Singapore, like her ASEAN counterparts, faces a human and economic burden of chronic diseases such as diabetes. The Singapore diabetes care model features a mixed financing and mixed care delivery model, with an increasing focus on integration of care across traditional boundaries, through information technology, clinical engagement, robust clinical governance and financing schemes, and patient education and self-management.
Delivery of Health Care ; Singapore

With the highest prevalence of diabetes in the region, Malaysia faces a massive task ahead to care for its people afflicted with the disorder. For a successful Diabetes Care model to work, it requires a well-established functioning multidisciplinary team comprising Endocrinologists/Physicians/Family Medicine Specialist Physicians, Diabetes Nurse Educators, Dietitians, Pharmacists, and others such as Podiatrists are needed to provide broad ranging services. Although we have many such individuals trained and working independently, these services are fragmented. What is required is coordination and integration of these services to enable patients’ access in a timely manner. The Disease Control Division, Ministry of Health continues to play a central role – coordinating and funding these initiatives. What is desperately needed are more certified Diabetes Nurse Educators to manage the overall care of the patients as well as to provide key diabetes education that enable patient-empowerment to improve self-care, compliance, and ultimately result in better lives.
Patient Participation

There has been significant magnitude of problems of diabetes in Myanmar, according to the estimates of International Diabetes Federation (IDF) and the recent National Survey on the prevalence of diabetes. There has been a wide gap of equity between the urban and rural healthcare delivery for diabetes. Myanmar Diabetes Care Model (MMDCM) aims to deliver equitable diabetes care throughout the country, to stem the tide of rising burden of diabetes and also to facilitate to achieve the targets of the Global Action Plan for the Prevention and Control of NCDs (2013-2020). It is aimed to deliver standard of care for diabetes through the health system strengthening at all level. MMDCM was developed based on the available health system, resources and the country's need. Implementation for the model was also discussed.

The global burden of diabetes and its accompanying risk factors is upon us. Asia is the focus of this burden, owing to huge population numbers and increasing prevalence rates. The Philippines National Health and Nutrition Survey (NNHeS) of 2013, has provided the latest health and disease score with prevalence rates of the major risk factors among adults >20 years of age: diabetes (5.4%), hypertension (22.3%), dyslipidemia, low HDL (71.3%), obesity, BMI >25 kg/m2 (31.1%), and smoking (25.4%). Metabolic syndrome as of the 2008 survey reports a 27% prevalence rate (unpublished data). Efforts have to be directed to achieve improvement in prevention, survival, and quality of life for all diabetics. The health infrastructure under the leadership of the Department of Health, in partnership with governmental and non-governmental organizations has to provide a cohesive plan engaging all partners in various aspects of care. Strategies to enhance outcomes include: 1) a national screening program, 2) implementation of practice guidelines that will elevate the quality of care for all, 3) access to healthcare, medications, 4) development of an environment for research in institutions to allow a better understanding of these conditions among Filipino patients and 5) enhancement of training, education and service to benefit the Filipino diabetic. Indeed, the challenge is upon all of us as a nation, and we need to stand up and move forward with an organized and accessible system of care, as we aim to combat the epidemic of diabetes and its complications.

OBJECTIVE: To report the clinical characteristics and outcomes of subacute thyroiditis (SAT) patients at the Theptarin Hospital Thyroid Clinic. Methodology. A retrospective review of medical records of SAT patients in the Theptarin Hospital from January 2007 to December 2013 was conducted. Clinical characteristics, laboratory findings, modes of treatment and complications were recorded.

RESULTS: From January 2007 to December 2013, SAT was diagnosed in 149 patients, with the occurrence of SAT peaking in October and November. Of 115 patients who had complete follow-up data, mean age was 43.8±10.8 years, 88.7% were women, and SAT was preceded by an upper respiratory tract infection in 68.7%. Oral prednisolone was given in 83 cases (72.2%) at a median starting dose of 30 mg/day and was continued for a median duration of 49 days. Recurrence of SAT during the tapering period of oral prednisolone was observed in 12% of patients, resulting in reinitiation of steroid in 13% of patients for late recurrence. Transient and permanent hypothyroidism developed in 6.1% and 8.7% of patients respectively.

