Assignment 1: Patient Study Candidate Number: M9757

Assignment 1:
Patient Study
A Biopsychosocial
Report

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Assignment 1: Patient Study Candidate Number: M9757

CONTENTS
Aim..............................................................................................................3
Methodology................................................................................................3
Consent.....................................................................................................3
Confidentiality and Anonymity..................................................................3
Medical Context...........................................................................................4
The Patient................................................................................................4
Mak Midahs Illness Experience................................................................4
Onset......................................................................................................4
Investigation and Diagnosis...................................................................4
Epidemiology............................................................................................5
Illness Experience and Evolution..............................................................6
Main Discussion........................................................................................7
Pathophysiology.....................................................................................7
Associated Risk Factors.............................................................................8
etiology.....................................................................................................8
Lifestyle Risk Factors..............................................................................8
Genetic Susceptibility............................................................................8
Complications...........................................................................................8
Treatment and Management..................................................................9
Shared Decision Making.........................................................................9
Self-Management.................................................................................10
Health Definition..................................................................................10
Roles of Healthcare Professionals.........................................................10
Social Context...........................................................................................11
The Patients Educational Level..............................................................11
The Patients Family................................................................................11
Family Tree..............................................................................................12
Social Class.............................................................................................13
Localities.................................................................................................13
Lifestyle..................................................................................................14
Impact of Illness......................................................................................14

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Stigma..................................................................................................14
Behavioural Change.............................................................................14
Biographical Disruption........................................................................15
Family...................................................................................................15
Public Health.............................................................................................16
Epidemiology..........................................................................................16
Health Issues..........................................................................................16
Iceberg-Concept of Illness.......................................................................17
Health Promotion and disease prevention..............................................17
Community Healthcare Agency.................................................................19
Malaysia..................................................................................................19
United Kingdom......................................................................................20
Comparison.............................................................................................20
Reflection-Patient Study............................................................................21
Reflection-GP Visit.....................................................................................22
List Of Tables.............................................................................................23
List Of Figures............................................................................................23
Word Count................................................................................................23
References.................................................................................................24

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Assignment 1: Patient Study Candidate Number: M9757

AIM
To portray the impact of chronic illness, by patient-centered
approach, taking into consideration the biological,
psychological, and sociological aspect.
To emphasize the importance of reflection on the attitude and
experience throughout the study.

*Ideas, Concerns and Expectations will be in RED and BOLD.

METHODOLOGY

CONSENT

During the first visit, we ensure that the patient understands the purpose
of the study before signing the Consent Form.

CONFIDENTIALITY AND ANONYMITY

Good Medical Practice 2013 states that patients have the right to
expect that information about them will be held in confidence by their
doctors. (1) Hence patients information are only shared among the group
members. Pseudonyms are also used to maintain patient anonymity.

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Assignment 1: Patient Study Candidate Number: M9757

MEDICAL CONTEXT
THE PATIENT

Midah is currently 73 years old. She was diagnosed with Type 2 Diabetes
Mellitus (T2DM) since 1998, and has been living with it for more than 50
years. Initially, it was hard for her to accept this shocking news, as
she was not aware of any chronic illness in her family.

MAK MIDAHS ILLNESS EXPERIENCE

ONSET
She started experiencing polydipsia and lethargy in 1998, at the age of
55. She thought it was due to insufficient water intake and
subsequently drank 6-8 glasses of water as recommended by healthcare
professionals. (2) She then sought advice from her husband when no
improvement was observed. Freidsons lay referral system suggests
patient might portray help-seeking behaviour by referring to friends and
family before attending consultations. (3)

Zolas Trigger to Consultation was also noticed. (4)

Temporalizing of symptomatology: Midah fixed a date to attend

consultation when she could not cope with the symptoms.
Sanctioning: Ahmad persuaded Midah to attend follow-ups.

INVESTIGATION AND DIAGNOSIS

In 1998, Midah was presented late to the GP, as initially she thought she
was still able to cope with the symptoms. The GP took thorough
history and performed various physical examinations. Midah was informed
to attend consultations every 2 months. For the next 2 subsequent
consultations, Midah was arranged for tests like fasting blood glucose
(FBG) as well as oral glucose tolerance test (OGTT) to confirm the
diagnosis. The diagnostic criteria below confirms T2DM diagnosis(5):

Raised FBG >7mM on more than 2 occasions.

