INTRODUCTION

Caring for persons with diabetes involves a holistic approach. Addressing diabetes distress is crucial to achieve optimal health outcomes for persons with diabetes. This study aims to validate a Filipino version of the diabetes distress scale (DDS).

We conducted forward and backward translations to construct a Filipino version from the validated English questionnaire. We performed statistical analysis to check internal consistency and validation and to correlate diabetes distress with glycemic control based on the subjects’ HbA1c levels.

We included one hundred and seventy patients (170) seen at the Outpatient Diabetes Clinic in the analysis. Of the participants, 13 (7.6%) have Type 1 Diabetes Mellitus (T1DM), while the rest have Type 2 (T2DM). We found physician distress (PD) to be significantly associated with having T1DM. All domains in the Filipino DDS showed good internal consistency, ranging from 0.81 to 0.85. We used factor analysis to extract four factors similar to the original diabetes distress scale. We did not find any significant correlation between diabetes distress and HbA1c level.

The Filipino DDS showed good internal reliability and had consistent results similar to the original diabetes distress scale. However, we did not find a significant correlation between diabetes-related distress and the HbA1c level.

BACKGROUND/OBJECTIVE

Although nutritional assessment tools have been available internationally, local data for their use in foreseeing adverse outcomes among admitted patients are currently unavailable. The primary objective of this study was to determine the association of nutritional status using Short Nutritional Assessment Questionnaire (SNAQ) and malnutrition risk using the MST (Malnutrition Screening Tool) with ICU admission and in-hospital mortality.

This was a prospective-cohort study which included 122 purposively-selected adult participants who were non-intubated, admitted for medical and surgical managements, stayed for at least 24 hours, had no COVID-19 infection, and were not admitted in any critical care unit. The SNAQ and MST questionnaires, which are validated tools and consists of  two to three easy-to-answer questions, were used among the participants and their scores were tallied in order to get their nutritional status and malnutrition risk. Primary endpoints measured were length of hospital stay, incidence of mortality, and ICU admission rate. Comorbidities were taken into account using the Charlson Comorbidity Index.

Categorizing the SNAQ scores showed 33.61% were severely malnourished which was similar when using the MST classification, wherein 34.43% were at risk of malnutrition. None of the participants were admitted to the intensive care unit (ICU). Malnutrition risk and nutritional status was not significantly associated with 30-day in-hospital mortality (p >0.05). On the other hand, results of the Cox proportional hazards showed that SNAQ and MST significantly predicted the hazard of 30-day in-hospital mortality, increasing the hazard of mortality by 2.58 times and 3.67 times, respectively, for every 1-unit increase in SNAQ and MST scores. Similarly, nutritional status using the SNAQ classification indicated the severely malnourished category significantly predicted the hazard of mortality, increasing it by 9.22 times for those who are severely malnourished. Also, malnutrition risk using the MST classification indicated that those who were at risk of malnutrition were 9.80 times at greater hazard of mortality than those who were not at risk of malnutrition.

The MST and SNAQ classification are screening tools for nutritional status (SNAQ) and malnutrition risk (MST) that can be administered at the onset of the patient’s hospital course and have been demonstrated in this study to predict 30-day in-hospital mortality. It is important to note that none of the patients included in this study required intensive care unit admission.

OBJECTIVE

This study determined the incidence of perioperative complications associated with routine preoperative glucocorticoid use in patients undergoing pituitary surgery with normal preoperative hypothalamo-pituitary-adrenal axis (HPA axis).

From 2011-2021 retrospective chart review, 243 patients undergoing pituitary surgery with normal preoperative HPA axis were analyzed into 2 groups: 1) with preoperative steroids and 2) without preoperative steroids.  Development of postoperative complications was subsequently evaluated.

Incidence of primary composite postoperative complications of in-hospital mortality, postoperative infection and postoperative diabetes insipidus (DI) was significantly increased among those who had preoperative steroids compared to those without (58.33% versus 33.33%, p-value 0.004)  with an adjusted odds ratio of 2.90 (CI 1.29 to 6.53, p-value 0.010). Among the components of the composite outcome, post-operative DI was statistically higher among those who were given preoperative steroids (52.45% versus 28.21%, p-value 0.006) with an adjusted OR of 3.31 (CI 1.43 to 7.67, p-value 0.005). The incidence of postoperative adrenal insufficiency was similar between the 2 groups (20.15% with steroids versus 8.70% without steroids, p-value 0.258).

