No abstract available.
Diabetes Mellitus, Type 2*

No abstract available.
Diabetes Mellitus, Type 2*

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

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

Aims: The aim of the study was to re-evaluate the relationship between hospital based diabetes care delivery and prevention of complications. Methods: DiabCare is an observational, non-interventional, cross-sectional study of hospital-based outpatient diabetes care. Results: A total of 1668 patients participated in the study: mean age 57.8 ± 11.0 years, duration of diabetes 13.0 ± 8.6 years, and duration of insulin treatment 5.6 ± 5.5 years. Mean weight was 74.3 ± 16.6 kg (BMI 29.1 ± 5.8 kg/m2). The majority of patients were female (53.6%) and the largest ethnic group was Malay (51.3%), followed by Indian (21.9%) and Chinese (20.1%). The percentage of patients with HbA1c < 6.5% (< 42 mmol/mol) and < 7.0% (< 53 mmol/mol) was 12.2% and 23.8%, respectively (mean HbA1c 8.52 ± 2.01% [70 ± 22 mmol/mol]). The proportion of patients using insulin was 65% at a total daily dose of 60 ± 37 IU. One or more episodes of hypoglycaemia were reported by 39% (n=658) of patients within the previous three months. The risk of any hypoglycaemia was associated with the use of insulin (odds ratio [OR 3.26, 95% CI 2.59–4.09]), and total daily insulin dose (OR 1.04, 95% CI 1.01–1.07 per 10 IU increase). Mean HbA1c had not changed significantly between DiabCare cohorts 2008 and 2013 (p=0.08). Conclusions: Despite evidence of improving processes of diabetes care, glycaemic control and the prevalence of many diabetes related complications were unchanged.
Diabetes Mellitus, Type 2

Background: Diabetes is one of the major health concerns worldwide. Self-care is one of the most important methods in controling this disease and preventing development of complications. Objective: The study aimed to determine the level of adherence to self care behavior among Type 2 diabetic patients consulting at the Out Patient Department of Batangas Medical Center and Bolbok Health Center from January 2020 to December 2020 Methods: This analytic cross-sectional study consists of administration of a validated Behavior Score Instrument and Family APGAR questionnaire among 143 diagnosed Type 2 Diabetic patients in the Family Medicine OPD Clinic and Bolbok Health Center. A purposive nonprobability sampling method was used. Data obtained were encoded and analyzed using the Stata version 17. To compare the levels of adherence between family function groups, Chi-square test and Fisher Exact test were used. Results: Over-all adherence to the self-care behaviors showed good adherence 94.4% (135) of the participants. None of the patients had poor adherence to self care behaviors. Majority had highly functional families (n 131; 91.6%) and none of the patients had severely dysfunctional families. Overall levels of adherence were comparable among family function groups. Good adherence to glucose monitoring was noted among higher proportions of participants with highly functional families. Conclusions The study showed that the least followed behavior was medication adherence and risk reduction. Having patients adhere to anti diabetic medications is important in achieving blood glucose control and following the behaviors under risk reduction can help them from developing more complications due to their disease.
Diabetes Mellitus, Type 2

No abstract available.
Diabetes Mellitus, Type 2

Objective: To evaluate the effect of adding DPP4 inhibitor (DPP4-i) on glycemic variability (GV) in patients with type 2 diabetes mellitus (T2DM) treated with premixed human insulin (MHI). Methodology: We conducted a prospective study in patients with T2DM on twice-daily MHI with or without metformin therapy. Blinded continuous glucose monitoring was performed at baseline and following 6 weeks of Vildagliptin therapy. Results: Twelve patients with mean (SD) age of 55.8 (13.1) years and duration of disease of 14.0 (6.6) years were recruited. The addition of Vildagliptin significantly reduced GV indices (mmol/L): SD from 2.73 (IQR 2.12-3.66) to 2.11 (1.76-2.55), p=0.015; mean amplitude of glycemic excursions (MAGE) 6.94(2.61) to 5.72 (1.87), p=0.018 and CV 34.05 (8.76) to 28.19 (5.36), p=0.010. In addition, % time in range (3.9-10 mmol/l) improved from 61.17 (20.50) to 79.67 (15.33)%, p=0.001; % time above range reduced from 32.92 (23.99) to 18.50 (15.62)%, p=0.016; with reduction in AUC for hyperglycemia from 1.24 (1.31) to 0.47 (0.71) mmol/day, p=0.015. Hypoglycemic events were infrequent and the reduction in time below range and AUC for hypoglycemia did not reach statistical significance. Conclusion The addition of DPP4-I to commonly prescribed twice-daily MHI in patients with T2DM improves GV and warrants further exploration.
Diabetes Mellitus, Type 2

