supplemented with the combination of Trp and Arg. Growth performance parameters and serum parameters were measured at 27 and 49 days of age. To evaluate the immunomodulatory effects of the combination of Trp and Arg on the challenged chickens, we measured the serum levels of interferon-α, interferon-γ and immunoglobulin G at 27, 35, 42, and 49 days of age. The results showed that the three evaluated immune system parameters including interferon-α, interferon-γ and immunoglobulin G were significantly enhanced after treatment. This enhancement resulted in the recovery of infectious bursal disease virus-infected chickens compared with controls as confirmed by histopathological examinations. Moreover, serum parameters such as albumin and total protein increased, whereas the treatment decreased (P<0.05) the feed:gain ratio, aspartate amino-transferase, alkaline phosphatase, lactic dehydrogenase, triglyceride and cholesterol. These findings suggest that the combination of Arg and Trp has a regulatory effect on growth performance. Moreover, it modulates the systemic immune response against infectious bursal disease.

Matched MeSH terms: Immunoglobulin G/blood; Interferon-gamma/blood; Interferon-alpha/blood
Beta-2 microglobulin as an immunological marker to assess the progression of human immunodeficiency virus infected patients on highly active antiretroviral therapy

Chitra P, Bakthavatsalam B, Palvannan T

Clin Chim Acta, 2011 May 12;412(11-12):1151-4.
PMID: 21300045 DOI: 10.1016/j.cca.2011.01.037

Acquired immune deficiency syndrome (AIDS) defines the end stage of Human immunodeficiency viral (HIV) infection before the introduction of highly active antiretroviral therapy (HAART). This study was carried out to assess the serum β-2 microglobulin (B2M) as a marker for progression of HIV infected patients undergoing HAART.

Matched MeSH terms: beta 2-Microglobulin/blood*; Biomarkers/blood; HIV Infections/blood
Fulltext Late intravascular embolization of a chemo port catheter

Loch A, Singh RV, Abidin IZ, Han CK, Ahmad WA

J Thorac Oncol, 2011 Jul;6(7):1292.
PMID: 21847043 DOI: 10.1097/JTO.0b013e31821f9771
Matched MeSH terms: Blood Vessels*; Breast Neoplasms/blood
Immunochromatographic gold-based test strip for rapid detection of Infectious bursal disease virus antibodies

Nurulfiza I, Hair-Bejo M, Omar AR, Aini I

J Vet Diagn Invest, 2011 Mar;23(2):320-4.
PMID: 21398455

The immunochromatographic assay is an alternative method for simple and rapid detection of Infectious bursal disease virus (IBDV) in chickens using colloidal gold-antibody conjugate. The whole-virus antigen of IBDV (UPM04190 isolate) and the high-affinity polyclonal antibodies directed against IBDV were blotted onto nitrocellulose membranes for test and control lines, respectively. Evaluation of the strip was performed using serum samples from experimentally and naturally infected chickens. The results showed that the test strip was more sensitive than the commercial enzyme-linked immunosorbent assay (ELISA) because it could detect a dilution factor up to 120,000 (250 ELISA units) for positive samples. It was also specific, in that it detected IBDV antibodies and did not cross-react with antibodies to other chicken viruses. The method was rapid (2 min) in both clinical and field environments with samples needing only a minimum amount (50 µl) of blood to produce an acceptable detection signal. The pen-site test strip proved successful in monitoring the immune status of chickens against the IBDV infection.

Matched MeSH terms: Antibodies, Viral/blood*; Poultry Diseases/blood; Birnaviridae Infections/blood
Influencing factors of glycaemic control in patients attending different types of urban health care settings in Malaysia

Ahmad B, Khalid BA, Zaini A, Hussain NA, Quek KF

Diabetes Res Clin Pract, 2011 Jul;93(1):e12-4.
PMID: 21397969 DOI: 10.1016/j.diabres.2011.02.020

The objective of this study was to elucidate influencing factors of HbA1C in various health care settings. The glycaemic control was suboptimal in all settings. Multivariate analysis confirmed three factors were significant in HbA1C outcome; insulin (p=0.000), medication (p=0.043) and ethnicity (p=0.000).

