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Probiotics for the management of type 2 diabetes mellitus: A systematic review and meta-analysis

Samah S, Ramasamy K, Lim SM, Neoh CF

Diabetes Res Clin Pract, 2016 Jun 18;118:172-182.
PMID: 27388674 DOI: 10.1016/j.diabres.2016.06.014

AIMS: To systematically review evidence of probiotic interventions against type 2 diabetes mellitus (T2DM) and analyse the effects of probiotics on glycaemic control among T2DM patients.
METHODS: Electronic search using five electronic databases was performed until October 2015. Relevant studies were identified, extracted and assessed for risk of bias. The primary outcomes of this review were glycated haemoglobin (HbA1c) and fasting blood glucose (FBG). Fasting plasma insulin, homeostasis model assessment-insulin resistance, C-reactive protein, interleukin-6 and malondialdehyde, were identified as the secondary outcomes. Mean differences (MD) between probiotics and control groups for all outcomes were pooled using either Fixed- or Random-Effect Model. Statistical heterogeneity was assessed using I(2) and Chi(2) tests.
RESULTS: Six randomised controlled trials (RCTs) were included in the systematic review, whereas only five were included in meta-analysis. Most RCTs were presented with low or unclear risk of bias. When compared to placebo, FBG was significantly lower with probiotic consumption (MD=-0.98mmol/L; 95% CI: -1.17, 0.78, p<0.00001), with moderate but insignificant heterogeneity noted. Insignificant changes between the groups were also noted for HbA1c and other secondary outcomes.
CONCLUSIONS: A moderate hypoglycaemic effect of probiotics, with a significantly lower FBG was noted. Findings on HbA1c, anti-inflammatory and anti-oxidative effects of probiotics in the clinical setting, however, remain inconsistent. The findings imply the need for well-designed clinical studies to further assess the potential beneficial effects of probiotics in management of T2DM.
KEYWORDS: Glycaemic; Probiotics; Review; Type 2 diabetes mellitus
Fulltext Pulmonary disease empirically treated as tuberculosis-a retrospective study of 107 cases

Loh LC, Abdul Samah SZ, Zainudin A, Wong GLS, Gan WH, Yusuf WS, et al.

Med J Malaysia, 2005 Mar;60(1):62-70.
PMID: 16250282

Pulmonary disease is sometimes treated empirically as tuberculosis (TB) in the absence of microbial confirmation if the clinical suspicion of active TB is high. In a country of relatively high TB and low HIV burden, we retrospectively studied 107 patients (69.2% male; mean age (SD): 45 (17) years) who received empirical anti-TB treatment for intrapulmonary opacities or pleural effusions suspected of active TB in our hospitals between 1998 and 2002. The diagnosis of definite or probable 'smear-negative' pulmonary TB was made based on treatment outcome at two months with rifampicin, isoniazid, pyrazinamide and ethambutol (or streptomycin). At this end-point, 81 patients (84.4%) had both clinical and radiological improvement (definite cases), 12 (12.5%) had clinical improvement alone and 3 (3.1%) had radiological improvement alone (probable cases). Confirmation of acid-fast bacilli was subsequently obtained in 12 patients (all definite cases) from culture of initial pulmonary specimens. Eleven patients (10.5%) were diagnosed as 'non-TB' based on absence of both clinical and radiological improvement or discovery of another cause for the pulmonary condition at or before this two-month study end-point. In the 'non-TB' group, 2 had carcinoma, 2 had HIV-related pulmonary diseases, 1 had bronchiectasis, while in 6 causes were indeterminate. Six (6.3%) and 3 (27.3%) patients reported adverse effects from anti-TB drugs from the 'TB' and 'non-TB' groups respectively. Our findings suggest that empirical anti-TB treatment is an acceptable practice if clinical suspicion is high in patients coming in our region.
Response to Linguistic and psychometric validation of the Malaysian version of Diabetes Quality of Life-Brief Clinical Inventory (DQoL-BCI): Methodological issues to avoid misinterpretation

Neoh CF, Samah S, Wong YY, Hassali MA, Shafie AA, Lim SM, et al.

Res Social Adm Pharm, 2017 02 12;13(4):884.
PMID: 28259586 DOI: 10.1016/j.sapharm.2017.02.004
Linguistic and psychometric validation of the Malaysian version of Diabetes Quality of Life-Brief Clinical Inventory (DQoL-BCI)

Samah S, Neoh CF, Wong YY, Hassali MA, Shafie AA, Lim SM, et al.

Res Social Adm Pharm, 2017 11;13(6):1135-1141.
PMID: 27825607 DOI: 10.1016/j.sapharm.2016.10.017

BACKGROUND: Quality of life (QoL) assessment provides valuable outcome to support clinical decision-making, particularly for patients with chronic diseases that are incurable. A brief, 15-item diabetes-specific tool [i.e. Diabetes Quality of Life-Brief Clinical Inventory (DQoL-BCI)] is known to be developed in English and validated for use in clinical practice. This simplified tool, however, is not readily available for use in the Malaysian setting.
OBJECTIVE: To translate the DQoL-BCI into a Malaysian version and to assess its construct validity (factorial validity, convergent validity and discriminant validity), reliability (internal consistency) and floor and ceiling effects among the Malaysian diabetic population.
MATERIAL AND METHODS: A forward-backward translation, involving professional translators and experts with vast experience in translation of patient reported outcome measures, was conducted. A total of 202 patients with Type 2 diabetes mellitus (T2DM) who fulfilled the inclusion criteria were invited to complete the translated DQoL-BCI. Data were analysed using SPSS for exploratory factor analysis (EFA), convergent and discriminant validity, reliability and test-retest, and AMOS software for confirmatory factor analysis (CFA).
RESULTS: Findings from EFA indicated that the 4-factor structure of the Malaysian version of DQoL-BCI was optimal and explained 50.9% of the variance; CFA confirmed the 4-factor model fit. There was negative, moderate correlation between the scores of DQoL-BCI (Malaysian version) and EQ-5D-3L utility score (r = -0.329, p = 0.003). Patients with higher glycated haemoglobin levels (p = 0.008), diabetes macrovascular (p = 0.017) and microvascular (p = 0.013) complications reported poorer QoL. Cronbach's alpha coefficient and intraclass coefficient correlations (range) obtained were 0.703 and 0.86 (0.734-0.934), indicating good reliability and stability of the translated DQoL-BCI.
CONCLUSION: This study had validated the linguistic and psychometric properties of DQoL-BCI (Malaysian version), thus providing a valid and reliable brief tool for assessing the QoL of Malaysian T2DM patients.