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Fulltext Diabetes epidemic in Malaysia

Mustaffa BE

Med J Malaysia, 2004 Aug;59(3):295-6.
PMID: 15727372 MyJurnal
Matched MeSH terms: Diabetes Mellitus/therapy*
Telemedicine Cost-Effectiveness for Diabetes Management: A Systematic Review

Lee JY, Lee SWH

Diabetes Technol Ther, 2018 Jul;20(7):492-500.
PMID: 29812965 DOI: 10.1089/dia.2018.0098

BACKGROUND: Telemedicine has been utilized increasingly worldwide for diabetes management, due to its potential to improve healthcare access and clinical outcomes. Few studies have assessed the economic benefits of telemedicine, which may contribute to underfunding in potentially important programs. We aim to systematically review the literature on economic evaluations of telemedicine in diabetes care, assess the quality, and summarize the evidence on driver of cost-effectiveness.
MATERIALS AND METHODS: A literature search was performed in 10 databases from inception until February 2018. All economic evaluations assessing the economic evaluation of telemedicine in diabetes were eligible for inclusion. We subsequently evaluated the study quality in terms of effectiveness measures, cost measure, economic model, as well as time horizon.
RESULTS: Of the 1877 studies identified, 14 articles were included in our final review. The healthcare providers' fees are a major predictor for total cost. In particular, the use of telemedicine for retinal screening was beneficial and cost-effective for diabetes management, with an incremental cost-effectiveness ratio between $113.48/quality-adjusted life year (QALY) and $3,328.46/QALY (adjusted to 2017 inflation rate). Similarly, the use of telemonitoring and telephone reminders was cost-effective in diabetes management.
CONCLUSIONS: Among all telemedicine strategies examined, teleophthalmology was the most cost-effective intervention. Future research is needed to provide evidence on the long-term experience of telemedicine and facilitate resource allocation.

Matched MeSH terms: Diabetes Mellitus/therapy
Fulltext Beliefs and practices of Chinese diabetic patients concerning the cause and treatment of their ill-health

Soong FS

Singapore Med J, 1971 Dec;12(6):309-13.
PMID: 5141587

Information on the beliefs and practices of 50 Chinese diabetic patients concerning the cause and treatment of their ill-health were collected by the interview method with the aid of a questiOnnaire which has been protested. it was found that 34 of the patients were using “Chinese” medicines, in addition to Western-style treatment. Only two of the patients knew the true cause of diabetes. 37 of the patients understood that treatment cannot effect a radical cure. The beliefs and practices of the diabetic patients were inﬂuenced by two main sources of information, the pattern of traditional Chinese beliefs and Western medicine. The implications of the study in community health education on diabetes and education of the diabetic patient were discussed.

Matched MeSH terms: Diabetes Mellitus/therapy*
Fulltext The status of diabetes control in Malaysia: results of DiabCare 2008

Mafauzy M, Hussein Z, Chan SP

Med J Malaysia, 2011 Aug;66(3):175-81.
PMID: 22111435 MyJurnal

DiabCare Malaysia 2008 evaluated the current status of diabetes care in Malaysia as a continuation of similar cross-sectional studies conducted previously in 1997, 1998, 2001 and 2003. The current study recruited 1670 patients from general hospitals, diabetes clinics and referral clinics to study current scenario of diabetes management. We report the results of type 2 diabetic population who constituted 92.8% (n = 1549). Results showed deteriorating glycaemic control with mean HbA1c of 8.66 +/- 2.09% with only 22% of the patients achieving ADA target of < 7%. 80.3% of patients were hypertensive and 75% were on anti-hypertensive medication. 46% of patients had LDL levels > 2.6 mmol/L; 19.8% had triglycerides > 2.2 mmol/L; 27.4% had HDL < 1 mmol/L despite 85% of the patients being on lipid lowering agents. Microvascular, macrovascular and severe late complications were reported in 75%, 28.9% and 25.4% patients respectively. The rates of diabetic complications were cataract 27.2%, microalbuminuria 7%, neuropathy symptoms 45.9%, leg amputation 3.8% and history of angina pectoris was 18.4%. Quality of life evaluation showed that about one third of patients have poor quality of life. Also, there was poor adherence to diet, exercise and self testing of blood glucose. In conclusion, majority of the patients were still not satisfactorily controlled. There is an urgent need for effective remedial measures to increase adherence to practice guidelines and to educate both patients and healthcare personnel on importance of achieving clinical targets for metabolic control.

