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  1. Risk factors associated with diabetic retinopathy among type 2 diabetes patients at teaching hospital in Malaysia
    Abougalambou SS, Abougalambou AS
    Diabetes Metab Syndr, 2015 Apr-Jun;9(2):98-103.
    PMID: 25470640 DOI: 10.1016/j.dsx.2014.04.019
    BACKGROUND: Diabetic retinopathy (DR) is the leading cause of blindness in the United States and it is the leading cause of new cases of blindness in adults aged 20-74. It is estimated that about 20% of patients with type 2 DM have evidence of diabetic retinopathy at diagnosis with diabetes.
    OBJECTIVE: To evaluate the prevalence of DR and to determine risk factors related to diabetic retinopathy among type 2 diabetes patients attending endocrinology clinics at Hospital Universiti Sains Malaysia (HUSM).
    SUBJECTS AND METHODS: The study design was observational prospective longitudinal follow-up study, the study was conducted with sample of 1077 type 2 diabetes mellitus outpatient recruited via attended the diabetes clinics at HUSM. Diagnosis of retinopathy is based on finding the diagnostic signs of retinopathy on eye exams by fundoscopy. Logistic regression analysis was used to assess the independent variables that affect the development of retinopathy.
    RESULTS: The prevalence of retinopathy was 39.3%. It has been noticed from this study findings, that the progression of retinopathy is been influenced by five independent risk factors such as duration of diabetes, presence neuropathy, total cholesterol at second and third visit and createnine clearance.
    CONCLUSION: DR is highly prevalent among type 2 DM. The progression of retinopathy is been influenced by five independent risk factors such as duration of diabetes, presence neuropathy, total cholesterol at second and third visit and createnine clearance. DR is a serious diabetic complication and public health strategies are required in order to reduce its risk factors and decrease its prevalence.
    KEYWORDS: Prevalence; Retinopathy; Risk factors; Type 2 diabetes mellitus
    Study site: Endocrinology clinics, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
  2. 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
  3. Prevalence and risk factors of microalbuminuria in type 2 diabetes mellitus outpatients at University Sains Malaysia Hospital
    Abougalambou SS, Abougalambou AS
    Diabetes Metab Syndr, 2013;7(2):64-7.
    PMID: 23680242 DOI: 10.1016/j.dsx.2013.02.034
    BACKGROUND AND OBJECTIVE: Microalbuminuria is early stage of diabetic nephropathy as well as a marker of cardiovascular disease. The objective of this study is to determine the prevalence of microalbuminuria and associated risk factors among type 2 diabetic outpatients, attending a diabetic clinic in University Sains Malaysia Hospital (HUSM).
    PATIENTS AND METHODS: Prospective study design was used in the data collection process. The study sample consists of 1066 type 2 diabetes mellitus outpatients who fit the inclusion criteria. All the patients were recruited from the diabetic outpatient clinics from HUSM. The study period was from January till December 2008. Microalbuminuria was diagnosed if the urinary albumin excretion more than 30 mg/g of creatinine.
    RESULTS: A total of 1661 patients were included in this study. Microalbuminuria was diagnosed in 273 (25.4%) patients. Multivariate logistic regression analysis indicated that microalbuminuria was positively associated with duration of hypertension (P=0.044), HbA1c (P=0.004), systolic blood pressure (<0.001), creatinine clearance (P=0.007) and the presence of neuropathy (P=0.004).
    CONCLUSION: High prevalence of microalbuminuria was in type 2 diabetic outpatients. Predictive factors for microalbuminuria were duration of hypertension, HbA1c, systolic blood pressure, creatinine clearance and the presence of neuropathy. The study suggests the need to screen for microalbuminuria early and the active management of modifiable risk factors in particular, hyperglycemia, hypertension and creatinine clearance, to reduce the burden of end-stage renal disease in the future.

