1.Idiopathic thrombocytopenic purpura in childhood, Langerhans cell histiocytosis in adulthood: More than a chance association?
Kuan Yueh Chien ; Nurain Mohd Noor
The Medical Journal of Malaysia 2017;72(1):50-52
Described herein, a case of Langerhans cell histiocytosis
(LCH) in an adult with Idiopathic Thrombocytopenic Purpura
(ITP) diagnosed at age ten. She presented with cranial
diabetes insipidus, later developed hypogonadotrophic
hypogonadism and multiple cervical lympadenopathy from
which histopathology of excisional biopsy confirmed LCH.
Magnetic resonance imaging showed thickened pituitary
stalk. Association of ITP and LCH is unknown but the
question of LCH presenting as isolated thrombocytopenia in
childhood only to be discovered in adulthood when there
was pituitary and bone involvement remains. It
reemphasizes the need for high index of suspicion and the
challenges in diagnosing LCH at the outset.
Histiocytosis, Langerhans-Cell
2.Prevalence of hypoglycaemia among insulin-treated pregnant women with diabetes- who achieved tight glycaemic control.
Danish NG ; Nurain Mohd NOOR ; Sy Liang YONG
Journal of the ASEAN Federation of Endocrine Societies 2019;34(1):29-35
OBJECTIVE: To determine the prevalence of hypoglycaemia using continuous glucose monitoring system (CGMS) among insulin-treated pregnant women with diabetes whose glycosylated haemoglobin (HbA1c) were <6.0% and identify the risk factors associated with hypoglycaemia occurrence.
METHODOLOGY: We conducted a cross-sectional study using 6-days CGMS to detect the prevalence of hypoglycaemia in 31 insulin-treated pregnant women with diabetes who achieved HbA1c <6.0%. Patients were required to log-keep their self-monitoring blood glucose (SMBG) readings and hypoglycaemia events.
RESULTS: Eight women experienced confirmed hypoglycaemia with additional seven experienced relative hypoglycaemia, giving rise to prevalence rate of 45.2% (one had both confirmed and relative hypoglycaemia). Nine relative hypoglycaemia and 17 confirmed hypoglycaemic events were recorded. Sixteen (94%) out of 17 confirmed hypoglycaemia events recorded by CGMS were asymptomatic and were missed despite performing regular SMBG. Nocturnal hypoglycaemia events were recorded in seven women. Univariable analysis did not identify any association between conventional risk factors and hypoglycaemia events in our cohort.
CONCLUSION: Insulin-treated pregnant women with diabetes who achieved HbA1c < 6.0% were associated with high prevalence of hypoglycaemia. Asymptomatic hypoglycaemia is common in our cohort and frequently missed despite regular SMBG. Present study did not identify any association between conventional risk factors and hypoglycaemia events in our cohort.
Human ; Female ; Hypoglycemia ; Pregnancy ; Diabetes Mellitus
3.Management of diabetes in pregnancy in primary care
Nurain Mohd. Noor ; Lili Zuryani Marmuji ; Mastura Ismail ; Hoong Farn Weng Micheal ; Barakatun Nisak Mohd Yusof ; Mohd. Aminuddin Mohd. Yusof ; Rohana Abdul Ghani ; Norasyikin Binti A. Wahab ; Nazatul Syima Idrus ; Noor Lita Adam ; Norlaila Mustafa ; Imelda Balchin ; Ranjit Singh Dhalliwal
Malaysian Family Physician 2019;14(3):55-59
Diabetes in pregnancy is associated with risks to the woman and her developing fetus. Management
of the condition at the primary care level includes pre-conception care, screening, diagnosis, as well
as antenatal and postpartum care. A multidisciplinary approach is essential in ensuring its holistic
management.