Matched MeSH terms: Blood Glucose/drug effects*; Diabetes Mellitus/blood
Fulltext Efficacy and tolerability of Dianex in Type 2 diabetes mellitus: a non randomized, open label non-comparative study

Sudha V, Bairy KL, Shashikiran U, Sachidananda A, Jayaprakash B, Shalini S

Med J Malaysia, 2005 Jun;60(2):204-11.
PMID: 16114162

OBJECTIVE AND STUDY DESIGN: A nonrandomized open labeled clinical trial to evaluate the efficacy and tolerability of Dianex (a poly herbal formulation developed by Apex Laboratories [PVT] Chennai, Tamil Nadu, India) in type 2 diabetes mellitus was carried out during a 6-month period.
SETTING/LOCATION: This study was conducted in TMA Pai Hospital, Udupi, South India.
SUBJECTS: A total of 40 patients were recruited for this study. Three patients dropped out of the study leaving a total of 37 patients (11 for monotherapy and 26 for add on therapy).
OUTCOME MEASURES: Eighteen (18) clinical variables were investigated, including liver enzymes, kidney function tests, hematologic parameters, blood glucose, and insulin and lipid profiles.
RESULTS: at the end of 12 weeks it was found that there was a significant decrease in the level of glycated hemoglobin, fasting plasma insulin level, insulin resistance, and systolic and diastolic blood pressure. At the end of 24 weeks results were similar to those at 12 weeks. Dianex did not alter the liver function tests, hematological parameters, or kidney function tests.
CONCLUSION: In this preliminary study, Dainex is found to be an effective adjuvant drug with either oral antidiabetic agents or insulin that can be used in the control of blood sugars in diabetic patients. Dianex is a safe drug that does not cause any clinical, hematological or biochemical alteration in major organ systems.

Matched MeSH terms: Blood Glucose/metabolism; Diabetes Mellitus, Type 2/blood
Fulltext The prognostic value of C-reactive protein (CRP) levels in patients with acute ischaemic stroke

Hamidon BB, Sapiah S, Nawawi H, Raymond AA

Med J Malaysia, 2004 Dec;59(5):631-7.
PMID: 15889566 MyJurnal

Increasing evidence suggests that inflammation plays an important role in the development of both cardiovascular and cerebrovascular events. Recently C-reactive protein (CRP) levels have been reported to be a prognostic factor for cerebrovascular and cardiovascular events. The main objective of the study was to evaluate the prognostic value of CRP levels in a first ever ischaemic stroke at one month. All ischaemic stroke patients who were admitted to Hospital Universiti Kebangsaan Malaysia (HUKM) between May 2002 and July 2002 were eligible for the study. CRP levels were taken within 72 hours after an acute ischaemic stroke. The functional ability was assessed using the Barthel Index (BI) after one month of stroke. During the study period 84 patients were admitted to HUKM with the diagnosis of ischaemic stroke; 49 patients were enrolled and 35 were excluded. Twenty-nine patients (59.2%) had elevated CRP levels (median 1.64+/-3.07 mg/dL, range 0.06 to 16.21 mg/dL). Elevated CRP levels were found to be a predictor of severe functional disability (BI<5) and were also associated with larger infarcts. In conclusion, elevated CRP levels are associated with poorer functional outcome and predict a larger infarct size.

Matched MeSH terms: Brain Ischemia/blood*; Biomarkers/blood; Stroke/blood*
A new and simple solid-phase extraction method for LC determination of pyronaridine in human plasma

Ramanathan S, Karupiah S, Nair NK, Olliaro PL, Navaratnam V, Wernsdorfer WH, et al.

J Chromatogr B Analyt Technol Biomed Life Sci, 2005 Sep 25;824(1-2):45-50.
PMID: 16046285

A new approach using a simple solid-phase extraction technique has been developed for the determination of pyronaridine (PND), an antimalarial drug, in human plasma. After extraction with C18 solid-phase sorbent, PND was analyzed using a reverse phase chromatographic method with fluorescence detection (at lambda(ex)=267 nm and lambda(em)=443 nm). The mean extraction recovery for PND was 95.2%. The coefficient of variation for intra-assay precision, inter-assay precision and accuracy was less than 10%. The quantification limit with fluorescence detection was 0.010 microg/mL plasma. The method described herein has several advantages over other published methods since it is easy to perform and rapid. It also permits reducing both, solvent use and sample preparation time. The method has been used successfully to assay plasma samples from clinical pharmacokinetic studies.