    Study site: diabetic outpatient clinics from HUSM
  4. A study evaluating prevalence of hypertension and risk factors affecting on blood pressure control among type 2 diabetes patients attending teaching hospital in Malaysia
    Abougalambou SS, Abougalambou AS
    Diabetes Metab Syndr, 2013 Apr-Jun;7(2):83-6.
    PMID: 23680246 DOI: 10.1016/j.dsx.2013.02.019
    INTRODUCTION: Hypertension is extremely common disease found in patients with diabetes mellitus. Eighty to 90% of patients with type 2 diabetes mellitus will develop hypertension, and about 20% of hypertensive patients develop diabetes. The aim of this study was designed to assess the prevalence of hypertension and factors affecting the control of hypertension among type 2 diabetic patients.
    MATERIALS AND METHODS: A total of 1077 type 2 diabetes mellitus patients were included in this study who attended at diabetes clinic of Universiti Sains Malaysia (USM) teaching hospital in Kelantan. All these patients were prospectively followed from January to December 2008. Logistic regression analysis was used to assess the independent effect of variables on hypertension.
    RESULTS: The prevalence of hypertension (BP>130/80 or on medication for high blood pressure) was 92.7%. A total 471 (47.2%) patients had achieved blood pressure targets ≤ 130/80 mmHg. The logistic regression indicated that hypertension was positively associated with age (P=0.040), BMI (P=0.027), HbA1c (P=0.046), and level of education (P=0.039).
    CONCLUSION: Hypertension is a common co-morbidity among diabetic patients. Hypertension was not controlled to the recommended levels of blood pressure in about one-half (52.8%) of diabetes patients. Age, BMI, HbA1c and level of education are factors affecting on hypertension.
  5. Prevalence of hypertension, control of blood pressure and treatment in hypertensive with type 2 diabetes in Hospital University Sains Malaysia
    Abougalambou SS, Abougalambou AS, Sulaiman SA, Hassali MA
    Diabetes Metab Syndr, 2011 Jul-Sep;5(3):115-9.
    PMID: 22813562 DOI: 10.1016/j.dsx.2012.03.001
    AIMS: To determine the prevalence of hypertension, control of hypertension and patterns of antihypertensive medications in Malaysian type 2 diabetic patients who attended diabetes clinics in Hospital University Sains Malaysia (Tertiary Hospital).
    MATERIALS AND METHODS: The study design was observational prospective longitudinal follow-up study; the study was conducted with sample of 1077 type 2 diabetes mellitus outpatient recruited whom attended the diabetes clinics at Hospital Universiti Sains Malaysia (HUSM) in Kelantan. The study period was from January till December 2008. Blood pressure was defined as >130/80 or use of antihypertension medications. Demographic characteristics of patients, level of blood pressure control, use of antihypertensive medications and patterns of antihypertensive therapy.
    RESULTS: The prevalence of hypertension in Malaysian type 2 diabetic patients was 998 (92.7%),antihypertensive drugs were prescribed in 940 (94.2%) of hypertensive patients with type 2 diabetic mellitus. The achievement of blood pressure control (≤130/80 mmHg) was 471 (47.2%) %. The percentage of patients receiving one, two, three, and four drugs were 253 (25.3%), 311 (31.3%), 179 (17.9%), and 197 (19.7%) respectively. Calcium channel blockers were the most commonly prescribed antihypertensive agents 757 (75.7%) followed by Angiotensin-converting enzyme inhibitors 446 (44.6%), and Angiotensin receptor blockers 42.4 (42.4%).
    CONCLUSION: The prevalence of hypertension is high in Malaysian type 2 diabetic patients, hypertension was not controlled to the recommended levels of blood pressure in about one-half (52.8%) of diabetes patients. Calcium channel blockers were the most commonly prescribed antihypertensive agents. There is an urgent need to educate both patients and health care providers of importance of achieving target of treatment in order to reduce morbidity and mortality due to diabetes with hypertension.
  6. Explorative study on diabetes neuropathy among type II diabetic patients in Universiti Sains Malaysia Hospital
    Abougalambou SS, Abougalambou AS
    Diabetes Metab Syndr, 2012 Jul-Sep;6(3):167-72.
    PMID: 23158982 DOI: 10.1016/j.dsx.2012.09.002
    OBJECTIVE: The aim of this study was to determine risk factors and prevalence of diabetic neuropathy (DN) among type II diabetic patients in Malaysian hospital setting.
