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Hospital-acquired Clostridium difficile infection among patients with type 2 diabetes mellitus in acute medical wards

Hassan SA, Rahman RA, Huda N, Wan Bebakar WM, Lee YY

J R Coll Physicians Edinb, 2013;43(2):103-7.
PMID: 23734349 DOI: 10.4997/JRCPE.2013.203

Clostridum difficile (C. difficile) infection is increasingly seen among hospitalised patients with type 2 diabetes mellitus but its rate and associated risk factors are not known. We aimed to determine the rate and characteristics of hospital-acquired C. difficile infection in subjects with type 2 diabetes mellitus admitted into acute medical wards.
Prevalence, risk factors, and clinical features of thyroid-associated ophthalmopathy in multiethnic Malaysian patients with Graves' disease

Lim SL, Lim AK, Mumtaz M, Hussein E, Wan Bebakar WM, Khir AS

Thyroid, 2008 Dec;18(12):1297-301.
PMID: 19012471 DOI: 10.1089/thy.2008.0044

The prevalence of thyroid-associated ophthalmopathy (TAO) has been reported to be lower in several Asian populations than in Caucasians. The risk factors for TAO that have been demonstrated in Caucasians have not been studied in Asian populations. The aim of this study, therefore, was to determine the prevalence, risk factors, and clinical features of TAO in a cohort of multiethnic Malaysian patients with Graves' disease (GD).
Fulltext Efficacy and safety of liraglutide compared to sulphonylurea during Ramadan in patients with type 2 diabetes (LIRA-Ramadan): a randomized trial

Azar ST, Echtay A, Wan Bebakar WM, Al Araj S, Berrah A, Omar M, et al.

Diabetes Obes Metab, 2016 10;18(10):1025-33.
PMID: 27376711 DOI: 10.1111/dom.12733

AIMS: Compare effects of liraglutide 1.8 mg and sulphonylurea, both combined with metformin, on glycaemic control in patients with type 2 diabetes (T2D) fasting during Ramadan.
MATERIALS AND METHODS: In this up to 33-week, open-label, active-controlled, parallel-group trial, adults [glycated haemoglobin (HbA1c) 7%-10% (53-86 mmol/mol); body mass index ≥20 kg/m(2) ; intent to fast] were randomized (1:1) ≥10 weeks before Ramadan to either switch to once-daily liraglutide (final dose 1.8 mg) or continue pre-trial sulphonylurea at maximum tolerated dose, both with metformin.
PRIMARY ENDPOINT: change in fructosamine, a validated marker of short-term glycaemic control, during Ramadan.
RESULTS: Similar reductions in fructosamine levels were observed for both groups during Ramadan [liraglutide (-12.8 µmol/L); sulphonylurea (-16.4 µmol/L); estimated treatment difference (ETD) 3.51 µmol/L (95% CI: -5.26; 12.28); p = 0.43], despite lower fructosamine levels in the liraglutide group at start of Ramadan. Fewer documented symptomatic hypoglycaemic episodes were reported in liraglutide-treated (2%, three subjects) versus sulphonylurea-treated patients (11%, 18 subjects). No severe hypoglycaemic episodes were reported by either group. Body weight decreased more during Ramadan with liraglutide (ETD: -0.54 kg; 95% CI: -0.94;-0.14; p = 0.0091). The proportion of patients reporting adverse events was similar between groups. Liraglutide led to greater HbA1c reduction [ETD: -0.59% (-6.40 mmol/mol), 95% CI: -0.79; -0.38%; -8.63; -4.17 mmol/mol; p
Fulltext Insulin sensitivity and secretory status of a healthy malay population

Al-Mahmood AK, Ismail AA, Rashid FA, Wan Bebakar WM

Malays J Med Sci, 2006 Jul;13(2):37-44.
PMID: 22589603 MyJurnal

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
Fulltext Prevalence of aspirin resistance in diabetic patients and its associated factors

Habizal NH, Abdul Halim S, Bhaskar S, Wan Bebakar WM, Abdullah JM

Malays J Med Sci, 2015 Jan-Feb;22(1):50-7.
PMID: 25892950 MyJurnal

BACKGROUND: Aspirin resistance has posed a major dilemma in the prevention of cardiovascular disease and stroke. There have been many factors that have been associated with aspirin resistance. Among these factors, the inflammatory processes of diabetes and glycaemic control have been significantly associated with aspirin resistance. Our study evaluated the prevalence of aspirin resistance and its associated factors.
METHODS: This was a cross-sectional, interventional study, which was implemented from October to November 2012 at the Hospital Universiti Sains Malaysia (HUSM). Sixty-nine patients with diabetes who were taking aspirin were enrolled. The glycosylated haemoglobin (HbA1c) and C-reactive protein (CRP) levels were measured in these patients. The thromboelastography (TEG) level was measured using a TEG machine by a trained technician employing standard methods. The variables obtained were analysed for prevalence of aspirin resistance, HbA1c, CRP, and TEG level. The Chi-square test (and Fisher exact test where applicable) were used to evaluate the associations between aspirin resistance with glycaemic control (HbA1c) and inflammatory markers (CRP).
RESULTS: The prevalence of aspirin resistance was 17.4% (95%; CI 9.3, 28.4). Glycaemic control (HbA1c) and inflammatory markers (CRP) were not associated with aspirin resistance. Aspirin resistance was prevalent in our study population and was comparable to other studies. The mean HbA1c in the aspirin-resistant group was 8.9%, whereas the mean HbA1c in the aspirin-sensitive group was 8.6%.
CONCLUSION: There was no significant difference in HbA1c between the two groups. There was no significant association between CRP levels and aspirin resistance.
KEYWORDS: aspirin resistance; diabetes mellitus; thromboelastography
Study site: NeuroMedical Specialist Clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
Fulltext Prevalence of abnormal glucose tolerance and risk factors in urban and rural Malaysia