Matched MeSH terms: Antimalarials/blood*; Naphthyridines/blood*; Malaria, Falciparum/blood
Fulltext Angiotensinogen M235T gene variants and its association with essential hypertension and plasma renin activity in Malaysian subjects: a case control study

Say YH, Ling KH, Duraisamy G, Isaac S, Rosli R

BMC Cardiovasc Disord, 2005;5(1):7.
PMID: 15811183

Essential hypertension is a major public health concern worldwide where its prevalence accounts for various cerebrovascular diseases. A common molecular variant of angiotensinogen (AGT), the precursor of potent vasoactive hormone angiotensin II, has been incriminated as a marker for genetic predisposition to essential hypertension in some ethnics. This case-control study was designed not only to determine the association of the AGT M235T gene variants with essential hypertension, but also its relationship to Plasma Renin Activity (PRA) in subjects attending the Health Clinic, Kuala Lumpur, Malaysia.

Matched MeSH terms: Blood Pressure; Hypertension/blood; Renin/blood*
Fulltext A low molecular weight lipopolysaccharide antigen preparation reactive to acute leptospirosis heterologous sera

Riazi M, Abdul Rani B, Fairuz A, Zainul FZ

Trop Biomed, 2010 Aug;27(2):241-53.
PMID: 20962722 MyJurnal

There is a need for identification of new infection markers against common Leptospira isolates in Malaysia. To achieve this goal, seven-day-old cultures of Leptospira interrogans serogroup Icterohemorrhagiae (L44) and Leptospira interrogans serogroup Javanica (L55) were used for antigen preparation by sequential extraction method using 40 mM Tris, 8M Urea and 2M thiourea. Immunoblot analysis of the antigens were performed using serum samples from 46 local patients with confirmed acute leptospirosis, 28 patients with other infections and 14 healthy controls. The patients serum samples used in this study contained heterologous antibody against a number of different leptospira serovars. A strong IgM reactivity to a broad diffuse band of 10-15 kDa was observed. Combining results using L44 and L55 antigens showed sensitivity of 80.4% and specificity of 95.2% for detection of leptospirosis. Proteinase K and periodate treatment indicated that the band is likely to be lipopolysaccharide (LPS) in nature. This study showed that the 10-15 kDa antigen could potentially be useful for serodiagnosis of acute leptospirosis in Malaysia.

Matched MeSH terms: Antibodies, Bacterial/blood*; Immunoglobulin M/blood; Leptospirosis/blood*
Can the acute-phase reactant proteins be used as cancer biomarkers?

Pang WW, Abdul-Rahman PS, Wan-Ibrahim WI, Hashim OH

Int. J. Biol. Markers, 2010 Jan-Mar;25(1):1-11.
PMID: 20155712

The association between the acute-phase reactant proteins (APRPs) and cancer has long been established. There have been numerous reports correlating altered levels of various APRPs with different types of cancers. However, researchers are often quick to dismiss the use of these APRPs as potential biomarkers for the diagnosis and monitoring of cancer because alterations in APRP concentrations are observed in a wide range of diseases. Recent progress in proteomics studies which profiled the serum proteins of cancer patients and those of normal individuals indicated that the altered APRP expressions were different for distinct types, subtypes, and even stages of cancer. Interestingly, these data are in agreement with those observed earlier using immunochemical and biochemical assays. In view of this compelling association of different patterns of APRPs with various types of cancers and in an apparent shift of paradigm, we present in this review some indications that APRP fingerprinting may be used as complementary cancer biomarkers.

Matched MeSH terms: Inflammation/blood; Neoplasms/blood*; Biomarkers, Tumor/blood*
Safety evaluation of Bifidobacterium pseudocatenulatum G4 as assessed in BALB/c mice

Kabeir BM, Yazid AM, Stephenie W, Hakim MN, Anas OM, Shuhaimi M

Lett Appl Microbiol, 2008 Jan;46(1):32-7.
PMID: 17944838

To assess the safety of Bifidobacterium pseudocatenulatum G4 in BALB/c mice that involves examination of bacterial translocation, changes in the internal organs and histology of the intestinal lining.

