BACKGROUND: Diabetes mellitus is becoming prevalent in developing countries like the Philippines. Mass screening is not recommended and is not cost effective. Targeted screening is a more practical way to detect people with disease.
Overseas employment is one of the most common occupations in the country. Primary medical examination is done in pre-employment clinics with routine panel of diagnostics, urinalysis included. Fasting blood sugar(FBS) and oral glucose tolerance test (OGTT) are not part of the panel of pre-employment medical examination for overseas Filipino workers (OFW). They are mostly done when they are referred to endocrinology or diabetes clinics when suspicion arises or glucosuria is noted on urinalysis. However, there are patients who consulted endocrinology clinics but deny any symptoms of diabetes.                                                                                                                                                                
OBJECTIVE: The objective of this study is to determine the prevalence of diabetes among OFW by employing FBS and OGTT among those who had urinalysis and referred to endocrinology clinic.
RESULTS: Among the 192 OFWs with glucosuria, doing FBS detected 21 percent, 51 percent and 28 percent with diabetes mellitus (DM), impaired fasting glucose (IFG) and normal fasting glucose respectively. By doing OGTT among the OFW with normal FBS, 46 percent were reclassified as diabetic or have impaired glucose tolerance (IGT). OGTT among those with IFG also detected 71 percent with diabetes or IGT. Overall the patients with glucosuria have a DM prevalence that is more than ten times that of the general population done by the National Nutrition and Health Survey in 2003.
Among the 149 OFWs without glucosuria, FBS detected 36 percent, 54 percent, and 10 percent with DM, IFG and normal fasting sugar respectively. OGTT among those with normal FBS detected 67 percent of them to have diabetes or prediabetes. Doing the same among those with IFG reclassified 60 percent to have DM or IGT. Similarly the prevalence of DM is about ten times of the national survey.
CONCLUSION: Among OFW with or without glucosuria referred for suspicion of diabetes FBS confirmed many to have diabetes and pre-diabetes. This prevalence is doubled by employing OGTT as part of the screening test.

Human ; Male ; Female ; Middle Aged ; Adult ; Diabetes Mellitus ; Asymptomatic Diseases ; Blood Glucose ; Endocrinology ; Glucose Intolerance ; Glucose Tolerance Test ; Glycosuria ; Philippines ; Urinalysis

Among the serious complications associated with radioiodine therapy (RAI) for thyroid cancer, cerebral edema is uncommon and has been reported previously in cases of swelling of brain metastases. This case is of a patient with papillary thyroid carcinoma who complained of nausea and vomiting after RAI and was then found unconscious the next day. Laboratory results showed electrolyte imbalances including hyponatremia and cranial imaging only revealed cerebral edema, and she regained consciousness after sodium correction. The etiology of the cerebral edema here is likely multifactorial - due to hyponatremia from hypothyroidism, aggravated by vomiting, copious water intake and a low sodium diet.

Human ; Female ; Adult ; Brain ; Brain Edema ; Carcinoma ; Consciousness ; Diet, Sodium-restricted ; Electrolytes ; Hyponatremia ; Hypothyroidism ; Iodine Radioisotopes ; Nausea ; Sodium ; Thyroid Neoplasms ; Vomiting

OBJECTIVES: Describe health beliefs of pregnant women with diabetes using tweets. Describe how information on diabetes in pregnancy is shared on Twitter.

METHODS: Tweets by women with diabetes were identified from Symplur Signals. "Status" tweets were mapped to the Health Belief Model. Tweets by women with preexisting diabetes and gestational diabetes (GD) were analyzed separately. Links within tweets were surveyed for the Health on the Net (HON) Foundation seal.

RESULTS: Women with GD tweeted about cravings and the connection of high carbohydrate meals with big babies. Perceived barriers included food restriction, hunger, lab tests, clinic consults and blood glucose monitoring. Perceived benefits of blood glucose testing and a healthy diet were linked to healthy babies. Blood glucose monitoring, weight gain, and age of gestation were cues to action. Perceived barriers of women with preexisting diabetes were feelings of helplessness, loss of control, and anger. Nine domains (9.7%) had the HON Code seal. Women with preexisting diabetes shared blog posts. Women with GD shared links from organizations.

CONCLUSION: Women with GD and preexisting diabetes had differing perceptions of susceptibility, severity, barriers, benefits, cues to action, and self-efficacy; and shared links to information differently on Twitter.