CONCLUSIONS: SAT in Thai patients showed seasonal clustering during October and November. Recurrences of SAT were common in the course of steroid treatment. SAT patients require careful follow-up during steroid treatment and long-term surveillance for thyroid dysfunction.
Thyroiditis, Subacute

OBJECTIVES: We aimed to develop and validate a carbohydrate and insulin dosing knowledge quiz for adult Asian patients with diabetes mellitus.

METHODOLOGY: A self-administered quiz was developed to test carbohydrate recognition; single food carbohydrate estimation; meal carbohydrate estimation and food label reading; and insulin dosing calculation for carbohydrate, blood glucose and for a meal in a multi-ethnic Asian population. The subjects’ carbohydrate knowledge and insulin dosing ability were rated by the study dietitian and the subjects’ primary physicians, respectively. We compared the quiz scores with the dietitians’ and physician ratings and the subjects’ HbA1c. Reliability of the quiz was tested by measuring internal consistency and split half reliability.

RESULTS: Seventy-five subjects completed the study. Median (inter-quartile range) quiz score was 71.9 (60.2 to 83.6)%. The quiz score was found to be correlated with the healthcare provider assessments (r=0.652, p<0.001) and the subjects’ HbA1c (r=-0.375, p=0.001). Cronbach alpha was 0.897 and Guttman split half coefficient was 0.930.

CONCLUSIONS: Our analysis suggested that this newly developed quiz had good reliability and validity for testing carbohydrate and insulin dosing knowledge in a group of Asian subjects with diabetes mellitus. This can be a useful screening tool in clinical practice.
Diabetes Mellitus ; Asian

OBJECTIVE: The aim of this paper is to examine the oral health of children attending a diabetes camp. Despite studies showing diabetes to be a risk factor for periodontitis on the one hand and periodontitis having been shown to affect glycemic control and increase the risk for developing complications among diabetic patients, oral health is only beginning to receive much needed attention as an important aspect of general health in diabetic patients.

METHODOLOGY: A simple count of the number of decayed, missing, and filled teeth was performed and added to come up with the Decayed Missing and Filled Teeth index (DMFT). Periodontal examination was performed using a Community Periodontal Index of Treatment Needs (CPITN) probe. Pocket probing was performed on six sites (mesiobuccal, midbuccal, distobuccal, mesiolingual, mid-lingual, and distolingual) on each tooth. The teeth were then scored on a scale of 0–4 similar to the CPITN method of the World Health Organization.

RESULTS: The proportion of participants with dental caries was 72% (18) with a mean number of decayed, missing and filled teeth (DMFT) of 4.6. 5 (20%) of the participants had a DMFT score of 0, meaning that they have no decayed missing or filled teeth while 10 (40%) either already had permanent teeth extracted. or required tooth extraction for nonrestorable, severely decayed permanent teeth. Periodontitis (Pockets > 3.5 mm; CPITN = 4) was found in only 1 (4%) patient. 21 (84%) of the participants either had a CPITN score of 1 or 2, meaning bleeding upon probing or calcular deposits were observed. 3 (12%) had a CPITN score of 0.

CONCLUSIONS. Diabetes camps are a good place to screen oral health problems among type 1 diabetic patients given the different socio-economic factors, levels of concern for oral health, and availability of dental care providers among families of with type 1 diabetic children. Physicians managing type 1 diabetics should motivate their patients to see the dentist twice a year for preventive visits and strongly encourage them to have treatment when dental diseases are present. An oral exam should be part of the cursory examination performed by physicians handling these patients.
Periodontitis