A 2-hour OGTT test results show > 11.1mM

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EPIDEMIOLOGY

Quoted from Ministry of Health (MOH) Malaysia, Midah is among the Malay
population which shows the highest prevalence percentage (58.9%) of
T2DM, as compared to other races. (6) For life expectancies, Midah, being
a female with diabetes, is expected to have 5-year less of life compared to
healthy female adults. (7)

Figure 1 Prevalence of T2DM according to ethnicity

Parsons Sick-Role Model states that sick role is a temporary role

accepted by society with privileges and obligations, aiming to return sick
individuals to become functioning members of society in a family or work
environment. (8) Although knowing that she is suffering from chronic
illness, she stays positive hoping that her health status could be
maintained or even recovered. She wants to show contribution and not
becoming a burden to the family.

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ILLNESS EXPERIENCE AND EVOLUTION

Hypertension,
Prescribed
with Anti-
Hypertensive
Drugs.

Figure 2 Midah's Illness Experience and Evolution

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MAIN DISCUSSION

PATHOPHYSIOLOGY
Insulin, an endocrine hormone produced by -cells of Islets of
Langerhans in the pancreas, maintains normal blood glucose
concentration by facilitating glucose uptake into cells and diminishing rate
of gluconeogenesis. Closely linked to normal functioning of -cells, it also
affects the feedback loop of blood glucose metabolism, as well as insulin
sensitivity of the target tissues.

In T2DM, peripheral fat, liver and muscle cells develop insulin resistance.
This results in failure of cells to utilize free glucose in bloodstream,
subsequently increases the blood glucose concentration. In return, -cells
have to compensate by upregulating insulin production. Overburdened
insulin production eventually fails to meet the demand, leads to
progressive pancreatic damage and hyperglycaemia. (9)

Figure 3 Pathophysiology of T2DM

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ASSOCIATED RISK FACTORS

Risk Factors Elaboration

Body Mass Index BMI is >31kg/m2, considered Obese. (10)

(BMI)
Diet Prefer sweet foods/food with high calorific
values.

Physical Activity Lacks exercise

Table 1 Midah's Risk Factors for T2DM

ETIOLOGY
T2DM can be contributed by lifestyle risk factors as well as genetic
susceptibility. (11)

LIFESTYLE RISK FACTORS

Poor diet management and unhealthy lifestyle are the major

determinants. (12) Diets containing huge portion of sweet food or food
with high calorific value pose greater risks for T2DM. (13)

GENETIC SUSCEPTIBILITY
Presence of TCF7L2 gene is most commonly associated with T2DM,
notably the obstruction in insulin secretion and glucose production, due to
functional abnormality of -cells. (14, 15)

COMPLICATIONS
In 2013, Midah complained that her eyesight deteriorated gradually,
and was worried about the effect on her daily routine. A possible
indication of her developing diabetic retinopathy. Researches also
displayed several other diseases like nephropathy (27.8%) and myocardial
infarction (10.8%) are also strongly associated with diabetes. (16) She
elaborated that she was also diagnosed with hypertension in the same
year and was prescribed with anti-hypertensive drugs. This diagnosis
further confirms the association between T2DM and heart & blood vessel

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disease. She explained on her concern of getting heart attack

that would lead to her death.

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TREATMENT AND MANAGEMENT

Midah was advised on a strict diet and prescribed anti-diabetic medication
to subdue her glucose level. She understands the need for long-term
treatments and the complications of T2DM. She believes doctors
would know what is best for the patient and therefore she showed
full compliance to the medications. Metformin (500mg), an oral
antidiabetic drug (OAD) was prescribed since the first consultation. It
acts to reduce blood glucose concentration. According to Clinical Practice
Guidelines for Management of T2DM, OAD should be prescribed if normal
fasting blood glucose concentration are still unattainable with >3 months
lifestyle modifications. (17)

