Displaying publications 1 - 20 of 80 in total

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  1. Biochemical evaluation of an infant with hypoglycemia resulting from a novel de novo mutation of the GLUD1 gene and hyperinsulinism-hyperammonemia syndrome
    Balasubramaniam S, Kapoor R, Yeow JH, Lim PG, Flanagan S, Ellard S, et al.
    J Pediatr Endocrinol Metab, 2011;24(7-8):573-7.
    PMID: 21932603
    Hyperinsulinism-hyperammonemia syndrome (HI/HA) (OMIM 606762), the second most common form of congenital hyperinsulinism (CHI) is associated with activating missense mutations in the GLUD1 gene, which encodes the mitochondrial matrix enzyme, glutamate dehydrogenase (GDH). Patients present with recurrent symptomatic postprandial hypoglycemia following protein-rich meals (leucine-sensitive hypoglycemia) as well as fasting hypoglycemia accompanied by asymptomatic elevations of plasma ammonia. In contrast to other forms of CHI, the phenotype is reported to be milder thus escaping recognition for the first few months of life. Early diagnosis and appropriate management are essential to avoid the neurodevelopmental consequences including epilepsy and learning disabilities which are prevalent in this disorder. We report an infant presenting with afebrile seizures secondary to hyperinsulinemic hypoglycemia resulting from a novel de novo mutation of the GLUD1 gene.
    Matched MeSH terms: Hypoglycemia/blood; Hypoglycemia/diagnosis; Hypoglycemia/genetics*; Hypoglycemia/physiopathology
  2. Dissociative episode secondary to hypoglycemic state in anorexia nervosa: a case report
    Ramli M, Hassan AS, Rosnani S
    Int J Eat Disord, 2009 Apr;42(3):290-2.
    PMID: 19016482 DOI: 10.1002/eat.20596
    Hypoglycemic attack had been reported as one of the medical complications in anorexia nervosa.
    Matched MeSH terms: Hypoglycemia/complications*; Hypoglycemia/etiology*
  3. Role of probiotics in modulating glucose homeostasis: evidence from animal and human studies
    Firouzi S, Barakatun-Nisak MY, Ismail A, Majid HA, Nor Azmi K
    Int J Food Sci Nutr, 2013 Sep;64(6):780-6.
    PMID: 23484591 DOI: 10.3109/09637486.2013.775227
    Evidences from several studies suggest that probiotics affect glucose homeostasis. This paper reviews the results of animal and human studies on the role of probiotics in modulating glucose homeostasis.
    Matched MeSH terms: Hypoglycemia/immunology; Hypoglycemia/microbiology; Hypoglycemia/prevention & control*
  4. Hypoglycemia in Type 2 Diabetes Mellitus patients: A review article
    Tourkmani AM, Alharbi TJ, Rsheed AMB, AlRasheed AN, AlBattal SM, Abdelhay O, et al.
    Diabetes Metab Syndr, 2018 Sep;12(5):791-794.
    PMID: 29678605 DOI: 10.1016/j.dsx.2018.04.004
    Hypoglycemia is an essential issue for diabetic patients and considered a limiting factor in the glycemic management. Heterogeneity of the diseases in Type 2 Diabetes Mellitus can affect the frequency of hypoglycemia, especially when the patient has cardiovascular diseases. There are several factors that lead to hypoglycemia including sulfonylurea therapy, insulin therapy, delaying or missing a meal, physical exercise, or alcohol consumption. Long-term studies reported that repeated hypoglycemia could increase the risk of cardiovascular diseases. During Ramadan fasting, diabetic patients have high incidence of hypoglycemia. Therefore, focused education about hypoglycemia in routine life of diabetic patients and during fasting in Ramadan is important to reduce the complications.
    Matched MeSH terms: Hypoglycemia/blood*; Hypoglycemia/diagnosis; Hypoglycemia/epidemiology*
  5. Fulltext A prospective cohort study on the effect of various risk factors on hypoglycaemia in diabetics who fast during Ramadan
    Loke SC, Rahim KF, Kanesvaran R, Wong TW
    Med J Malaysia, 2010 Mar;65(1):3-6.
    PMID: 21265238 MyJurnal
    Muslim diabetics who fast during Ramadan are at risk of hypoglycaemia, and previous consensus guidelines have highlighted certain risk factors. This prospective cohort study aims to determine the relative risk (RR) of hypoglycaemia during Ramadan fasting compared with a non-fasting period of equivalent length, and to ascertain which risk factors are clinically significant. From the results, Ramadan fasting carries a RR of hypoglycaemia of 1.60 (95% CI 1.05 to 2.43). Good metabolic control (HbAlc < 8%) and old age (> 60 years) increased RR more than twice, while taking breakfast prior to fasting reduces RR to less than half.
    Matched MeSH terms: Hypoglycemia/etiology*
  6. Quantifying health-related quality of life in Malaysian type 2 diabetes: focusing on complication types and severity
    Tan MHP, Ong SC, Vasan Thakumar A, Mustafa N
    Qual Life Res, 2023 Jul;32(7):1925-1941.
    PMID: 36781810 DOI: 10.1007/s11136-023-03360-x
    PURPOSE: There is a knowledge gap of health utility values for Type 2 Diabetes Mellitus (T2DM) complications in Malaysia. This study aimed to estimate EQ-5D-5L utility values and evaluate health-related quality of life (HRQoL) for Malaysian T2DM associated with complications and clinical characteristics.

