Prevalence of diabetes mellitus and pre-diabetes in the Philippines: A sub-study of the 7th National Nutrition and Health Survey (2008)

INTRODUCTION: Diabetes mellitus is rapidly increasing worldwide but the greatest increase is expected in developing countries including the Philippines. It is of public health concern to monitor countrywide prevalence of diabetes as it leads to significant cardiovascular-related mortality as well as significant complications such end stage renal disease, blindness, lower leg amputations and blindness.METHODOLOGY: This is a national survey to estimate the prevalence of diabetes and pre-diabetes using the criteria of the World Health Organization through a stratified multi-stage sampling design representing each of the 17 regions in the country.RESULTS AND DISCUSSION: The national prevalence of diabetes in the year 2008 was 7.2% (6.5-7.9); impaired glucose tolerance 7.0% (6.1-7.8) and impaired fasting glucose was 2.2% (2.2-3.1). There was a greater prevalence of individuals with diabetes in the urban areas at 8.5% (7.5-9.5) compared to the rural areas at 5.7% (4.6-6.8). Diabetes is slightly more preponderant among females at 7.4% (6.4-8.3) compared to males at 7.0% (6.1-8.0).CONCLUSION: The prevalence of diabetes mellitus in the Philippines is rising with the prevalence in 2008 at 7.2%. The prevalence of pre-diabetes exceeds that of diabetes mellitus at approximately 10.2%.

Tuberculous abscess of the thyroid / Journal of the ASEAN Federation of Endocrine Societies

Tuberculosis (TB) of the thyroid gland is rare, with acute abscess formation being the least common form of presentation. As such, TB of the thyroid may be overlooked as an initial clinical impression. A careful approach by history, physical examination, laboratory testing and radiologic imaging may aid in defining the etiology of the thyroid abscess, but these remain nonspecific. An accurate diagnosis may only be made by histologic examination. We present a case of a tuberculous abscess of the thyroid gland in a 37-year-old female. TB of the thyroid should also be considered when evaluating patients presenting with a painful thyroid nodule.

Angiotensin I-converting enzyme gene polymorphism and diabetic nephropathy in Filipino type 2 diabetes mellitus patients / Journal of the ASEAN Federation of Endocrine Societies

Objective. Previous studies have demonstrated the role of genetic susceptibility in the pathogenesis of diabetic nephropathy. The study aimed to determine the frequencies of angiotensin I-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism in a pilot population of Filipino type 2 diabetic patients and normal controls. Methods. An analysis of the ACE gene polymorphism was performed in 42 diabetic patients with and without nephropathy, and 24 normal controls. The analysis was done using polymerase chain reaction, restriction enzyme digestion, and gel electrophoresis techniques to determine the polymorphism (II, DD or ID). Independent T-tests and chi-square tests were used to compare clinical characteristics, and logistic regression analysis was done to determine odds ratio for development of nephropathy. Results. The ID polymorphism of the ACE gene was more frequent (52.4%) in patients with diabetic nephropathy (n=21). In those without nephropathy (n=21), II was more common (61.9%). ID was the more frequent genotype in the normal controls (n=24) (58.3%). The odds of developing diabetic nephropathy were increased by 4.8 times in those with ID polymorphism, and 2.9 times in those with DD. Conclusion. The D allele was more common in patients with diabetic nephropathy, similar to the observation in South Indian patients. Since the study involved only a small pilot group, studies on a larger population is needed to establish the hypothesized role of the D allele in susceptibility to diabetic nephropathy in Filipinos.

Changes in ovarian function after radioactive iodine among patients with differentiated thyroid carcinoma at St. Luke's Medical Center / Journal of the ASEAN Federation of Endocrine Societies

OBJECTIVE: To determine the prevalence of menstrual and reproductive dysfunction among subjects who have undergone radioiodine treatment for thyroid carcinoma.METHODOLOGY: This study enrolled adult women with Differentiated Thyroid Carcinoma who received the treatment at age 40 years and below. Data was processed using SAS program and evaluated using Fischer's test and Wilcoxon test.RESULTS: The study enrolled 46 women. Three reported cycle irregularities, 4 reported changes in amount of bleeding and 1 had amenorrhea. The prevalence rate of menstrual abnormalities was 15.2%. These women received a significantly higher dose of radioactive iodine (RAI) (120 vs. 110 mCi, p = 0.0064). Eleven women tried to conceive and there were 5 births to 5 different subjects after radiation. There were no congenital anomalies and 1 miscarriage. Four women were menopausal with an average age of 44.4 years old.CONCLUSION: This study showed that the prevalence of menstrual disturbances after high dose radioactive iodine treatment among thyroid cancer patients is 15.2%. The affected group received a significantly higher dose of radioactive iodine compared to the unaffected group.

