Delivery of Health Care, Integrated ; trends ; Diabetes Mellitus ; epidemiology ; therapy ; Health Promotion ; Health Surveys ; Humans ; Singapore ; epidemiology

Initiation of insulin therapy is challenging in the primary care setting without nursing support. Doctors have to prepare their practices to deal with these challenges in order not to delay insulin therapy when needed.

Initiation of insulin therapy is challenging in the primary care setting without nursing support. Doctors have to prepare their practices to deal with these challenges in order not to delay insulin therapy when needed.

Adult ; Age Factors ; Ambulatory Care ; Appointments and Schedules ; Asian Continental Ancestry Group ; China ; Cohort Studies ; Diabetes Mellitus ; therapy ; Ethnic Groups ; statistics & numerical data ; European Continental Ancestry Group ; Female ; Humans ; India ; Logistic Models ; Malaysia ; Male ; Middle Aged ; Multivariate Analysis ; No-Show Patients ; statistics & numerical data ; Outpatient Clinics, Hospital ; ROC Curve ; Referral and Consultation ; Reminder Systems ; Retrospective Studies ; Seasons ; Sex Factors ; Singapore ; Text Messaging

The chronic and acute effects of hyperglycemia affecting cognition and work are as important as those of hypoglycemia. Its impact, considering that majority of diabetic patients fail to reach therapeutic targets, would be potentially significant. Self monitoring of blood glucose, recognition of body cues and management interventions should be geared not only towards avoidance of disabling hypoglycemia, but also towards unwanted hyperglycemia. Over the long term, chronic hyperglycemia is a risk for cognitive decline. Acute episodes of hyperglycemia, above 15 mmol/L have also been shown to affect cognitive motor tasks. Maintaining blood sugar to avoid hyperglycemia in diabetic workers will help promote safety at work.
Blood Glucose ; Cognition ; Cues ; Humans ; Hyperglycemia ; Hypoglycemia

INTRODUCTIONDiabetes mellitus (DM) is a serious chronic illness that has a major impact on the quality of life of the individuals. Our aim was to examine the determinants of health-related quality of life (HRQOL) in patients with DM.

MATERIALS AND METHODSAdult outpatients attending a Diabetes Centre were recruited on consecutive basis between August 2006 and February 2007. Clinical data were collected from interviews with the subjects and from medical records. Assessment of depressive symptoms was done using the Center for Epidemiologic Studies Depression Scale (CES-D) and HRQOL using the Short Form 36 Health Survey (SF-36). A two-step regression analysis was conducted for identifying factors affecting patients' quality of life.

RESULTSFive hundred and thirty-seven patients participated in the study. The mean (SD) age of the participants was 54.7 (13.3) years and 315 (58.7%) were males. The prevalence of depressive symptoms was 31.1% (n = 167). After adjusting for other variables, the effects of depressive symptoms persisted for all the 8 domains of SF-36 (P <0.001 for all). The medical factors that were negatively associated with HRQOL were a diagnosis of Type 1 DM, duration of the illness of more than 10 years, HbA1c levels of ≥7%, and comorbidity of stroke and retinopathy. Being male and a regular exerciser had a positive effect on HRQOL.

CONCLUSIONThese findings highlight the importance of detecting and treating comorbid depression in DM.

Adult ; Aged ; Depression ; epidemiology ; physiopathology ; psychology ; Diabetes Mellitus, Type 1 ; epidemiology ; physiopathology ; psychology ; Diabetes Mellitus, Type 2 ; epidemiology ; physiopathology ; psychology ; Female ; Health Status ; Health Surveys ; Humans ; Interviews as Topic ; Male ; Medical Records ; Middle Aged ; Quality of Life ; Singapore ; epidemiology

The majority of people diagnosed with diabetes mellitus are in the working age group in developing countries. The interrelationship of diabetes and work, that is, diabetes affecting work and work affecting diabetes, becomes an important issue for these people. Therapeutic options for the diabetic worker have been developed, and currently include various insulins, insulin sensitizers and secretagogues, incretin mimetics and enhancers, and alpha glucosidase inhibitors. Hypoglycemia and hypoglycaemic unawareness are important and unwanted treatment side effects. The risk they pose with respect to cognitive impairment can have safety implications. The understanding of the therapeutic options in the management of diabetic workers, blood glucose awareness training, and self-monitoring blood glucose will help to mitigate this risk. Employment decisions must also take into account the extent to which the jobs performed by the worker are safety sensitive. A risk assessment matrix, based on the extent to which a job is considered safety sensitive and based on the severity of the hypoglycaemia, may assist in determining one's fitness to work. Support at the workplace, such as a provision of healthy food options and arrangements for affected workers will be helpful for such workers. Arrangements include permission to carry and consume emergency sugar, flexible meal times, self-monitoring blood glucose when required, storage/disposal facilities for medicine such as insulin and needles, time off for medical appointments, and structured self-help programs.
alpha-Glucosidases ; Appointments and Schedules ; Blood Glucose ; Developing Countries ; Diabetes Mellitus ; Emergencies ; Employment ; Humans ; Hypoglycemia ; Incretins ; Insulin ; Insulins ; Meals ; Needles ; Risk Assessment

Humans ; Diabetes Mellitus, Type 2/therapy* ; Self Care ; Renal Insufficiency, Chronic/complications*

INTRODUCTIONMillions of Muslim patients with diabetes mellitus (DM) fast during Ramadan. However, little is known about the metabolic impact of Ramadan fasting. We aimed to study the changes in body composition and metabolic profile in this group of patients.