BACKGROUND: Periodontitis affects more than half of patients with diabetes. In resource poor areas in the Philippines, access to routine dental visits may be difficult and thus, a selective approach might be needed to identify those who need dental evaluation and management. An easy-to-administer oral health self-report questionnaire was developed in order to predict serious (moderate to severe) periodontitis.
OBJECTIVE: The study aims to determine the validity of the Oral Health Screening Questionnaire for Persons with Diabetes (OHSQPD) in estimating the prevalence of serious periodontitis.
METHODOLOGY: A cross-sectional criterion-referenced study of 175 participants with T2DM were included in the study. They were asked to answer the questionnaire and then made to undergo a full dental examination to identify the presence and severity of periodontitis. The validity of the questionnaire was assessed by determining the sensitivity, specificity, positive predictive value, negative predictive value and area under the receiver-operating curve (AUROC) with the dental examination as the gold standard.
RESULTS: Using the questionnaire, the prevalence of serious periodontitis was 61% (106) based on an optimal cut-off score of ?12. At this score, the questionnaire yielded a sensitivity of 80.4% and a specificity of 70.6%, with an AUROC of 0.83.
CONCLUSION: The OHSQPD is a valid tool in detecting serious periodontitis

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Adult ; Questionnaires ; Diabetes Mellitus ; Periodontitis ; Oral Health ; Philippines

OBJECTIVES: The study aims to develop and validate a health-related quality of life (HRQoL) questionnaire for adult Filipinos with differentiated thyroid cancer (DTC) that can be used in combination with the European Organization for Research and Treatment of Cancer QLQ-C30 Questionnaire.
METHODOLOGY: The study had 4 phases. Phase I involved generation of HRQoL issues from literature review, focus group discussions with 6 DTC patients and 5 health care professionals (HCP). Subsequent assessment for relevance and importance of the HRQoL issues by 20 patients and HCP panel was done. Phase II was formulation of the HRQoL issues into questionnaire and subsequent translation into Filipino. Phase III was pilot testing of the questionnaire in 15 patients. Phase IV was validation of the pre-final questionnaire in 231 patients.
RESULTS: In Phase I, 28 HRQoL issues were generated. In Phase II, a 28-item Filipino questionnaire was created. In Phase III, 22 items that were not upsetting or confusing to patients and with good range of responses were retained. After Phase IV, a 22-item questionnaire with 5 conceptual scales (perceived fears, psychological distress/anxiety, functionality, voice complaints, neck complaints) was created.
CONCLUSIONS: The developed and validated 22-item questionnaire can be used to assess HRQoL issues in adult Filipinos with DTC.

Human ; Male ; Thyroid Gland ; Neoplasms ; Quality Of Life ; Philippines ; Validation Studies ; Patients ; Anxiety

OBJECTIVES: To assess the validity of the Filipino-translated version of the Michigan Neuropathy Screening Instrument(MNSI) in screening for diabetic neuropathy among Filipino patients with diabetes mellitus using nerve conduction velocity(NCV) as gold standard and to determine the most accurate cut-off score for the diagnosis of neuropathy using MNSI.
METHODOLOGY: A cross-sectional analytic study was done among adult diabetic patients. The original MNSI Questionnaire was translated and back-translated to the Filipino language. Each patient answered the Filipino version of MNSI Questionnaire followed by a lower extremity examination done by the investigator. All patients underwent NCV as reference standard. Sensitivity and specificity of MNSI were determined.
RESULTS: We studied a total of 150 subjects. Eighty-seven (58%) were diagnosed to have diabetic neuropathy based on NCV. The sensitivity and specificity of the MNSI Questionnaire improved to 73.6% and 52.4% respectively when the cut off was reduced to ?4, whereas for the MNSI Examination, the sensitivity and specificity improved to 86.2% and 55.6% respectively when the cut off was reduced to ?1. Combining both MNSI Questionnaire and MNSI Examination further improves the sensitivity to 95.4% whereas specificity is at 39.7%.
CONCLUSION: The analyses in 150 subjects confirm that the Filipino-version of MNSI is a valid screening tool for diabetic neuropathy when compared with NCV as gold standard.

Human ; Male ; Female ; Adult ; Questionnaires ; Diabetes Mellitus ; Philippines ; Patients