    METHODS: A cross-sectional study was conducted on T2DM patients at a tertiary hospital outpatient using the Malay and English version of the EQ-5D-5L questionnaire. Health utility values were derived using the Malaysian EQ-5D-5L value set. Ordinary least squares (OLS) multivariable regression model was used to estimate the health utility decrements associated with T2DM-related complications and clinical characteristics.

    RESULTS: A total of 513 T2DM patients were recruited. Overall, pain was the most affected of all five EQ-5D-5L dimensions. Patients with foot ulcer, amputation, severe heart failure and frequent hypoglycemia reported more problems collectively in all EQ-5D-5L dimensions. Older age, lower education level, longer duration of T2DM, urine protein creatine index (UPCI) > 0.02 g/mmol, and injection therapy were significantly associated with lower EQ-5D-5L utility values (p hypoglycemia 0.74 (0.22) and being amputated 0.78 (0.47). In the multivariable regression model after controlling for sociodemographic and clinical characteristics, the largest utility value decrement was observed for amputation (- 0.158, SE 0.087, p = 0.05), frequent hypoglycemia (- 0.101, SE 0.030, p = 0.001), myocardial infarction (-0.050, SE 0.022, p = 0.022) and obesity (-0.034, SE 0.016, p = 0.029).

    CONCLUSION: Larger utility value decrements were found for severe stages of complications. These findings suggest the value of defining severity of complications in utility elicitation studies. The utility decrement quantified for different T2DM complication severity will be useful for economic evaluations within diabetic-related fields.