After few trials of OAD, insulin injection was prescribed by the GP to

complement the initial OAD treatment. Research shows that when both
OAD and insulin injection are applied, these showed more superior
outcomes on glycaemic control, especially lower amount of insulin
required in medication with less weight gain.(18)

SHARED DECISION MAKING

Paternalistic doctor-patient relationship was observed when the GP
showed dominance in the consultations, while taking Midahs full history,
and subsequently prescribed her medications. Midah was a bit
disappointed as she did not have much opportunity to clear her
doubts. There must be a reason why Im asking, as I dont want
to take up the wrong medications. Shared decision making, as well
as concordance, the mutualistic agreement between doctor and patient
in determining the management plans, should be emphasised across
healthcare sectors for better prognosis. (19, 20)

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Doctor
Patient Low High

Low Default Paternalistic

High Consumerist Mutuality

Table 2 Contribution in Decision Making

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SELF-MANAGEMENT
Midah goes for consultation every 2 months as she thought she could
manage her T2DM better. However, she does not have any glucometer
due to financial constrain. Studies showed only 4.9% of the diabetic
patients own glucometer. (20) NICE guidelines recommend diabetic
patients to have glucometer so that early intervention could be given if
blood glucose concentration rises. (21) Stated in Banduras Self-
Efficacy Theory, Health-promoting behaviour is based on goals,
outcome expectancies and self-efficacy. (22) Patients ought to
demonstrate self-management to prolong or even better, prevent
deterioration of chronic illness. (23)

HEALTH DEFINITION
According to World Health Organization (WHO), health is a state of
complete physical, mental and social well-being and not merely the
absence of disease. (24) Midah perceived health as the ability to carry
out daily activities with the absence of symptoms that suggest
illness. She emphasizes on physical well-being, consistent with the
biomedical model of health. (25) Having thought of healthy people dont
usually take tablets, she considers herself unhealthy as she have
to rely on tablets. On a scale from 1-10 (1 being the worst), Midah
rated her condition 6. She expressed diminished self-esteem as she
have to live with the disease.

ROLES OF HEALTHCARE PROFESSIONALS

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Healthcare Roles
Professionals

General Practitioner (GP) Evidence-based practitioner

Confirms T2DM diagnosis

Gatekeeper- Refers to other

departments

Nurses Technician- Take Blood Sample

Lab Technician Blood Test

Pharmacists Educator-Medication Dispenser

Table 3 Roles of Healthcare Professionals

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SOCIAL CONTEXT
THE PATIENTS EDUCATIONAL LEVEL
Midah received formal education up to Primary Education. The interview
was conducted in Bahasa (a.k.a. Malay Language) as she was illiterate in
English. According to Malaysian Standard Classification of Occupation
(MASCO) 2008, Midah is categorized under 1st skilled level for Education.
(26) Studies showed that educational level is highly associated with
diabetes mortality. (27) Lack of education might impact on her self-
management of diseases especially during emergency medical conditions,
where more likely she would be presented late to healthcare as she did
not know how to react.

THE PATIENTS FAMILY

Midah was married to Pak Ahmad for more than 50 years and they were
blessed with 6 children. They live in a single-storey house in Gelang Patah
village since 1960s. Midah is a housewife while Pak Ahmad is a retiree.
Before he retired, he worked for the government. Currently, they depend
on his pension fund for living. They spend approximately RM1500 per
month on their basic needs.

Midah learnt that T2DM was strongly linked with family history,
and was worried that this could affect her children. Research shows
that the probability of a child to suffer from T2DM is 1 in 7 if one of the
parents is diagnosed from T2DM before age 50. (28)

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Figure 4 Example of Midahs Residential

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FAMILY TREE

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Figure 5 Midah's Family Tree

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LOCALITIES
Midah is comfortable staying in the neighborhood, as most of her
neighbours are Malays. She feels that if something bad happens, she
could easily get help from as there is no communication barrier.
Klinik Kesihatan Gelang Patah (KKGP) and hypermarket are just 5-minute
ride away from their house. Her husband drives her to the clinic whenever
she needs to attend follow-ups.