Matched MeSH terms: Blood/microbiology; Enzymes/blood
Prevalence and predictors of low serum retinol and hypoalbuminaemia among children in rural Peninsular Malaysia

Al-Mekhlafi MH, Azlin M, Aini UN, Shaik A, Sa'iah A, Norhayati M

Trans R Soc Trop Med Hyg, 2007 Dec;101(12):1233-40.
PMID: 17936317

Vitamin A deficiency and malnutrition are still considered public health problems in rural areas of developing countries, including Malaysia. A cross-sectional exploration study was carried out on 281 Orang Asli (Aborigine) children aged between 2 and 15 years in Selangor, Malaysia. The overall prevalence of low serum retinol (<70 micromol/l) and hypoalbuminaemia (<35 g/l) were 25.2 and 7.8%, respectively. Univariate analysis showed that severe ascariasis, significant stunting and giardiasis were significantly associated with low concentration of serum retinol. As well as intestinal parasitic infections, low socio-economic status was a significant predictor of hypoalbuminaemia. Logistic regression analysis identified severe ascariasis and significant stunting as predictors of low serum retinol, while mixed intestinal parasitic infection and low household income were predictors of hypoalbuminaemia. In conclusion, control measures for intestinal parasitic infections should be included as one of the strategies for the prevention and control of malnutrition and vitamin A deficiency in this population.

Matched MeSH terms: Ascariasis/blood; Giardiasis/blood; Vitamin A/blood*
Method development and validation of repaglinide in human plasma by HPLC and its application in pharmacokinetic studies

Ruzilawati AB, Wahab MS, Imran A, Ismail Z, Gan SH

J Pharm Biomed Anal, 2007 Apr 11;43(5):1831-5.
PMID: 17240100

In this study, the development and validation of a high-performance liquid chromatography (HPLC) assay for determination of repaglinide concentration in human plasma for pharmacokinetic studies is described. Plasma samples containing repaglinide and an internal standard, indomethacin were extracted with ethylacetate at pH 7.4. The recovery of repaglinide was 92%+/-55.31. Chromatographic separations were performed on Purospher STAR C-18 analytical column (4.8 mm x 150 mm; 5 microm particle size). The mobile phase composed of acetonitrile-ammonium formate (pH 2.7; 0.01 M) (60:40, v/v). The flow rate was 1 ml/min. The retention time for repaglinide and indomethacin were approximately 6.2 and 5.3 min, respectively. Calibration curves of repaglinide were linear in the concentration range of 20-200 ng/ml in plasma. The limits of detection and quantification were 10 ng/ml and 20 ng/ml, respectively. The inter-day precision was from 5.21 to 11.84% and the intra-day precision ranged from 3.90 to 6.67%. The inter-day accuracy ranged 89.95 to 105.75% and intra-day accuracy ranged from 92.37 to 104.66%. This method was applied to determine repaglinide concentration in human plasma samples for a pharmacokinetic study.

Matched MeSH terms: Carbamates/blood*; Hypoglycemic Agents/blood*; Piperidines/blood*
Trust in physician among patients with type 2 diabetes mellitus in Luyang Health Clinic, Sabah and its association with treatment adherence and glycaemic control

Flecia K, Mohd FA

Med J Malaysia, 2023 May;78(3):329-335.
PMID: 37271842

INTRODUCTION: A patient's trust in their physician is associated with their self-reported health outcome. However, the relationship between trust in physician with therapeutic and health outcome has not been adequately explored. Therefore, this study aims to assess the level of trust in physician among type 2 diabetes mellitus patients and its association with treatment adherence and glycaemic control.
MATERIALS AND METHODS: A cross-sectional study was conducted in Luyang Health Clinic from 1st June 2020 to 3rd September 2020. A self-interviewed questionnaire comprises of three sections; sociodemographic, Wake Forest Physician Trust Scale (WFS) and Adherence to Refills and Medications Scale (ARMS) was completed by 281 respondents. Glycaemic control is based on the latest Hba1c profile of the respondents. Descriptive and nonparametric bivariate analysis were performed using IBM SPSS version 26.
RESULTS: The median (IQR) level of trust in physician was 43(8) out of a possible score range of 10 to 50. Trust in physician was correlated with treatment adherence (r=-0.12, p=0.048). There was no significant association between trust in physician with sociodemographic factors, which include age (p=0.33), gender (p=0.46), ethnicity (p=0.70), education level (p=0.50), and household income (p=0.37). Similarly, there was no significant association between the level of trust in physician with glycaemic control (p=0.709).
CONCLUSION: In conclusion, trust in physician was associated with treatment adherence but not with glycaemic control. In our local context, the glycaemic control could be due to other factors. Further studies should include a multicentre population to assess other potential factors that could contribute to glycaemic control.