    Matched MeSH terms: Hypoglycemia*
  7. Hypoglycemic symptoms in patients with type 2 diabetes in Asia-Pacific-Real-life effectiveness and care patterns of diabetes management: the RECAP-DM study
    Chan SP, Ji LN, Nitiyanant W, Baik SH, Sheu WH
    Diabetes Res Clin Pract, 2010 Aug;89(2):e30-2.
    PMID: 20541826 DOI: 10.1016/j.diabres.2010.05.008
    Symptoms of hypoglycemia were reported by 35.8% of patients with type 2 diabetes treated with oral antihyperglycemic agents in the Asia-Pacific region. Symptoms were severe in 11.6% and very severe in 8.2% of patients experiencing hypoglycemia.
    Matched MeSH terms: Hypoglycemia/blood*; Hypoglycemia/metabolism; Hypoglycemia/physiopathology
  8. Fulltext Insulinoma aggravating or masquerading as late-onset schizophrenia?
    Chien, K.Y.
    Malaysian Journal of Psychiatry, 2013;22(2):72-75.
    MyJurnal
    A 76 year-old lady with late-onset schizophrenia was admitted with hypoglycaemia. She was later found to have a pancreatic tail insulinoma, confirmed biochemically and radiologically. She is treated medically with Diazoxide while awating laparascopic enucleation of the pancreatic tumour. The question remains if neuroglycopenia aggravates co-existing schizophrenia or if insulinoma-induced neuroglycopenia had been misdiagnosed as schizophrenia.
    Matched MeSH terms: Hypoglycemia
  9. Fulltext Economic burden of hypoglycemia for type II diabetes mellitus patients in Malaysia
    Aljunid SM, Aung YN, Ismail A, Abdul Rashid SAZ, Nur AM, Cheah J, et al.
    PLoS One, 2019;14(10):e0211248.
    PMID: 31652253 DOI: 10.1371/journal.pone.0211248
    This study mainly aims to identify the direct cost and economic burden of hypoglycemia for patients with type II diabetes mellitus in Malaysia. A cross-sectional study explored the cost incurred for hypoglycemia among patients admitted to University Kebangsaan Malaysia Medical Centre (UKMMC). The study covered patients aged 20-79 years hospitalized with a primary diagnosis of ICD-10 hypoglycemia and discharged between January 2010 and September 2015 according to the casemix database. A costing analysis was done through a step-down approach from the perspective of health providers. Cost data were collected for three levels of cost centers with the help of a hospital-costing template. The costing data from UKMMC were used to estimate the national burden of hypoglycemia among type II diabetics for the whole country. Of 244 diabetes patients admitted primarily for hypoglycemia to UKMMC, 52% were female and 88% were over 50 years old. The cost increased with severity. Managing a hypoglycemic case requires five days (median) of inpatient stay on average, with a range of 2-26 days, and costs RM 8,949 (USD 2,289). Of the total cost, 30% related to ward (final cost center), 16% to ICU, and 15% to pharmacy (secondary-level cost center) services. Considering that 3.2% of all admissions were hypoglycemia related, the total annual cost of hypoglycemia care for adult diabetics in Malaysia is estimated at RM 117.4 (USD 30.0) million, which translates to 0.5% of the Ministry of Health budget. Hypoglycemia imposes a substantial economic impact even without the direct and indirect cost incurred by patients and other cost of complications. Diabetic management needs to include proper diabetic care and health education to reduce episodes of hypoglycemia.
    Matched MeSH terms: Hypoglycemia/drug therapy; Hypoglycemia/economics*; Hypoglycemia/epidemiology
  10. Fulltext Review of insulin-associated hypoglycemia and its impact on the management of diabetes in Southeast Asian countries
    Goh SY, Hussein Z, Rudijanto A
    J Diabetes Investig, 2017 Sep;8(5):635-645.
    PMID: 28236664 DOI: 10.1111/jdi.12647
    Although the incidence of diabetes is rising in Southeast Asia, there is limited information regarding the incidence and manifestation of insulin-associated hypoglycemia. The aim of the present review was to discuss what is currently known regarding insulin-associated hypoglycemia in Southeast Asia, including its known incidence and impact in the region, and how the Southeast Asian population with diabetes differs from other populations. We found a paucity of data regarding the incidence of hypoglycemia in Southeast Asia, which has contributed to the adoption of Western guidelines. This might not be appropriate, as Southeast Asians have a range of etiological, educational and cultural differences from Western populations with diabetes that might place them at greater risk of hypoglycemia if not managed optimally. For example, Southeast Asians with type 2 diabetes tend to be younger, with lower body mass indexes than their Western counterparts, and the management of type 2 diabetes with premixed insulin preparations is more common in Southeast Asia. Both of these factors might result in higher rates of hypoglycemia. In addition, Southeast Asians are often poorly educated about hypoglycemia and its management, including during Ramadan fasting. We conclude there is a need for more information about Southeast Asian populations with diabetes to assist with the construction of more appropriate national and regional guidelines for the management of hypoglycemia, more closely aligned to patient demographics, behaviors and treatment practices. Such bespoke guidelines might result in a greater degree of implementation and adherence within clinical practice in Southeast Asian nations.
    Matched MeSH terms: Hypoglycemia/chemically induced; Hypoglycemia/complications*; Hypoglycemia/epidemiology
  11. Fulltext Glycated haemoglobin is a good predictor of neonatal hypoglycaemia in pregnancies complicated by diabetes
    Arumugam K, Abdul Majeed N
    Malays J Pathol, 2011 Jun;33(1):21-4.
    PMID: 21874747 MyJurnal
    We investigated the usefulness of a single value of maternal HbA1c in late pregnancy as a predictor for neonatal hypoglycaemia and secondly, to find the appropriate threshold value. A prospective analysis of the HbA1c concentration between 36 to 38 weeks of gestation in 150 pregnant mothers with either pre-existing or gestational diabetes was performed. At delivery, glucose levels in the cord blood were analysed. Neonatal hypoglycaemia was defined as a blood sugar level of < 2.6 mmol/l. Receiver operator characteristic curve was constructed to evaluate the value of HbA1c concentration in predicting hypoglycaemia. There were 16 foetuses who were hypoglycaemic at delivery. The area under the ROC curve for predicting neonatal hypoglycaemia was 0.997 with a 95% confidence interval of 0.992 to 1, a very good prediction rate. The optimal threshold value for HbA1c in predicting hypoglycaemia in the foetus was 6.8% (51 mmol/mol). HbA1c level in late pregnancy is a good predictor for hypoglycaemia in the newborn.
    Matched MeSH terms: Hypoglycemia/blood; Hypoglycemia/diagnosis*
  12. Persistent neonatal hypoglycaemia as a result of hypoplastic pituitary gland
    Yong SC, Boo NY, Wu LL
    Br J Hosp Med (Lond), 2006 Jun;67(6):326.
    PMID: 16821748 DOI: 10.12968/hmed.2006.67.6.21296
    Matched MeSH terms: Hypoglycemia/drug therapy; Hypoglycemia/etiology*
  13. Fulltext Hypoglycemia awareness among insulin-treated patients with diabetes in Malaysia: A cohort subanalysis of the HAT study
    Hussein Z, Kamaruddin NA, Chan SP, Jain A, Uppal S, Bebakar WMW, et al.
    Diabetes Res Clin Pract, 2017 Nov;133:40-49.
    PMID: 28888148 DOI: 10.1016/j.diabres.2017.08.007
    AIMS: The present Malaysian cohort analysis determined the prevalence of hypoglycemia among patients with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) attending primary care- or hospital-based diabetes clinics in Malaysia and their awareness of the symptoms of hypoglycemia.