Human ; Female ; Pregnancy ; Diabetes, Gestational ; Weight Gain ; Craving ; Blood Glucose ; Self Efficacy ; Hunger ; Cues ; Healthy Diet ; Emotions ; Anger ; Perception

Objectives: The increasing use of the Internet as a source of health information makes the accuracy of such information crucial. An example is the use of the widely advertised bitter melon (Momordica charantia) in treating diabetes despite its unproven efficacy. This study aims to assess the accuracy of websites containing information on bitter melon’s role in diabetes, to search for the presence of the proposed quality indicators, and to determine their correlation with accuracy. Methodology: An Internet search was used to generate a list of websites. The accuracy of each website was determined by comparing its content with that of a tool that was developed from authoritative sources. The presence of the proposed quality indicators, taken from published guidelines, was then correlated with accuracy. Results: Of the 158 websites identified, 10 (6.33%) were characterized as “most accurate” and 21 (13.3%) as “somewhat accurate.” The identified indicators of accuracy were the HONcode logo (OR 12.1, p=0.011); the author, identified as a healthcare professional (OR = 6.11, p = 0.008); and a citation from a peer-reviewed medical literature (OR 2.92, p = 0.029). Conclusion These findings suggest that most of the Internet-based information on bitter melon’s role in diabetes is inaccurate. The public can use several indicators of accurate information on the use of bitter melon in diabetes to improve health care.
Internet ; Momordica charantia

Objectives: The use of Facebook (FB) to share and gather information on diabetes is commonplace but no data is available on its use among Filipinos during the COVID-19 pandemic. We sought to determine the engagement from instructional slide decks on diabetes and its management shown on two Philippine-based FB pages under the Enhanced Community Quarantine (ECQ). Methodology: We used Insights data from the slide decks and slide shows shown on the Philippine Society of Endocrinology, Diabetes and Metabolism’s (PSEDM) public FB page and the Endocrine Witch’s FB page. The slide set contained a mix of mostly images and text on COVID-19 and Diabetes, dietary advice, medications and self-care in the setting of the ECQ where access to insulin, ambulatory clinics and healthy food is limited. Data was summarized in terms of post clicks, reactions, shares and comments. Total engagement rate was computed. Results: We noted a high engagement rate (4-15%) in both public FB pages with higher engagement rates in slides shown in the Filipino language for most topics. The slides that gathered more shares and reactions were primarily those containing general information on COVID-19 and diabetes, nutrition including the safety of canned goods, as well as sick day rules. Conclusion In the setting of the ECQ, the use of image and text-based slide-decks on the PSEDM and Endocrine Witch FB pages to communicate health information yielded high engagement.
Social Media ; Diabetes Mellitus ; COVID-19

Objectives: The increasing use of the Internet as a source of health information makes the accuracy of such information crucial. An example is the use of the widely advertised bitter melon (Momordica charantia) in treating diabetes despite its unproven efficacy. This study aims to assess the accuracy of websites containing information on bitter melon’s role in diabetes, to search for the presence of the proposed quality indicators, and to determine their correlation with accuracy. Methodology: An Internet search was used to generate a list of websites. The accuracy of each website was determined by comparing its content with that of a tool that was developed from authoritative sources. The presence of the proposed quality indicators, taken from published guidelines, was then correlated with accuracy. Results: Of the 158 websites identified, 10 (6.33%) were characterized as “most accurate” and 21 (13.3%) as “somewhat accurate.” The identified indicators of accuracy were the HONcode logo (OR 12.1, p=0.011); the author, identified as a healthcare professional (OR = 6.11, p = 0.008); and a citation from a peer-reviewed medical literature (OR 2.92, p = 0.029). Conclusion These findings suggest that most of the Internet-based information on bitter melon’s role in diabetes is inaccurate. The public can use several indicators of accurate information on the use of bitter melon in diabetes to improve health care.
Internet ; Diabetes Mellitus ; Momordica Charantia

OBJECTIVE: This study assessed whether short message service (SMS) reminders would improve follow-up rate among gestational diabetes mellitus (GDM) patients by 12 weeks postpartum.

METHODOLOGY: In this single-center, single-blind randomized controlled trial, we assigned 308 patients with GDM to either of 2 arms, usual care alone versus usual care with SMS reminders. In the usual care group, 154 patients received a 10-minute short lecture on GDM and a 75 g oral glucose tolerance test (OGTT) request prior to discharge. In the SMS group, 154 patients received twice a week SMS reminders at 4 weeks, 8 weeks, and 10 weeks after delivery in addition to usual care. The primary outcome was clinic visit within 6 to 12 weeks postpartum with a 75 g OGTT result.

