The effect of telemedicine on self-care activities of patients with Type 2 Diabetes Mellitus and patient satisfaction during the Coronavirus-19 (COVID-19) pandemic: A repeated cross-sectional study

Introduction@#Patients with diabetes require regular follow-ups to achieve optimal glycemic targets. The coronavirus- 19 (COVID-19) pandemic resulted in interruptions in healthcare delivery placing greater importance on patient’s self-management of their condition. Telemedicine bridged the gap between the physician and patient that was created by community quarantines. @*Objective@#To determine if there is a difference in patient’s self-care activities before and after using telemedicine using the Diabetes Self-Management Questionnaire (DSMQ). @*Methodology@#A descriptive repeated cross-sectional study of patients with type 2 diabetes mellitus at the University of Santo Tomas Hospital who consulted via telemedicine using different available platforms were included. Self-care was measured using the DSMQ. Patient satisfaction with telemedicine was also assessed using a patient satisfaction survey. @*Results@#An improvement in self-care practices was seen as significantly higher mean DSMQ scores after telemedicine consultations (6.79 ± 1.33 to 7.32 ± 1.21, p = 0.0015), with the highest scores on dietary control and physical activity. There was a statistically significant reduction in HbA1c on follow up (8.37 ± 2.31 to 7.31 ± 1.36; p<0.00001). Those with well-controlled diabetes (n = 14) at baseline remained to have good control while the proportion of those with poorly controlled diabetes (n = 34) showed improved glycemic control on follow up (p = 0.0045). Most patients were highly satisfied with telemedicine. @*Conclusion@#The use of telemedicine by patients with diabetes showed numerical improvement in both self-care practices and glycemic control. These findings imply that telemedicine may be mainstreamed as part of diabetes care among Filipinos.

Successful reduction in thyroid and nodule volumes in large solitary and multinodular goiters with serial 131 iodine therapy

Introduction@#131Iodine therapy is effective in nodular nontoxic goiter with enhanced effects using recombinant thyroid stimulating hormone (rTSH). The eventual fibrosis of the thyroid tissue and blood vessels ligates the vascular supply of the nodule. The study aims to show the successful reduction of thyroid and nodule volumes in large solitary and multinodular goiters using serial low dose 131iodine therapy (10mCi) at three to six months interval.@*Methods@#A retrospective analytical study was done from January 2010 to December 2012 and included twenty three patients with enlarged solitary and multinodular (nodule/s ≥2cm) non-toxic goiter (females: age range 35-65yrs) given serial 131iodine therapy (eight to10mCi) at three to six-month interval. Before each course, serum thyroid stimulating hormone (TSH) was done to document hypothyroidism while thyroid gland and nodule sizes were monitored by ultrasonographic measurements serially with each 131iodine therapy. Relief of compressive symptoms was monitored on follow-up at clinic.@*Results@#Thyroid size reduced by 38-40% from baseline after first radioactive iodine (RAI) and by 33-39% after the second RAI. Thyroid nodules reduced by 63-69% and 11-25% serially. Significant reduction was noted after the first RAI. One subject underwent third RAI with 80-85% overall reduction in nodule size. All patients developed post-RAI hypothyroidism and overall had greater than 50% increase in levothyroxine replacement dose after the last RAI. Significant relief of compressive symptoms was noted by 91% post-therapy. Four thyroid nodules disappeared which resulted in reduced total number of thyroid nodules from 29 to 25 nodules post serial RAI.@*Conclusion@#Serial 131iodine therapy proved to have thyroid and nodule size reduction by more than 70% in this study. Among patients who do not consent or have contraindications to surgery, serial 131iodine therapy may be considered a safe and effective non-surgical alternative.

Prevalence of Hyponatremia in Hypothyroid Patients during Radioactive ¹³¹I Ablation for Differentiated Thyroid Cancer: Single Institution Experience

BACKGROUND: Hyponatremia developing in hypothyroid patients has been encountered in clinical practice; however, its prevalence has not been well established. METHODS: Thirty patients diagnosed with differentiated thyroid cancer, rendered hypothyroid after surgery and levothyroxine withdrawal, and who are for radioactive iodine (RAI) ablation were included. Serum sodium concentrations were measured twice, at the time of admission for RAI ablation, and before discharge after increased oral fluid intake. The outcome measures were to determine the prevalence of hyponatremia among hypothyroid patients prior to RAI ablation and after oral hydration post-RAI, and to correlate the serum sodium levels pre-RAI and post-RAI with thyroid-stimulating hormone (TSH) concentration and age. RESULTS: Thirty patients were included, with ages from 23 to 65 years old (median, 40). Two patients (6.7%) were hyponatremic prior to RAI ablation, and eight patients (26.7%) had mild hyponatremia (130 to 134 mEq/L) after RAI and hydration. There was no significant correlation between TSH levels and serum sodium levels prior to or after RAI. There was also no significant correlation between pre- and post-RAI sodium concentration and age. CONCLUSIONS: The prevalence of hyponatremia pre-RAI was 6.7%, and 26.7% post-RAI. No significant correlation was noted between TSH concentration and age on pre- or post-RAI sodium concentrations. Routine measurement of serum sodium post-RAI/isolation is still not advised. Measurement of sodium post-RAI may be considered in patients who are elderly, with comorbid conditions or on medications.