Matched MeSH terms: Diabetes Mellitus/therapy*
Fulltext Audit of diabetes mellitus in general practice

Lee TW, Chan SC, Chua WT, Harbinder K, Khoo YL, Ow Yeang YL, et al.

Med J Malaysia, 2004 Aug;59(3):317-22.
PMID: 15727376 MyJurnal

An audit on diabetic management was done in seven Perak general practice (GP) clinics in December 2001. The results showed inadequacies in nine out of eleven criteria assessed. Remedial measures were implemented. A second audit in March 2003, at the completion of the audit cycle, showed improvements in all the criteria used. All clinics established a diabetic register compared to 28.6% in the first audit and 57.1% of the clinics set up a reminder mechanism compared to 0% in the first audit. In the process of care, recording of weight, height, blood pressure; feet examination, fundoscopy, blood sugar monitoring and urine for albumin improved at the end of the audit cycle. In the only outcome criteria, the blood sugar control improved from 21.8% to 31.3%.

Matched MeSH terms: Diabetes Mellitus/therapy*
Fulltext Audit of diabetes in Perak outpatient departments

Chan SC, Tan OH, Tee AS

Med J Malaysia, 1997 Dec;52(4):382-9.
PMID: 10968115

Adequacy of diabetic management in 5 Perak outpatient departments was studied in April 1996. Two hundred diabetic patients' records were analysed. All doctors and 100 patients answered questionnaires on diabetes. Fifty five percent of doctors had adequate knowledge. Patients' knowledge varied between centres (13% to 80% adequacy). Most records had insufficient data to determine adequacy of early detection. Centres with screeners had adequate weight and blood pressure measurement. Overall control and monitoring of diabetes were inadequate. Referral of complications were delayed in 2 centres. Refresher courses for doctors, patient health education, protocols, screeners and physician visits are recommended.
Study site: Klinik kesihatan, outpatient clinics, hospitals, Perak, Malaysia

Matched MeSH terms: Diabetes Mellitus/therapy*
Fulltext Diabetes care: is it adequate?--An audit of diabetes care in a hospital

Lim TO

Med J Malaysia, 1990 Mar;45(1):18-22.
PMID: 2152064

An audit of diabetes care was done in a hospital to assess its effectiveness. The results revealed that diabetic patients received less than adequate care. Only 9% of the patients achieved good glycaemic control; 39% had hypertriglyceridemia and 65% had undesirable weight gain while on treatment. The average duration of diabetes in this group of young diabetic patients under study was only 4.5 years, yet 12% of them had evidence of diabetic retinopathy. Few patients possessed adequate knowledge and skills of diabetes self-care. No patients could draw up and mix insulin adequately. Only one patient could self-inject insulin correctly. Few understood the nature of hypoglycaemia, hence few took adequate precaution against it. Patients had frequent hypoglycaemia; 61% had at least one episode per week and 56% of the diabetic drivers admitted to occurrence of hypoglycaemia while driving. No patient understood the principle of diabetic diet therapy, nor did they carry out regular home-monitoring of their diabetes. Good diabetes care requires organisation with supportive patient education. The less than adequate standard of care achieved by the hospital under study is probably explained by the absence of both.
Study site: Outpatient clinic, Hospital Mentakab, Pahang, Malaysia

Matched MeSH terms: Diabetes Mellitus/therapy*
Fulltext Caring for patients with diabetes during COVID-19 pandemic: Important considerations for pharmacists

