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Fatal Leptospirosis and Escherichia coli co-infection in a post-partum woman

Tan TL, Lee LY, Lim WC

Med J Malaysia, 2018 12;73(6):427-429.
PMID: 30647223

The occurrence of Leptospirosis and Escherichia coli coinfection in the post-partum period is a novel case. This report illustrated a previously well woman from a suburban area presented with acute neurological deterioration following a two days history of fever during her puerperal period. Early interventions with fluids, broad spectrum antibiotics and intensive supportive care were given. Despite that, she deteriorated rapidly and developed pulmonary hemorrhage, disseminated intravascular coagulopathy, and multi-organ failure. She succumbed within 12 hours of admission. The knowledge about such fatal co-infections should be disseminated to medical practitioners encountering Leptospirosis infection and general public.
Fulltext Pregnancy outcomes in women with non-transfusion dependent thalassaemia (NTDT): A haematology centre experience

Lee BS, Sathar J, Sivapatham L, Lee LI

Malays J Pathol, 2018 Aug;40(2):149-152.
PMID: 30173232 MyJurnal

INTRODUCTION: Non-transfusion dependent thalassaemia (NTDT) is a term used for thalassaemia patients who do not require lifelong regular transfusions for survival. Pregnancy in these women, whether spontaneous or through assisted reproductive technology, represents a challenge for the physician.
MATERIALS AND METHODS: The maternal and foetal outcomes of patients with NTDT followed up in a tertiary haematology centre over 6 months period were studied. A total of 36 pregnancies in 26 pregnant women with NTDT were analysed.
RESULTS: Among these women, all of the pregnancies resulted in successful delivery of singleton live-born neonates. There were four clinically distinct forms of NTDT among these women which include Hb E/β-thalassemia (mild and moderate forms), HbH disease, HbH-Constant Spring, and homozygous δβ-thalassemia. No blood transfusion was needed in 15 of the 36 pregnancies (41.6%). The lowest mean Hb level in which no blood transfusion was given was 8.21 g/dL. The mean of packed-cell units received during pregnancy was 6.95 units per pregnancy. There was no worsening of serum ferritin observed during pregnancy with mean serum ferritin pre- and post-pregnancy of 409.35 ug/L and 418.18 ug/L respectively. The mean gestational age at delivery was 38.6 weeks with no preterm delivery reported. The mean foetal birth weight was 2729 grams. There was no intrauterine growth restriction (IUGR) or congenital malformation. There was a case of small for gestational age (SGA) and a case of oligohydramnios.
CONCLUSION: This study showed that pregnancy was possible, safe and has a favourable outcome in patients with NTDT with multidisciplinary care.
Fulltext Reliability, agreement, and validity of digital weighing scale with MatScan in limb load measurement

Kumar SN, Omar B, Htwe O, Joseph LH, Krishnan J, Jafarzedah Esfehani A, et al.

J Rehabil Res Dev, 2014;51(4):591-8.
PMID: 25144172 DOI: 10.1682/JRRD.2013.07.0166

Limb loading measurements serve as an objective evaluation of asymmetrical weight bearing in the lower limb. Digital weighing scales (DWSs) could be used in clinical settings for measurement of static limb loading. However, ambiguity exists whether limb loading measurements of DWSs are comparable with a standard tool such as MatScan. A cross-sectional study composed of 33 nondisabled participants was conducted to investigate the reliability, agreement, and validity of DWSs with MatScan in static standing. Amounts of weight distribution and plantar pressure on the individual lower limb were measured using two DWSs (A, B) and MatScan during eyes open (EO) and eyes closed (EC) conditions. The results showed that intra- and interrater reliability (3, 1) were excellent (0.94-0.97) within and between DWS A and B. Bland-Altman plot revealed good agreement between DWS and MatScan in EO and EC conditions. The area under the receiver operating characteristic curve was significant and identified as 0.68 (p = 0.01). The measurements obtained with DWSs are valid and in agreement with MatScan measurements. Hence, DWSs could be used interchangeably with MatScan and could provide clinicians an objective measurement of limb loading suitable for clinical settings.
Effect of vitamin D replacement in primary hyperparathyroidism with concurrent vitamin D deficiency: a systematic review and meta-analysis

Loh HH, Lim LL, Yee A, Loh HS, Vethakkan SR

Minerva Endocrinol., 2019 Jun;44(2):221-231.
PMID: 28294593 DOI: 10.23736/S0391-1977.17.02584-6