4.Relationship Between Dyslipidaemia And Glycaemic Status In Patients With Type 2 Diabetes Mellitus
Subashini C Thambiah Mbbs ; Intan Nureslyna Samsudin ; Elizabeth George ; Siti Yazmin Zahari Sham ; Huey Ming Lee ; Mohd Azril Muhamad ; Zanariah Hussein ; Nurain Mohd Noor ; Masni Mohamad
The Malaysian Journal of Pathology 2016;38(2):123-130
The risk of coronary heart disease (CHD) is dramatically increased in diabetic patients due to their
atherogenic lipid profile. The severity of CHD in diabetic patients has been found to be directly
associated with glycated haemoglobin (HbA1c). According to the Malaysian Clinical Practice
Guidelines on diabetes mellitus (DM), HbA1c level less than 6.5% reduces the risk of microvascular
and macrovascular complications. Hence, this study aimed to determine the relationship between
dyslipidaemia and glycaemic status in patients with type 2 DM (T2DM) patients in Hospital
Putrajaya, a tertiary endocrine centre in Malaysia. This was a cross sectional, retrospective study of
214 T2DM patients with dyslipidaemia who had visited the endocrine clinic between January 2009
and December 2012. Significant correlations were found between fasting blood glucose (FBG) and
HbA1c with total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL),
non-high density lipoprotein cholesterol (non-HDL), LDL/HDL ratio and TC/HDL ratio; greater
correlation being with HbA1c than FBG. In patients with HbA1c ≥ 6.5%, TC, TG, non-HDL and
TC/HDL ratio were significantly higher than in patients with HbA1c < 6.5%. Non-HDL, LDL/HDL
ratio, TC/HDL ratio and HbA1c were significantly lower in patients on statin treatment than nontreated
patients (p<0.05). This significant association between glycaemic status and dyslipidaemia
emphasises the additional possible use of HbA1c as a biomarker for dyslipidaemia as well as a
potential indirect predictor of cardiovascular disease (CVD) risk in T2DM patients.
5.Anaemia in Type 2 Diabetes Mellitus (T2DM) Patients in Hospital Putrajaya
Subashini Chellappah Thambiah ; Intan Nureslyna Samsudin ; Elizabeth George ; Lydiar Kaur Ranjit ; Nur Syakila Saat ; Zanariah Hussein ; Nurain Mohd Noor ; Masni Mohamad
Malaysian Journal of Medicine and Health Sciences 2015;11(1):49-62
Patients with diabetes have an earlier onset and increased severity of anaemia compared to those with
similar degree of renal impairment from other causes. Anaemia is associated with an increased risk
of vascular complications. In this study, we determined the prevalence of anaemia in T2DM patients
and its association with sociodemographic, clinical and laboratory parameters in an endocrine tertiary
hospital in Malaysia. This was a cross-sectional study using retrospective electronic data from January
2011 to December 2013 of 165 T2DM patients in Hospital Putrajaya. Data was analysed using IBM
SPSS Statistics version 21.0 for Windows. The prevalence of anaemia was 39.4% and majority had
normocytic normochromic (80%), mild (58.5%) anaemia. Majority were Malays (73.9%), aged below
60 with comparable gender percentage and long-standing, poorly-controlled DM [median fasting blood
sugar (FBS) 8mmol/L; glycated haemoglobin (HbA1c) 7.9%]. Using the KDIGO chronic kidney disease
(CKD) staging system, 86% of these patients were in stages 3-5. Anaemic patients had a significantly
higher serum urea, creatinine and a lower FBS, estimated glomerular filtration rate (eGFR) compared to
non-anaemic patients. Anaemic patients with diabetic nephropathy had a significantly lower haemoglobin
(Hb) compared to those without this complication (p=0.022). The sensitivity and specificity at a cut-off
eGFR value of 38.3 ml/min/1.73 m2 (maximum Youden index = 0.462) was 66.7% and 79.5%, respectively
to discriminate mild from moderate anaemia. This study shows that anaemia is already present in T2DM
patients in Hospital Putrajaya at initial presentation to the specialist outpatient clinic and is significantly
associated with CKD. Hence, it emphasises the obligatory need for routine and follow-up full blood
count monitoring in T2DM patients in primary care as well as tertiary settings in Malaysia to enable
early detection and aggressive correction of anaemia in preventing further complications.
Diabetes Mellitus, Type 2
6.Awareness of Glycosylated Haemoglobin (HbA1c) Among Type 2 Diabetes Mellitus Patients in Hospital Putrajaya
Intan Nureslyna Samsudin ; Subashini C. Thambiah ; Wan Mohamad Asyraf Wan Mohammed Ayub ; Ng Wan Cheng ; Zanariah Hussein ; Nurain Mohd Noor ; Masni Mohamad ; Elizabeth George
Malaysian Journal of Medicine and Health Sciences 2015;11(2):1-8
The glycosylated haemoglobin (HbA1c) test is the most widely accepted laboratory test for evaluating
long term glycaemic control. Patient’s understanding of HbA1c can lead to better glycaemic control.
This study is aimed to determine the awareness and level of understanding of HbA1c among type 2 DM
patients and its association with glycaemic control. A cross-sectional descriptive study among Type 2
DM patients undergoing routine follow up in an endocrine clinic of a tertiary centre in Malaysia. Patients
were invited to answer a validated questionnaire which assessed their awareness and understanding of
HbA1c. Their last HbA1c results were retrieved from the laboratory information system. A total of
92 participants were recruited. Fifty-six (60.9%) were aware of the term HbA1c. Fifty percent were
categorised as having good HbA1c understanding, with age, monthly income and level of education
being the factors associated with understanding. No significant association was noted between HbA1c
understanding and glycaemic control, although more patients with good HbA1c understanding had
achieved the target glycaemic control compared to those with poor understanding. The level of HbA1c
awareness and understanding was acceptable. Factors associated with understanding were age, income
and level of education. Continuing efforts however, must be made to improve patients understanding of
their disease and clinical disease biomarkers.