Figure 6 Local Amenities

LIFESTYLE
Midah does not smoke and drink. She believes that smoking and
drinking are sinful for Muslims and are harmful to health.
Disability as defined by WHO, is an umbrella term, covering
impairments, activity limitations, and participation restrictions. (29)
Supported by the definition, she perceives herself as being disabled as
she gets exhausted easily while doing exercises.

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IMPACT OF ILLNESS

PSYCHOLOGICAL CHANGE

Stigma is a mark of disgrace that sets a person apart. (30) Erving

Goffman (1963) classified stigmatized conditions based on the
noticeability of disease. There are two types of stigma, Discredited or
Discreditable. In T2DM, patients condition will only be stigmatized if
the condition is visible to others, and this can be explained as discredited
stigma. (31) When her family members bring her for a meal, she was
given less freedom to choose her dishes. She felt somehow
disrespected and dictated although she knew she has restricted
diet.

BEHAVIOURAL CHANGE
Midah implemented changes to her lifestyle after having T2DM. At first, it
was harsh to adapt to dietary changes. She felt helpless as she did
not have proper knowledge on self-management of T2DM.
Transtheoretical Models Stages of Change illustrates on the stages
of behavioural change. (32) She is currently in Maintainence stage as
she is controlling her diet to prevent more health complications.

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Figure 7 Transtheoretical Model's Stages of Changes

BIOGRAPHICAL DISRUPTION

Midah felt that her quality of life was diminished because of

T2DM. One may deem less fortunate after being diagnosed with chronic
disease, causing reduced confidence in social interaction. (33)

FAMILY

She felt committed to stay positive living with T2DM. With lifestyle
changes, she hopes to be the role model in guiding her family members
towards healthier lifestyle, thus reducing the risk of them getting
T2DM.

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PUBLIC HEALTH
EPIDEMIOLOGY

Quoted from International Diabetes Federation (IDF), approximately 415

million people suffer from T2DM globally in 2015. Malaysia contributes
almost 3.3 million cases, with 16.6% prevalence among the age group
between 20-79 years old. (34) According to MoH Malaysia, roughly 70.1%
of diabetic patients have hypertension, making it the commonest
comorbidity. (6)

HEALTH ISSUES

Few reasons suggest the alarmingly high T2DM prevalence rate in

Malaysia. (35)

Lack of initiative on disease self-management

Unpromising self-awareness towards disease

Unaffordability and less accessibility to health equipments

Midah hopes to buy one glucometer, as she feels it is necessary to

monitor the illness. Studies revealed most diabetes patient are unable
to afford the increasing price of better healthcare services. (36) She did
not have insurance coverage as she was unaware of the
importance of being insured. Unfortunately, she surpassed the age
limit of purchasing one.

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ICEBERG-CONCEPT OF ILLNESS

Iceberg-Concept of Illness suggests the trigger for patients to attend

consultations are based on the symptoms severity. Patients will not seek
professional medical help before their symptoms deteriorate.

Figure 8 Iceberg-Concept of Illness

HEALTH PROMOTION AND DISEASE PREVENTION

Health promotion and disease prevention should be nurtured at both

individual and population level. WHO defines health promotion as the
process of enabling people to increase control over, and to improve their
health. (37) Health promotion can be achieved through

Healthier dietary habits.

Health camps or seminars

Cost-effective healthcare.

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Three possible approaches for disease prevention are as below. (38)

Primary Prevention: Reduce preventable risk factors of T2DM

Secondary Prevention: Lower the probability of T2DM

manifestation by providing screening tests in early period.

Tertiary Prevention: Elicit the disease complications caused by

T2DM

PETeR Model illustrates the various schemes of health prevention. (39)

Primary Prevention Secondary Tertiary Prevention

Prevention
Policy Healthy Food Policy at National Plan Penalty on unhealthy
schools of Action for food
Nutrition
Malaysia
Educatio School Education about Healthy Guidance on
n T2DM Lifestyle Disability
Campaigns Management.
Technolo T2DM Risk Factor Screening T2DM self-
gy management
program
Resource Low-Sugar Foods Free Free Insulin Injection
s glucostrips Pen
Table 4 PETeR Model

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COMMUNITY HEALTHCARE AGENCY

MALAYSIA

Persatuan Diabetes Malaysia (PDM) was founded in 1981, but was

renamed as Diabetes Malaysia subsequently. PDM is given the mandate to
serve as diabetic information distribution centre. (40)

Services provided:

Organising diabetes seminars and health camps.