    SUBJECTS AND METHODS: a observational prospective longitudinal follow up study design was selected, total no of respondents were 1077 type 2 diabetes mellitus outpatients recruited via attended the diabetes clinics at Hospital Universiti Sains Malaysia (HUSM) in Kelantan. The diagnosis of neuropathy was confirmed by nerve conduction studies. Logistic regression analysis was used to assess the independent variables that affect the development of neuropathy.
    RESULTS: The prevalence of nephropathy is 54.3%. Longitudinal logistic regression identified four predictive variables on the development and progression of diabetic neuropathy that are: duration of diabetes, retinopathy, HbA1c at second visit, and creatinine clearance third visit.
    CONCLUSION: Findings of this study show high prevalence of diabetic neuropathy. HbA1c and creatinine clearance are two modifiable risk factors for the development of diabetic neuropathy.
    Study site: Diabetes clinics, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
  7. Serum osteocalcin in subjects with metabolic syndrome and central obesity
    Bador KM, Wee LD, Halim SA, Fadi MF, Santhiran P, Rosli NF, et al.
    Diabetes Metab Syndr, 2016 Jan-Mar;10(1 Suppl 1):S42-5.
    PMID: 26482049 DOI: 10.1016/j.dsx.2015.09.009
    AIMS: The aim of this study was to determine if osteocalcin is related to adiposity and hyperglycaemia in metabolic syndrome irrespective of the presence of diabetes mellitus.
    MATERIALS AND METHODS: This was a cross sectional study of 90 patients (59 men and 31 women) with metabolic syndrome as defined by the International Diabetes Federation criteria. Based on medical history 50 out of 90 patients had a diabetes. Anthropometric data were collected and blood taken for measurement of osteocalcin, fasting lipids, fasting glucose and insulin resistance (using homeostatic model assessment index, HOMA-IR).
    RESULTS: Osteocalcin correlated negatively with fasting glucose (r=-0.366, p<0.001) and HOMA-IR (r=-0.305, p<0.05) but not with waist circumference (r=0.079), body mass index (r=0.028), total cholesterol (r=0.061) or triglycerides (r=0.009). Diabetics had higher HOMA-IR (p<0.01) and lower osteocalcin levels (p<0.01) than non-diabetics. Among diabetics, osteocalcin correlated with glucose only (r=-0.341, p=0.015). In non-diabetics, osteocalcin correlated with HOMA-IR (r=-0.359, p=0.023) via insulin (r=-0.402, p=0.010). Patients with impaired fasting glucose levels (5.6-6.9mmol/L) had the same HOMA-IR as diabetics (p=0.076) but not low osteocalcin (p=0.025).
    CONCLUSIONS: In this cross-sectional study of subjects with metabolic syndrome and central obesity, low osteocalcin was associated with diabetes but not adiposity.
    KEYWORDS: Adiposity; Central obesity; Diabetes; Metabolic syndrome; Osteocalcin
  8. Patient satisfaction and medication adherence assessment amongst patients at the diabetes medication therapy adherence clinic
    Bakar ZA, Fahrni ML, Khan TM
    Diabetes Metab Syndr, 2016 Apr-Jun;10(2 Suppl 1):S139-43.
    PMID: 27055354 DOI: 10.1016/j.dsx.2016.03.015
    AIMS: To determine the satisfaction and current adherence status of patients with diabetes mellitus at the diabetes Medication Therapy Adherence Clinic and the relationship between patient satisfaction and adherence.
    METHODS: This cross-sectional descriptive study was carried out at three government hospitals in the state of Johor, Malaysia. Patient's satisfaction was measured using the Patient Satisfaction with Pharmaceutical Care Questionnaire; medication adherence was measured using the eight-item Morisky Medication Adherence Scale.
    RESULTS: Of n=165 patients, 87.0% of patients were satisfied with DMTAC service (score 60-100) with mean scores of 76.8. On the basis of MMAS, 29.1% had a medium rate and 26.1% had a high rate of adherence. Females are 3.02 times more satisfied with the pharmaceutical service compared to males (OR 3.03, 95% CI 1.12-8.24, p<0.05) and non-Malays are less satisfied with pharmaceutical care provided during DMTAC compared to Malays (OR 0.32, 95% CI 0.12-0.85, p<0.05). Older patients age group ≥60 years were 3.29 times more likely to adhere to their medications (OR 3.29, 95% CI 1.10-9.86, p<0.05). Females were the most adherent compared to males (OR 2.33, 95%CI 1.10-4.93, p<0.05) and patients with secondary level of education were 2.72 times more adherent to their medications compared to those in primary school and no formal education (OR 2.72, 95%CI 1.13-6.55, p<0.05). There is a significant (p<0.01), positive fair correlation (r=0.377) between satisfaction and adherence.
