Introduction. Vitamin B12 deficiency is more common among metformin-treated subjects although the prevalence is variable. Many factors have been associated with this. The aim of this study is to determine the prevalence of vitamin B12 deficiency and its associated factors among patients with type 2 diabetes mellitus (DM) who are on metformin. Methodology. A total of 205 patients who fit eligibility criteria were included in the study. A questionnaire was completed, and blood was drawn to study vitamin B12 levels. Vitamin B12 deficiency was defined as serum B12 level of ≤300 pg/mL (221 pmol/L). Results. The prevalence of vitamin B12 deficiency among metformin-treated patients with type 2 DM patients was 28.3% (n=58). The median vitamin B12 level was 419 (±257 ) pg/mL. The non-Malay population was at a higher risk for metformin-associated vitamin B12 deficiency [adjusted odds ratio (OR) 3.86, 95% CI: 1.836 to 8.104, p<0.001]. Duration of metformin use of more than five years showed increased risk for metformin-associated vitamin B12 deficiency (adjusted OR 2.06, 95% CI: 1.003 to 4.227, p=0.049). Conclusion. Our study suggests that the prevalence of vitamin B12 deficiency among patients with type 2 diabetes mellitus on metformin in our population is substantial. This is more frequent among the non-Malay population and those who have been on metformin for more than five years.
Introduction: A large number of Muslims fast during the holy month of Ramadan worldwide. A specific approach is needed to manage diabetic patients who intend to fast during Ramadan because of potential harm. Thus, the study aimed to describe the sociodemography and the characteristic of fasting diabetic patients admitted due to acute diabetic complications during Ramadan. Materials and Methods: A cross-sectional study was conducted among fasting diabetic patients in Hospital Tengku Ampuan Afzan (HTAA) who were admitted due to severe hypoglycemia, diabetic ketoacidosis, hyperglycemic hyperosmolar syndrome and uncontrolled diabetes mellitus during the month of Ramadan 2017/1438H. Subjects were interviewed and blood investigation results were obtained from medical records and recorded in patients' case report. Results: Thirteen patients who were admitted due to acute complications of diabetics during Ramadan were included in this study. Of these, 38.5% had severe hypoglycemia, 23.1% diabetic ketoacidosis, 15.4% hyperglycemia hyperosmolar syndrome and 23.1% uncontrolled diabetes mellitus. All of the patients had a long standing diabetes mellitus (median duration of 10 years). HbA1C was high (11.5%) among hyperglycemic subjects. Types of treatment and previous history of severe hypoglycemia prior to Ramadan were the only independent factors identified to be related with acute complications of diabetes during fasting month (p=0.030 and p=0.032 respectively). Insulin, either alone or in combination with oral hypoglycemic agent, was associated with higher number of hypoglycemic event. Conclusion: The significant risk factors found were consistent with other studies. A thorough, individualized and holistic approach is needed in managing patients with diabetes who intend to fast.
Introduction: Data on the burden of thyroid disease in pregnant women in our community is scarce albeit the detrimental effects it brought to both the mother and fetus if left untreated. The aim of this study was to determine the prevalence of thyroid disorders, socio-demography distribution, and method of diagnosis in pregnant women of both tertiary centres in Kuantan, Pahang. Materials and Methods: A retrospective cross sectional study involving patients under follow ups at the Endocrine and Obstetric Clinics of Hospital Tengku Ampuan Afzan (HTAA) and International Islamic University Malaysia Medical Center (IIUM MC) from the 1st January until the 30th June 2017. Out of 923 pregnant women, 29 were found to have thyroid disorders. Detailed demographic data and thyroid function test readings were taken from their medical records and thyroid status were determined from TSH and FT4 readings using the trimester-specific thyroid reference range. Results: The prevalence of thyroid disorders in both centres was 3.14%, with specific prevalence of 2.80% for HTAA and 6.12% for IIUM MC. Nearly half of them were hyperthyroid (47.85%), 17.4% was hypothyroid and Graves’ disease dominated the diagnosis of thyroid disease (30.43%). Significant association was found in weight changes with patients’ thyroid status; reduction in weight in first trimester and increment in weight in second trimester were mainly seen in the hyperthyroid group (p<0.01, p=0.027). Conclusion: The acceptable prevalence of 3.14% for thyroid disorders in pregnancy could be contributed by the iodine availability in this community. High prevalence of Graves’ disease warrants future screening for maternal thyroid stimulating immunoglobulin amongst hyperthyroid women.
Introduction: Type 2 diabetes (T2D) and obesity often coexist and are associated with increased cardiovascular complications. Objective: This study aims to determine the effects of cabergoline, a dopamine agonist on fasting blood glucose (FBG), glycated hemoglobin (HbA1c), lipid profile, blood pressure (BP) and arterial stiffness in overweight and obese T2D patients. Methods: Fifty-eight T2D patients were randomized to cabergoline 0.5 mg biweekly or control groups for 12 weeks. BP and arterial stiffness were recorded at baseline before starting study medication and repeated after 12 weeks. Pulse wave velocity (PWV) and central augmentation index (AIx) were used to assess arterial stiffness. Other parameters measured were anthropometric measurements, FBG, HbA1c and lipid profile. Changes in these parameters after 12 weeks compared to baseline were calculated for each group, and compared between the two groups. Results: Twenty-eight and twenty-six patients from cabergoline and control groups completed the treatment respectively. After 12 weeks, weight and diastolic BP were increased for both groups while body mass index (BMI) and waist circumference (WC) were increased in cabergoline group. PWV and AIx were not significantly different either within or between group comparisons. There were no significant differences in mean changes in all parameters between the two groups. Conclusion: Weight and diastolic BP were elevated in both groups while BMI and WC were increased in cabergoline group. Compared to control, cabergoline treatment at 0.5 mg biweekly in overweight and obese T2D patients for 12 weeks did not improve BP and arterial stiffness.
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