Counselling sessions on diabetes management.

Agency for discounted diabetic-prevention products and equipment.

Benefits included:

Increase awareness towards diabetes.

Close monitoring of diabetic progression

Cost-effective diabetic-prevention products and equipment.

Midah did not receive any form of diabetic prevention support and was not
aware of Diabetes Malaysia. She hopes this information can be
spread across the society to benefit other T2DM patients.

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UNITED KINGDOM

Founded in 1934, Diabetes UK is well-known for its comprehensive support

and guidance for the public especially to patients with diabetes. (40)

Their services include:

Know Your Risk Roadshows

Screening of diabetes risk factors

Hotline to Diabetes UK

Provide advice for diabetes-related enquiries

Establishment of Support Groups

Platform for diabetes patients to share their knowledge and

experiences.

COMPARISON

Comparing between Diabetes Malaysia and Diabetes UK, emphases are

given to different aspects. Diabetes Malaysia contributes more on the
management of diabetes, but not much into prevention. Whereas,
Diabetes UK delivers more effective approaches like health screening for
diabetes risk factors. With higher amount of funding, as compared to
Diabetes Malaysia, Diabetes UK is able to conduct researches in treating
or preventing diabetes.

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REFLECTION-PATIENT STUDY

Through the advancement into Stage 2, we start to appreciate the

importance of patient-centered medicine, with this being emphasized
in a consistent manner at Newcastle University Medicine Malaysia
(NUMed). This year, we are being distributed another assignment which
requires us to pay visits to a real patient, diagnosed with chronic illnesses.
I personally think that this would be a suitable platform for us to
realistically approach a patient, and come up with a broader view about
the whole mechanism and consequences of the diseases. However,
through the process, I did encounter some issues which we can ponder
upon. One of those which I would like to share is the patients
perception towards us, medical students.

For example, during our interview with the patient, we will be

bombarded with lots of questions regarding T2DM. She even asked about
the biological mechanism which causes diabetes, as well as the
medications that were prescribed by the GP. My group mates and I were
shocked by the eagerness of the patient wanting to acquire more
knowledge about T2DM, as if she thought we were doctors. Somehow, I
did feel embarrassed as I was not well equipped with the basic concepts
on T2DM. I was scared that we would be condemned for our incompetency
as medical students. From this experience, we can improve by having that
initiative to prepare ourselves with the possible questions which will be
asked by the patients in our future consultations. We can even read up
some information about the common illness that shows high prevalence
rate in our community.

To me, this skill should be cultivated as early as during the learning

phase as medical students. With this, I think we will be better prepared for
our own consultations in near future as we will soon adapt ourselves with
the impromptu generation of information or message to be conveyed to
our patients.

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REFLECTION-GP VISIT

Although making lots of adjustments to our schedule, ultimately we failed

to arrange a GP visit together with our patient. By right, this should have
been done in order for us to have a better insight of what she would
experience during the consultations. However, we were still able to inquire
our patient of how she felt during the consultations. There will be much
more room for improvements if we take patients experience seriously as
it lays a strong foundation on how we can enhance our communication
skills.

Recalling on her consultation experiences with the GP, Midah said it

was generally fine. But, she did point out a few areas which we can
ponder upon. She elaborated that the GP did not seem to pay much
attention to her Ideas (I), Concerns (C), and Expectations (E), and did not
seek for her opinion regarding the medications. Apart from this, she also
explained that the GP concentrated more on using Close-type questions
rather than Open-type questions. This happened most probably because
the GP is very experienced, and has encountered many similar cases. By
doing this, the GP would be able to cut short the consultation period and
cope with the long queue of patients waiting for consultations.

After considering the advice and information that was given by

Midah, I think that emphasis should be given more on patients Ideas (I),
Concerns (C), and Expectations (E) through the use of more Open-type
questions. Perhaps, a more cost & time-effective consultation system
should be introduced, so that the GP will not be stressed by the huge
amount of patients and will have longer consultation period, which in
return provides better health outcomes for the patients.