Diabetes Mellitus, Type 2
7.Successful modified desensitization therapy with analog insulin in an individual with severe allergy to multiple insulin preparations: A case report
Wan Juani Wan Seman ; Azraai Bahari Nasruddin ; Nurain Mohd Noor
Journal of the ASEAN Federation of Endocrine Societies 2018;33(1):53-56
We present a case of a 27-year-old female with T2 DM who developed allergic reactions after commencement of insulin therapy. Trial with different types of insulin resulted in a series of allergic reactions ranging from urticarial rash to development of angioedema, bronchospasm and anaphylactic shock. She was successfully treated with a modified insulin desensitization protocol using rapid-acting insulin.
Excipients
8.Prevalence of Glucose Intolerance in Early Postpartum and Its Associated Factors Among Women With History of Gestational Diabetes Mellitus
Rashidah Bahari ; Lisa Mohamed Nor ; Nurain Mohd Noor
Malaysian Journal of Medicine and Health Sciences 2022;18(No.1):200-205
Introduction: Gestational diabetes mellitus (GDM) is a known risk of developing type 2 diabetes mellitus in the
future. The prevalence of glucose intolerance in the early postpartum period among women with GDM ranges
between 13.5% to 50%, depending on the population. This study aims to estimate the prevalence of glucose intolerance 6 to 12 weeks postpartum and its associated factors among women with GDM in Putrajaya, a federal government administrative centre of Malaysia. Methods: All women with history of GDM who had oral glucose tolerance
test (OGTT) done 6 to 12 weeks postpartum at Putrajaya clinic from June 2013 to December 2016 were included.
Sociodemographic data, details of GDM diagnosis and management, and postpartum OGTT results were collected.
Results: There were 443 women with a mean age of 31.7 years. Postpartum OGTT showed 58 (13.2%) had prediabetes and 10 (2.1%) had diabetes. The independent risk factors associated with early postpartum glucose intolerance
were 2-hour plasma glucose of diagnostic OGTT, gestational age of GDM diagnosis and HbA1c level in pregnancy.
Conclusion: A diagnosis of postpartum glucose intolerance can occur early in women with history of GDM. Factors
such as 2-hour plasma glucose of diagnostic OGTT, gestational age of GDM diagnosis and HbA1c level increase the
risk of postpartum glucose intolerance.
9.Trajectory, Perceived Causes and Efforts in Diabetes Selfmanagement: A Qualitative Study Among Young People With Type 2 Diabetes Mellitus and Caregivers
Nursyuhadah Othman ; Qi Ying Lean ; Chin Fen Neoh ; Mohd Shahezwan Abd Wahab ; Nurain Mohd Noor ; Shueh Lin Lim ; Yuet Yen Wong
Malaysian Journal of Medicine and Health Sciences 2024;20(No.1):242-252
Introduction: Previous studies have suggested that young individuals with type 2 diabetes mellitus (T2DM) face
challenges in achieving optimal diabetes self-management, leading to difficulties in attaining the recommended
glycaemic target. The reasons behind these suboptimal practices remain unclear due to the limited number of studies conducted in Malaysia that focused on diabetes self-management among young people. This qualitative study
aimed to understand the lived experience of young people with T2DM on self-management in Malaysia. Methods:
Young people at the age of 10 to 24 years, who had been diagnosed with T2DM and the caregivers who managing
young people with T2DM were interviewed. Data were thematically analysed with the aid of QSR NVivo version 12.
Results: Sixteen young informants and eleven caregivers participated in this study. Three major themes conceptualised the lived experience of diabetes self-management: (1) the trajectory to T2DM diagnosis; (2) perceived causes of
T2DM; (3) the efforts in diabetes self-management. The route of diagnosis and experiential knowledge about T2DM
might determine their efforts in the self-management among the young people. Healthy eating, medication taking
and physical activity were perceived as important tasks in diabetes self-management. The involvement of the caregivers in diabetes self-management evolved over time. Conclusion: The study highlighted the experience of young
people and caregivers since the beginning of the diagnosis and their strategies in diabetes self-management. More
understanding of the lived experiences of patients and caregivers in disease management within the socio-ecological
context could help to improve health-care services and intervention for this population.