1.Bone health among older persons in medical clinic: A clinical audit
Cheng Lay Teh ; Seow Lin Chuah ; Hong Khoh Lee ; Sharifah Aishah binti Wan Mohd Akbar ; Tze Shin Leong ; Florence Hui Sieng Tan ; Bik Kui Lau
The Medical Journal of Malaysia 2020;75(2):191-193
Osteoporosis is commonly underdiagnosed and
undertreated. We performed a clinical audit to assess the
risk factors and clinical care for osteoporosis among older
persons who attended medical clinic during a 4-week period
in August 2013. There was a total of 128 patients with a mean
age of 73.1±5.8 years, and 20.3%. had a history of fall.
Fracture Risk Assessment Tool (FRAX) scores assessment
showed 14.2% and 68.8% had a 10-year risk of major
osteoporotic and hip fractures respectively. Only 6.3%
underwent Dual-energy X-ray absorptiometry (DXA) and
73.4% did not receive any preventive treatment for
osteoporosis. Older persons attending medical clinic at high
risk of osteoporosis fractures did not receive appropriate
screening and treatment. There is a need to improve the
suboptimal care for bone health among older persons.
2.The Effect of DPP4 Inhibitor on Glycemic Variability in Patients with Type 2 Diabetes treated with twice-daily Premixed Human Insulin
Florence Hui Sieng Tan ; Chin Voon Tong ; Xun Ting Tiong ; Bik Kui Lau ; Yueh Chien Kuan ; Huai Heng Loh ; Saravanan A/L Vengadesa Pillai
Journal of the ASEAN Federation of Endocrine Societies 2021;36(2):167-171
Objective:
To evaluate the effect of adding DPP4 inhibitor (DPP4-i) on glycemic variability (GV) in patients with type 2 diabetes mellitus (T2DM) treated with premixed human insulin (MHI).
Methodology:
We conducted a prospective study in patients with T2DM on twice-daily MHI with or without metformin therapy. Blinded continuous glucose monitoring was performed at baseline and following 6 weeks of Vildagliptin therapy.
Results:
Twelve patients with mean (SD) age of 55.8 (13.1) years and duration of disease of 14.0 (6.6) years were recruited. The addition of Vildagliptin significantly reduced GV indices (mmol/L): SD from 2.73 (IQR 2.12-3.66) to 2.11 (1.76-2.55), p=0.015; mean amplitude of glycemic excursions (MAGE) 6.94(2.61) to 5.72 (1.87), p=0.018 and CV 34.05 (8.76) to 28.19 (5.36), p=0.010. In addition, % time in range (3.9-10 mmol/l) improved from 61.17 (20.50) to 79.67 (15.33)%, p=0.001; % time above range reduced from 32.92 (23.99) to 18.50 (15.62)%, p=0.016; with reduction in AUC for hyperglycemia from 1.24 (1.31) to 0.47 (0.71) mmol/day, p=0.015. Hypoglycemic events were infrequent and the reduction in time below range and AUC for hypoglycemia did not reach statistical significance.
Conclusion
The addition of DPP4-I to commonly prescribed twice-daily MHI in patients with T2DM improves GV and warrants further exploration.
Diabetes Mellitus, Type 2
3.Initiating or switching to insulin degludec/insulin aspart in adults with type 2 diabetes in Malaysia
Mafauzy Mohamed ; Siang Chin Lim ; Malik Mumtaz ; Shweta Uppal ; Deepak Mukherjee ; Mohamed Saiful Mohd Kassim ; Shalini Sreedharan ; Amudha Murugan Doraiswamy ; Kuck Meng Chong ; Lu Yu Tat ; Sudzilla Binti Nordin ; Jeshen Lau Hui Giek ; Zanariah Hussein ; Khalid Abdul Kadir ; Bik Kui Lau ; Siew Pheng Chan
Journal of the ASEAN Federation of Endocrine Societies 2023;38(1):37-44
Objectives:
Insulin degludec (IDeg)/insulin aspart (IAsp; IDegAsp) is a co-formulation of 70% IDeg and 30% IAsp. According to several randomized controlled trials, IDegAsp is effective and safe for patients with type 2 diabetes mellitus (T2DM). A subgroup analysis of the ARISE study was conducted to explore the safety and efficacy of IDegAsp among Malaysian patients with T2DM in real-world settings.
Methodology:
ARISE, an open-label, multicenter, non-interventional, prospective study was conducted between August 2019 and December 2020. Adult Malaysian patients with T2DM who were enrolled from 14 sites received IDegAsp as per the local label for 26 weeks. The primary endpoint was change in glycated hemoglobin (HbA1c) levels from baseline
to end of study (EOS).
Results:
Of the 182 patients included in the full analysis set, 159 (87.4%) completed the study. From baseline to EOS, HbA1c (estimated difference [ED]: –1.3% [95% CI: –1.61 to –0.90]) and fasting plasma glucose levels (ED: –1.8 mmol/L [95% CI: –2.49 to –1.13]) were significantly reduced (p<0.0001). The patient-reported reduced hypoglycemic episodes (overall and nocturnal) during treatment. Overall, 37 adverse events were observed in 23 (12.6%) patients.
Conclusion
Switching or initiating IDegAsp treatment resulted in significant improvements in glycemic control and a reduction in hypoglycemic episodes.