    METHODS: The Hypoglycemia Assessment Tool (HAT) study was a non-interventional, 6-month retrospective and 4-week prospective analysis of hypoglycemic events in 24 countries, using self-assessment questionnaires and diaries among patients with T1DM/T2DM aged ≥18years, using insulin for >12months. This report focuses on prospective data, as they are less prone to recall bias.

    RESULTS: There were 1153 participants in the Malaysian cohort (114 T1DM; 1039 T2DM). In the prospective period, 50.4% and 33.4% of patients reported ≥1 hypoglycemic events, with estimated rates of 20.3 and 13.1 events per patient-year of exposure in patients with T1DM and T2DM, respectively. 24.8% and 16.1% of patients with T1DM or T2DM, respectively, reported ≥1 nocturnal hypoglycemic event. The majority of patients (96.5%, T1DM; 91.8%, T2DM) knew what hypoglycemia was prior to the study. Impaired awareness was present in 48.0% (T1DM) and 36.9% (T2DM) of patients. In the prospective period, 50% of patients with T1DM or T2DM consulted a doctor or nurse following a hypoglycemia episode.

    CONCLUSIONS: Half of patients with T1DM and a third of patients with T2DM reported ≥1 hypoglycemic event during the prospective period. Although the majority of patients knew the typical features of hypoglycemia, many reported impaired ability to recognize symptoms in real life. The present findings highlight the importance of patient education and physician awareness in dealing with hypoglycemia, in particular the burden of hypoglycemic unawareness.