INTRODUCTION: We conducted a meta-analysis to assess the effects of vitamin D replacement on biochemical and skeletal parameters in subjects with mild primary hyperparathyroidism (PHPT) and coexistent vitamin D deficiency.
EVIDENCE ACQUISITION: A systematic search of all English-language medical literature published from 1980 till May 2016 using PubMed, Embase and Ovid was performed. Nine observational studies were evaluated after fulfilling the inclusion and exclusion criteria.
EVIDENCE SYNTHESIS: A total of 547 patients were examined. All studies used vitamin D2/D3 or calcifediol (25-hydroxyvitamin D3), There was significant improvement of serum 25(OH)D with unchanged serum iPTH level after vitamin D replacement, with pooled d+: 3.10 (95% CI 2.25 to 3.95), P<0.01 and pooled d+: 0.82 (95% CI -0.35 to 1.98), P=0.16 respectively. There was neither worsening of the pre-existing hypercalcemia (pooled d+: -0.27 [95% CI -1.09 to 0.64, P=0.56]) nor hypercalciuria (pooled d+: 3.64 [95% CI -0.55 to 7.83, P=0.09]). Two studies assessed in this meta-analysis reported unchanged bone density with vitamin D replacement.
CONCLUSIONS: Vitamin D replacement in subjects with mild PHPT and coexistent vitamin D deficiency improved serum 25(OH)D level without worsening of pre-existing hypercalcemia or hypercalciuria. Well-designed multicenter randomized controlled trials examining pre- and postoperative outcomes of vitamin D therapy in patients with different severities of PHPT and vitamin D inadequacy are warranted to elucidate the most appropriate vitamin D treatment protocol and determine the long-term safety concerns.
Fulltext Update on the management of peripheral arterial disease (PAD)

Liew NC, Moissinac K, Lee L, Gee T, Zezeman RB

Med J Malaysia, 2011 Oct;66(4):386-8; quiz 389.
PMID: 22299571 MyJurnal

There has been much progress made in the management of peripheral arterial disease (PAD) in the past two decades. Progress in the understanding of the endothelial-platelet interaction during health and disease state have resulted in better antiplatelet drugs that can prevent platelet aggregation, activation and thrombosis during angioplasty and stenting. Collaborative effort by different international societies has resulted in a consensus guideline that recommends the modality of intervention in certain disease states. Progress in perioperative care has reduced the morbidity and mortality associated with peripheral vascular reconstruction surgery. Nevertheless, the advances in percutaneous peripheral intervention (PPI) have made a paradigm shift in the current management of patients. The procedure is safe and effective and is emerging as the first choice revascularization procedure.
Smoking among secondary school students in Negeri Sembilan, Malaysia

Lee LK, Paul CY, Kam CW, Jagmohni K

Asia Pac J Public Health, 2005;17(2):130-6.
PMID: 16425658 DOI: 10.1177/101053950501700212

This study was done to determine the prevalence of smoking and factors influencing cigarette smoking among secondary school students in Negeri Sembilan, Malaysia. This is a cross-sectional school survey conducted on 4500 adolescent students based on a structured questionnaire. Data was collected using the supervised self-administered questionnaire the Youth Risk Behaviour Surveillance in the Malaysian National Language Bahasa Malaysia. The prevalence of smoking among the students was 14.0%. About a third of the students (37.8%) started smoking at 13 to 14 years of age. The prevalence of smoking among the male students was higher (26.6%) compared to the female students (3.1%). Adolescent smoking was associated with (1) sociodemographic factors (age, ethnicity, rural/urban status); (2) environmental factors (parental smoking, staying with parents); (3) behavioural factors (playing truant and risk-taking behaviours such as physical fighting, drug use, alcohol use, sexual activity, lack of seatbelt use, riding with a drunk driver); (4) lifestyle behaviours (being on diet and lack of exercise); (5) personal factors (feeling sad and suicidal behaviours). In conclusion, smoking is a major problem among Malaysian adolescents. Certain groups of adolescents tend to be at higher risk of smoking. This problem should be curbed early by targeting these groups of high risk adolescents.
Fulltext Enhancing rate of water absorption in seeds via a miniature surface acoustic wave device