RESULTS: In our population, the overall follow-up rate was 19.8% (61/308). Follow up rates were 20.1% (31/154) for the usual care group and 19.5% (30/154) for the SMS. The addition of SMS reminders was not associated with an increase in follow-up rate at 12 weeks postpartum (adjusted RR 0.98, 95% CI 0.63-1.52; p=0.932). The use of insulin or metformin for GDM control was associated with increased follow-up (adjusted RR 1.92, 95% CI 1.20-3.07; p=0.006).

CONCLUSION: SMS reminders did not improve postpartum follow-up rate among GDM patients at 12 weeks postpartum.

Human ; Diabetes, Gestational ; Text Messaging

Objective: To determine the association of adverse perinatal outcomes among women with gestational diabetes mellitus (GDM) according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) and the Philippine Obstetrical and Gynecological Society (POGS) diagnostic cut-offs for 75 g oral glucose tolerance test (OGTT). Methodology: A review of deliveries from September to December 2013 at the charity services of the Philippine General Hospital (PGH) looking at 75 g OGTT results and perinatal outcomes was done. The association between GDM and perinatal outcomes were estimated and tested using logistic regression analysis. The diagnostic accuracy between the POGS and the IADPSG criteria was tested by comparing their areas under the curve (AUC). Results: A total of 236 deliveries were included. The GDM group had a significantly increased risk for primary Caesarean section (CS) (OR=1.79, 95% CI: 1.02-3.16, p=0.041) and infant admission to the Neonatal Intensive Care Unit (NICU) (OR=2.66, 95% CI: 1.3-5.44, p=0.007). Per category of glycemia, a 1-hour OGTT value >180 mg/dL was associated with an increased risk for primary CS (OR=1.968, 95% CI: 1.08-3.55); a fasting blood sugar (FBS) >92 mg/dL with increased risk for large for gestational age (LGA) infants (OR=20.97, 95% CI 2.27-192.97); and elevated FBS, 1-hour and 2-hour OGTT blood glucose values with increased risk for infant admission to the NICU (OR=2.18, OR=2.39, OR=2.34, respectively). There was no significant difference in outcomes between women diagnosed using the IADPSG and POGS criteria (n=104) and those diagnosed with the IADPSG criteria only (n=90). Conclusion The currently used cut-off values in diagnosing GDM was associated with increased risk for primary CS and infant admission to NICU. No significant difference in outcomes was found between the group of women that included those diagnosed with the more stringent POGS criteria from the group that excluded them, implying adequacy of the IADPSG thresholds for local use.
Diabetes, Gestational ; Pregnancy Outcome ; Glucose Tolerance Test

Introduction: The Hearing for Life (HeLe) is a novel newborn hearing screening device initially designed according to specifications of clinicians of the Philippine National Ear Institute (PNEI). Unfortunately, targeted end-users, rural health workers, had difficulty using it. This research applied the user-centered design (UCD) methodology involving rural health workers in recommending design, content, and function requirements for HeLe. Objectives: This study aims to 1) describe how UCD was applied in a time-limited and resource-constrained environment, 2) assess the usability of the design prototypes, and 3) recommend design, content, and function requirements for HeLe. Methods: This research is a descriptive study using mixed methods. Six rural health units (RHU) involved in the HeLe research program were purposively selected for the study. There were 30 participants included, five health care workers per RHU. Applying the UCD method, the study had three phases: 1) user profiling (where participants accomplished a survey questionnaire, 2) inspiration phase (focus group discussions, workflow analysis, and interviews with a technical expert were conducted), and 3) ideation phase (designing and assessment of prototypes were done). Results: Participatory methods and structured procedures (i.e., card sorting, MoSCoW matrix prototyping, etc.) were applied to help determine and prioritize user requirements and elicit user feedback. These methods were chosen considering the time and resource constraints in the RHU. The prototype's System Usability Scale (SUS) score (81.94) was higher than the SUS score previously obtained (68) from the older version of the interface. Accuracy, durability, in-app instructions, feedback, and an easily understood interface were the most requested requirements for the telemedicine device. The need for the technology to be aligned with the RHU's workflow and available resources was highlighted in the focus group discussions. Conclusions The study documents practices and lessons learned in applying UCD methodology in design and development that have been demonstrated to improve usability of the device. The involvement of the users surfaced in the design, content, and functional requirements which can guide future iterations of HeLe and contribute to better understanding of ways to develop user-friendly telemedicine devices in the Philippines. This paper emphasizes that users should be involved in the entire process and not just recipients of the technology.
User-Centered Design ; Digital Technology ; Telemedicine

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