    CLINICAL TRIAL NUMBER: This trial was registered at www.clinicaltrials.gov as NCT01696266 on 26 September 2012.
    Matched MeSH terms: Hypoglycemia/chemically induced*; Hypoglycemia/diagnosis
  14. Managing post stroke hyperglycaemia: moderate glycaemic control is better? An update
    Wan Sulaiman WA, Hashim HZ, Che Abdullah ST, Hoo FK, Basri H
    EXCLI J, 2014;13:825-33.
    PMID: 26417305
    Post stroke hyperglycaemia (PSH) is prevalent in acute ischaemic stroke (AIS) patients and it has been associated with a dismal outcome of death and disability. Insulin has been proven to attenuate glucose effectively in stroke patients, thus many trials over the years had studied the efficacy of intensive treatment aiming at normalization of blood sugar level in order to improve the bleak outcomes of PSH. However, tight glycaemic control failed to be translated into clinical benefits and the outcomes are no different from the conventional approach, despite the costly healthcare expenditure invested. On the contrary, it brings more significant harm than the intended benefit, as 1 in every 9 treated patients had symptomatic hypoglycaemia. Thus, the benefits of tight glucose control, if any, are overshadowed by this potential risk of hypoglycaemia causing permanent neurological injury. Therefore, international practice guidelines recommend for less aggressive treatment to maintain blood glucose level within an appropriate range in AIS patients. However, there are limited details for stroke-specific glycaemic management and this made management of PSH particularly difficult. This review is to discuss and provide suggestions concerning glycaemic control in acute ischaemic stroke; the direction of its future prospective clinical trials and the treatment strategy required based on recent literature.
    Matched MeSH terms: Hypoglycemia
  15. Fulltext Regional variations in definitions and rates of hypoglycaemia: findings from the global HAT observational study of 27 585 people with Type 1 and insulin-treated type 2 diabetes mellitus
    Khunti K, Cigrovski Berković M, Ludvik B, Moberg E, Barner Lekdorf J, Gydesen H, et al.
    Diabet Med, 2018 May 05.
    PMID: 29729048 DOI: 10.1111/dme.13662
    AIM: To determine participant knowledge and reporting of hypoglycaemia in the non-interventional Hypoglycaemia Assessment Tool (HAT) study.

    METHODS: HAT was conducted in 24 countries over a 6-month retrospective/4-week prospective period in 27 585 adults with Type 1 or insulin-treated Type 2 diabetes mellitus. Participants recorded whether hypoglycaemia was based on blood glucose levels, symptoms or both.

    RESULTS: Hypoglycaemia rates were consistently higher in the prospective compared with the retrospective period. Most respondents (96.8% Type 1 diabetes; 85.6% Type 2 diabetes) knew the American Diabetes Association/European Association for the Study of Diabetes hypoglycaemia definition, but there were regional differences in the use of blood glucose measurements and/or symptoms to define events. Confirmed symptomatic hypoglycaemia rates were highest in Northern Europe/Canada for Type 1 diabetes (63.9 events/year) and in Eastern Europe for Type 2 diabetes (19.4 events/year), and lowest in South East Asia (Type 1 diabetes: 6.0 events/year; Type 2 diabetes: 3.2 events/year). Unconfirmed symptomatic hypoglycaemia rates were highest in Eastern Europe for Type 1 diabetes (5.6 events/year) and South East Asia for Type 2 diabetes (4.7 events/year), and lowest for both in Russia (Type 1 diabetes: 2.1 events/year; Type 2 diabetes: 0.4 events/year). Participants in Latin America reported the highest rates of severe hypoglycaemia (Type 1 diabetes: 10.8 events/year; Type 2 diabetes 3.7 events/year) and severe hypoglycaemia requiring hospitalization (Type 1 diabetes: 0.56 events/year; Type 2 diabetes: 0.44 events/year). The lowest rates of severe hypoglycaemia were reported in South East Asia (Type 1 diabetes: 2.0 events/year) and Northern Europe/Canada (Type 2 diabetes: 1.3 events/year), and the lowest rates of severe hypoglycaemia requiring hospitalization were in Russia (Type 1 diabetes: 0.15 events/year; Type 2 diabetes: 0.09 events/year). The blood glucose cut-off used to define hypoglycaemia varied between regions (Type 1 diabetes: 3.1-3.6 mmol/l; Type 2 diabetes: 3.5-3.8 mmol/l).