Wong KS, Lee L, Yeo LY, Tan MK

R Soc Open Sci, 2019 Mar;6(3):181560.
PMID: 31032012 DOI: 10.1098/rsos.181560

Seeds, which are high in protein and essential nutrients, must go through a hydration process before consumption. The ability to rapidly increase water absorption can significantly reduce the soaking time as well as the amount of energy needed for cooking seeds. Many studies in the literature employ high-power (102 W) low-frequency (104 Hz) ultrasound; although their results are very promising where more than 100% increase in water content can be obtained between the treated and untreated seeds, the high-power and low-frequency ultrasound often causes acoustic cavitation under high intensity, which can severely disrupt the cell walls and damage the seeds. In our study, however, we demonstrate that treating the seeds via a miniature surface acoustic wave device, which operates at low-power (100 W) and high-frequency (107 Hz) range, gives rise to a higher water absorption rate without the acoustic cavitations. By comparing the water content between the treated and untreated seeds, an increase of up to 2600% (for chickpeas) and 6350% (for mung bean) can be obtained after 60 min. A significantly higher water absorption in mung beans can be attributed to the larger pore size when compared with the acoustic wavelength in water, enabling an efficient transmission of acoustic wave inside the pores. Our results also indicate that the germination time can be reduced by half for treated seeds as compared to the untreated seeds.
Fulltext Healing of venous ulcers secondary to an ankle arteriovenous fistula

Liew NC, Lee L, Gee T, Jabar MF

J Vasc Surg Cases, 2015 Dec;1(4):229-231.
PMID: 31724592 DOI: 10.1016/j.jvsc.2015.07.007

Venous ulcer as a complication of ankle arteriovenous fistula for hemodialysis is rarely reported. It poses a challenge between ulcer healing and fistula preservation. We report our experience in the management of venous ulcers secondary to an ankle arteriovenous fistula in a hemodialysis patient.
Fulltext Human leukocyte class I antigen alleles A2 and A11 are not associated with nasopharyngeal carcinoma in West Malaysia

Lee LK, Tan EL, Gopala K, Sam CK

Singapore Med J, 2007 Jul;48(7):632-4.
PMID: 17609824

Nasopharyngeal carcinoma (NPC) is the second most common cancer among Malaysian Chinese males. We determined the frequencies of 17 human leukocyte antigens (HLA), HLA-A and HLA-B, alleles in 88 Malaysian Chinese with NPC.
Fulltext Premarital sexual intercourse among adolescents in Malaysia: a cross-sectional Malaysian school survey

Lee LK, Chen PC, Lee KK, Kaur J

Singapore Med J, 2006 Jun;47(6):476-81.
PMID: 16752015

INTRODUCTION: Sexual intercourse among Malaysian adolescents is a major concern, especially with the worry of HIV/AIDS. This study was done to determine the prevalence of sexual intercourse among secondary school students aged 12 to 19 years in Negeri Sembilan, Malaysia.
METHODS: This is a cross-sectional school survey conducted on 4,500 adolescent students based on a structured questionnaire. Data were collected using the self-administered questionnaire (translated version of the Youth Risk Behaviour Surveillance in Bahasa Malaysia).
RESULTS: The study showed that 5.4 percent of the total sample were reported to have had sexual intercourse. The proportion among male students who had had sex was higher (8.3 percent) compared with female students (2.9 percent). The mean age at first sexual intercourse was 15 years. One percent of students reported that they had been pregnant or had made someone else pregnant. Adolescent sexual intercourse was significantly associated with (1) socio-demographical factors (age, gender); (2) environmental factors (staying with parents); and (3) substance use (alcohol use, cigarette smoking, drug use), even after adjustment for demographical factors. The survey showed that 20.8 percent of respondents had taken alcohol, 14.0 percent had smoked cigarettes, 2.5 percent had tried marijuana, 1.2 percent had tried ecstasy pills, 2.6 percent had tried glue sniffing, 0.7 percent had tried heroin, and 0.7 percent had intravenous drugs.
CONCLUSION: Prevalence of sexual intercourse among Malaysian adolescents was relatively low compared to developed countries. However, certain groups of adolescents tend to be at higher risk of engaging in sexual intercourse. This problem should be addressed early by targeting these groups of high-risk adolescents.
Fulltext Menstruation among adolescent girls in Malaysia: a cross-sectional school survey

Lee LK, Chen PC, Lee KK, Kaur J

Singapore Med J, 2006 Oct;47(10):869-74.
PMID: 16990962

The onset of menstruation is part of the maturation process. However, variability in menstrual cycle characteristics and menstrual disorders are common. The purpose of this study was to determine the menstrual characteristics of adolescent females and factors associated with it.
The effects of heat exposure on tropical farm workers in Malaysia: six-month physiological health monitoring

