The effect of USM-IAM-based counselling vs standard counselling on insulin adherence, FBS and HbA1c among patients with uncontrolled type 2 diabetes mellitus (T2DM): a randomised controlled trial.

BACKGROUND: Many patients with T2DM on insulin are not optimally controlled despite receiving standard diabetes education counselling. Poor insulin adherence may be a contributing factor. We developed and evaluated a new module [Universiti Sains Malaysia-Insulin Adherence Module (USM-IAM)] on insulin-treated patients with poorly controlled diabetes. METHODS: Eligibility criteria are those diagnosed with T2DM, aged between 18 and 65 years, with HbA1c between 8 and 15% and on insulin therapy for 1 year. Patients were randomly allocated to receive either the USM-IAM-based counselling or the standard counselling (SC) at baseline and the second visit. Patients were instructed to adjust insulin doses based on blood glucose levels. Outcomes were changes in adherence score, FBS and HbA1c levels from baseline to 3 months and baseline to sixth month. RESULTS: Ninety patients were randomised to each group. The baseline sociodemographic and clinical characteristics were homogenous among groups. Ninety patients were analysed for each group. Adherence score changes between baseline to 3 months were - 8.30 (- 11.47, - 5.14) in USM-IAM-based counselling group (USM-IAM) and - 7.64 (- 10.89, - 4.40) in standard counselling group (SCG), between baseline to sixth month were - 10.21 (- 13.40, - 7.03) in USM-IAM and - 10.79 (- 14.64, - 6.97) in SCG. FBS changes between baseline to 3 months were 1.374 (0.25, 2.50) in USM-IAM and 0.438 (- 0.66, 1.54) in SCG, and between baseline to sixth month were 1.713 (0.473, 2.95) in USM-IAM and 0.998 (- 0.02, 2.01) in SCG. HbA1c changes between baseline to 3 months were 1.374 (0.25, 2.50) in USM-IAM and 0.547 (0.12, 0.98) in SCG, and between baseline to sixth month were 1.03 (0.65, 1.41) in USM-IAM and 0.617 (0.20, 1.03) in SCG. Between-subjects effects for all outcomes were not statistically significant. CONCLUSION: Both groups had significant improvements in adherence score and HbA1c with time, with higher improvement in patients receiving the USM-IAM. FBS reductions were significant in the intervention group but not in the control group. TRIAL REGISTRATION: This study protocol is registered with Clicaltrials.gov with ID NCT05125185 dated 17th November 2021.

Effects of Fruit and Vegetable Polyphenols on the Glycemic Control and Metabolic Parameters in Type 2 Diabetes Mellitus: A Review.

The high prevalence of diabetes in recent decades has been associated with lifestyle changes and dietary habits correlated with economic development. Fruits and vegetables are a vital source of nutraceuticals and components of the healthy diet recommended in the medical nutrition therapy for type 2 diabetes mellitus (T2DM) to prevent hyperglycemia and related complications. They are low in calories and rich in dietary fiber, consist of many polyphenols, and are an essential component of a healthy lifestyle. Recently, researchers have developed a significant interest in understanding the effects of polyphenols (flavonoids and non-flavonoids) on blood glucose levels. In this review, the authors summarize the effects of polyphenols commonly found in the fruits and vegetables, such as resveratrol and anthocyanins, on the glycemic control and metabolic parameters, based on human clinical trials. Significant reductions in fasting blood glucose, glycated hemoglobin, and low-density lipoprotein cholesterol levels were reported after resveratrol, anthocyanin, and naringin were administered to patients with prediabetes and diabetes. Decreased insulin levels were observed after resveratrol intervention but not with the other types of polyphenols. These effects of polyphenolic compounds on the glycemic and metabolic parameters might be mediated by multiple pathophysiological mechanisms, such as activating regulator proteins to increase insulin signaling and eventually suppress insulin resistance. The benefits of certain polyphenols on T2DM remain ambiguous; therefore, further studies, especially clinical trials, are required to substantiate the available evidence.

Higher Parental Age and Lower Educational Level are Associated with Underweight among Preschool Children in Terengganu, Malaysia.

This cross-sectional study aimed to investigate the determinants of underweight among preschool children. A total of 218 preschool children were enrolled. Their sociodemographic data were collected using self-reported questionnaires whilst body weight and height were measured, recorded and the BMI for-age z-score was calculated using WHO AnthroPlus software. Of all preschool children participants, 47.7% were male and 53.3% were female. Most of them were Malays (99.5%), aged 4 to <5 years (40.8%) and came from low-income household (92.7%). Overall, the prevalence of underweight, normal, overweight and obese was 17.9%, 73.8%, 4.6% and 3.7% respectively. The underweight prevalence was higher than the national prevalence (13.7%). Of all parent participants, 12.4% were male and 87.6% were female. Most of them aged 30-39 years (55.5%) and did not hold a degree (89.4%). Multivariate logistic regression showed that parental age and their level of education were the determinants of childhood underweight. The risk of being underweight increased with the age of parents (p=0.033) and lower level of education of parents (p=0.042). In conclusion, this study found that underweight among preschool children was mainly associated with parental factors. Hence, designing a special nutritional intervention program involving older parents and lower education levels could overcome this problem.

Understanding Dieting and Previous Weight Loss Attempts among Overweight and Obese Participants: Insights into My Body Is Fit and Fabulous at Work Program.

BACKGROUND: A qualitative study providing an in-depth exploration of people's view and the increasing burden of overweight and obesity is required. This study aimed to explore the understanding of dieting and previous experiences on weight loss attempts among overweight and obese government employees in Kelantan, Malaysia, prior to recruitment into the intervention program. METHODS: Thirteen focus group discussions involving 129 participants from a weight-loss intervention program were conducted within the first 1 month of recruitment. These discussions were moderated by two trained researchers in the Malay language and assisted by an interview guide. They were audio-recorded and transcribed verbatim. A thematic analysis was performed, and codes and themes from each discussion were constructed. RESULTS: The participants understood dieting with various meanings, including skipping meals and removing rice from daily diets. They applied numerous methods to lose weight and achieved various outcomes. Health and appearance, social support, and compliance with current trends were the factors motivating these participants to lose weight. Their determination to lose weight was limited by lack of self-control and motivation, experiences of unpleasant effects, influence on weight, and environmental and health factors. CONCLUSION: Real-life weight loss experiences and perceptions provided relevant insights into current weight loss management strategies. Some of these issues and misunderstandings should be emphasized in weight loss strategies during health promotion.