Diabetes Mellitus and Its Therapy in Brunei Darussalam - A Critical Revisit.

Introduction: Diabetes is becoming an increasingly common condition across the world including Brunei Darussalam. Bruneian population, although is relatively small, represents a miniature urban community of neighbouring Southeast Asian countries as they share similar dietary and ethnicity patterns. Thus, it would be valuable to examine the findings of studies conducted among Bruneians. This study aimed to identify and review research related to the practice of patients with DM in Brunei Darussalam in order to identify associated factors influencing diabetic medication knowledge and adherence. Methods: This narrative review analyzed literature related to DM and its therapy in Brunei Darussalam. Other issues consisting of knowledge and adherence related to DM were also explored. Databases (Scopus, PubMed, and Google Scholar) were used to search literature published up to May 2022. Search terms "diabetes mellitus", "Brunei" combined using Boolean operator were used. Results and Discussion: Conducting appropriate studies in Brunei Darussalam can benefit the government and policymakers to implement effective measures and programmes to combat the diabetes epidemic. Despite the government's efforts, additional relevant stakeholders must be included in order to work together and engage in these initiatives in order to increase diabetes awareness, give people the power to make healthy decisions, and ultimately reduce the prevalence of diabetes in Brunei Darussalam. Patients' medication knowledge proficiency plays a main component of ensuring appropriate and safe use of medication prescribed to them. Conclusion: Relatively poor medication knowledge and inappropriate diabetes-related practices were observed in studies conducted in Brunei Darussalam. However, no study has been done which directly measures both medication awareness and compliance among Brunei Darussalam T2DM patients. Future studies can focus on the relation between these two factors in different geographical locations of the world that are characterized by different diabetes-related practices and culture.

Contextual and culturally appropriate video narratives: A potential health promotion tool for young adults.

ISSUE ADDRESSED: There is an increasing incidence of diabetes mellitus (DM) among the young adult population worldwide, with a high prevalence of undiagnosed DM in. This study aims to evaluate the preliminary effects of a culturally appropriate DM audio-visual among young adults. METHODS: This study involved two phases; the first to develop and validate the videos followed by the second phase exploring the engagement level among 80 young adults. The variables of interest included the participants' knowledge and their planned action after watching the video. RESULTS: Most of the participants (60%) were between the age of 21 and 25 years and had a family history of DM. The majority of participants (80.0%) demonstrated good awareness of DM. Slightly more than half of them (58.8%) thought that DM was curable, which contradicts their knowledge measure. Nevertheless, 88.8% of participants were interested to learn more about DM. CONCLUSIONS: The use of a strategic storyboard and creative editing of the promotional video was a potential trigger to raise the young adults' curiosity to find out more about DM.

Investigating the prevalence of diabetic complications in overweight/obese patients: a study in a tertiary hospital in Malaysia.

Background: In Malaysia, although diabetes accounts for more than 70% of all deaths, it is unclear how it relates to BMI and diabetic complications. This study aimed to investigate the prevalence of obesity and diabetic complications among diabetic patients in Malaysia. Materials and methods: A cross-sectional study using an existing clinical registry was performed from 1 January 2020 to 31 December 2020 at Hospital Serdang, Malaysia. Adult patients with type 2 diabetes mellitus had their medical records examined for disease complications, as reported by the patient at first contact with the DMTAC pharmacist. Results: The study comprised a total of 495 participants with an average HbA1c of 10.5%. About 91% (n = 451) of the 495 patients were obese/overweight. Around 37.8% (n = 187) of diabetic patients are between the ages of 50 and 59, and 59% (n = 292) have had diabetes for less than 10 years. A total of 8.5% (n = 42) and 9.7% (n = 48) consume alcohol and smoke, respectively. Around 29.9% (n = 148) had one other comorbidity (hypertension or dyslipidemia), and 63.4% (n = 314) had two comorbidities. Regarding the prevalence of complications, there were 18.9% (n = 94) who had myocardial infarction, 11.1% (n = 55) who had stroke, and 9% (n = 45) who had CKD. Age (adjusted OR = 1.03; 95% CI 1.00 to 1.07; p = 0.041) and hypertension (adjusted OR = 4.06; 95% CI 1.21 to 13.60; p = 0.023) were significantly related with the prevalence of complications in patients with diabetes. Conclusion: In our study, a BMI of more than 23 kg/m2 (obese/overweight) does not seem to be associated with the prevalence of complications. Age and hypertension, on the other hand, appear to be strong risk predictors of the incidence of complications. With the understanding of the recent outlook on diabetes, it is recommended that public education on the targeted population should be encouraged to negate these complications. Supplementary Information: The online version contains supplementary material available at 10.1007/s13410-022-01131-x.

Effect of Standardized Warfarin Treatment Protocol on Anticoagulant Effect: Comparison of a Warfarin Medication Therapy Adherence Clinic with Usual Medical Care.

Objective: To evaluate the impact of pharmacist-led warfarin management and standardized treatment protocol. Methods: A retrospective cohort study was carried out in a cardiology referral hospital located in central Kuala Lumpur, Malaysia, from 2009 to 2014. The inclusion criteria were: adult patients who were diagnosed and treated for atrial fibrillation (AF) with warfarin, attended the warfarin medication therapy adherence clinic (WMTAC) for at least 12 weeks, and with at least four international normalized ratio (INR) readings. The electronic medical records were reviewed for demographics, type of AF, warfarin dose, INRs, adverse events, co-morbidities, and drug-drug interactions. The outcome measures included the mean time to therapeutic INR, the mean percentage of time in therapeutic range (TTR), bleeding events, and common drug interactions. Results: Out of 473 patients, 151 patients fulfilled the inclusion criteria. The findings revealed that there were significant associations between the usual medical care (UMC) group and pharmacist-led WMTAC in terms of TTR (p = 0.01) and INR (p = 0.02) levels. A positive impact of pharmacists' involvement in the WMTAC clinic was where the "pharmacist's recommendation accepted" (p = 0.01) and "expanded therapeutic INR range" (p = 0.04) were statistically significantly higher in the WMTAC group. Conclusion: There was a significant positive association between the pharmacist-led WMTAC and anticoagulation effect (therapeutic TTR, INR). The identified findings revealed that expanded role of pharmacist in pharmacist-managed warfarin therapy is beneficial to optimize the warfarin therapy. This study also highlighted the critical roles that pharmacists can actively play to ensure optimal anticoagulation pharmaceutical care. KEY MESSAGES: What is already known on this subject?• Pharmacist-managed warfarin therapy is beneficial for optimizing warfarin therapy. In such therapy, recommendations such as dose adjustment and safer alternative drugs (given drug-drug interactions and/or food-drug interactions) are made.• The active involvement of pharmacists in warfarin adherence clinics could significantly improve adherence.• However, the warfarin treatment outcomes from UMC, pharmacist-and-physician-led care and pharmacist-led care have not been studied.• The impact of the implementation of the standardized protocol for the warfarin adherence clinic has not been assessed.What this study adds?• INR levels among UMC group and WMTAC group were significantly different.• Though the TTR level for the WMTAC group was not significantly different than the UMC group, it was higher and close to the targeted 60% level.• The identified findings show that pharmacists' focus on intervention for missed doses, adherence and dose adjustment provide positive impact on patients' warfarin therapy.