The growing prevalence of type 2 diabetes mellitus (T2DM) and the parallel increase in the prevalence of obesity warrants for effective intervention strategies. Overweight/obese patients with T2DM who attempt weight reduction often face considerable challenges. A recent study in Malaysia conducted among overweight/obese patients with T2DM showed that weight reduction and improved glycaemic control could be achieved with structured lifestyle intervention and the incorporation of behavioural counselling. The structured lifestyle recommendations in this study consisted of 1) a fixed low-calorie diet plan of 1200 kcal/day for female and 1500 kcal/day for male patients; 2) incorporation of one or two servings/day of diabetes-specific formula as a meal replacement; 3) a 14-day structured meal plan consisting of the ingredients list, cooking methods and nutrition facts; and the 4) healthy low-calorie snack options. Exercise prescription of ≥150 min/week of moderate-intensity was also encouraged. Behavioural counselling such as motivational interviewing not only facilitated adherence to the lifestyle recommendations but also further enhanced weight loss and glycaemic control in these patients. This article outlines the localisation of the structured lifestyle recommendations and its effectiveness in achieving weight loss and good glycaemic control in overweight/obese patients with T2DM.

INTRODUCTIONWomen with previous gestational diabetes mellitus (PGDM) are at increased risk of future glucose intolerance. This study aimed to determine the prevalence of prediabetes and type 2 diabetes mellitus (T2DM), and the associated antenatal and historical risk factors among women with PGDM.

METHODSThis was a cross-sectional study conducted at University Malaya Medical Centre, Kuala Lumpur, Malaysia. A 75-g 2-hour oral glucose tolerance test was performed in a cohort of multiethnic women with PGDM. Body mass index, waist and hip circumferences, fasting lipid profile and blood pressure were obtained. Data pertaining to the index gestational diabetes mellitus (GDM) were obtained from medical records and interviews.

RESULTS448 women were enrolled in the study. The prevalence of prediabetes and T2DM was 26.2% and 35.5%, respectively. On multinomial logistic regression analysis, fasting plasma glucose at diagnosis of index GDM and duration lapse after index GDM were shown to be significantly higher in women with isolated impaired fasting glucose (IFG), combined IFG/impaired glucose tolerance and T2DM, as compared to women with normal glucose tolerance (p < 0.05). 2-hour plasma glucose at diagnosis of index GDM was significantly higher only in women who progressed to T2DM when compared to those that remained normal glucose tolerant (p < 0.05).

CONCLUSIONIn this study, duration lapse after index GDM, fasting plasma glucose and 2-hour plasma glucose at diagnosis of index GDM were important risk factors for early identification of women at high risk for future glucose intolerance. These may be useful for developing potential preventive strategies.

Adult ; Blood Glucose ; metabolism ; Body Mass Index ; Cross-Sectional Studies ; Diabetes, Gestational ; blood ; Female ; Glucose Intolerance ; blood ; epidemiology ; etiology ; Glucose Tolerance Test ; Humans ; Malaysia ; epidemiology ; Postpartum Period ; blood ; Prediabetic State ; epidemiology ; etiology ; Pregnancy ; Prevalence ; Risk Factors

Introduction: Self-efficacy for eating predicts successful weight loss and maintenance in Type 2 Diabetes Mellitus (T2DM) individuals. The Weight Efficacy Lifestyle (WEL) questionnaire determines self-efficacy for controlling eating. This study aims to validate the Malay-translated version of the WEL questionnaire and to establish the cut-off scores to define the level of eating self-efficacy in Malaysian T2DM individuals. Methods: A total of 334 T2DM individuals, aged 55.0±9.0 years, were recruited from a primary healthcare clinic based on sampling ratio. Medical records were reviewed for eligibility. Inclusion criteria included BMI ≥23kg/m2, and no severe diabetes complications. The WEL questionnaire assessed eating resistance during negative emotions, food availability, social pressure, physical discomfort and positive activities, and was back translated into Malay language. Self-efficacy was rated on a 0-9 scale with higher WEL scores indicating greater self-efficacy to resist eating. Factor analysis established the factor structure of the WEL questionnaire. Inter-item and item-total correlations determined construct validity while internal consistency described the reliability of the structure. Results: A two-factor structure accounting for 49% of variance was obtained, and it had adequate reliability, as indicated by Cronbach’s α of 0.893 and 0.781 respectively. Item-total correlations of r>0.700, p<0.01 and inter-item correlations of r<0.500, p<0.01 demonstrated construct validity. Cut-off scores of ≥44 and ≥32, respectively for factor one and two defined high eating self-efficacies in T2DM individuals. Conclusion: The Malaytranslated version of the WEL questionnaire appears to be a valid and reliable tool to assess self-efficacy for controlling eating behaviour in Malaysian T2DM population.