    CONCLUSION: Patients were highly satisfied with DMTAC service, while their adherence levels were low. There is an association between patient satisfaction and adherence.
    Keyword: Diabetes medication therapy adherence clinic (DMTAC)
    Study site: Medication Therapy Adherence Clinic, Pharmacy, Hospitals, Johor, Malaysia
  9. The discriminative ability of waist circumference, body mass index and waist-to-hip ratio in identifying metabolic syndrome: Variations by age, sex and race
    Kee CC, Mohd Ghazali S, Lim KH, Subenthiran S, Teh CH, Lim KK, et al.
    Diabetes Metab Syndr, 2015 Apr-Jun;9(2):74-8.
    PMID: 25819369 DOI: 10.1016/j.dsx.2015.02.006
    OBJECTIVES: Many studies have suggested that there is variation in the capabilities of BMI, WC and WHR in predicting cardiometabolic risk and that it might be confounded by gender, ethnicity and age group. The objective of this study is to examine the discriminative abilities of body mass index (BMI), waist circumference (WC) and waist-hip ratio (WHR) to predict two or more non-adipose components of the metabolic syndrome (high blood pressure, hypertriglyceridemia, low high density lipoprotein-cholesterol and high fasting plasma glucose) among the adult Malaysian population by gender, age group and ethnicity.
    METHODS: Data from 2572 respondents (1044 men and 1528 women) aged 25-64 years who participated in the Non Communicable Disease Surveillance 2005/2006, a population-based cross sectional study, were analysed. Participants' socio-demographic details, anthropometric indices (BMI, WC and WHR), blood pressure, fasting lipid profile and fasting glucose level were assessed. Receiver operating characteristics curves analysis was used to evaluate the ability of each anthropometric index to discriminate MetS cases from non-MetS cases based on the area under the curve.
    RESULTS: Overall, WC had better discriminative ability than WHR for women but did not perform significantly better than BMI in both sexes, whereas BMI was better than WHR in women only. Waist circumference was a better discriminator of MetS compared to WHR in Malay men and women. Waist circumference and BMI performed better than WHR in Chinese women, men aged 25-34 years and women aged 35-44 years.
    CONCLUSIONS: The discriminative ability of BMI and WC is better than WHR for predicting two or more non-adipose components of MetS. Therefore, either BMI or WC measurements are recommended in screening for metabolic syndrome in routine clinical practice in the effort to combat cardiovascular disease and type II diabetes mellitus.
    Copyright © 2015 Diabetes India. Published by Elsevier Ltd. All rights reserved.
    KEYWORDS: Adult; Body mass index; Metabolic syndrome; Waist circumference; Waist–hip ratio
    Study name: Malaysia Non-Communicable Disease Surveillance-1 (MyNCDS-1) survey
  10. Fulltext Letter to the Editor in response to the article: "Increase in the risk of type 2 diabetes during lockdown for the COVID19 pandemic in India: A cohort analysis" (Ghoshal et al.)
    Chand R, Asmil SH, Chico M
    Diabetes Metab Syndr, 2020 07 12;14(5):1305.
    PMID: 32755826 DOI: 10.1016/j.dsx.2020.06.057
  11. Evaluation of illness perceptions and their associations with glycaemic control, medication adherence and chronic kidney disease in type 2 diabetes mellitus patients in Malaysia
    Balasubramaniam S, Lim SL, Goh LH, Subramaniam S, Tangiisuran B
    Diabetes Metab Syndr, 2019 07 09;13(4):2585-2591.
    PMID: 31405680 DOI: 10.1016/j.dsx.2019.07.011
    BACKGROUND: Illness perceptions (IP) involve coping strategies and behavioural responses that can influence glycaemic control. Despite the importance of good glycaemic control, the majority of patients in Asia are not achieving glycaemic targets. An evaluation of IP in association with glycaemic control, medication adherence and chronic kidney disease (CKD) in Type 2 diabetes mellitus patients (T2DM) was carried out in an outpatient setting in Malaysia METHOD: A cross-sectional study was conducted using the Revised Illness Perception Questionnaire in a purposive sample of 384 T2DM patients.

