Comparing the acceptability of total diet replacement and food-based low-calorie diets for type 2 diabetes remission amongst Southeast Asians: a public and patient involvement activity

Background: With type 2 diabetes prevalence rising at alarming rates, low-calorie diets (total diet replacement and food-based low-calorie diets) are increasingly used to induce weight loss and achieve diabetes remission. The effectiveness of these diets has been primarily tested in the UK white population but not in the Southeast Asian population at high risk of diabetes. Obtaining the opinion of members of the community on what would constitute a culturally acceptable diet is essential for successful interventions aiming to achieve diabetes remission in the southeast Asian population. Methods: We organised two patient and public involvement activities in the North West of England to understand views of people from the Southeast Asian population on whether low-calorie diets (850 Kcal) in the form of total diet replacement or food-based meals, are acceptable dietary interventions to achieve diabetes remission. Results: Thirteen people, with either type 2 diabetes or having someone with diabetes in the family attended a virtual or a face-to-face meeting. Low-calorie total diet replacement in the form of soups and shakes was considered unacceptable, while there was a preference for a culturally tailored low-calorie food-based diet. Ready-made portion controlled catered meals were suggested as an excellent approach to improve adherence. Conclusions: This work provided valuable insights to shape a future study looking at the feasibility to reverse diabetes in primary care through dietary intervention in the Southeast Asian population.

Radial versus femoral access percutaneous coronary intervention in patients with acute myocardial infarction: Experience from a Southeast Asian country PCI registry

IntroductionBleeding complications adversely affect patient’s outcomes following percutaneous coronary intervention (PCI). Radial approach PCI was advocated to overcome this complication. The information regarding the safety and feasibility of radial approach PCI in acute myocardial infarction (AMI) in the Southeast Asian population was limited. Hence, we sought to examine the outcome of radial versus femoral approach in this particular cohort.Materials and MethodsThis is an observational retrospective analysis of the Malaysian National Cardiovascular Disease Database-Percutaneous Coronary Intervention (NCVD – PCI) registry, recruiting patients with AMI from 2007 – 2014. Patients were stratified into radial and femoral groups depending on the PCI access route. The patient's baseline characteristics, lesion, and procedural data, complications, and outcomes are assessed accordingly.ResultsA total of 11,555 (4895 radial and 6660 femoral) cases were included in the analysis. In the radial group, there were predominantly more males (89.2%) with the younger patient (mean age 55.2 ± 10.5 years) as compared to the femoral group. They also had a higher body mass index (BMI) and taller. However, femoral group patients had significantly more premorbid conditions, namely diabetes mellitus, hypertension, previous stroke, heart failure, and chronic kidney disease. Complex lesions were similar in both groups with no difference in fluoroscopy time, although higher contrast load recorded in the femoral group. The adjusted odds ratio of developing in-hospital complications after femoral approach PCI compared to radial approach for death, MACE and vascular complications were OR: 8.21 95% CI 5.38 – 12.54, OR: 3.39 95% CI 2.51 – 4.58, OR: 1.79 95% CI 1.01 – 3.16 respectively. ConclusionPCI via the trans-radial approach has resulted in a significantly lower risk of vascular complications, MACE and death compared to the trans-femoral approach. Our study confirmed the superiority of the trans-radial approach in the setting of primary PCI in the Southeast Asian population and underscores the importance of trans-radial interventions to reduce bleeding complication rates.