How V, Singh S, Dang T, Fang Lee L, Guo HR

Int J Environ Health Res, 2023 Apr;33(4):413-429.
PMID: 35157533 DOI: 10.1080/09603123.2022.2033706

Farmers in tropical countries have been impacted by slow-onset heat stress. By comparing the nature of farming activities performed by conventional farmworkers and agroecological farmers, this study examined the changes in physiological health in responses to heat exposure through a six-month longitudinal study. Throughout the six-month follow-up period, the heat stress index (HSI), physiological strain indices (PSI), and physiological health parameters (BMI, blood glucose level, blood cholesterol level, uric acid level) were measured and repeated every two-month. Physiological parameters were recorded twice daily, before and during their first lunch break. This study found that slow-onset heat stress affects farmers differently. The health of agroecological farmers is more resistant to slow-onset extreme temperatures. Pre-existing metabolic health effects from pesticide exposure make conventional farmers more susceptible to extreme temperatures, delaying their bodies' adaptation to rising temperatures.
Fulltext Integrated Assessment of Nickel Electroplating Industrial Wastewater Effluent as a Renewable Resource of Irrigation Water Using a Hydroponic Cultivation System

Chow YN, Lee LK, Zakaria NA, Foo KY

Front Plant Sci, 2021;12:609396.
PMID: 33746995 DOI: 10.3389/fpls.2021.609396

Nickel, a micronutrient essential for plant growth and development, has been recognized as a metallic pollutant in wastewater. The concentration of nickel ions in the water course, exceeding the maximum tolerable limit, has called for an alarming attention, due to the bioaccumulative entry in the water-plant-human food chain, leaving a burden of deteriorative effects on visible characteristics, physiological processes, and oxidative stress response in plants. In this work, the renewable utilization of nickel electroplating industrial wastewater effluent (0, 5, 10, 25, 50, and 100%) as a viable source of irrigation water was evaluated using a hydroponic cultivation system, by adopting Lablab purpureus and Brassica chinensis as the plant models, in relation to the physical growth, physiological and morphological characteristics, photosynthetic pigments, proline, and oxidative responses. The elongation of roots and shoots in L. purpureus and B. chinensis was significantly inhibited beyond 25 and 5% of industrial wastewater. The chlorophyll-a, chlorophyll-b, total chlorophyll, and carotenoid contents, accompanied by alterations in the morphologies of xylem, phloem, and distortion of stomata, were recorded in the industrial wastewater-irrigated groups, with pronounced toxicity effects detected in B. chinensis. Excessive proline accumulation was recorded in the treated plant models. Ascorbate peroxidase (APX), guaiacol peroxidase (POD), and catalase (CAT) scavenging activities were drastically altered, with a profound upregulation effect in the POD activity in L. purpureus and both POD and APX in B. chinensis, predicting the nickel-induced oxidative stress. Conclusively, the diluted industrial wastewater effluent up to the optimum concentrations of 5 and 25%, respectively, could be feasibly reused as a renewable resource for B. chinensis and L. purpureus irrigation, verified by the minimal or negligible phytotoxic implications in the plant models. The current findings have shed light on the interruption of nickel-contaminated industrial wastewater effluent irrigation practice on the physical and biochemical features of food crops and highlighted the possibility of nutrient recycling via wastewater reuse in a sustainable soilless cultivation.
Fulltext Comparison of decision tree and naïve Bayes algorithms in detecting trace residue of gasoline based on gas chromatography-mass spectrometry data

