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.

VALIDATION AND RELIABILITY OF A GUIDED QUESTIONNAIRE (GQ) FOR TYPE 1 DIABETES MELLITUS (T1DM) CHILDREN AND PARENTS ON PERIODONTAL DISEASE (PD) The prevalence of PD is notably high in individuals with T1DM. Despite this, there is a limited availability of research on the utilization of questionnaires to evaluate self-perceived PD, patient knowledge, and their perception of PD in T1DM patients. Therefore, our objective was to establish validity and reliability of a bilingual (English-Malay) version of the guided questionnaire (GQ) to be used among pediatric T1DM patients attending Universiti Teknologi MARA (UiTM) Sungai Buloh campus and the Universiti Malaya (UM). This questionnaire focused on self-reported periodontal disease (PD), assessing their knowledge, and understanding of the bidirectional relationship between PD and T1DM. The dual-language GQ was adapted from the Self-Reported Questionnaire Malay Modified (SRQMM) to suit the targeted participants. Content validation was carried out among five field experts, and face validation was done among pediatric patients in Dental Faculty UiTM. Reliability testing was administered in T1DM patients attending UiTM and UM. The structure and words of the component in GQ were modified to ensure that it was appropriate for the participants. The item-level Content Validity Index (I-CVI) turned out to be valid with an average of 0.98. The subjective measurement of face validation showed satisfactory results after the second revision. Reliability concerning Cronbach’s alpha (α) values was computed relying on all 21 items, which were acceptable at about 0.777, 0.644, 0.780 in the self-perceived PD assessment domain, knowledge domain and perception domain, respectively. Hence, the adapted dual language paediatrics version of the GQ is a reliable and valid tool for assessing self-perceived PD, knowledge, and perception in T1DM patients on PD and it can be effectively utilized by non-dental healthcare personnel.

Stunting is a common phenomenon in Malaysian children. Optimising outcomes for children with growth disorders rests on early recognition and prompt referral. In this context, a framework for the clinical approach can help to guide appropriate growth assessment and referral. This review article aims to provide family medicine specialists with such a framework whilst raising awareness about the shortcomings of the existing growth monitoring system in Malaysia. It also invites readers to consider additional measures that could further optimise this system.

Introduction: This cross-sectional study aimed to investigate relationships between diet quality assessed by Malaysian Healthy Eating Index (HEI) and cardiometabolic risk factors in adolescents aged 13 years. Methods: 336 adolescents from various public secondary schools provided information on sociodemography and their anthropometric measurements including height (cm), weight (kg) and waist circumference (cm) were measured. Body mass index (BMI) was estimated thereafter. Dietary intakes assessed using a validated adolescent food frequency questionnaire (FFQ) was used to estimate Malaysian HEI. Biomarker parameters including lipid profile, fasting glucose, insulin and insulin resistance were also assessed. Associations of diet quality indicators to cardiometabolic risk factors were examined using regression models. Results: The overall diet quality of the adolescents was rather poor (49%), with a greater percentage of males were found to have low dietary quality score compared to females (56% vs. 39%; p<0.05). While males were more obese, a higher number of females (46.7%) were found to have at least one risk factors for cardiometabolic health compared to males (37.7%). After adjusting for covariates, no significant associations were observed among adolescents in the lowest quartile compared to those in the highest quartile of HEI score for obesity and abdominal obesity, as well as other cardiometabolic risk factors, in both males and females. Conclusion: Despite of poor dietary quality, no significant associations were observed between dietary quality assessed by Malaysia HEI and cardiometabolic risk factors in adolescents. Prospective studies are needed to establish a causal link between dietary patterns and cardiometabolic risk factors during adolescence.

Introduction: The causes of congenital hypothyroidism (CHT) are thyroid dysgenesis (TD), dyshormonogenesis (TDH) or transient hypothyroidism (TH). Methodology: This is a cross-sectional study looking at data over a period of 16 years (2000-2016). Confirmed cases had thyroid scan at the age of 3-years-old and repeated TFT (after 6 weeks off medications). Relevant data was collected retrospectively. Results: Forty (60% female) children with CHT were included in the study. Thirty (75%) children presented with high cord TSH. Nine (23%) presented after 2 weeks of life. Majority were diagnosed with TDH (42.5%) with TD and TH of 40% and 17.5% respectively. Median cord TSH of children with TD was significantly higher compared to TDH and TH (p=0.028 and p=0.001 respectively). L-thyroxine doses were not significantly different between TD, TDH and TH at diagnosis or at 3 years. Conclusions TDH is highly prevalent in our population. TD may present after 2 weeks of life. One in five children treated for CHT had TH. Differentiating TD, TDH and TH before initiating treatment remains a challenge in Malaysia. This study provides clinicians practical information needed to understand the possible aetiologies from a patient’s clinical presentation, biochemical markers and treatment regime. Reassessing TH cases may be warranted to prevent unnecessary treatment.
Thyroid Dysgenesis ; Thyroxine