Among patients with normal preoperative HPA axis, the routine use of preoperative steroids is associated with an increased risk of composite postoperative complications (in-hospital mortality, postoperative infection and postoperative DI). Steroid-sparing protocol is not associated with an increased risk of postoperative AI. The findings will encourage more rational use of steroids and minimize preventable complications.

Editorial ; Abstracting And Indexing

Twenty-six years earlier in their famous chess rematch, an IBM Supercomputer called Deep Blue defeated then-world chess champion Garry Kasparov: it was the first-ever chess match won by a machine, a much celebrated milestone in the field of Artificial Intelligence. Just last year, the World Association of Medical Editors released the “WAME Recommendations on Chatbots and Generative Artificial Intelligence in Relation to Scholarly Publications,” a recognition of not just the expanding applications of AI in scholarly publishing but more so of the accompanying emergence of concerns on authenticity and accuracy. In recognition of this relevant topic, our Vice Editor in Chief, Dr. Cecile Jimeno, provided a well-attended and interesting talk during the last ASEAN Federation of Endocrine Society Convention in Thailand on the “Emerging Issues on the Use of Artificial Intelligence for Scientific Publications.”
Artificial Intelligence

Objectives: We aimed to study the trend of referrals for precocious puberty during the COVID-19 pandemic compared to pre-COVID years, explore the differences in the demographic and clinical features, and evaluate the contributing factors. Methodology: The cases referred for assessment of PP from 2018-2021 to our endocrine centre were grouped into pre-COVID (2018-2019) and COVID (2020-2021) years. Cases fulfilling the diagnosis of PP included the onset of thelarche <8 years in females and 4 ml testicular volume <9 years in males. The PP was further differentiated as Isolated Thelarche (IST) and Central Precocious Puberty (CPP). Early menarche was defined as menarche <10 years old. Results: There were more referrals for PP and more diagnosed as CPP during the COVID-19 pandemic, predominantly among females. There were more endocrine tests done and more cases received treatment. None of the abnormal magnetic resonance imaging (MRI) pituitary findings required surgical intervention. The body mass index (BMI) was found to be positively associated with the risk of getting CPP with a crude-odd ratio (COR) of 1.8, P <0.001, and early menarche (COR 2.1, P <0.001). Conclusion We found a significant increase in the referrals of PP and diagnosis of CPP during the COVID-19 pandemic. Higher BMI was found to be associated with CPP and early menarche.
Puberty, Precocious ; COVID-19 ; Obesity

Objective: The study aims to determine the prevalence and risk factors for endocrine disorders in childhood brain tumour survivors. Methodology: 124 childhood brain tumour survivors aged 18 years old or younger with either stable disease or in remission, and had survived for at least 2 years after diagnosis were included in the study. Demographic data (age at diagnosis, gender, ethnicity, socioeconomic status), clinical clues for endocrine disorders, anthropometrics (weight, height, midparental height), pubertal staging, tumour-related characteristics, treatment modalities and endocrine laboratory measurements at diagnosis and during follow up were obtained. Logistic regression was applied to evaluate risk factors for endocrine disorders in childhood brain tumour survivors. Results: The prevalence of endocrine disorders in childhood brain tumour survivors was 62.1%. The risk factors were high BMI [adjusted odds ratio (OR) 1.29, 95% CI: 1.12 to 1.5], high-risk site [adjusted odds ratio (OR) 7.15, 95% CI: 1.41 to 36.3] and chemotherapy [adjusted odds ratio (OR) 0.18 , 95% CI: 0.05 to 0.62]. Conclusion The prevalence of endocrine disorders in childhood brain tumour survivors in our centre was 62.1%. The significant risk factors were high BMI, tumour location (suprasellar and intrasellar) and chemotherapy.
Risk Factors

Objectives: Gestational diabetes mellitus (GDM) is a common pregnancy complication with adverse fetal and maternal outcomes. Currently, there are only a few validated tools available that address knowledge in GDM. Recognition of the inconsistencies will provide for an effective learning program to achieve optimal results. This study aimed at validating the “Gestational Diabetes Mellitus Knowledge Questionnaire” (GDMKQ). Methodology: A cross-sectional validation study on GDMKQ among 51 GDM patients aged at least 18 years was conducted in the outpatient clinics of a tertiary hospital. Excluded were those with pre-existing diabetes. The questionnaire was submitted for peer review for translation to Filipino and back-translation. Concurrent validity, internal consistency and test-retest reliability of the questionnaire were undertaken as part of the validation process. Descriptive analysis was used for data elaboration by using SPSS v23. Results: The Filipino version of GDMKQ demonstrated sensible content and face validity. As measured, respondents obtained higher total and domain scores with better knowledge levels of GDM compared to its English version. An overall adequate knowledge was observed among those married and college subgroup as compared to single women and those with secondary level of education. The reliability of the questionnaire was calculated at 0.632 using the Kuder-Richardson 20. The test-retest scores using the Filipino-translated questionnaire has a Pearson correlation coefficient of 0.853 with moderate to good level of agreement with each other, and Cohen’s kappa of 0.564 with an intra-class correlation coefficient of 0.828. Conclusion The Filipino-translated version of GDMKQ is a valid screening tool that assesses a patient’s knowledge of gestational diabetes. Identifying the level of their understanding will enable clinicians to develop an individualized, effective learning program to improve pregnancy outcomes.
Diabetes, Gestational ; Knowledge ; Surveys and Questionnaires

