1.Managing the diabetic foot: A comprehensive approach
The Filipino Family Physician 2010;48(4):130-137
Conclusion: The many aspects of the diabetic foot make it an interesting and challenging concern not only for diabetologists but for all primary care physicians as well. The evaluation, diagnosis, and management of such infections are vital to the well-being of the diabetic patient. Optimal wound care techniques and appropriate technologies are imperative. Education, a multi-disciplinary approach and active participation of all stakeholders are essential elements in the prevention and successful management of this multifaceted disease.
DIABETES
2.Deranged Liver Enzymes in Type 2 Diabetes Mellitus Subjects in a Tertiary Malaysian Hospital
Malaysian Journal of Medicine and Health Sciences 2019;15(2):62-68
Introduction: The prevalence of diabetes mellitus (DM) in Malaysia is drastically increasing. Subjects with DM are more likely to have deranged liver function tests (LFT). This study aimed to determine the prevalence of abnormal liver enzymes [(alanine aminotransferase (ALT) and alkaline phosphatase (ALP)] and its associated factors among type 2 DM (T2DM) subjects visiting a referral diabetic clinic in a tertiary government hospital. Methods: This retrospective, cross-sectional study included electronic data of 300 T2DM subjects ≥18 years old in the outpatient specialist clinic from January 2011 to December 2014. Statistical analysis was performed using SPSS version 22. Results: The study population at large included Malays, of age >60 years with comparable gender percentage. Most subjects had long-standing DM, poor glycaemic control and were on treatment. The prevalence of abnormal ALT and ALP was 27.3% and 13%; with 90.2% and 97.4% having mild ALT and ALP elevations, respectively. Significant associations noted for age, body mass index (BMI) and duration of T2DM for ALT whereas for ALP, anti-diabetic medication was significant between groups of normal and abnormal levels. Deranged liver enzymes were associated significantly with dyslipidaemia. Conclusion: Our study on the crude prevalence of raised liver enzymes may help identify T2DM patients at increased risk of non-alcoholic fatty liver disease (NAFLD). Modification of metabolic risk factors, such as weight loss, control of dyslipidaemia rather than just tighter glycaemic control should be emphasised to reduce morbidity and mortality. Liver enzymes remain a simple and non- invasive marker of liver pathology in daily medical practice
Diabetes
3.Strategic Interventions in the Management of Gestational Diabetes to Reduce Type 2 Diabetes Mellitus in Women in Malaysia
The Medical Journal of Malaysia 2015;70(4):211-213
According to the Global status report on non-communicable
diseases 2010, the prevalence of high blood sugars among
adults exceeds 11 % in both males and females in Malaysia.
This is the highest among ASEAN countries. This ties up
closely with the prevalence of overweight adults in both sexes
in the same report, again Malaysians rank highest among
ASEAN countries. The burden of diabetes mellitus in
Malaysia is estimated to be 12% of the population with a
projected figure exceeding 15 % in 2020.
1
This enormous rise in both obesity and hyperglycaemia in
adults is alarming and clear strategies to combat this noncommunicable
disease is urgently warranted. One such
strategy is to relook at the focussed approach of gestational
diabetes mellitus (GDM) management currently in vogue in
Malaysia, and suggest more effective preventive measures in
view of information currently coming to light on both short
and long term implications of GDM on both mother and
offspring.
Although information on actual prevalence of GDM in
Malaysia is lacking, available crude data from hospital births
obtained from the National Obstetric Register in 2010
involving 14 major government hospitals was 9.9% with
Indians ranking highest followed by Malays and Chinese.
Incidence of macrosomia in GDM mothers was double that of
non-GDM mothers. A higher caesarean section rate with a
threefold increase in shoulder dystocia was also recorded in
those with GDM.
Diabetes Mellitus
;
Diabetes, Gestational
4.Sharing a microbe with man’s best friend: A case of canine streptococcal infection in a diabetic patient
Brian M K Cheong ; Ai Y’ng Lim
The Medical Journal of Malaysia 2015;70(5):318-319
We report a case of a diabetic patient with an infected leg
wound leading to septicemia and abscess formation in the
contra-lateral leg due to Streptococcus canis. This organism
belongs to the Lancefield group G and is more commonly
found in dogs. It is often mistaken for Streptococcus
dysgalactiae which is a human strain of streptococci.
Infections in humans are not common and usually involve
infected wounds or ulcers and the surrounding soft tissue.
