Diabetes is a highly prevalent metabolic disorder that stands as an independent risk factor for respiratory infection which was identified as the second leading cause of premature mortality in Malaysia in 2018. The gut microbiome is fundamental for physiological metabolic and immunological processes both locally and at distant sites for instance the pulmonary termed the gut-lung axis. Such inter-organ crosstalk occurs mainly via the translocation of metabolites. The implication of the gut-lung axis becomes evident following the identification of perturbated gut microbial composition, termed gut dysbiosis, among those with diabetes who are more susceptible to respiratory infections. However, such an association in the Malaysian diabetic population is underexplored. In this study, we aim to examine the carriage rate of upper respiratory tract pathobionts, and to identify the gut microbial and metabolome signatures related to diabetes. A total of 31 Type 2 diabetics and 14 controls were recruited from Hospital Putrajaya and public community. Each subject provided nasopharyngeal (NP), urine and stool samples. DNA was extracted from NP and stool samples and analysed using 16S rRNA sequencing targeting V3-V4 hypervariable regions. Urine samples were analysed using 1H-NMR. In the gut microbiome of diabetics, beneficial short chain fatty acid producing bacteria Dorea sp, Diallister sp. and Romboutsia illealis were reduced. Significantly higher levels of urinary D-sorbitol and taurine were reported in diabetics. A higher prevalence of opportunistic respiratory pathogens S. agalactiae and M. catarrhalis were observed among diabetics. These changes in gut microbiome and urine metabolome are linked to impaired general immunity, which may contribute to the observed enrichment of respiratory pathogens and potentially raising susceptibility to respiratory infections. These results would shed light on developing novel and targeted therapies for diabetes and associated respiratory infections.

Background: Despite the well-documented benefits of work health promotion programmes (WHPPs) in reducing non-communicable diseases and their risk factors, the services are under-utilised. The study assesses private university employees’ awareness, perception and utilisation of WHPP and identifies the factors influencing WHPP utilisation. Methods: A cross-sectional study was conducted among employees of five private universities using an online self-administered questionnaire. The independent variables were predisposing factors (age, gender, marital status, race, education, job classification and years of working), enabling factors (awareness, perception, financial and organisational factors) and need factors (perceived, evaluated health status and health risk factors) while the dependent variable was WHPP utilisation. Results were analysed using IBM SPSS Version 28. Results: The proportion of 161 respondents with high WHPP awareness, positive perception and high utilisation was respectively 57.8%, 55.0% and 50.9% . Education level (OR: 0.428, 95%CI: 0.214-0.860), awareness (OR: 6.13, 95%CI: 3.060-12.281) and no transportation (OR: 5.286, 95%CI: 1.7-16.433) were associated with utilisation. Awareness (OR: 5.953, 95%CI: 2.859-12.396) and no transportation (OR: 5.286, 95%CI: 1.7 - 16.433) best predicted WHPP utilisation. Conclusion: The actual employees’ WHPP utilisation was low despite having a high level of WHPP awareness and positive perception. Enabling factors were the predictors of WHPP utilisation. Keywords: knowledge, attitude, engagement, occupational health services