Objectives: The aim of these Clinical Practice Guidelines is to provide evidence-based recommendations to assist healthcare providers in the screening, diagnosis and management of patients with postmenopausal osteoporosis (OP). Methods: A list of key clinical questions on the assessment, diagnosis and treatment of OP was formulated. A literature search using the PubMed, Medline, Cochrane Databases of Systematic Reviews, and OVID electronic databases identified all relevant articles on OP based on the key clinical questions, from 2014 onwards, to update from the 2015 edition. The articles were graded using the SIGN50 format. For each statement, studies with the highest level of evidence were used to frame the recommendation. Results: This article summarizes the diagnostic and treatment pathways for postmenopausal OP. Risk stratification of patients with OP encompasses clinical risk factors, bone mineral density measurements and FRAX risk estimates. Non-pharmacological measures including adequate calcium and vitamin D, regular exercise and falls prevention are recommended. Pharmacological measures depend on patients’ fracture risk status. Very high-risk individuals are recommended for treatment with an anabolic agent, if available, followed by an anti-resorptive agent. Alternatively, parenteral anti-resorptive agents can be used. High-risk individuals should be treated with anti-resorptive agents. In low-risk individuals, menopausal hormone replacement or selective estrogen receptor modulators can be used, if indicated. Patients should be assessed regularly to monitor treatment response and treatment adjusted, as appropriate. Conclusions The pathways for the management of postmenopausal OP in Malaysia have been updated. Incorporation of fracture risk stratification can guide appropriate treatment.

Introduction: Good health literacy and knowledge are associated with improved outcomes in diabetes. The purpose of this study was to determine diabetes-specific literacy and knowledge levels, and its associated socio-demographic factors, among adults with type 2 diabetes mellitus (T2DM). Methods: This cross-sectional study was conducted among 196 adults from the Indian, Chinese, and Malay ethnic groups with T2DM who attended a primary care clinic in Seremban, Malaysia. The Literacy Assessment for Diabetes and Diabetes Knowledge Test 2 were used to assess diabetes-specific literacy and knowledge, respectively. Results: The majority of participants (75.0%) had literacy scores that corresponded to Ninth Grade Level but only 3.6% of participants had a good knowledge of diabetes. Literacy scores explained up to 19.8% of the variance in knowledge scores (r=0.445, p<0.01). Indian participants had the lowest literacy and knowledge scores when compared to Chinese and Malays (p<0.05). Participants with higher education had better literacy and knowledge scores (p<0.05). Educational level was more likely than ethnicity to predict both literacy and knowledge scores (p<0.001), while gender and age did not significantly predict either score. The majority of participants could answer general questions about physical activity, diabetes-related complications and healthy eating. Knowledge of diabetes and its relation to specific foods and the effect of diet on glucose control were limited among the participants. Conclusion: Education and ethnicity were associated with literacy and knowledge on diabetes. There existed a deficit of diabetes-related nutrition knowledge among the participants. These findings may help healthcare providers tailor individualised patient educational interventions.

Introduction: Evidence showed considerable variability of health risk factors within different socioeconomic groups. This study aimed to characterise dietary intakes by total household income among a sample of Malaysian pre-adolescents in urban Kuala Lumpur. Methods: Baseline data of 243 healthy, pre-adolescent children between 9 and 11 years old including socio-demographic background (gender, ethnicity, and total household monthly income), anthropometry (body weight and height), and 7-day diet histories were collected. Secondary analysis was performed on dietary intakes to quantify food groups based on the Malaysian Dietary Guidelines and NOVA classification systems besides nutrients. Differences and associations between total monthly household income categories with anthropometry and dietary intakes were tested using independent t-test/Mann-Whitney U (depending on normality) and chi-square tests, respectively. Results: Most children in this study population had dietary intakes below the recommended serving sizes for five food groups, except meat/poultry (195.2±107.2%) and fish (110.1±106.3%) and consumed about 32% of energy from ultra-processed foods (NOVA food group 4). While there was no difference in dietary intake between the bottom 40% with the middle 40% and high 20% household income groups, the percentage of energy contributed by NOVA food group 4 (processed fats/oils, condiments, and sauces) was higher in the bottom 40% households (p=0.024). Conclusion: Most pre-adolescent children in this study, regardless of household income, did not meet dietary recommendations and ate diets comprised of less nutritious foods. Comprehensive approaches that aim to improve dietary patterns and reduce the risk of diet-related chronic diseases are warranted.