Cost-Effectiveness of Mobile Application Use in Managing Type 2 Diabetes Mellitus: A Systematic Review Introduction Type 2 diabetes mellitus (T2DM) is a debilitating condition that imposes a significant economic burden on its management. This study aims to systematically review the published evidence on the cost-effectiveness of mobile health (mHealth) application interventions for T2DM. Methods A search strategy was conducted using electronic bibliographic databases, including PubMed, Web of Science and Scopus for published studies. The inclusion criteria included original articles that reporting cost-effectiveness evaluation studies on mHealth application interventions directed at patients diagnosed or at risk of T2DM, English-language articles and published in the year 2016 to 2020. Results A total of 6 eligible studies were selected. The cost savings per person for treating T2DM ranged from USD 1,346 to USD 3,781 per year. The major contributor to cost savings was reduced complication management resulting from good glycaemic control. The direct impacts of the intervention include reduced hospitalisation and fewer unplanned clinic visits, while diabetes- related mortality was indirectly reduced usingmHealth. Conclusions The mHealth intervention was cost-effective in managing patients with T2DM. Implementation can be extended to other disease management areas to not only reduce total healthcare expenditure but also improve patients’ quality of life.

Introduction: Insulin deintensification is an emerging strategy to reduce hypoglycemia and treatment burden in patients on multiple daily injection (MDI ≥3), with potential to improve adherence and glycemic control. However, evidence in poorly controlled type 2 diabetes mellitus (T2DM) remains limited. This study evaluated its effectiveness and identified factors associated with achieving adequate glycemic control following deintensification among patients with poorly controlled T2DM attending Malaysian primary care. Methodology: A retrospective cohort study was conducted among 107 T2DM patients with hemoglobin A1c (HbA1c) >9%, attending Enhanced Diabetic Clinic at Cheras Health Clinic between 2021 and 2025. All patients on basal-bolus insulin (BBI) underwent deintensification. Multivariate logistic regression was performed to identify factors associated with achieving adequate glycemic control (HbA1c <7.5%). Changes in HbA1c following deintensification were assessed using paired t-tests. Results: Overall, 50.5% of patients achieved adequate glycemic control. Hypoglycemia events (AOR 9.5, 95% confidence interval [CI] 1.6–58.3; p = 0.015), MDI (AOR 9.6, 95% CI 1.4–67.1; p = 0.023) and Diabetes Medication Therapy Adherence Clinic (DMTAC) visits (AOR 1.1, 95% CI 1.0– 1.2; p = 0.039) were significantly associated with achieving HbA1c <7.5%. Conversely, patients transitioned from BBI to premixed regimens were less likely to achieve HbA1c <7.5% (AOR 0.22, 95% CI 0.05–0.93, p = 0.039). All insulin deintensification strategies were associated with significant HbA1c improvements with transitioned from BBI to premixed human insulin (mean difference -2.54%, 95% CI 1.77–3.31, p <0.001, Cohen’s d = 1.09), BBI to premixed analogue insulin (mean difference -3.38%, 95% CI 2.26– 4.49, p <0.001, Cohen’s d = 1.62), BBI to basal insulin (mean difference -3.67%, 95% CI 1.79–5.54, p = 0.004, Cohen’s d = 2.05). Conclusion Insulin deintensification is an effective strategy for improving glycemic control in poorly controlled T2DM. These findings highlight the importance of deintensification with careful consideration of hypoglycemia, MDI-related treatment burden, and patient engagement through regular DMTAC visits, which are integral to achieving optimal outcomes and support a personalized approach to diabetes management in primary care.
Diabetes Mellitus, Type 2 ; Glycemic Control ; Retrospective Studies ; Primary Health Care ; Insulins

Introduction: Adolescents with type 1 diabetes (T1D) are vulnerable to diabetes-related distress (DRD), an emotional burden that may adversely affect glycemic control. Data on DRD among adolescents in Southeast Asia, particularly Malaysia, remain limited. This study aims to determine the prevalence of DRD and examine its association with glycemic control and sociodemographic background among Malaysian adolescents with T1D. Methodology: This cross-sectional study recruited adolescents aged 10–19 years with T1D attending a tertiary Paediatric Endocrine Clinic in Malaysia between May and August 2025. DRD was assessed using two validated instruments: the Problem Areas in Diabetes–Teen version (PAID-T) and the Type 1 Diabetes Distress Scale (T1-DDS). Sociodemographic and clinical data, including glycated hemoglobin (HbA1c), were collected. Associations between distress, glycemic control, and other variables were analyzed using non-parametric tests, correlation analyses, and multiple linear regression. Results: Seventy adolescents participated (median age: 14.65 years). Moderate to severe DRD was reported by 32.9% using PAID-T and 38.6% using T1-DDS. Higher distress scores on both instruments were significantly correlated with poorer current and prior HbA1c levels. Adolescents with HbA1c ≤7.0% were more likely to report minimal distress compared to those with higher HbA1c (p = 0.042, T1-DDS). Subdomain analyses revealed strong associations between emotional distress domains, particularly powerlessness and family/friends distress, and higher HbA1c. In multivariable regression, DRD, body mass index, and family/friends distress together explained 35% of the variance in HbA1c. Attendance at diabetes management camps was not associated with differences in distress levels. Conclusion Approximately one-third of Malaysian adolescents with T1D experience clinically significant DRD, which is strongly associated with suboptimal glycemic control. Emotional and family-related distress appear to play a particularly important role. Routine screening and targeted psychosocial interventions should be integrated into adolescent diabetes care to improve both emotional well-being and metabolic outcomes.
Adolescent ; Humans ; Diabetes Mellitus, Type 1

