Association Between Metformin Use and Mortality Among Patients with Type 2 Diabetes Mellitus Hospitalized for COVID-19 Infection / Journal of the ASEAN Federation of Endocrine Societies

Introduction@#Metformin has known mechanistic benefits on COVID-19 infection due to its anti-inflammatory effects and its action on the ACE2 receptor. However, some physicians are reluctant to use it in hypoxemic patients due to potential lactic acidosis. The primary purpose of the study was to determine whether metformin use is associated with survival. We also wanted to determine whether there is a difference in outcomes in subcategories of metformin use, whether at home, in-hospital, or mixed home/in-hospital use.@*Objectives@#This study aimed to determine an association between metformin use and mortality among patients with type 2 diabetes mellitus hospitalized for COVID-19 infection.@*Methodology@#This was a cross-sectional analysis of data acquired from the COVID-19 database of two tertiary hospitals in Cebu from March 1, 2020, to September 30, 2020. Hospitalized adult Filipino patients with type 2 diabetes mellitus who tested positive for COVID-19 via RT-PCR were included and categorized as either metformin users or metformin non-users.@*Results@#We included 355 patients with type 2 diabetes mellitus in the study, 186 (52.4%) were metformin users. They were further categorized into home metformin users (n=109, 30.7%), in-hospital metformin users (n=40, 11.3%), and mixed home/in-hospital metformin users (n=37, 10.4%). Metformin use was associated with a lower risk for mortality compared to non-users (p=0.001; OR=0.424). In-hospital and mixed home/in-hospital metformin users were associated with lower mortality odds than non-users (p=0.002; OR=0.103 and p=0.005; OR 0.173, respectively). The lower risk for mortality was noted in metformin, regardless of dosage, from 500 mg to 2 g daily (p=0.002). Daily dose between ≥1000 mg to <2000 mg was associated with the greatest benefit on mortality (p≤0.001; OR=0.252). The survival distributions between metformin users and non-users were statistically different, showing inequality in survival (χ2=5.67, p=0.017).@*Conclusion@#Metformin was associated with a lower risk for mortality in persons with type 2 diabetes mellitus hospitalized for COVID-19 disease compared to non-users. Use of metformin in-hospital, and mixed home/in-hospital metformin use, was also associated with decreased risk for mortality. The greatest benefit seen was in those taking a daily dose of ≥1000 mg to <2000 mg.

A comparison of the maternal and perinatal outcomes of pregnant patients who are Euthyroid versus those with Subclinical Hypothyroidism treated with Levothyroxine using different TSH Cut-off levels

Introduction@#In 2017, the American Thyroid Association (ATA) revised their guidelines that when trimester and assay specific TSH reference intervals is unavailable, a TSH cut-off of 4.0 mIU/L replacing the previously recommended 2.5-3.0 mIU/L may be used to define maternal hypothyroidism. It states that levothyroxine treatment is considered if anti-TPO levels are elevated and TSH is between 2.5 mIU/L and the trimester-specific upper limit. These recommendations are a major departure from our current practice because the local TSH trimester-specific reference interval is not applicable due to a different assay used and the anti-TPO result is not readily available. In this population-based study, we aimed to determine and compare the maternal and perinatal outcomes of pregnant women who are euthyroid (TSH 0.3-2.4 mIU/L) versus those with subclinical hypothyroidism at different TSH cut-off levels (TSH 2.5-4.0 mIU/L, TSH 4.0-10.0 mIU/L) treated with levothyroxine.@*Methods@#This is a single-center, prospective cohort study conducted at Chong Hua Hospital, Cebu City from September 2017 to September 2018 where a total of 505 pregnant women qualified. The cohort was divided into three groups: the euthyroid group of 404 women with TSH 0.3-2.4 mIU/L as control subjects; 101 women with subclinical hypothyroidism treated with levothyroxine further subdivided into TSH level 2.5-4.0 mIU/L (81 women) and TSH level >4.0-10.0 mIU/L (20 women). These patients were followed through to delivery to document and compare the maternal and perinatal outcomes versus euthyroid patients.@*Results@#There was no statistically significant difference among the group of patients with subclinical hypothyroidism treated with levothyroxine versus euthyroid patients in documented complications of pregnancy, such as GDM, gestational HPN, pre-eclampsia, PROM, low APGAR score and fetal distress. However, in patients with baseline TSH 2.5-4.0 mIU/L there was preterm delivery in six (7.41%) patients, post-term delivery in two (2.5%) patients, with seven (8.6%) small for gestational age (SGA) infants and two (2.5%) large for gestational age (LGA) infants. In patients with baseline TSH > 4.0-10.0 mIU/L, preterm delivery occurred in two (10%) patients. In secondary analysis adjusted for age and parity at enrolment, pregnant women treated with levothyroxine at baseline TSH 2.5-4.0 mIU/L and TSH > 4.0-10.0 mIU/L versus the untreated women with TSH < 2.5 mIU/L showed no difference in the maternal and perinatal outcomes of pregnancy measured. @*Conclusion@#This study has shown a 12.5% prevalence of subclinical hypothyroidism in our setting. There was no difference in the maternal and perinatal outcomes of pregnant patients who are euthyroid versus those with subclinical hypothyroidism treated with levothyroxine at a TSH threshold of 2.5-4.0 mIU/L and >4.0-10.0 mIU/L. These findings support the view that levothyroxine treatment in pregnant women with subclinical hypothyroidism at a TSH cut-off of 2.5 mIU/L shows no harmful effects.

