Objective: To determine prevalence and factors associated with neuropathic pain symptoms in a multiethniccohort of Malaysian adult diabetic patients. Methods: This was aprospective cross-sectionalobservational study of hospital-based diabetic outpatients in Malaysia. Subjects were interviewedfor their demographic data and medical history. The painDETECT questionnaire was used to screenfor neuropathic pain symptoms and pain intensity was assessed using the numeric pain rating scale(NPRS). Neuropathy symptoms and signs were assessed using the Neuropathy Symptom Score(NSS) and Neuropathy Disability Score (NDS). Results:Of 242 patients,140 (58%) were women,with a mean age of 61 + 11.4 years (range 21 to 81). Ninety nine(40.9%) were Malay, 64 (26.4%)Chinese, 76 (31.4%) Indian and three (1.2%) were Eurasian. Mean duration of diabetes was 15.9+ 9.8years (range 1 to 53) and 232 (95.9%) patients had Type II diabetes. Peripheral neuropathy,based onNSS and NDS criteria, was found in 83 (34.3%). Thirteen (5.4%) patients were found to likely haveneuropathic pain symptoms and this was independently associated with peripheral neuropathy ((OR)= 3.40, 95% confidence interval (CI): 1.04, 11.14) and Indian ethnicity (OR = 5.44, 95% CI: 1.50,19.57)). Patients with neuropathic pain had higher average pain intensity scores.Conclusions: The prevalence of neuropathic pain symptoms in a Malaysian DM patient cohort waslow and was associated with the severity of neuropathy symptoms and Indian ethnicity. The causesfor ethnic differences are unknown and could be due socio-cultural or physiological differences inneuropathic pain perception.

People with type 2 diabetes mellitus have increased risk of chronic kidney disease and atherosclerotic cardiovascular disease. Improved care delivery and implementation of guideline-directed medical therapy have contributed to the declining incidence of atherosclerotic cardiovascular disease in high-income countries. By contrast, the global incidence of chronic kidney disease and associated mortality is either plateaued or increased, leading to escalating direct and indirect medical costs. Given limited resources, better risk stratification approaches to identify people at risk of rapid progression to end-stage kidney disease can reduce therapeutic inertia, facilitate timely interventions and identify the need for early nephrologist referral. Among people with chronic kidney disease G3a and beyond, the kidney failure risk equations (KFRE) have been externally validated and outperformed other risk prediction models. The KFRE can also guide the timing of preparation for kidney replacement therapy with improved healthcare resources planning and may prevent multiple complications and premature mortality among people with chronic kidney disease with and without type 2 diabetes mellitus. The present review summarizes the evidence of KFRE to date and call for future research to validate and evaluate its impact on cardiovascular and mortality outcomes, as well as healthcare resource utilization in multiethnic populations and different healthcare settings.

Objective: This study aims to report the demographic features of patients with acromegaly the disease burden, and the corresponding treatment patterns and outcomes in Malaysia. Methodology: This is a retrospective study that included patients from the Malaysian Acromegaly registry who were diagnosed with acromegaly from 1970 onwards. Data collected included patient demographics, clinical manifestations of acromegaly, biochemical results and imaging findings. Information regarding treatment modalities and their outcomes was also obtained. Results: Registry data was collected from 2013 to 2016 and included 140 patients with acromegaly from 12 participating hospitals. Median disease duration was 5.5 years (range 1.0 – 41.0 years). Most patients had macroadenoma (67%), while 15% were diagnosed with microadenoma. Hypertension (49.3%), diabetes (37.1%) and hypopituitarism (27.9%) were the most common co-morbidities for patients with acromegaly. Majority of patients had surgical intervention as primary treatment (65.9%) while 20.7% were treated medically, mainly with dopamine agonists (18.5%). Most patients had inadequate disease control after first-line treatment regardless of treatment modality (79.4%). Conclusion This registry study provides epidemiological data on patients with acromegaly in Malaysia and serves as an initial step for further population-based studies.
acromegaly ; treatment outcomes