Introduction: Childhood obesity is associated with significant metabolic morbidity, particularly insulin resistance (IR) and metabolic syndrome. Acanthosis nigricans (AN) is frequently observed in children with obesity and may represent a practical clinical marker of IR. This study evaluated the association between AN, IR, and metabolic complications in paediatric obesity. Methodology: A retrospective review was performed of 148 children (88 males, 60 females; median age 12 years) attending the Paediatric Obesity Clinic at Universiti Malaya Medical Centre. Data included anthropometry, AN grading, family history, HOMA-IR, and metabolic screening. Outcomes assessed were dyslipidemia, metabolic-associated fatty liver disease (MAFLD), hypertension, obstructive sleep apnea syndrome (OSAS), and glucose dysregulation. Comparisons were made between children with and without AN at baseline and over follow-up (median 2.4 years). Results: AN was present in 81.8% of patients, and 82.4% had central obesity. Increasing AN grade was significantly associated with higher BMI SDS and American Academy of Paediatrics obesity class (p <0.05). AN was more prevalent among Malay and Indian children and was associated with a family history of obesity (p <0.05). Baseline metabolic abnormalities were common, including dyslipidemia (high triglycerides 31.8%, low HDL 30.4%, high LDL 29.7%), MAFLD (23.6%), OSAS (31.1%), and glucose dysregulation (27.7%), with no significant difference between groups. During follow-up, children with AN and more severe obesity developed significantly more metabolic complications, particularly MAFLD and OSAS, with increased requirement for non-invasive ventilation (p <0.05). Higher HOMA-IR was associated with glucose dysregulation but was not independently associated with AN. Conclusion AN is strongly associated with greater adiposity and predicts the progression of metabolic complications in children with obesity. Routine assessment of AN may help identify high-risk patients who would benefit from early, intensive intervention to reduce long-term cardiometabolic morbidity
Child ; Acanthosis Nigricans ; Biomarkers ; Obesity

Introduction: Endocrine abnormalities are frequently observed in children with Down syndrome, with thyroid dysfunction being the most common. The distribution and patterns of thyroid disorders vary between populations. Methodology: Retrospective data were collected from the electronic medical records of children with Down syndrome who attended the paediatric clinic at University Malaya Medical Centre from the year 2000 to 2025. Data were analyzed to determine the frequency and distribution of thyroid disorders in this cohort. Results: The study included 57 patients, the majority of whom were identified through routine screening (n = 56, 98.2%). Only one child (1.8%) was diagnosed following a symptomatic presentation of diarrhea. Within the cohort, 51 patients were diagnosed with hypothyroidism and six with hyperthyroidism. Among those with hypothyroidism, the mean TSH was 22.5 mIU/L, with a median age at presentation of 61 days (IQR: 19–211.5). Notably, 25% of the cohort presented within the first 19 days, while the rest presented after 7 months of age. Of these, 24 cases (47.1%) were transient, with medications successfully discontinued at a mean age of 4.0 ± 2.13 years. Only 26 patients underwent thyroid scan, which was normal except for one case of thyroid agenesis. Imaging was not performed in others due to early discontinuation of therapy or loss to follow-up. All hyperthyroid patients had autoimmune thyroid disease (4 Graves’ disease, 2 Hashimoto’s thyroiditis) with positive autoantibodies. The median age at presentation was 5.4 years (IQR: 2.3–10.2). Conclusion Screening for thyroid dysfunction successfully identified almost all cases in patients with Down syndrome. Notably, patients which hyperthyroidism in this cohort had co-occurring autoimmune thyroid dysfunction and demonstrated a significantly earlier age of presentation compared to the general paediatric population.
Child ; Down Syndrome ; Thyroid Gland