Elnaem MH, Cheema E

Res Social Adm Pharm, 2021 01;17(1):1938-1941.
PMID: 32507575 DOI: 10.1016/j.sapharm.2020.05.030

The current pandemic of the COVID-19 infection, coupled with the increased global burden of diabetes, has imposed significant challenges to the healthcare providers in providing effective and sustained care to patients with diabetes during the ongoing pandemic. It is, therefore, important for healthcare providers to understand and follow the recommended changes in the delivery of care, lifestyle modifications, and pharmacotherapy to ensure optimal care to the patients during and post-pandemic era. This commentary aims to discuss the impact of COVID-19 on diabetes care and the important considerations for pharmacists during this pandemic.

Matched MeSH terms: Diabetes Mellitus/therapy*
Fulltext Feasibility of implementing chronic care model in the Malaysian public primary care setting

Ariffin F, Ramli AS, Daud MH, Haniff J, Abdul-Razak S, Selvarajah S, et al.

Med J Malaysia, 2017 04;72(2):106-112.
PMID: 28473673 MyJurnal

INTRODUCTION: Non-communicable diseases (NCD) is a global health threat. the Chronic Care Model (CCM) was proven effective in improving NCD management and outcomes in developed countries. Evidence from developing countries including Malaysia is limited and feasibility of CCM implementation has not been assessed. this study intends to assess the feasibility of public primary health care clinics (PHC) in providing care according to the CCM.

METHODOLOGY: A cross-sectional survey was conducted to assess the public PHC ability to implement the components of CCM. All public PHC with Family Medicine Specialist in Selangor and Kuala Lumpur were invited to participate. A site feasibility questionnaire was distributed to collect site investigator and clinic information as well as delivery of care for diabetes and hypertension.

RESULTS: there were a total of 34 public PHC invited to participate with a response rate of 100%. there were 20 urban and 14 suburban clinics. the average number of patients seen per day ranged between 250-1000 patients. the clinic has a good mix of multidisciplinary team members. All clinics had a diabetic registry and 73.5% had a hypertensive registry. 23.5% had a dedicated diabetes and 26.5% had a dedicated hypertension clinic with most clinic implementing integrated care of acute and NCD cases.

DISCUSSION: the implementation of the essential components of CCM is feasible in public PHCs, despite various constraints. Although variations in delivery of care exists, majority of the clinics have adequate staff that were willing to be trained and are committed to improving patient care.

Matched MeSH terms: Diabetes Mellitus/therapy
Clinical trials among Arab diabetic patients; the challenges

Mikhael EM, Hassali MA, Hussain SA

Diabetes Metab Syndr, 2019 11 21;14(1):1.
PMID: 31805470 DOI: 10.1016/j.dsx.2019.11.011
Matched MeSH terms: Diabetes Mellitus/therapy*
Fulltext Acute myocardial infarction in young Asian women: a comparative study on Chinese, Malay and Indian ethnic groups

Xie CB, Chan MY, Teo SG, Low AF, Tan HC, Lee CH

Singapore Med J, 2011 Nov;52(11):835-9.
PMID: 22173254

There is a paucity of data on acute myocardial infarction (AMI) in young Asian women and of comparative data among various ethnic groups with respect to risk factor profile and clinical outcomes. We present a comprehensive overview of the clinical characteristics of young Asian women with AMI and a comparative analysis among Chinese, Malay and Indian women in a multi-ethnic Asian country.

