The study was conducted to determine whether the clinical targets for the control of diabetes recommended by American Diabetes Association can be met in the context of routine diabetes practice. This cross-sectional study was undertaken on 211 type 2 diabetic patients at the Outpatients Diabetes Clinic, Hospital Universisti Sains Malaysia (HUSM) Kubang Kerian, Kelantan between the year 2001-2002. Patients' physical examination and their medical history as well as their family history were obtained by administering a structured questionnaire. Samples of patients' venous blood during fasting were taken and analysed for plasma glucose, glycated haemoglobin and lipid profile. Analysis showed that many patients had comorbidities or complications. A large number of them had poor glycaemic control (73%). Systolic and diastolic blood pressures of 75% and 85% subjects were > or = 130 and > or = 80 mmHg, respectively. Body Mass Index (BMI) values of 66% of the patients were outside the clinical target (BMI > or = 25 in male and > or = 24 kg/m2 in female). The lipid profile showed that 96% of the patients had at least one lipid value outside the clinical target level. In this study, 70% of the patients had total cholesterol > or = 5.2 mmol/L, 87% had LDL cholesterol > or = 2.6 mmol/L, 57% had HDL cholesterol less than the normal range, < or = 1.15 mmol/L in men and < or = 1.4 mmol/L in women, while 46% had triglycerides > or = 1.71 mmol/L. Complications of diabetes were observed in 48% of the total number of patients. As for the patients' systolic blood pressure, age and duration of diabetes were found to have significant effects. Older subjects with a longer duration of diabetes were more hypertensive. Variables that had significant effects on BMI were age, duration of diabetes, glycaemic control and gender. Younger females and newly diagnosed subjects with better glycaemic control (A1C < 7%) were found to have higher BMI values. The overall clinical targets were suboptimal. The prevalence of hyperlipidaemia and hypertension was high. It is imperative that better treatment strategies and methods be adopted to enhance diabetes control and reduce long-term complications of the disease.
Study site: Outpatients Diabetes Clinic, Hospital Universisti Sains Malaysia (HUSM)
Two hundred and eleven (211) patients with type 2 diabetes mellitus who were on treatment and monitored for complications at the Outpatient Diabetes Clinic in Hospital Universiti Sains Malaysia, Kubang Kerian between 2001 - 2002 were selected for the study. A structured questionnaire was administered to obtain their medical and family history. Physical examination was performed and fasting venous blood sample was collected for plasma glucose and A1C analysis. Of the total 211 patients, only 4 % were on diet treatment alone, 37 % of them were on mono therapy while 59 % were on combination of therapies. Fasting plasma glucose (FPG) > 7.2 mmol/L and glycated hemoglobin (A1C) levels ≥ 7 % were observed in 60 % and 73 % of type 2 diabetic patients, respectively. Glycated hemoglobin level of 28 % of the subjects were < 7 %; 36 % were between 7 - 9 % and 36 % were more than 9 %. The worst glycaemic control was observed in Malay patients. A1C of Malay and non-Malay subjects were 8.7 ± 2.3 % and 7.7 ± 1.7 %, respectively. Younger patients (age group < 50 years) had significantly higher mean A1C than elderly patients. Duration of diabetes had a clear influence on glycaemic level. Patients with recently diagnosed diabetes (duration of disease < 5 years) had the best glycaemic control. In this study a large proportion of the patients had poor glycaemic control. The variables with significant effects on glycaemic control were ethnicity, age and duration of diabetes mellitus. Better treatment strategies and methods should be used to improve diabetes control and to reduce long-term complications of diabetes.
Study site: Outpatient diabetic clinic, Hospital Universiti Sains Malaysia, Kelantan, Malaysia
Poly(ethylene-vinyl acetate) (PEVA) nanocomposite incorporating dual clay nanofiller (DCN) of surface modified montmorillonite (S-MMT) and bentonite (Bent) was studied for biomedical applications. In order to overcome agglomeration of the DCN, the S-MMT and Bent were subjected to a physical treatment prior to being mixed with the copolymer to form nanocomposite material. The S-MMT and Bent were physically treated to become S-MMT(P) and Bent(pH-s), respectively, that could be more readily dispersed in the copolymer matrix due to increments in their basal spacing and loosening of their tactoid structure. The biocompatibility of both nanofillers was assessed through a fibroblast cell cytotoxicity assay. The mechanical properties of the neat PEVA, PEVA nanocomposites, and PEVA-DCN nanocomposites were evaluated using a tensile test for determining the best S-MMT(P):Bent(pH-s) ratio. The results were supported by morphological studies by transmission electron microscopy (TEM) and scanning electron microscopy (SEM). Biostability evaluation of the samples was conducted by comparing the ambient tensile test data with the in vitro tensile test data (after being immersed in simulated body fluid at 37 °C for 3 months). The results were supported by surface degradation analysis. Our results indicate that the cytotoxicity level of both nanofillers reduced upon the physical treatment process, making them safe to be used in low concentration as dual nanofillers in the PEVA-DCN nanocomposite. The results of tensile testing, SEM, and TEM proved that the ratio of 4:1 (S-MMT(P):Bent(pH-s)) provides a greater enhancement in the mechanical properties of the PEVA matrix. The biostability assessment indicated that the PEVA-DCN nanocomposite can achieve much better retention in tensile strength after being subjected to the simulated physiological fluid for 3 months with less surface degradation effect. These findings signify the potential of the S-MMT(P)/Bent(pH-s) as a reinforcing DCN, with simultaneous function as biostabilizing agent to the PEVA copolymer for implant application.
Poly(ethylene-co-vinyl acetate) (PEVAc) is a copolymer that consists of non-polar polyethylene (PE) and a polar polyvinyl acetate (PVAc) monomer. PEVAc has high elasticity and is resilient, making it suitable for a variety of applications. However, the tensile strength of this copolymer needs to be improved for specific applications that require enough strength to tolerate high external tension or stress. This study proposed the use of dual-functionalized dolomite nanoparticles (DF-DNPs) composed of polar and non-polar nano-dolomite (P-DNPs and NP-DNPs) as nanofillers to reinforce the PEVAc. PEVAc/DF-DNP film appears to have a more homogeneous mixture, which is better for forming an optimal nanocomposite material. It also exhibits the highest tensile strength (10.48 MPa), elongation at break (1175.73%), and tensile toughness (62.12 MPa), which are higher by increments of 46.8%, 9.4%, and 20.3%, respectively, as compared to the neat PEVAc. The result proved that using DF-DNPs as a nanofiller can improve the strength of PEVAc while maintaining its flexibility to avoid brittleness of the nanocomposite film. Furthermore, its thermal characteristics were also successfully enhanced. A biostability assessment showed that the use of DF-DNPs as nanofiller caused the PEVAc copolymer to achieve the best water resistance, as it only exhibited a 2.63% weight increase, the lowest reduction in tensile properties among the studied fillers, and the best retention in surface degradation upon 3-month exposure to the in vitro environment. These findings indicate that the DF-DNPs help in developing a homogeneous nanocomposite by interacting with PE and PVAc.