Diabetes-related attitudes of health care providers in Rural Health Centers in Aklan, Philippines using the Filipino Version of Diabetes Attitude Scale (DAS-3) / Journal of the ASEAN Federation of Endocrine Societies

Objectives@#To determine the beliefs and attitudes towards diabetes of rural health care providers in Aklan, Philippines using the Diabetes Attitude Scale 3 (DAS-3) and to determine factors associated with it.@*Methodology@#This is a cross-sectional analytic survey. A total of 339 health care providers were given self-administered DAS-3 questionnaires. Additional data gathered included their age, highest educational attainment, position, municipality class, diabetes as a co-morbidity, attendance to diabetes classes, and family history of diabetes.@*Results@#Rural health care providers showed an overall mean positive attitude score of 3.5 using the DAS-3 questionnaire. In decreasing order, mean scores of participants according to subscale is as follows: “Need for Special Training in Education” (4.13) >“Autonomy of diabetes for patients” (3.70) >“Psychosocial Impact of Diabetes” (3.60) >“Value of Tight Glucose Control” (3.14) and “Seriousness of Type 2 Diabetes” (3.09). Physicians have the highest mean scores consistently in all subscales compared to other health care providers. Among the different factors considered, educational attainment (p=0.005) and work position (p=<0.001) were found out to affect attitude score of health care providers.@*Conclusions@#This study has shown that the majority of the rural health care providers believe in the need for special training of healthcare providers, psychosocial impact of diabetes and patient autonomy in diabetes self-care. However, the majority still do not strongly believe in the seriousness of diabetes and the benefits of tight sugar control. Educational attainment and work position are the consistent factors that impact diabetes-related attitude; therefore, the need to strengthen continuous medical education among health care providers

Nutritional status and hospital outcomes of in-patients in a tertiary hospital

Introduction@#Malnutrition is a widespread condition that impacts millions of people across the world annually. The World Health Organization defines malnutrition as the deficiency, excess or imbalance in a person’s intake of energy and/or nutrients. It has been highly prevalent in hospitalized patients and is often overlooked as it continues to be an unrecognized problem. It is also associated with increased risk of complications, higher mortality rate, longer hospital stay, and higher hospitalization costs. The researchers aim to determine in-patients’ nutritional status using the Subjective Global Assessment (SGA) and their outcomes in a tertiary hospital.@*Methods@#A cross-sectional study was conducted in a tertiary hospital in Cebu city for three months. A total of 453 patients were selected through simple random sampling from those assessed to be at risk for malnutrition. The nutritional status was obtained using the SGA tool and correlated with the demographic, nutritional and clinical profiles. @*Results@#In the study, the mean age was 54 years with a female predominance (54.1%). A larger percentage belonged to the obese 1 category (34.9%). Fifty-eight percent had moderate risk for malnutrition and 57.2% had an SGA grade of B which corresponded to moderate malnutrition. The most common reason of admission was due to respiratory causes (25%) and the leading comorbidities were hypertension (48.79%), diabetes mellitus (36.42%) and chronic kidney disease (10.38%). The mean number of hospital stay was 6.8 days (98.9%) were discharged improved with a mortality rate of only one percent. The following factors had a positive relationship with the SGA grade: those in the older age group (p=0.000), those with more comorbidities (p=0.000), patients with diabetes (p=0.027) and chronic kidney diseases (0.001), those with higher nutritional risk on screening (p=0.000), those with pulmonologic (p=0.035) and oncologic cases (p=0.012) upon admission. The study results showed that the higher the SGA grade, the longer hospital stay (p=0.000).@*Conclusion@#In this study, the prevalence of malnutrition was 86% wherein 57.2% of the study population had moderate malnutrition, 28.9% had severe malnutrition and 13.9% had no malnutrition. The degree of malnutrition was associated with longer hospital stay, but not with mortality.