Mustafa N, Kamarudin NA, Ismail AA, Khir AS, Ismail IS, Musa KI, et al.

Diabetes Care, 2011 Jun;34(6):1362-4.
PMID: 21498788 DOI: 10.2337/dc11-0005

OBJECTIVE:
To determine the prevalence of prediabetes and diabetes among rural and urban Malaysians.
RESEARCH DESIGN AND METHODS:
This cross-sectional survey was conducted among 3,879 Malaysian adults (1,335 men and 2,544 women). All subjects underwent the 75-g oral glucose tolerance test (OGTT).
RESULTS:
The overall prevalence of prediabetes was 22.1% (30.2% in men and 69.8% in women). Isolated impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) were found in 3.4 and 16.1% of the study population, respectively, whereas 2.6% of the subjects had both IFG and IGT. Based on an OGTT, the prevalence of newly diagnosed type 2 diabetes was 12.6% (31.0% in men and 69.0% in women). The prediabetic subjects also had an increased prevalence of cardiovascular disease risk factors.
CONCLUSIONS:
The large proportion of undiagnosed cases of prediabetes and diabetes reflects the lack of public awareness of the disease.
Fulltext The Effect of Labisia pumila var. alata on Postmenopausal Women: A Pilot Study

Abdul Kadir A, Nik Hussain NH, Wan Bebakar WM, Mohd DM, Wan Mohammad WM, Hassan II, et al.

Evid Based Complement Alternat Med, 2012;2012:216525.
PMID: 22701504 DOI: 10.1155/2012/216525

This is a randomized, double-blind, placebo-controlled study comparing the effects of a water extract of Labisia pumila var. alata at 280 mg/day with placebo, given for 6 months in postmenopausal Malay women. There were 29 patients treated with Labisia pumila and 34 patients in the placebo group. Menopausal symptoms were assessed at baseline and at 6 months. The blood pressure, body mass index, waist circumference, fasting blood sugar, lipid profile, and hormonal profile (follicle stimulating hormone/luteinizing hormone/estradiol) were measured during visits every two months. ANCOVA model analysis showed significantly lower triglycerides levels in LP subjects at 6 months after treatment as compared to placebo (1.4 versus 1.9 mmol/L; adj. mean difference 0.5, 95% CI: 0.02, 0.89 after adjusted for the baseline values, age, BMI, and duration of menopause placebo). Other parameters in both groups did not differ significantly. In conclusion, daily intake of Labisia pumila at 280 mg/day for six months was found to provide benefit in reducing the triglyceride (TG) values.
Fulltext Prevalence of overweight and obesity among adult Malaysians: an update

Wan Nazaimoon WM, Musa KI, Md Khir AS, Ismail AA, Ismail IS, Khalid BAK, et al.

Asia Pac J Clin Nutr, 2011;20(1):35-41.
PMID: 21393108

A total of 4428 adults (>18 years old) from 5 different selected regions in Peninsular and East Malaysia participated in this health survey. Using World Health Organization recommendations for body mass index (BMI), the prevalence of overweight and obesity were found to be 33.6% (95% CI= 32.2, 35.0) and 19.5% (95% CI= 18.3, 20.7) respectively. There were more females who were obese (22.5%, 95% CI=20.9, 24.0) compared to males (14.1%, 95% CI=12.3, 15.9). Highest prevalence of obesity were among the Indians (24.6%, 95% CI=20.3, 29.3), followed closely by the Malays (23.2%, 95% CI=21.6, 24.8%) and lowest prevalence was among the Chinese subjects (8.2%, 95% CI=6.2, 10.6). More than 43% of the 531 younger subjects (<30 years old) were either overweight (20%, 95% CI=16.6, 23.6) or obese (13.9%, 95% CI=11.1, 17.2%). All subjects who claimed to be non-diabetes were required to undergo 75 g glucose tolerance test. Compared to subjects with normal BMI (18.5-24.9 kg/m2), there was a 3- and 2-folds increase in the prevalence of newly diagnosed diabetes and impaired glucose tolerance respectively, among obese subjects (BMI>30 kg/m2) who initially claimed to have no diabetes. This study highlights a need for more active, inter-sectoral participation advocating a health-promoting environment in order to combat obesity in this country.