Md Ghazi MGB, Chuen Lee L, Samsudin AS, Sino H

Forensic Sci Res, 2023 Sep;8(3):249-255.
PMID: 38221967 DOI: 10.1093/fsr/owad031

Fire debris analysis aims to detect and identify any ignitable liquid residues in burnt residues collected at a fire scene. Typically, the burnt residues are analysed using gas chromatography-mass spectrometry (GC-MS) and are manually interpreted. The interpretation process can be laborious due to the complexity and high dimensionality of the GC-MS data. Therefore, this study aims to compare the potential of classification and regression tree (CART) and naïve Bayes (NB) algorithms in analysing the pixel-level GC-MS data of fire debris. The data comprise 14 positive (i.e. fire debris with traces of gasoline) and 24 negative (i.e. fire debris without traces of gasoline) samples. The differences between the positive and negative samples were first inspected based on the mean chromatograms and scores plots of the principal component analysis technique. Then, CART and NB algorithms were independently applied to the GC-MS data. Stratified random resampling was applied to prepare three sets of 200 pairs of training and testing samples (i.e. split ratio of 7:3, 8:2, and 9:1) for estimating the prediction accuracies. Although both the positive and negative samples were hardly differentiated based on the mean chromatograms and scores plots of principal component analysis, the respective NB and CART predictive models produced satisfactory performances with the normalized GC-MS data, i.e. majority achieved prediction accuracy >70%. NB consistently outperformed CART based on the prediction accuracies of testing samples and the corresponding risk of overfitting except when evaluated using only 10% of samples. The accuracy of CART was found to be inversely proportional to the number of testing samples; meanwhile, NB demonstrated rather consistent performances across the three split ratios. In conclusion, NB seems to be much better than CART based on the robustness against the number of testing samples and the consistent lower risk of overfitting.
Glycaemic and insulin responses of diabetic patients to traditional Malaysian meals and the effect of guar gum

Khalid BA, Lee LF, Samad AH, Ng ML

Asia Pac J Clin Nutr, 1996 Dec;5(4):239-43.
PMID: 24394617

The aims of the project were to determine the glycaemic and insulin responses of non-insulin dependent diabetic patients (NIDDM) to 3 traditional Malaysian meals compared to oral glucose, and to determine whether guar gum would affect these responses. Patients with NIDDM were tested with 75 g oral glucose and three common breakfast meals of the three main ethnic groups of Malaysia. When compared with the oral glucose group, significantly by lower blood glucose responses were seen at 90 and 120 minutes post prandial for nasi lemak (p<0.05) and at 60, 75 and 90 minutes for mee sup (p<0.05). No significant difference was seen for roti telur. There was no significant difference in plasma glucose at any time point of the study when the three test meals were compared with each other. Addition of 5g granulated guar gum mixed with water taken prior to the glucose significantly lowered the plasma glucose at 60, 120 and 150 minutes postprandially (p<0.05). Similarly for the test meals, guar gum significantly lowered plasma glucose concentration between 15 and 45 minutes (p<0.03) postprandial for nasi lemak and between 15 and 30 minutes (p<0.03) for mee sup but not with roti telur. With addition of guar gum, there was no significant change of insulin responses with the three meals but a significant increase was seen at 30 minutes (p<0.02) after ingestion of glucose.
Fulltext Draft Genome Sequence of Klebsiella pneumoniae Isolate PR04

Zulkifli MH, Teh LK, Lee LS, Zakaria ZA, Salleh MZ

Genome Announc, 2013;1(4).
PMID: 23950113 DOI: 10.1128/genomeA.00418-13

Klebsiella pneumoniae PR04 was isolated from a patient hospitalized in Malaysia. The draft genome sequence of K. pneumoniae PR04 shows differences compared to the reference sequences of K. pneumoniae strains MGH 78578 and NTUH-K2044 in terms of their genomic structures.
Fulltext Genome sequence of Proteus mirabilis strain PR03, isolated from a local hospital in Malaysia

Khalid MI, Teh LK, Lee LS, Zakaria ZA, Salleh MZ

Genome Announc, 2013;1(3).
PMID: 23792750 DOI: 10.1128/genomeA.00327-13

Proteus mirabilis is one of the pathogenic agents that commonly causes urinary tract infections among elderly individuals and long-term catheterized patients. Here, we report a draft genome sequence of Proteus mirabilis strain PR03 (3,932,623 bp, with a G+C content of 38.6%) isolated from a local hospital in Malaysia.
Determinants of depression and insomnia among institutionalized elderly people in Malaysia

Shahar S, Hassan J, Sundar VV, Kong AY, Ping Chin S, Ahmad SA, et al.