MATERIALS AND METHODSWe studied 29 Southeast Asian Muslim patients with type 2 diabetes; all underwent pre-Ramadan education. Study variables were weight change, body composition (using multifrequency bioimpedance method, InBody S20®, Biospace, South Korea), blood pressure (BP), glycated haemoglobin (HbA1c), fasting lipid profile, and caloric intake assessment using FoodWorks® nutrient analysis software.

RESULTSTwenty-three subjects fasted ≥15 days; mean ± SD: 57 ± 11 years; 52% were males. HbA1c improved significantly (8.6 ± 2.4% pre-Ramadan vs 8.0 ± 2.3% end-Ramadan, P = 0.017). Despite similar body weight, there was reduction in body fat mass (BFM) (30.9 ± 11 kg vs 29.2 ± 12.2 kg, P = 0.013). Multivariate analysis suggested that the reduction in HbA1c was attributed by reduction in BFM (β = -0.196, P = 0.034). There was no change in visceral adiposity (visceral fat area (VFA)) but stratification by gender showed a reduction amongst females (137.6 ± 24.5 cm2 to 132.5 ± 25.7 cm2, P = 0.017). These changes occurred despite similar total caloric intake (1473.9 ± 565.4 kcal vs 1473.1 ± 460.4 kcal, P = 0.995), and proportion of carbohydrate (55.4 ± 6.3% vs 53.3 ± 7.5%, P = 0.25) and protein intake (17.6 ± 4.1% vs 17.3 ± 5.4%, P = 0.792), before and during Ramadan respectively, but with increased proportion of fat intake (11.9 ± 2.4% vs 13 ± 11.7%, P = 0.04). Seven out of 23 patients had medications adjusted to avert symptomatic hypoglycaemia but none of the patients developed severe hypoglycaemia.

CONCLUSIONRamadan fasting can be practiced safely with prior patient education and medication adjustment. It also confers modest benefits on metabolic profile and body composition, especially among females.

Adult ; Aged ; Biomarkers ; blood ; Blood Glucose ; metabolism ; Body Composition ; Body Mass Index ; Diabetes Mellitus, Type 2 ; blood ; physiopathology ; Energy Intake ; Fasting ; physiology ; Female ; Glycated Hemoglobin A ; metabolism ; Holidays ; Humans ; Islam ; Male ; Middle Aged ; Multivariate Analysis ; Prospective Studies ; Sex Factors ; Singapore ; Weight Gain ; Weight Loss

INTRODUCTIONDiabetes mellitus (DM) is a major cause of chronic kidney disease (CKD). The epidemiology of CKD secondary to type 2 DM (T2DM) (i.e. diabetic nephropathy (DN)) has not been well studied in Singapore, a multi-ethnic Asian population. We aimed to determine the prevalence of CKD in adult patients with T2DM.

MATERIALS AND METHODSWe conducted a cross-sectional study on patients (n = 1861) aged 21 to 89 years with T2DM who had attended the DM centre of a single acute care public hospital or a primary care polyclinic between August 2011 and November 2013. Demographic and clinical data were obtained from patients using a standard questionnaire. Spot urine and fasting blood samples were sent to an accredited hospital laboratory for urinary albumin, serum creatinine, HbA1c and lipid measurement. CKD was defined and classified using the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines and classification.

RESULTSThe distribution by risk of adverse CKD outcomes was: low risk, 47%; moderate risk, 27.2%; high risk, 12.8%; and very high risk, 13%. The prevalence of CKD in patients with T2DM was 53%. Variables significantly associated with CKD include neuropathy, blood pressure ≥140/80 mmHg, triglycerides ≥1.7 mmol, body mass index, duration of diabetes, HbA1c ≥8%, age, cardiovascular disease, and proliferative retinopathy.

CONCLUSIONCKD was highly prevalent among patients with T2DM in Singapore. Several risk factors for CKD are well recognised and amenable to intervention. Routine rigorous screening for DN and enhanced programme for global risk factors reduction will be critical to stem the tide of DN.

Adult ; Aged ; Aged, 80 and over ; Cross-Sectional Studies ; Diabetes Mellitus, Type 2 ; complications ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Prevalence ; Renal Insufficiency, Chronic ; diagnosis ; epidemiology ; etiology ; Risk Factors ; Singapore