In most reported cases, patients had close contact with
domestic dogs and a pre-existing wound as a portal of entry.
Our patient recovered after surgical debridement and
drainage of abscess together with antibiotics. This organism
is sensitive to common antibiotics like penicillin,
amoxycillin, cephalosporins and erythromycin. The
incidence of infections due to Streptococcus canis may be
under-reported as laboratories may just report an isolate as
group G streptococcus. Susceptible patients with wounds or
ulcers should be counselled on proper wound care and
advised to avoid or minimise contact with the family dog.
Diabetes Complications
;
Diabetes Mellitus
5.Investigation of eye complications in diabetics in Ha Noi communities
Journal of Vietnamese Medicine 2005;309(4):29-33
Investigation of 72 patients with diabetics who were ≥ 16 years old, in 20 communes of Gia Lam, Soc Son and Dong Da districts, Ha Noi, from June to September 2001. Results: the common eye complications included retinopathy, cataract, uveites, and conjunctivitis. In diabetic’s subjects, three common ophthalmic diseases such as amblyopia, retinopathy and cataract in males were more distinct than in females. But ophthalmitis (uveites, conjunctivitis) in females were more than in males. The old age and the long duration of diabetics were the risk factor related to increase of retinopathies and amblyopia
Diabetes Mellitus
;
Diabetes Complications
6.Clinical characteristics of chronic inflammatory demyelinatingpolyradiculoneuropathy in diabetes patients
Narupat Suanprasert ; Suchat Hanchaiphiboolkul
Neurology Asia 2017;22(3):227-234
Background & Objective: Co-exiting of CIDP and diabetes mellitus had been reported. Idiopathic
CIDP(I-CIDP) is a treatable disease and had favorable response to immunosuppressive therapies but
there is no established data for CIDP in diabetic patients (DM-CIDP). This study aims to determine
clinical characteristics, phenotypes, electrophysiological tests and treatment response of CIDP in
diabetic patients; and to determine the response to immunosuppressive therapy in DM-CIDP and I-CIDP.
Methods: The study was a retrospective chart review of Prasat Neurological Institute patients with
diagnosis of CIDP between January 1st, 2008 and December 31th, 2015.
Results: Sixty four CIDP patients were identified, 12 were DM-CIDP and 52 were I-CIDP. Clinical
characteristics, phenotypes, disease duration and disease severity in DM-CIPD were not different from
I-CIDP. Demyelinating changes in nerve conduction studies were not different in the two entities but
axonal features were more predominant in DM-CIDP. DM-CIDP also responded to immunosuppressive
treatment, with modified Ranking Scale decreased after treatment as in I-CIDP. There was no difference
in treatment response in DM-CIDP and I-CIDP.
Conclusion: Clinical characteristics, phenotypes, disease severity and treatment response to
immunosuppressive treatment in DM-CIPD were not different from I-CIDP. Demyelinating features
in nerve conduction studies were not different in the two entities but axonal features were more
predominant in DM-CIDP.
Diabetes Mellitus
7.Decision making in hyperglycaemia seen in pregnancy
Kavitha Nagandla ; Sivalingam Nalliah
International e-Journal of Science, Medicine and Education 2014;8(1):8-18
Delay in childbearing, family history of type
2 diabetes mellitus and obesity in childbearing years
increases a possibility of glucose intolerance or overt
diabetes in pregnancy which may remain unrecognised
unless an oral glucose tolerance test is done.
The International Association of Diabetes and
Pregnancy Study Group (IADPSG, 2010) recommended
the detection and diagnosis of hyperglycaemic disorders
in pregnancy at two stages of pregnancy, the first stage
looking for ‘overt diabetes’ in early pregnancy based
on risk factors like age, past history of gestational
diabetes and obesity and the second stage where
‘gestational diabetes’ at 24-28 weeks with 75 g oral
glucose tolerance test. Although the one step approach
with 75 g of glucose offers operational convenience
in diagnosing gestational diabetes, there are concerns
raised by the National Institute of Health in the recent
consensus statement, supporting the two step approach
(50-g, 1-hour loading test screening 100-g, 3-hour oral
glucose tolerance test) as the recommended approach
for detecting gestational diabetes. Medical nutrition
therapy (MNT) with well-designed meal plan and
appropriate exercise achieves normoglycemia without
inducing ketonemia and weight loss in most pregnant
women with glucose intolerance. Rapidly acting insulin
analogues, such as insulin lispro and aspart are safe in
pregnancy and improve postprandial glycemic control in
women with pre-gestational diabetes. The long acting
analogues (Insulin detemir and glargine) though proven
to be safe in pregnancy, do not confer added advantage
if normoglycemia is achieved with intermediate insulin
(NPH). Current evidence indicates the safe use of
glyburide and metformin in the management of Type
2 diabetes and gestational diabetes as other options.