Matched MeSH terms: Diabetes Mellitus/therapy
Exploring mHealth app utilization for diabetes self-management: survey insights from a northern district in Malaysia

Supramaniam P, Beh YS, Junus S, Devesahayam PR

BMC Public Health, 2024 Dec 19;24(1):3542.
PMID: 39702047 DOI: 10.1186/s12889-024-21056-w

BACKGROUND: Mobile health applications (mHealth apps) offer potential benefits for improving diabetes management, such as better glucose monitoring and patient engagement, but their widespread adoption faces challenges, including privacy concerns and user adherence. This research investigates mHealth app usage among patients living with diabetes in Kinta District, Perak, exploring experiences, challenges and patient perceptions regarding diabetes management using mHealth apps.
METHODOLOGY: A cross-sectional community survey was conducted in September till November 2020 across nine government health clinics focusing on diabetes mellitus (Type 1 or Type 2) patients, aged 18 years and older, receiving Diabetes Medication Adherence Counseling (DMTAC) services and able to use smart devices. A self-developed questionnaire with four sections was used to gather demographic information, explore mHealth apps usage and understand both users and non-users' experiences and perceptions. The questionnaire was tested through cognitive debriefing, translated into Malay, pre-tested and finalized by the expert committee. The questionnaire was digitally implemented using Google® Form and QR code. After obtaining informed consent, data collection was performed by the trained DMTAC pharmacists. Statistical analyses involved descriptive and inferential analyses.
RESULTS: The study analyzed the engagement of 295 patients living with diabetes with mHealth apps. Females (54.9%), of Malay ethnicity (58.3%) and with a mean age of 53.8 years (SD: 12.38) constituted the majority. Diabetes duration had a median of 6 years (IQR: 3.0, 10.0) with prevalent comorbidities like hypertension (58.0%) and dyslipidemia (42.7%). Most patients were employed (44.7%) and their primary source of diabetes management information was through healthcare providers (92.5%). Despite the high app use for social interaction, only 13.6% used mHealth apps for disease management. Users were influenced by social media (65.0%) and favored for wellness apps and disease monitoring. Users perceived the mHealth app as useful (97.5%), yet faced challenges over the app initiation, charges and data security. Non-users cited lack of awareness (70.2%), struggled with app startup (22.4%) and preference for conventional healthcare visits (22.0%). In multivariable analysis, longer diabetes duration reduced mHealth app usage (p = 0.046), while multimorbidity increased the likelihood (p = 0.001). Awareness of the availability of health apps significantly influenced the usage of mHealth apps (p

Matched MeSH terms: Diabetes Mellitus/therapy
Fulltext Diabetic retinopathy in native and non-native Sarawakians--findings from the Diabetic Eye Registry

Mallika PS, Aziz S, Goh PP, Lee PY, Cheah WL, Chong MS, et al.

Med J Malaysia, 2012 Aug;67(4):369-74.
PMID: 23082443

This study aims to determine the risk factors associated with diabetic retinopathy (DR) among natives and non-natives Sarawakians who were seen at 3 public hospitals and one health clinic in Sarawak. It is a cross sectional study where data on patients with DM were collected by staff at these healthcare facilities and entered into the web-based Diabetic Eye Registry. Univariate and multivariate analysis was used to determine the association factors for DR. DR was significantly less associated with natives (24.4%) compared to non-native Sarawakians (34.1%) (p < 0.001). The odds of getting DR was higher in patients whose duration of DM was more than 20 years (OR = 2.6), who have renal impairment (OR = 1.7) and non-natives (OR = 1.4).

Matched MeSH terms: Diabetes Mellitus/therapy
Scalable production of pancreatic islet progenitors for diabetes cell therapies

Lock LT, Tzanakakis ES

Med J Malaysia, 2008 Jul;63 Suppl A:5-6.
PMID: 19024957

Embryonic stem cells (ESCs) can be an inexhaustible source of islet cells for transplantation. Previously published protocols have been characterized by low differentiation efficiency. In this study, we developed a scalable system for the growth and differentiation of hESCs towards pancreatic islets. Our results showed that hESCs can be grown on microcarriers to a larger scale and directed to differentiate into pancreatic progenitor endoderm cells. This culture system would represent an economical differentiation protocol that can be scaled-up to meet the demand in islet transplantation.