Asian J Psychiatr, 2011 Sep;4(3):188-95.
PMID: 23051116 DOI: 10.1016/j.ajp.2011.06.001

Depression and insomnia are common psychiatric disorders among elderly people and reported to be related to several social and health factors. However, their occurrences in relation to food intake have rarely been investigated. Therefore, this study was to identify determinants of depression and insomnia, with emphasised on food intake among 71 elderly people residing in a government funded institution in Malaysia. An interview based questionnaire was used to obtain information on socio-demography, health and functional status, depression, insomnia and food intake. A total of 71.8% subjects had depression and 53% had insomnia. Subjects who had insomnia [Adjusted Odds Ratio (AOR) 19.55, 95% CI=4.04-94.64], needed help/unable to perform >4 items of IADL (AOR=16.65, 95% CI=3.95-70.22), had hypertension (AOR=7.66, 95% CI=1.37-42.76), had >50% wastage of poultry or fish (AOR=3.66, 95% CI=1.06-12.60) and wastage of vegetables (AOR 3.31, 95% CI=1.03-10.60) were more likely to have depression. Subjects who had depression (AOR 19.55, 95% CI=4.04-94.64), needed help/unable to perform >4 items of IADL (AOR 2.97, 95% CI=1.12-7.84), needed help/unable to handle financial matters (AOR 5.01, 95% CI=1.37-18.27) and had >50% wastage of vegetables (AOR 3.91, 95% CI=1.42-10.82) were at a higher risk to develop insomnia. Depression and insomnia affected more than half of the subjects, interrelated, and associated with functional inability, socioeconomic factor and high food wastage of specific foods.
Fulltext Analysis of Antarctic proteobacteria by PCR fingerprinting and screening for antimicrobial secondary metabolites

Lee LH, Cheah YK, Nurul Syakima AM, Shiran MS, Tang YL, Lin HP, et al.

Genet. Mol. Res., 2012;11(2):1627-41.
PMID: 22782582 DOI: 10.4238/2012.June.15.12

Fifty-seven proteobacterium species were successfully isolated from soils of Barrientos Island of the Antarctic using 11 different isolation media. Analysis of 16S rDNA sequencing of these isolates showed that they belonged to eight different genera, namely Bradyrhizobium, Sphingomonas, Methylobacterium, Caulobacter, Paracoccus, Ralstonia, Rhizobium, and Staphylococcus. All isolates were studied for capability of producing antimicrobial and antifungal secondary metabolites using high-throughput screening models. Approximately 23 (13/57) and 2% (1/57) of isolates inhibited growth of Candida albicans ATCC 10231(T) and Staphylococcus aureus ATCC 51650(T), respectively. These results indicated that proteobacterium species isolates from Antarctic could serve as potential source of useful bioactive metabolites. Enterobacterial repetitive intergenic consensus (ERIC)-PCR fingerprinting produced nine clusters and 13 single isolates, with a high D value of 0.9248. RAPD fingerprinting produced six clusters and 13 single isolates, with a relatively low D value of 0.7776. ERIC-PCR analysis proved to have better discrimination capability than RAPD analysis and generated better clustering for all proteobacterium species isolates. We conclude that ERIC-PCR is a robust, reliable and rapid molecular typing method for discriminating different genera of proteobacteria.
Fulltext A brief structured education programme enhances self-care practices and improves glycaemic control in Malaysians with poorly controlled diabetes

Tan MY, Magarey JM, Chee SS, Lee LF, Tan MH

Health Educ Res, 2011 Oct;26(5):896-907.
PMID: 21715653 DOI: 10.1093/her/cyr047

We assessed the effectiveness of a brief structured diabetes education programme based on the concept of self-efficacy on self-care and glycaemic control using single-blind study design. One hundred and sixty-four participants with poorly controlled diabetes from two settings were randomized using computer-generated list into control (n = 82) and intervention (n = 82) groups, of which 151 completed the study. Monthly interventions over 12 weeks addressed the self-care practices of diet, physical activity, medication adherence and self-monitoring of blood glucose (SMBG). These self-care practices were assessed at Weeks 0 and 12 using pre- and post-questionnaires in both groups together with glycated haemoglobin A1c (HbA1c) and diabetes knowledge. In the intention-to-treat analysis (n = 164), the intervention group improved their SMBG (P = <0.001), physical activity (P = 0.001), HbA1c (P = 0.03), diabetes knowledge (P = <0.001) and medication adherence. At Week 12, HbA1c difference adjusted for SMBG frequency, medication adherence and weight change remained significant (P = 0.03) compared with control group. For within group comparisons, diabetes knowledge (P = <0.001), HbA1c level (P = <0.001), SMBG (P = <0.001) and medication adherence (P = 0.008) improved from baseline in the intervention group. In the control group, only diabetes knowledge improved (P = <0.001). These findings can contribute to the development of self-management diabetes education in Malaysia.

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