Introduction: Paediatric glucocorticoid-induced hyperglycemia (GIH) and diabetes are frequently under-recognized complications of cancer therapy. Early identification is essential, as delayed diagnosis may lead to severe metabolic consequences, including diabetic ketoacidosis (DKA). This study aims to characterize the clinical features, risk factors, and outcomes of GIH in a tertiary centre. Methodology: A descriptive cross-sectional study was conducted at the Paediatric Endocrinology Unit, University Malaya Medical Centre, reviewing cases from January 2023 to December 2025. Data were extracted from electronic records, including demographic, clinical, and treatment-related variables. Results: Twelve cases of GIH or diabetes were identified, including two presenting with DKA. Most patients had leukemia (92%), with a male predominance (75%). The median age was 13.6 years, and the median body mass index was 22.1 kg/m². Over half (54%) were overweight or obese, and 45% exhibited acanthosis nigricans. A family history of diabetes was present in 75% of cases. Hyperglycemia developed early in 66% of cases, typically within 2–5 days of initiating high-dose glucocorticoids. Median random blood glucose was 21.9 mmol/L, while median HbA1c was 6.4%. Half were symptomatic, most commonly with polyuria. Insulin therapy was required in 75% of cases, with a median duration of 26 days. Metformin was used in 50% of cases, often in combination with insulin. Most cases resolved following cessation of glucocorticoid therapy, except one who continues to receive metformin for a pre-diabetes state. Conclusion Adolescents, those with obesity, insulin resistance, and a positive family history of diabetes, represent highrisk groups for GIH. Importantly, GIH may present with life-threatening DKA. Routine glucose monitoring and risk stratification during glucocorticoid therapy are recommended. The development of local screening and management guidelines is crucial for improving early detection and optimizing patient outcomes.
Child ; Diabetic Ketoacidosis ; Glucocorticoids ; Neoplasms ; Hyperglycemia

BACKGROUND

The recent COVID-19 pandemic has led to a rise in the incidence of obesity both in children and adults. Studies on the effect of the pandemic on Type 2 diabetes mellitus (T2DM) trends in children are limited. In this study, we aim to evaluate the frequency, clinical characteristics and demographics of newly-diagnosed paediatric T2DM cases 4 years before and after the pandemic.

The frequency and clinical data of patients aged ≤18 years with newly-diagnosed T2DM in 4 tertiary centers in urban Malaysia from 18 March 2016 till 17 March 2020 (pre-pandemic) and 18 March 2020 till 17 March 2024 (postpandemic) was collected.

Seventy-five (75) patients were recorded with newly-diagnosed T2DM pre-pandemic and fifty-four (54) patients were recorded with newly-diagnosed T2DM post-pandemic. There was no significant increase in T2DM cases and diabetic ketoacidosis (DKA) during pandemic and T2DM cases fell to below pre-pandemic levels in the 3rd and 4th year postpandemic. HbA1c and serum glucose were lower post-pandemic than pre-pandemic: 10.1% vs 11.9%, p = 0.008 and 12.0 mmol/L vs 16.1 mmol/L, p = 0.038 respectively.

The incidence of T2DM and DKA did not increase during the pandemic and further declined in year 3 and 4 post-pandemic. Lower HbA1c and serum glucose in the post-pandemic group may suggest improved screening services and greater access to medical care.

Environmental Determinants in Sustaining the Transmission of Lymphatic Filariasis: A Systematic Review IntroductionSince mass drug administration continues in many of the endemic countries, it is vital to synthesise evidence to adapt the challenges contributed by the environments. As such, the aim of this review was to explore relationship between lymphatic filariasis prevalence and potential environmental determinants .MethodsWe searched the electronic databases PubMed, Web of Science, Cochrane, and Scopus between Jan 1, 2013, and Dec 31, 2022, for studies fulfilling the following criteria: it was an original article investigating the environmental determinants associated with transmission of lymphatic filariasis; and the study was published in English. The quality assessment tools for observational studies from the National Heart, Lung, and Blood Institute was used to assess the study quality. This systematic review was registered with the PROSPERO database (CRD42023393018).ResultsWe identified 409 potentially eligible published articles, of which 11 met our inclusion criteria. The main environmental determinants associated with lymphatic filariasis transmission were Normalised Difference Vegetation Index (NDVI), land cover, distance to waterbody, rainfall/precipitation, elevation, slope, day land surface temperature, average annual temperature, house type and distance to stable light. ConclusionsThis review is one of the steps towards understanding the associations between environmental determinantsand transmission of lymphatic filariasis. These results can be used in future evidence-based strategies to strengthen surveillance and control strategies.

Medication review is an intervention with the potential to reduce drug-related problems (DRPs) in the elderly. This study aimed to determine the effect of pharmacists’ medication reviews on geriatric patients. This study accessed two online databases, MEDLINE Complete and Scopus, and examined all studies published in English between 2019 and 2023, except for reviews. The studies included (1) participants over 65 years of age and (2) medication reviews conducted by pharmacists. The titles, abstracts, and full texts were reviewed for data extraction to determine whether the studies satisfied the inclusion and exclusion criteria. Forty-four of the initial 709 articles were included in this study. The articles included discussions on the incidence rates of DRPs and potentially inappropriate medications (PIMs) (n=21), hospitalization (n=14), medication adherence (n=9), quality of life (QoL) (n=8), and falls (n=7). Pharmacist medication reviews were associated with a reduced incidence of DRPs and PIMs, and improved adherence to medications. Patients’ overall QoL is also increasing. However, pharmacist medication reviews were not strongly associated with decreased hospitalization or falls. A pharmacist’s medication review may be a feasible intervention for reducing the incidence rates of DRPs and PIMs, regardless of whether it is performed as a sole intervention or supplemented with other interventions. The intervention was also effective in increasing medication adherence and QoL.