    RESULTS: There were 55.7% females, median age was 58.2 years and median duration of diabetes was 13 years. The majority (79.4%) of patients had poor diabetes control (HbA1c ≥ 7.0%) and 39.6% of patients had low medication adherence. Patients with good glycaemic control had a higher Timeline Acute/Chronic and Emotional Representations score, hence they held the correct belief that diabetes is chronic and experienced negative emotions. Highly adherent patients had a higher Illness Coherence (χ2 = 21.385, p 

  12. Nutritional strategies in managing postmeal glucose for type 2 diabetes: A narrative review
    Ch'ng LZ, Barakatun-Nisak MY, Wan Zukiman WZH, Abas F, Wahab NA
    Diabetes Metab Syndr, 2019 05 29;13(4):2339-2345.
    PMID: 31405640 DOI: 10.1016/j.dsx.2019.05.026
    Medical Nutrition Therapy (MNT) plays an essential role in overall glycemic management. Less focus is given on managing postmeal hyperglycemia despite the facts that, it is a common feature of Type 2 Diabetes (T2D). The purpose of this narrative review is to provide a comprehensive understanding of the existing literature on the nutritional approaches to improve postmeal hyperglycemia in patients with T2D. We searched multiple databases for the studies examining the nutritional approaches to manage postmeal glucose in patients with T2D. We included studies that involve human trials that were published in English for the past 10 years. Our review of the current literature indicates that the postmeal hyperglycemia can be improved with four nutritional approaches. These approaches include (i) utilizing the appropriate amount and selecting the right type of carbohydrates, (ii) using specific types of dietary protein, (iii) manipulating the meal timing and orders and (iv) others (promoting postmeal physical activity, incorporating diabetes-specific formula and certain functional foods). The potential mechanisms underlying these approaches are discussed and the identified gaps warranted further research. This array of nutritional strategies provide a set of options for healthcare professionals to facilitate patients with T2D in achieving the optimal level of postmeal glucose.
  13. School education and childhood obesity: A systemic review
    Nga VT, Dung VNT, Chu DT, Tien NLB, Van Thanh V, Ngoc VTN, et al.
    Diabetes Metab Syndr, 2019 07 08;13(4):2495-2501.
    PMID: 31405667 DOI: 10.1016/j.dsx.2019.07.014
    Childhood obesity prevalence is shooting up at a phenomenal rate worldwide, leading to long-term devastating consequences. A great number of studies have investigated factors contributing to the increase in BMI of children and adolescents. School-based, home-based and clinic-based solutions have been suggested as possible viable strategies, among which school-based interventions is believed to produce a noticeable effect on a massive scale. However, the question of whether school interventions, especially school education exert significant impact on childhood obesity or not, is left with mixing results. This article aims to holistically review the relationship between school education and childhood obesity. Various factors are covered, including health education, nutrition education, school nutrition, physical education, teachers' awareness, teaching practice and school stress, In all, school education is not the answer to childhood obesity but just part of it. More attempts from other stakeholders (parents, community, policy makers, researchers, etc.) should be made in order to solve this complicated puzzle.
  14. The statins effects on HbA1c control among diabetic patients: An umbrella review of systematic reviews and meta-analyses of observational studies and clinical trials
    Hammad MA, Abdo MS, Mashaly AM, Syed Sulaiman SA, Alghamdi S, Mangi AA, et al.
    Diabetes Metab Syndr, 2019 07 08;13(4):2557-2564.
    PMID: 31405676 DOI: 10.1016/j.dsx.2019.07.005
    Statins have impacts on the metabolism of glucose that might influence the progress of diabetes in non-diabetics or affect glycemic control in patients with existing diabetes. Experimental proof has been contradictory about whether some statins display beneficial properties while others indicate harmful impressions. Some systematic reviews of statins had stated conflicting findings on the concern of glucose metabolism. The current study investigates the published systematic reviews and meta-analyses to combine their results and give a clear situation regarding the influence of statins therapy on glycated hemoglobin (HbA1c). This study has valuable strength points; long follow-up period and big sample size.
  15. Dairy intake and type 2 diabetes risk factors: A narrative review
    Mitri J, Mohd Yusof BN, Maryniuk M, Schrager C, Hamdy O, Salsberg V
    Diabetes Metab Syndr, 2019 08 01;13(5):2879-2887.
    PMID: 31425952 DOI: 10.1016/j.dsx.2019.07.064
    AIM: The interest regarding the potential role of dairy products in the prevention of type 2 diabetes (T2D) has emerged. Although results remain mixed, numerous cohort studies have shown that increased dairy consumption is inversely associated with T2D risk. This narrative review evaluates the recent evidence of dairy products intake on T2D risk factors for the prevention of T2D.