Matched MeSH terms: Blood Glucose
Fulltext Effect of Taichi Chuan on health-related physical fitness in adults: A systematic review with meta-analysis

Qi F, Soh KG, Nasiruddin NJM, Leong OS, He S, Liu H

Complement Ther Med, 2023 Oct;77:102971.
PMID: 37586435 DOI: 10.1016/j.ctim.2023.102971

PURPOSE: Taichi Chuan was previously shown to benefit physical health, but the results were inconsistent. The main reason is that the mechanism is not clear and may be interpreted differently. In this systematic review, we analyzed the data obtained from various randomized controlled trials to identify the effectiveness of Taichi Chuan and the mechanism by which it improves the physical health of adults.
METHODS: We systematically searched various databases, including PubMed, Web of Science, Scopus, Embase, EBSCO Host, Science Direct, CNKI, Wan-Fang, and VPCS, and obtained 1448 articles for review. The articles were selected following the PICO eligibility criteria. We performed a systematic review and meta-analysis to interpret the results of the different studies.
RESULTS: We included 16 studies in the systematic review. Six of them were of very high quality, ten were of acceptable quality. Overall, the results showed that Taichi Chuan is beneficial to physical fitness, but not all indices supported this statement. Specifically, the effects were significant on Balance (ES = - 0.33; P = 0.02), BMI (ES = - 0.83; P blood pressure (ES = 0.07; P = 0.94) and diastolic blood pressure (ES = 0.03; P = 0.97).
CONCLUSION: We found sufficient high-quality evidence to suggest that Taichi Chuan affects balance, BMI, body fat, vital capacity, and flexibility (sit-reach) in adults. The mechanism can be explained by low posture (balance) and moderate intensity of Taichi Chuan. However, no study has explained how to maintain concentration while keeping a dynamic low posture, which made it difficult to validate the finding that Taichi Chuan can reduce sympathetic tension under stress. In this study, we assumed that relaxation methods, which work on the central nervous system that links the body and the mind, might be the key explanation. However, further studies based on scientific, replicable methods need to be performed to confirm our findings.

Matched MeSH terms: Blood Pressure
Fulltext Linear Segmented Arc-Shaped Piezoelectric Branch Beam Energy Harvester for Ultra-Low Frequency Vibrations

Piyarathna IE, Thabet AM, Ucgul M, Lemckert C, Lim YY, Tang ZS

Sensors (Basel), 2023 Jun 01;23(11).
PMID: 37299984 DOI: 10.3390/s23115257

Piezoelectric energy harvesting systems have been drawing the attention of the research community over recent years due to their potential for recharging/replacing batteries embedded in low-power-consuming smart electronic devices and wireless sensor networks. However, conventional linear piezoelectric energy harvesters (PEH) are often not a viable solution in such advanced practices, as they suffer from a narrow operating bandwidth, having a single resonance peak present in the frequency spectrum and very low voltage generation, which limits their ability to function as a standalone energy harvester. Generally, the most common PEH is the conventional cantilever beam harvester (CBH) attached with a piezoelectric patch and a proof mass. This study investigated a novel multimode harvester design named the arc-shaped branch beam harvester (ASBBH), which combined the concepts of the curved beam and branch beam to improve the energy-harvesting capability of PEH in ultra-low-frequency applications, in particular, human motion. The key objectives of the study were to broaden the operating bandwidth and enhance the harvester's effectiveness in terms of voltage and power generation. The ASBBH was first studied using the finite element method (FEM) to understand the operating bandwidth of the harvester. Then, the ASBBH was experimentally assessed using a mechanical shaker and real-life human motion as excitation sources. It was found that ASBBH achieved six natural frequencies within the ultra-low frequency range (<10 Hz), in comparison with only one natural frequency achieved by CBH within the same frequency range. The proposed design significantly broadened the operating bandwidth, favouring ultra-low-frequency-based human motion applications. In addition, the proposed harvester achieved an average output power of 427 μW at its first resonance frequency under 0.5 g acceleration. The overall results of the study demonstrated that the ASBBH design can achieve a broader operating bandwidth and significantly higher effectiveness, in comparison with CBH.