However, it is prudent to communicate to the women
that there is no data available on the long-term health
of the offspring and the safety of these oral hypoglycemic
drugs are limited to the prenatal period
Diabetes Mellitus
9.Effectiveness of selective risk based screening for Gestational Diabetes (GDM) in Malaysia: A retrospective cohort study based on the National Obstetric Registry (NOR) of Malaysia
Muniswaran Ganeshan ; Shahrul Aiman Soelar ; Shamala Devi Karalasingam ; Mohammad Adam Bujang ; Jeganathan R, M. ; Harris Suharjono
The Medical Journal of Malaysia 2017;72(1):46-49
Introduction: Gestational diabetes (GDM) has significant
maternal and foetal implications. screening allows active
interventions which significantly improves pregnancy
outcomes. Despite World Health Organization (WHO), FIGO
and National Institute of clinical Excellence (NIcE)
recommendations for universal screening especially among
high risk population; Malaysia currently adopts a selective
risk based screening for GDM.
Objective: the objective is to audit the effectiveness of the
current practice of selective risk based screening in
detection of GDM in Malaysia.
Methodology: this is a retrospective cohort study based on
the National Obstetric Registry (NOR) which comprises of 14
major tertiary hospitals in Malaysia. the study period was
from 1st January 2011 till 31st December 2012 and a total of
22,044 patients with GDM were analysed. Logistic
regression analysis was used to calculate the crude odd
ratio.
Results: the incidence of GDM in Malaysia is 8.4%. Maternal
age of ≥25, booking bMI ≥27kg/m2, booking weight ≥80kg
and previous hypertension are non-significant risk of
developing GDM in Malaysia. Parity 5 and more was only
associated with an odds-ratio of 1.02 (95% confidence
Interval: 0.90-1.17) as compared to parity below 5. the
association of women with previous stillbirth with GDM was
not significant.
conclusion: current risk based screening for GDM based on
maternal age, booking bMI, weight and hypertension is
inappropriate. An ideal screening tool should precede
disease complications, which is the novel objective of
screening. Universal screening for GDM in Malaysia may be
a more accurate measure, especially with regards to
reducing maternal and foetal complications.
Diabetes, Gestational
10.A 5-year follow-up visual evoked potentials and nerve conduction study in young adults with type 1 diabetes mellitus
Heon-Seok Han ; Heon Kim ; Sang-Soo Lee
Neurology Asia 2016;21(4):367-374
Central nervous system impairment is common in diabetic patients, even in the early stages of the
disease, and could be associated with peripheral neuropathy. The aims of this study were to prospectively
investigate central nerve conduction in young adults with type 1 diabetes using pattern-reversal visual
evoked potentials (PRVEP) and to determine how those results were related to clinical risk factors and
the parameters of the peripheral nerve conduction study (NCS). A total of 36 type 1 diabetic patients
(15 males) 5-24 years of age (mean 14.5 ± 4.7) underwent PRVEP and NCS annually for five years.
For comparison, 39 healthy age and sex matched individuals (mean 14.8 ± 5.0) were evaluated as
the control group. The P100 latencies of the PRVEP were prolonged at the study entry in the patients
compared with the controls (p< 0.001). Significant correlations were not found between any of the
parameters of PRVEP and the glycosylated hemoglobin levels; however, the changes in the parameters
of the peripheral NCS were well correlated with metabolic control. The latencies and amplitudes of
the P100 were not related to the majority of the parameters of the NCS. A prolonged PRVEP latency
may be a sign of optic pathway dysfunction, which begins before apparent diabetic retinopathy. Poor
glycemic control proved to be an important risk factor over the 5 years in terms of its relation to
the development of peripheral neural pathway abnormalities. However, once central conduction was
delayed, its changes were poorly related to diabetic control and the attributes of the peripheral nerve
conduction study over the 5-year follow-up.
Diabetes Mellitus