    MATERIAL AND METHOD: The review is framed within the systematic review and meta-analyses of cohort studies and the individual randomized controlled trials evidence. We searched for existing meta-analyses of cohort studies that addressed the association of dairy intake with incidence of T2D in adults using the MEDLINE (via PubMed) database. For the interventional studies, the literature searched was conducted using MEDLINE (via PubMed) with the following Medical Subjects Heading (MeSH) terms i.e. dairy OR milk OR cheese OR yogurt AND glucose OR diabetes OR insulin resistance OR insulin sensitivity OR pre-diabetes.

    RESULTS: Most of the meta-analyses and systematic reviews of the cohort studies point to a reduced risk of T2D with dairy intake of 3 servings per day. This effect was mainly attributed to low-fat dairy, particularly yogurt and cheese. However, there is no evidence in cohort studies that high-fat dairy intake poses any harm.

    CONCLUSION: Dairy products, when incorporated into a healthy diet, likely do not have detrimental effects on glucose-related outcomes. The potential impact of dairy consumption on glucose tolerance tests, insulin levels, insulin sensitivity measures, and plasma glucose levels warrant future investigation.

  16. The effects of green tea on lipid metabolism and its potential applications for obesity and related metabolic disorders - An existing update
    Dinh TC, Thi Phuong TN, Minh LB, Minh Thuc VT, Bac ND, Van Tien N, et al.
    Diabetes Metab Syndr, 2019 03 15;13(2):1667-1673.
    PMID: 31336539 DOI: 10.1016/j.dsx.2019.03.021
    Obesity is one of the top global issues, which induces several serious health consequences both physically and mentally, such as type 2 diabetes, cardiovascular diseases, dyslipidemia, eating disorders, depression and stress. However, the effective therapy to prevent and treat obesity and overweight, up to now, cannot be found nowadays. Several methods/medicines namely diet control, energy balance, environmental changes, genetic and stem cell therapies, new drugs/chemicals have been extensively studied to enhance the ability to control bodyweight and prevent obesity. Of all the aforementioned methods, green tea, used as a daily beverage, has shown beneficial impacts for the health, especially its anti-obesity effects. Available evidence shows that green tea can interrupt lipid emulsification, reduce adipocyte differentiation, increase thermogenesis, and reduce food intake, thus green tea improves the systemic metabolism and decreases fat mass. Here, we highlight and sum up the update investigations of anti-obesity effect of green tea as well as discuss the potential application of them for preventing obesity and its related metabolic disorders.
  17. The effects of glycemic control on morbidity and survival among diabetic patients
    Hammad MA, Syed Sulaiman SA, Abubakar U, Mohamed Noor DA
    Diabetes Metab Syndr, 2019 01 16;13(2):1035-1040.
    PMID: 31336440 DOI: 10.1016/j.dsx.2019.01.001
    AIMS: The study intended to investigate the impact of controlled glycemia on morbidity and estimated 10-year survival (ES-10Y).

    METHODS: A cross-sectional investigation was conducted at General Penang Hospital, Malaysia. Demographic criteria and laboratory tests of patients were investigated. Controlled glycemia (CG) was recognized as glycated hemoglobin (HbA1c) ≤7% depending on American Diabetes Association guidelines 2018. Charlson Comorbidity Index (CCI) was used to estimate the confounding influence of co-morbidities and predict ES-10Y. Data was managed by IBM-SPSS 23.0.

    RESULTS: A total of 400 cases categorized to (44.25%) patients with CG, and (55.75%) cases had uncontrolled glycemia (UCG). HbA1c mean in CG and UCG group was (6.8 ± 0.9 vs 9.5 ± 1.6, P-value: 0.001). Fasting blood glucose was (7 ± 2.3 vs. 9.9 ± 4.3, P-value: 0.001) in CG and UCG group. CCI was (3.38 ± 2.38 vs. 4.42 ± 2.70, P-value: 0.001) and, ES-10Y was (62% vs 46.2%, p-value: 0.001) in CG vs. UCG respectively. Spearman test indicates a negative correlation between CG and CCI (r: 0.19, p-value: 0.001). Logistic regression confirmed HbA1c as a significant predictor of CCI (r2: 0.036, P-value: 0.001). CG has a positive correlation with survival (r: 0.16, P-value: 0.001) and logistic regression of survival (r2: 0.26, P-value: 0.001).

    CONCLUSIONS: More than one-half of the investigated persons had UCG. Controlled HbA1c was associated with lower co-morbidities and higher ES-10Y.

