In 2021, 537 million adults were living with diabetes. Being a progressive disease, there would eventually be failure of oral hypoglycemic agents (OHA) to maintain good glycemic control and a majority will require insulin. However, optimal glycemic control has not been satisfactory in a significant proportion of patients who were on insulin therapy. Patient factors (eg, awareness, compliance, socioeconomic) have been identified but physician-related factors are as important. These include incorrect choice and inappropriate combination of insulin therapy which could be corrected by making the treatment physiologic. The purpose of this article is to improve management decisions in type 2 diabetes by reviewing its pathophysiology and identifying the optimum insulin regimen that could mimic such. Since eventual beta cell failure is central to its pathophysiology, it is but reasonable to replace insulin by mimicking its physiologic secretion. Hence, the term Insulin Replacement Therapy (IRT) should be utilized. This could be provided by the combination of premix insulin (ie, NPH + regular insulin) and rapid-acting insulin which has been reported to provide an initial 17.5% HbA1c reduction and even 18% reduction on 5-year follow-up providing sustainable control. A stepwise approach is an effective tool for insulin intensification. Hypoglycemia in insulin therapy could be prevented with an appropriate dietary regimen through automatic snacking.

Diabetes Mellitus, Type 2

OBJECTIVE

To evaluate the effect of mySugr^TM app on diabetes self-management, HbA1c level and its acceptability among app users with type 2 diabetes (T2DM).

METHODS

A prospective, single-arm interventional study in 70 adult Filipino patients with T2DM and HbA1c ≥ 8.0%. Participants used the basic mySugr^TM mobile app for 12 weeks. The Modified Behavior Score Instrument and the Diabetes Self-Management Questionnaire (DSMQ) pre- and post-intervention measured its impact on diabetes self-management while the Mobile Application rating Scale (MARS) assessed the quality of the app.

RESULTS

There was a significant increased adherence to the diabetes self-care behaviors. DSMQ showed that only 12% of the participants had poor self-care behaviors at week 12 particularly in physical activity and diet. The baseline median HbA1c [9.55% (8.43-11.30)] and estimated HbA1c [8.9% (8.3-10.9)] declined significantly after week 12, [8.0% (8.0-8.43)] and [7.2% (6.5-8.1)] respectively with a very significant p value of (p < 0.00001). About 42% of patients achieved an HbA1c level of ≤7%. MARS confirmed the app’s good quality and acceptability.

CONCLUSION

Mobile application such as mySugr^TM mobile app can be a viable tool for improved self-care behavior and help in achieving good glycemic control among patients with poorly controlled T2DM even as early as 12 weeks. The app has good quality and acceptability.

Human ; Diabetes Mellitus, Type 2

OBJECTIVES

This study aimed to determine the clinical profile of non thyroidal cancer patients with thyroid dysfunction associated with tyrosine kinase inhibitor (TKI) therapy at the University of Santo Tomas Hospital (USTH), Philippines.

METHODOLOGY

This is a retrospective observational study of TKI initiated adult non-thyroidal cancer patients with thyroid function testing from 2013 to 2018.

RESULTS

Forty percent (95% CI: 26.2% - 58.61%) of the sixty individuals who had thyroid function tests (TFT) had incident thyroid dysfunction. Thirty percent had hypothyroidism (i.e., 25% overt [mean TSH 16.64 uIU/mL]; 5% subclinical [mean TSH 6.62 uIU/mL]). The median time at risk was 8 and 16 months for overt and subclinical hypothyroidism, respectively. Fifty-six percent had persistent hypothyroidism (median TSH 16.75, p = 0.009). The average time to recovery of transient hypothyroidism was 39 months. Ten percent had hyperthyroidism with a median time at risk of 1.5 months. Non-small cell lung cancer and renal cell carcinoma were possible associated risk factors of thyroid dysfunction.

CONCLUSION

TKI-induced thyroid dysfunctions are common. Screening and monitoring for thyroid abnormalities during TKI therapy is important.

Tyrosine Kinase Inhibitors ; Hypothyroidism ; Hyperthyroidism