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LIST OF TABLES
Table 1 Midah's Risk Factors for T2DM.........................................................7

Table 2 Contribution in Decision Making......................................................8

Table 3 Roles of Healthcare Professionals....................................................9

Table 4 PETeR Model..................................................................................17

LIST OF FIGURES

Figure 1 Prevalence of T2DM according to ethnicity....................................6

Figure 2 Midah's Illness Experience and Evolution......................................7

Figure 3 Pathophysiology of T2DM..............................................................8

Figure 4 Example of Midahs Residential...................................................12

Figure 5 Midah's Family Tree......................................................................13

Figure 6 Local Amenities............................................................................14

Figure 7 Transtheoretical Model's Stages of Changes................................16

Figure 8 Iceberg-Concept of Illness...........................................................18

WORD COUNT

Words in Main Text 2260

Words in Reflection Sections 598

Words in Tables, and Figures 300

Total 3158

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REFERENCES
1. Confidentiality by Good Medical Practice UK General Medical Council 2009;
[10/1/2017]. Available from: http://www.gmc-
uk.org/guidance/ethical_guidance/confidentiality_1_5_about.asp.
2. Choices N. Six to eight glasses of water still best 13th July 2011
[13/1/2017]. Available from: http://www.nhs.uk/news/2011/07july/pages/eight-
glasses-of-water-a-day.aspx.
3. Freidson E. Client Control and Medical Practice. American Journal of
Sociology. Jan. 1960;65(4):9.
4. An Introduction to Medical Sociology (The International Behavioural and
Social Sciences Library. Tuckett D, editor: Routledge; 2001. 424 p.
5. Murray L., Ian W., Andrew B., Elizabeth W. Oxford Handbook of Clinical
Medicine (9th Edition): Oxford University Press; Jan 2014.
6. National Diabetes Registry Report. 2009-2012;1.
7. AT. C, PY. L, SG S, B. MA, BH. C, I. M, et al. Poor glycemic control in younger
women attending Malaysian public primary care clinics: findings from adults
diabetes control and management registry. BMC Family Practice. Dec 2013.
8. Armitage CJ, Christian J. Planned Bahviour : The Relationship Between
Human Thought and Action New Brunswick, New Jersey, USA: Transaction
Publisher; 2004. 49 p.
9. Kumar P, Clark M. Kumar & Clark's Clinical Medicine: Saunders Elsevier;
2012.
10. Tatsumi Y, Ohno Y, Morimoto A, Nishigaki Y, Mizuno S, Watanabe S. Age
differences in the risk of diabetes incidence according to body mass index level
in Japanese women. Obesity Res Clinical Practice. 2013;7(6):455-63.
11. Diseases NIoDaDaK. Symptoms & Causes of Diabetes November 2016
[14/1/2017]. Available from: https://www.niddk.nih.gov/health-
information/diabetes/overview/symptoms-causes.
12. Kruszynska YT. Principles of Diabetes Mellitus.
13. Pereira MA. Nutrition and Type 2 Diabetes: Etiology and Prevention: CRC
Press August 27, 2013. 234 p.
14. Gloyn AL, Braun. M, Rorsman P. Type 2 Diabetes Susceptibility Gene
TCF7L2 and Its Role in -Cell Function. Diabetes. April 2009;58(4):800-2.
15. Winter S. Is Type 2 Diabetes Caused by Genetics? : Healthline; [updated
21/11/201614/1/2017]. Available from: http://www.healthline.com/health/type-2-
diabetes/genetics#Overview1.
16. AD. D, M. H-H, M. S. Epidemiology of diabetes and diabetes-related
complications. Physician Therapy. November 2008;88(11):1254-64.
17. Ministry of Health M. Clinical Practice Guidelines-Management of Type 2
Diabetes Mellitus. May 2009;4th Edition:84.
18. Michiel G. W., Adriaan K., Philippe L., Daniel B., jeles C. O., Bob Borger V.D.
B., et al. Combination of Insulin and Metformin in the Treatment of Type 2
Diabetes. Diabetes Care. December 2002;25(12):8.