    CONCLUSIONS: Under-reporting of hypoglycaemia rates in retrospective recall and regional variations in participant definitions of hypoglycaemia may contribute to the global differences in reported rates. Discrepancies between participant definitions and guidelines may highlight a need to redefine hypoglycaemia criteria. (Clinical Trials Registry No: NCT01696266).
    Matched MeSH terms: Hypoglycemia
  16. Fulltext Diabetic hidden gem: high amylose content in Sabah’s traditional rice germplasm [Abstract]
    Tyng CF, Fui LF, Abdul Latip M, Kumar V
    Malaysian Journal of Medicine and Health Sciences, 2019;15(106):17.
    MyJurnal
    ABSTRACTS FOR THE 1ST INTERNATIONAL BORNEO HEALTHCARE AND PUBLIC HEALTH CONFERENCE AND 4TH BORNEO TROPICAL MEDICINE AND INFECTIOUS DISEASE CONGRESS. New Frontiers in Health: Expecting the Unexpected. Held at the Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia. 3rd-5th September 2019
    Introduction: Rice is classified as waxy, very low, low, intermediate and high based on its amylose content (AC). Most people prefer to consume intermediate AC rice because of its texture which tends to appear in between low (moist and sticky) and high (dry and less tender). Although rice with high AC appears dry and less tender, it usually possesses a low glycemic index (GI) i.e. a slower increase in blood glucose level after the consumption of food. Consequently, people with diabetes are recommended to eat low and intermediate GI foods. Although, rice is generally categorised as a high GI staple food there are some exceptions to it. For example, the premium Basmati aromatic rice possesses a low GI and is recommended for diabetic patients. The study aimed to identify Sabah’s traditional rice germplasm with low GI via AC that may be used as a replacement to commercial rice varieties.
    Methods: A total of 110 traditional rice samples were obtained from rice fields located in the Tuaran and Kota Belud districts of Sabah. The AC in each sample was determined via I:KI method (ISO AACC-6647).
    Results: We found that 46 (41.8%), 51 (46.4%), 7 (6.4%) and 6 (5.5%) Sabah’s traditional rice samples possess high, intermediate, low and very low AC, respectively. The intermediate AC type is predominant in Sabah’s traditional rice germplasm as it is the preferred rice texture by the general population. We have identified 46 rice germplasm with high AC type (i.e. with low GI value). The AC content in these is comparable to the Basmati rice and may be suitable candidates for diabetic patients.
    Conclusion: The present study showed Sabah’s traditional rice germplasm has the potential to be promoted as a low GI rice cultivar based on AC for diabetic patients in order to prevent spikes in blood glucose levels while still enjoying the staple food
    Matched MeSH terms: Hypoglycemia
  17. Fulltext Antihyperglycemic activity of oil palm elaeis guineensis fruit extract on streptozotocin-induced diabetic rats
    Faez Sharif, Muhajir Hamid, Amin Ismail, Zainah Adam
    Jurnal Sains Kesihatan Malaysia, 2015;13(2):37-43.
    MyJurnal
    Hypoglycaemic and antihyperglycemic activity of oil palm Elaeis guineensis fruit extract on normal and Streptozotocininduced
    diabetic rats was studied. The oil palm fruit extract (OPF) were administered orally at different concentrations (100,
    200 and 500 mg kg-1 b.w.) in fasting and post-prandial rats. Hypoglycaemia was not observed in the group of normal rats
    treated with OPF. In fasting rats, OPF (500 mg kg-1 b.w.) has caused the blood glucose level (BGL) to reduce significantly.
    For post-prandial diabetic rats, the antihyperglycemic activity was observed after OPF treatment at concentrations 200
    and 500 mg kg-1. Chronic OPF treatments (for 28 days) had increased the diabetic rat’s body weight and reduced BGL as
    well as improved plasma insulin secretion. The result of this study suggests E. guineensis palm fruit extract show evidence
    of antihyperglycemic properties from the reduction of the BGL in diabetic rats.
    Matched MeSH terms: Hypoglycemia
  18. Fulltext Type 2 diabetes patient's perspective on Ramadan fasting: a qualitative study
    Lee JY, Wong CP, Tan CSS, Nasir NH, Lee SWH
    BMJ Open Diabetes Res Care, 2017;5(1):e000365.
    PMID: 28761651 DOI: 10.1136/bmjdrc-2016-000365
    OBJECTIVE: We evaluated the beliefs, experience and diabetes management strategies of type 2 diabetes mellitus (T2DM) Muslim patients that chose to fast during Ramadan.
    RESEARCH DESIGN AND METHODS: A semistructured focus group interview was conducted with 53 participants with T2DM. Participants were purposefully sampled and asked to share their perspective on Ramadan fasting. All interviews were audio recorded, transcribed verbatim and analyzed thematically.
    RESULTS: Participants reported optimism towards fasting during Ramadan, as they believed that fasting was beneficial to their overall well-being, and a time for family bonding. Most participants made limited attempts to discuss with their doctors on the decision to fast and self-adjusted their medication based on experience and symptoms during this period. They also reported difficulty in managing their diet, due to fear of hypoglycemia and the collective social aspect of fasting.
    CONCLUSION: Muslims are optimistic about their well-being when fasting during Ramadan. Many choose to fulfill their religious obligation despite being discouraged by their doctors. Collaboration with religious authorities should be explored to ensure patients receive adequate education before fasting during Ramadan.
    TRIAL REGISTRATION NUMBER: NCT02189135; Results.
    Matched MeSH terms: Hypoglycemia
  19. Fulltext Estimating the utility value of hypoglycaemia according to severity and frequency using the visual analogue scale (VAS) and time trade-off (TTO) survey
    Shafie AA, Ng CH, Thanimalai S, Haron N, Manocha AB
    J Diabetes Metab Disord, 2018 Dec;17(2):269-275.
    PMID: 30918862 DOI: 10.1007/s40200-018-0369-z
    Objectives: The primary objective of this study was to estimate the health utility values for hypoglycaemia events according to their severity and frequency. The secondary objective was to compare the health utilities between those with Type 2 Diabetes Mellitus and the general population.