Matched MeSH terms: Diabetes Mellitus/therapy*
Fulltext Blood glucose control and diabetic microangiopathy

Cheah JS

Med J Malaysia, 1981 Dec;36(4):220-6.
PMID: 7334957

There is overwhelming evidence that the microangiopathic complications (retinopathy, nephropathy and neuropathy) of diabetes can be minimised, prevented or improved by optimal blood glucose control. There is little evidence to show otherwise. This paper reviews evidences to demonstrate that poor diabetic control predisposes to diabetic microangiopathy. The only way to minimise diabetic microangiopathy is to avoid hyperglycaemia and achieve euglycaemia for most part of the day. In doing so the dangers of hypoglycaemia must be clearly recognized and avoided.

Matched MeSH terms: Diabetes Mellitus/therapy*
Fulltext Diabetes and Ramadan: Practical guidelines

Hassanein M, Al-Arouj M, Hamdy O, Bebakar WMW, Jabbar A, Al-Madani A, et al.

Diabetes Res Clin Pract, 2017 Apr;126:303-316.
PMID: 28347497 DOI: 10.1016/j.diabres.2017.03.003

Ramadan fasting is one of the five pillars of Islam and is compulsory for all healthy Muslims from puberty onwards. Exemptions exist for people with serious medical conditions, including many with diabetes, but a large number will participate, often against medical advice. Ensuring the optimal care of these patients during Ramadan is crucial. The International Diabetes Federation (IDF) and Diabetes and Ramadan (DAR) International Alliance have come together to deliver comprehensive guidelines on this subject. The key areas covered include epidemiology, the physiology of fasting, risk stratification, nutrition advice and medication adjustment. The IDF-DAR Practical Guidelines should enhance knowledge surrounding the issue of diabetes and Ramadan fasting, thereby empowering healthcare professionals to give the most up-to-date advice and the best possible support to their patients during Ramadan.

Matched MeSH terms: Diabetes Mellitus/therapy*
Fulltext The effects of self-efficacy enhancing program on foot self-care behaviour of older adults with diabetes: A randomised controlled trial in elderly care facility, Peninsular Malaysia

Ahmad Sharoni SK, Abdul Rahman H, Minhat HS, Shariff-Ghazali S, Azman Ong MH

PLoS One, 2018;13(3):e0192417.
PMID: 29534070 DOI: 10.1371/journal.pone.0192417

BACKGROUND: Self-care behaviour is essential in preventing diabetes foot problems. This study aimed to evaluate the effectiveness of health education programs based on the self-efficacy theory on foot self-care behaviour for older adults with diabetes.
METHODS: A randomised controlled trial was conducted for 12 weeks among older adults with diabetes in elderly care facility in Peninsular Malaysia. Six elderly care facility were randomly allocated by an independent person into two groups (intervention and control). The intervention group (three elderly care facility) received a health education program on foot self-care behaviour while the control group (three elderly care facility) received standard care. Participants were assessed at baseline, and at week-4 and week-12 follow-ups. The primary outcome was foot-self-care behaviour. Foot care self-efficacy (efficacy expectation), foot care outcome expectation, knowledge of foot care and quality of life were the secondary outcomes. Data were analysed with Mixed Design Analysis of Variance using the Statistical Package for the Social Sciences version 22.0.
RESULTS: 184 respondents were recruited but only 76 met the selection criteria and were included in the analysis. Foot self-care behaviour, foot care self-efficacy (efficacy expectation), foot care outcome expectation and knowledge of foot care improved in the intervention group compared to the control group (p < 0.05). However, some of these improvements did not significantly differ compared to the control group for QoL physical symptoms and QoL psychosocial functioning (p > 0.05).
CONCLUSION: The self-efficacy enhancing program improved foot self-care behaviour with respect to the delivered program. It is expected that in the future, the self-efficacy theory can be incorporated into diabetes education to enhance foot self-care behaviour for elderly with diabetes living in other institutional care facilities.
TRIAL REGISTRATION: Australian New Zealand Clinical Trial Registry ACTRN12616000210471.