Matched MeSH terms: Blood Cell Count
Practical considerations for the use of SGLT-2 inhibitors in the Asia-Pacific countries-An expert consensus statement

Liew A, Lydia A, Matawaran BJ, Susantitaphong P, Tran HTB, Lim LL

Nephrology (Carlton), 2023 Aug;28(8):415-424.
PMID: 37153973 DOI: 10.1111/nep.14167

Recent clinical studies have demonstrated the effectiveness of SGLT-2 inhibitors in reducing the risks of cardiovascular and renal events in both patients with and without type 2 diabetes mellitus. Consequently, many international guidelines have begun advocating for the use of SGLT-2 inhibitors for the purpose of organ protection rather than as simply a glucose-lowering agent. However, despite the consistent clinical benefits and available strong guideline recommendations, the utilization of SGLT-2 inhibitors have been unexpectedly low in many countries, a trend which is much more noticeable in low resource settings. Unfamiliarity with the recent focus in their organ protective role and clinical indications; concerns with potential adverse effects of SGLT-2 inhibitors, including acute kidney injury, genitourinary infections, euglycemic ketoacidosis; and their safety profile in elderly populations have been identified as deterring factors to their more widespread use. This review serves as a practical guide to clinicians managing patients who could benefit from SGLT-2 inhibitors treatment and instill greater confidence in the initiation of these drugs, with the aim of optimizing their utilization rates in high-risk populations.

Matched MeSH terms: Blood Glucose
Fulltext Roadmap for the Management of Type 2 Diabetes and Hypertension in the Middle East: Review of the 2022 EVIDENT Summit

Al Saleh Y, Al Busaidi N, Al Dahi W, Almajnoni M, Mohammed AS, Alshali K, et al.

Adv Ther, 2023 Jul;40(7):2965-2984.
PMID: 37233878 DOI: 10.1007/s12325-023-02529-7

Type 2 diabetes mellitus (T2DM) and hypertension are leading risk factors for death and disability in the Middle East. Both conditions are highly prevalent, underdiagnosed and poorly controlled, highlighting an urgent need for a roadmap to overcome the barriers to optimal glycaemic and blood pressure management in this region. This review provides a summary of the Evidence in Diabetes and Hypertension Summit (EVIDENT) held in September 2022, which discussed current treatment guidelines, unmet clinical needs and strategies to improve treatment outcomes for patients with T2DM and hypertension in the Middle East. Current clinical guidelines recommend strict glycaemic and blood pressure targets, presenting several treatment options to achieve and maintain these targets and prevent complications. However, treatment targets are infrequently met in the Middle East, largely due to high clinical inertia among physicians and low medication adherence among patients. To address these challenges, clinical guidelines now provide individualised therapy recommendations based on drug profiles, patient preferences and management priorities. Efforts to improve the early detection of prediabetes, T2DM screening and intensive, early glucose control will minimise long-term complications. Physicians can use the T2DM Oral Agents Fact Checking programme to help navigate the wide range of treatment options and guide clinical decision-making. Sulfonylurea agents have been used successfully to manage T2DM; a newer agent, gliclazide MR (modified release formulation), has the advantages of a lower incidence of hypoglycaemia with no risk of cardiovascular events, weight neutrality and proven renal benefits. For patients with hypertension, single-pill combinations have been developed to improve efficacy and reduce treatment burden. In conjunction with pragmatic treatment algorithms and personalised therapies, greater investments in disease prevention, public awareness, training of healthcare providers, patient education, government policies and research are needed to improve the quality of care of patients with T2DM and/or hypertension in the Middle East.

Matched MeSH terms: Blood Pressure

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