  18. An assessment of self-care knowledge among patients with diabetes mellitus
    Alhaik S, Anshasi HA, Alkhawaldeh J, Soh KL, Naji AM
    Diabetes Metab Syndr, 2018 10 10;13(1):390-394.
    PMID: 30641730 DOI: 10.1016/j.dsx.2018.10.010
    PURPOSES: This study aimed to (1) assess the level of diabetes self-care knowledge among patients with diabetes mellitus and (2) examine the relationship between patients' diabetes self-care knowledge and their demographic and medical characteristics.

    METHODS: A cross-sectional design was used to implement the study. A convenience sample of 273 diabetic patients were recruited from five primary health-care centers in Amman- Jordan.

    RESULTS: The overall level of knowledge of diabetes self-care in the total sample was moderate (58.28% (SD = 18.24)). The highest level of knowledge was meal planning (70.2%) followed by monitoring, causes of diabetes, foot care, symptoms and complication, diabetic medication, and the lowest level was exercise (42.5%). Furthermore, knowledge of diabetes self-care was found to be associated with age, educational status, diabetic medications and years with diabetes.

    CONCLUSION: and Practice implications: The study findings emphasized that diabetic patients had a moderate level of knowledge and there were many of the learning needs for each area of knowledge. The health-care professional has an important role in developing the appropriate diabetes educational programs based on patients' learning needs and patients' characteristics. These programs that enhances knowledge on diabetes could be reduced or prevented diabetes-related complications.
  19. Type 1 and 2 diabetes mellitus: A review on current treatment approach and gene therapy as potential intervention
    Tan SY, Mei Wong JL, Sim YJ, Wong SS, Mohamed Elhassan SA, Tan SH, et al.
    Diabetes Metab Syndr, 2018 10 10;13(1):364-372.
    PMID: 30641727 DOI: 10.1016/j.dsx.2018.10.008
    Type 1 and type 2 diabetes mellitus is a serious and lifelong condition commonly characterised by abnormally elevated blood glucose levels due to a failure in insulin production or a decrease in insulin sensitivity and function. Over the years, prevalence of diabetes has increased globally and it is classified as one of the leading cause of high mortality and morbidity rate. Furthermore, diabetes confers a huge economic burden due to its management costs as well as its complications are skyrocketing. The conventional medications in diabetes treatment focusing on insulin secretion and insulin sensitisation cause unwanted side effects to patients and lead to incompliance as well as treatment failure. Besides insulin and oral hypoglycaemic agents, other treatments such as gene therapy and induced β-cells regeneration have not been widely introduced to manage diabetes. Therefore, this review aims to deliver an overview of the current conventional medications in diabetes, discovery of newer pharmacological drugs and gene therapy as a potential intervention of diabetes in the future.
  20. Diabetic nephropathy: An update on pathogenesis and drug development
    A/L B Vasanth Rao VR, Tan SH, Candasamy M, Bhattamisra SK
    Diabetes Metab Syndr, 2018 11 30;13(1):754-762.
    PMID: 30641802 DOI: 10.1016/j.dsx.2018.11.054
    Diabetic nephropathy (DN) is a major cause of end-stage renal disease and affects a large number of individuals with diabetes. However, the development of specific treatments for DN has not yet been identified. Hence, this review is concisely designed to understand the molecular pathways leading to DN in order to develop suitable therapeutic strategies. Extensive literature search have been carried in regard with the pathogenesis and pathophysiology of DN, drug targets and updates on clinical trials, the consequences associated with DN and the potential biomarkers for diagnosis and prediction of DN are discussed in this review. DN is characterised by microalbuminuria and macroalbuminuria, and morphological changes such as glomerular thickening, interstitial fibrosis, formation of nodular glomerulosclerosis and decreased endothelial cell fenestration. Besides, the involvement of renin-angiotensin-aldosterone system, inflammation and genetic factors are the key pathways in the progression of DN. In regard with drug development drugs targeted to epidermal growth factor, inflammatory cytokines, ACTH receptor and TGFβ1 receptors are in pipeline for clinical trials whereas, several drugs have also failed in phase III and phase IV of clinical trials due to lack of efficacy and severe adverse effect. The research on DN is limited with respect to its pathogenesis and drug development. Thus, a more detailed understanding of the pathogenesis of DN is very essential to progress in the drug development process.
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