30 | P a g e
Assignment 1: Patient Study Candidate Number: M9757

19. EA. J, L D-M, GH. dW, T. S, CP. vdS, CA. dJ. Systematic review of the effects
of shared decision-making on patient satisfaction, treatment adherence and
health status. Psychother Phycosom. 2008;77(4):219-26.
20. I M, H. Z, I. F, M. FI, MY. WS, H. J, et al. An Audit of Diabetes Control and
Management (ADCM). Medical Journal Malaysia. 2008;63:76-7.
21. Excellence NIfHaC. Type 2 diabetes in adults: management December
2015 [updated July 201614/1/2017]. Available from:
https://www.nice.org.uk/guidance/ng28.
22. A. B. Health Promotion from the Perspective of Social Cognitive Theory.
Psychology and Health. 1998;13:623-49.
23. Funnell MM, Brown TL, Childs BP, Haas LB, Hosey GM, Jensen B, et al.
National Standards for Diabetes Self-Management Education. Diabetes Care.
2010;33(1):89-96.
24. World Health Organization. WHO definition of Health 2003 [14/1/2017].
Available from: http://www.who.int/about/definition/en/print.html.
25. ME. T. Models of Health and Disease. British Journal of Medical Psychology.
1993;66.
26. Malaysia Standard Classification of Occupation (MASCO). 2008;3.
27. Saydah S, Lochner K. Socioeconomic status and risk of diabetes-related
mortality in the United States of America. Public Health Reports.
2010;125(3):377-88.
28. Genetics of Diabetes The United States of America (USA): American
Diabetes Association; 2013 [updated 21/11/201611/1/2017]. Available from:
http://www.diabetes.org/diabetes-basics/genetics-of-diabetes.html.
29. Organization WH. Disabilities [12/1/2017]. Available from:
http://www.who.int/topics/disabilities/en/.
30. Government of Western Australia MHC. What is stigma? [14/1/2017].
Available from:
http://www.mentalhealth.wa.gov.au/mental_illness_and_health/mh_stigma.aspx.
31. Chaudoir SR, Earnshaw VA, Andel S. Discredited Versus Discreditable:
Understanding How Shared and Unique Stigma Mechanisms Affect Psychological
and Physical Health Disparities. Basic Application of Social Psychology. Jan
2013;35(1):75-87.
32. DiClemente C, Velasquez M. Motivational interviewing and the stages of
change. Miller W, Rollnick S, editors. New York, U.S.A: Guilford Press; 2002.
33. Crinson I. Concepts of Health and Illness: Section 6. The Social Experience
of Living with Chronic Illness and Disability: HealthKnowledge; 2007 [12/1/2017].
Available from: http://www.healthknowledge.org.uk/public-health-
textbook/medical-sociology-policy-economics/4a-concepts-health-
illness/section6.
34. Federation ID. Diabetes in Malaysia - 2015 2015 [11/1/2017]. Available
from: http://www.idf.org/membership/wp/malaysia.
35. Rampal L, Loong Y, Azhar M, Sanjay R. Enhancing Diabetic Care in the
Community in Malaysia: Need for a Paradigm Shift. Malaysian Journal of Medicine
and Health Sciences. January 2010;6(1):3-11.

31 | P a g e
Assignment 1: Patient Study Candidate Number: M9757

36. Islam MA, Azad AK. An Increase of the Health Care Cost of Diabetes
Mellitus Type 2: A Precise Review on Economic Impact of Diabetes Australian
Journal of Basic and Applied Sciences. January 2014;8(1):40-4.
37. World Health Organization. Health Promotion [15/1/2017]. Available from:
http://www.who.int/topics/health_promotion/en/.
38. Carr S, Unwin N, Pless-Mulloli T. An Introduction to Public Health and
Epidemiology (Second Edition).
39. Non-Communicable Disease Section DCD, Ministry of Health Malaysia.
National Strategic Plan For Non-Communicable Disease. 2010.
40. : Diabetes UK; [13/1/2017]. Available from: https://www.diabetes.org.uk/.

32 | P a g e