Objectives: Fructosamine correlates well with glycated haemoglobin (HbA1c) in Caucasians. This study investigates this correlation and whether fructosamine can reliably estimate glycated haemoglobin in Southeast Asians. Methodology: We recruited 193 participants based on 4 HbA1c bands (<6.0%; 6.0 – 7.9%; 8.0– 9.9%; ≥10%) from a secondary hospital in Singapore between August 2017 and December 2021. Blood samples for fructosamine, glycated haemoglobin, albumin, haemoglobin, thyroid stimulating hormone and creatinine were drawn in a single setting for all participants. Scatter plot was used to explore correlation between fructosamine and glycated haemoglobin. Strength of linear correlation was reported using Pearson’s correlation coefficient. Simple linear regression was used to examine the relationship between fructosamine and glycated haemoglobin. Results: We performed simple linear regression to study the relationship between fructosamine and HbA1c in the research participants (R2 = 0.756, p<0.01). Further analysis with natural logarithmic transformation of fructosamine demonstrated a stronger correlation between HbA1c and fructosamine (R2 = 0.792, p<0.01). Conclusions Fructosamine is reliably correlated with HbA1c for the monitoring of glycaemic control in Southeast Asians.
Fructosamine ; Diabetes Mellitus

Objectives: Type 2 Diabetics have elevated risk for acute coronary syndrome (ACS). The current management algorithm focuses on atherosclerotic cardiovascular (ASCVD) risk score to stratify this risk. However, in medically managed subjects, this algorithm may not be accurate. This study compares the ASCVD risk score in an Indian population with T2DM under medical supervision and the actual incidence of ACS. It also compared the ASCVD risk scores in cases with T2DM who developed ACS to controls and tried to estimate whether the ASCVD risk score is different in the two subsets, evaluating the utility of the ASCVD risk score in predicting ACS. Methodology: This is an electronic medical record (EMR) based case-control study. Only records of subjects with T2DM where details of age, sex, body mass index, blood pressure, duration of diabetes, family history of ACS, lipid profile, renal and liver function tests were included. The incidence of ACS was calculated in the selected records, and the records of subjects with ACS were compared with age and sex-matched subjects without ACS. Data are summarized as median and interquartile range (IQR). Wilcoxon rank-sum test was used for checking differences in continuous variables and Pearson’s Chi-squared test for categorical data. Univariate and multivariate logistic regression analyses were used to check the effect of ASCVD scores and other variables on the occurrence of ACS. Statistical data analyses were performed using JASP, version 0.16.4 (JASP Team [2022]) for MS Windows. Results: Of the 1226 EMRs included in the analysis, 207 had ACS. The actual incidence of ACS was 16.85% in 6 years, higher than the mean predicted 10-year incidence of 14.56 percent (p <0.05). The cases were age and sex-matched with controls and the ASCVD incidence was estimated in the two groups. The mean ASCVD score in the cases was 14.565 ± 8.709 (Min: 1.5, Max: 38.3) and controls 13.114 ± 8.247 (Min: 1.4, Max: 45). The chance of development of ACS increases with elevated systolic blood pressure (per mmHg rise OR: 1.04, 95% CI: 1.03, 1.06; p <0.001), positive family history (OR: 5.70, 95% CI: 3.41, 9.77; p <0.001), statin use (OR: 2.26, 95% CI: 1.46, 3.52; p <0.001), and longer duration of diabetes (for every year increase OR: 1.19, 95% CI: 1.13, 1.25; p <0.001) Conclusion The ASCVD risk score underestimates the ACS risk in subjects with T2DM under medical supervision and may not differ in those who developed and did not develop ACS. We also conclude that factors like a negative family history (30% less risk), longer duration of diabetes, and higher SBP are relevant in those who developed ACS.
Acute Coronary Syndrome