Matched MeSH terms: Diabetes Mellitus/therapy*
Quality of diabetes care in low- and middle-income Asian and Middle Eastern countries (1993-2012): 20-year systematic review

Shivashankar R, Kirk K, Kim WC, Rouse C, Tandon N, Narayan KM, et al.

Diabetes Res Clin Pract, 2015 Feb;107(2):203-23.
PMID: 25529849 DOI: 10.1016/j.diabres.2014.11.004

To assess the extent to which people with diabetes in low- and middle-income countries (LMIC) of Asia and the Middle East met evidence-based care recommendations through a systematic review of published literature.

Matched MeSH terms: Diabetes Mellitus/therapy*
The results of a worksite health promotion programme in Kuala Lumpur, Malaysia

Moy F, Sallam AA, Wong M

Health Promot Int, 2006 Dec;21(4):301-10.
PMID: 16963785

The worksite is one of the key channels for the delivery of interventions to reduce chronic diseases among adult populations. It provides easy and regular access to a relatively stable population and it encourages sustained peer support. This paper reports a 2-year follow-up of the impact of a worksite health promotion programme on serum cholesterol and dietary changes among employees in a city in Malaysia. A quasi-experimental study was conducted among Malay-Muslim male security guards, with those working in a public university in Kuala Lumpur comprising the intervention group, and those working in the teaching hospital of the same university as the comparison group. They were comparable in socio-demographic characteristics. The intervention group received intensive individual and group counselling on diet, physical activity and quitting smoking. The comparison group was given minimal education on the same lifestyle changes through mail and group counselling. The intervention group showed a statistically significant reduction in their mean total cholesterol levels as compared with the comparison group, with an intervention effect of -0.38 (95% CI = -0.63, -0.14) mmol/l. The intervention group also reported a reduction in the amount of cigarettes smoked. The worksite was shown to be an effective channel for health promotion. The adoption of the new lifestyle behaviours should be supported and sustained through modification of work policies.

Matched MeSH terms: Diabetes Mellitus/therapy
Advances in the Generation of Functional β-cells from Induced Pluripotent Stem Cells As a Cure for Diabetes Mellitus

Kalra K, Chandrabose ST, Ramasamy TS, Kasim NHBA

Curr Drug Targets, 2018;19(13):1463-1477.
PMID: 29874998 DOI: 10.2174/1389450119666180605112917

Diabetes mellitus is one of the leading causes of death worldwide. Loss and functional failure of pancreatic β-cells, the parenchyma cells in the islets of Langerhans, progress diabetes mellitus. The increasing incidence of this metabolic disorder necessitates efficient strategies to produce functional β-cells for treating diabetes mellitus. Human induced Pluripotent Stem Cells (hiPSC), hold potential for treating diabetes ownig to their self-renewal capacity and the ability to differentiate into β- cells. iPSC technology also provides unlimited starting material to generate differentiated cells for regenerative applications. Progress has also been made in establishing in-vitro culture protocols to yield definitive endoderm, pancreatic endoderm progenitor cells and β-cells via different reprogramming strategies and growth factor supplementation. However, these generated β-cells are still immature, lack functional characteristics and exhibit lower capability in reversing the diseases conditions. Current methods employed to generate mature and functional β-cells include; use of small and large molecules to enhance the reprogramming and differentiation efficiency, 3D culture systems to improve the functional properties and heterogeneity of differentiated cells. This review details recent advancements in the generation of mature β-cells by reprogramming stem cells into iPSCs that are further programmed to β-cells. It also provides deeper insight into current reprogramming protocols and their efficacy, focusing on the underlying mechanism of chemical-based approach to generate iPSCs. Furthermore, we have highlighted the recent differentiation strategies both in-vitro and in-vivo to date and the future prospects in the generation of mature β-cells.

Matched MeSH terms: Diabetes Mellitus/therapy*

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