    Method: The health utilities of hypoglycaemia event were measured using Visual Analogue Scale (VAS) and Time Trade-Off (TTO) methods among conveniently sampled consenting adults (>18 years and literate in either English or Malay language), which were then divided into two groups: those in the general population (GP) and those with Type 2 Diabetes Mellitus (T2DM). Each respondent was required to value 13 different health states, including frequencies of daytime hypoglycaemia and nocturnal hypoglycaemia, each depending on its severity (non-severe or severe).

    Results: 256 respondents from the GP and 99 respondents with T2DM completed the survey. The T2DM group gave higher VAS-values compared to the GP group. The highest mean VAS-utility value for non-severe nocturnal hypoglycaemia occurring once monthly was 0.543 (SD 0.161), and for severe daytime hypoglycaemia occurring once quarterly was 0.293 (SD 0.162) which was the lowest utility value compared to other health states. However, non-severe nocturnal hypoglycaemia occurring once quarterly was 0.537 (SD 0.284) and has the highest TTO-utility value. Severe nocturnal hypoglycaemia occurring once quarterly has the lowest utility value which was -0.104 (SD 0.380). Daytime hypoglycaemia has lower utility value compared to nocturnal hypoglycaemia. Severe hypoglycaemia has a greater disutility compared with the non-severe hypoglycaemia in both studied groups.

    Conclusion: The findings show that as a health utility, hypoglycaemia has a substantial impact on utility with severe hypoglycaemia having a greater negative impact compared to non-severe events across the board. This highlights the importance of preventing development of severe hypoglycaemia in patients with Type 2 Diabetes Mellitus at any time of the day.

    Matched MeSH terms: Hypoglycemia
  20. Fulltext Telemonitoring in fasting individuals with type 2 diabetes mellitus during ramadan: A prospective, randomised controlled study
    Lee JY, Wong CP, Tan CSS, Nasir NH, Lee SWH
    Sci Rep, 2017 08 31;7(1):10119.
    PMID: 28860546 DOI: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC55790
    We determined the impact of a remote blood glucose telemonitoring program with feedback in type 2 diabetes mellitus patients fasting during Ramadan compared to conventional self-monitoring method. A twelve-week cluster randomised study, with 85 participants who wish to fast for at least 15 days during Ramadan was conducted. Self-measurement and transmission of blood glucose results were performed six times daily during Ramadan. Results were transmitted to a secure website for review with feedback from case manager if necessary. The control group received usual care. The main outcome was the number of participants experiencing hypoglycaemia during Ramadan and at the end of the study. During Ramadan, the number of participants reporting hypoglycaemia was significantly lower in the telemonitoring group [Odds ratio (OR): 0.186, 95% confidence interval: 0.04-0.936; p = 0.04]. Similarly, the proportion of participants reporting symptomatic hypoglycaemia at the end of the study was significantly lower in the telemonitoring group (OR: 0.257, 95% CI: 0.07-0.89; p = 0.03). A reduction of 1.07% in glycated haemoglobin levels was observed in the telemonitoring group compared to 0.24% in the control group (p 
    Matched MeSH terms: Hypoglycemia/blood*; Hypoglycemia/etiology; Hypoglycemia/prevention & control
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