Prevalence of thyroid dysfunction among patients taking glutathione supplementation: A cross-sectional study preliminary report

BACKGROUND: Glutathione due to its favorable side effect of skin whitening has been used by cosmetic centers and by individuals buying it as an over the counter supplementation. Because of this, this compound is prone to misuse. To date, there are limited studies on the adverse effects of exogenous supplementation of glutathione.OBJECTIVE: To determine the prevalence of thyroid dysfunction among individuals taking oral and intravenous glutathioneDESIGN: Cross-sectional studyMETHODS:Healthy Filipino subjects, 21 to 50 years of age, currently taking oral or intravenous glutathione, with no preexisting/ known thyroid disease and history of radiation exposure, and not taking medications with known effect on thyroid function were included in the study. Blood extraction for thyroid function test and thyroid ultrasound were conducted.RESULTS: A total of 36 subjects were analyzed with a mean age of 36.3±8 years, 86 percent were female. High dose glutathione (1000mg or more per day) was taken in by nine subjects (25%) while 27 subjects (75%) took doses below the recommended range (less than 1000ng per day). The prevalence of abnormal thyroid function was 5.56 percent (n=2). Both cases were taking low dose glutathione supplementation. No abnormal thyroid function was seen with higher doses of glutathione. No significant relationship was found between the duration of glutathione supplementation with thyroid function status. Thyroid stimulating hormone (TSH) levels were slightly higher among those taking high dose glutathione (mean=1.08 versus 1.04, p=.81). There was no significant differences in the duration and dose of supplementation with the size of the gland.RECOMMENDATION:The direct effect of L-glutathione supplements on thyroid function must be established using a longitudinal prospective study design. We also propose a group to serve as a negative control during the comparisons.

Prevalence of periodontitis and its association with glycemic control among patients with type 2 diabetes mellitus seen at St. Luke's Medical Center

BACKGROUND: Studies have shown that diabetes increases the prevalence and severity of periodontitis. Furthermore, among patients with Type 2 Diabetes Mellitus (DM), poorer glycemic control was found to be associated with poorer periodontal health.OBJECTIVE: To determine the prevalence of periodontitis and its association with glycemic control among Filipino patients with Type 2 DM.DESIGN: Cross-sectional studyMATERIALS AND METHODS: Diagnosed Type 2 DM patients 35 years and above were recruited from the out-patient clinics of St. Luke's Medical Center from June-October 2009. Periodontitis was evidenced by the presence of ?3mm probing depth and ?3mm periodontal attachment loss at the same site. Periodontitis severity was classified based on probing depth and furcation involvement. Glycemic control was assessed by laboratory assay for HbA1c grouped into RESULTS: A total of 192 subjects were analyzed. Prevalence of periodontitis among the Type 2 DM population studied was 68.23%. In this study, we found out that for those whose length of time since last dental check-up was >1 year, the odds of having periodontitis is 3.8 times higher (95% CI 1.45-9.76, p-value 0.007) among subjects with HbA1c ?7% compared to those with HbA1c CONCLUSION: Our findings suggest that periodontitis is prevalent among the Filipino Type 2 DM population studied. In this study, it is the interaction of both HbA1c ?7% and length of time since last dental check-up >1 year that resulted in a statistically significant association with periodontitis.

Prevalence of secondary hyperparathyroidism among outpatient type 2 diabetic patients undergoing hemodialysis in a tertiary hospital

BACKGROUND: Secondary hyperparathyroidism (SHPT) can lead to significant morbidity, mortality, and additional healthcare resource ut i l i zat ion in chronic k idney disease. Baseline prevalence data is highly required. This study aims to determine the prevalence of secondary hyperparathyroidi sm (SPTH) in pat ient s wi th Type 2 diabetes undergoing hemodialysis.MATERIALS AND METHODS: We reviewed all medical records of patients whose chronic kidney disease (CKD) was due to Type 2 diabetes mellitus and are undergoing chronic hemodialysis from 2000 to 2009. Excluded were those who underwent hemodialysis due to acute renal failure or for chronic renal failure due to other causes other than diabetic nephropathy (e.g. hypertensive nephropathy, chronic glomerulonephritis, etc). Data collected include age, sex, body mass index, bone markers, intact PTH, and urea reduction rate.RESULTS: The age and sex adjusted period prevalence of secondary hyperparathyroidism was 28.9%, commonly seen in the 5th to the 6th decade of life. Patients with SPTH had higher serum intact PTH, higher total calcium level (mean 9.05 versus 8.6, p=.026) and a higher urea reduction rate (mean 54.1 versus 45.2, p=.045). There was a longer duration of hemodialysis sessions among those with secondary hyperparathyroidism (mean 2.4 years versus 1.78 years, p=.004). Dialysis was likewise more adequate.CONCLUSION: Prolonged diabet ic kidney di sease is associated with secondary hyperparathyroidism for which a more aggressive monitoring of calcium and phosphorus imbalance is required.