Background: Genitourinary tract infections, mycotic as well as bacterial, as defined by clinical symptoms, are one of the common adverse effects associated with the use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in type 2 diabetes mellitus (T2DM) patients in clinical trials. However, Indian data in terms of the prevalence of culture-proven bacterial type of urinary tract infection (UTI), and the causative organism is limited. Objective: This study aimed to determine the prevalence and causative agents of bacterial UTI among patients with T2DM on SGLT2i. Methodology: This was a prospective longitudinal study involving all patients with T2DM who were prescribed with SGLT2i, uncontrolled on other oral anti-diabetic medications, from June 2019 to February 2020. Prevalence of bacterial UTI was evaluated at baseline and 12 weeks after initiation of SGLT2i. Results: A total of 80 patients were started on SGLT2i. One female patient on canagliflozin had significant asymptomatic bacteriuria and the causative agent was Acinetobacter baumannii. One male patient on dapagliflozin had symptomatic UTI with negative urine culture study. Four patients developed genital mycotic infection. Conclusion In this real-world study, SGLT2i as a class, was well tolerated with favorable safety profile, and risk of developing significant bacteriuria and/or symptomatic UTI was minimal.
Diabetes Mellitus, Type 2

Background: Alpha-amylase and alpha-glucosidase are essential enzymes in converting food into energy inside the body. However, the proper management of these enzymes is needed to maintain normal blood glucose levels in the body. Thus, inhibiting these carbohydrate-hydrolyzing enzymes is necessary for managing hyperglycemia and alleviating Type 2 Diabetes Mellitus complications. Studies have reported that the Piper species have inhibitory properties on these digestive enzymes. However, the locally cultivated P. umbellatum has not yet been studied. Objectives: The study evaluated the inhibitory potentials of the locally grown P. umbellatum leaf extracts against α-amylase and α-gluiosidase. Methodology: The P. umbellatum leaf extracts were screened for in vitro inhibitory α-amylase and α-glucosidase tests. The most active crude extract was subjected to semi-purification and fractions were subjected to inhibitory enzymatic tests. Qualitative and quantitative phytochemical analyses were conducted. Results: Among all crude extracts, the KMB-HE exhibited the highest activities comparable to that of the acarbose standard (p>0.05). The KMB-HE showed inhibitions of 81.01%±1.66 and 89.51%±3.03 on α-amylase and α-glucosidase at 250 μg/mL, respectively. In addition, it contained the highest phenolic (195.00 ±3.60 GAE mg/gram) and flavonoid (4.55±0.06 QE mg/gram) contents that may be linked to the observed activities. The semi-purification of KMB-HE collected 24 fractions with PF10 demonstrating inhibitions of 68.07%±13.48 and 74.21%±2.22 in α-amylase and α-glucosidase, respectively. Also, the PF10 contained the highest phenolic (204.75±2.42 GAE mg/gram) and flavonoid (4.00±0.07 QE mg/gram) compounds among all the active fractions tested. The PF10 satisfied the recommended criteria for plant natural inhibitors: a moderate-to-low α-amylase and stronger α-glucosidase inhibitory activity. Conclusion The P. umbellatum exhibited good inhibitory activities on carbohydrate-hydrolyzing enzymes. These may lead to further analysis of the P. umbellatum for future development of a safer, locally available natural remedy in managing Type 2 Diabetes Mellitus.
Diabetes Mellitus, Type 2