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.

The difference in risk factors between adults With early-onset (<40 Years Old) versus late-onset (≥40 Years Old) type 2 Diabetes in a University Hospital From January 2015-December 2017

Background@#Diabetes will remain a threat to global health. No longer just a disorder of mature age, there is now a well-recognized trend towards the young. Early diagnosis leads to early intervention and prevention of complications in this susceptible but vital portion of the population. @*Objective@#To compare the risk factors predisposing adults to early-onset (<40 years old) versus late-onset (≥40 years old) type 2 diabetes at the University of Santo Tomas Hospital from January 2015-December 2017. @*Methods@#This is a retrospective review of medical records. All adult patients who fulfilled the inclusion criteria from January 2015 to December 2017 were included in the study. Data from charts were reviewed and analyzed. @*Results@#The early-onset group had a mean age of 34 years, while the late-onset group had a mean age of 51 years. The early-onset diabetics were mostly obese, had higher HbA1c, worse lipid profiles, and had a positive family history of diabetes. Only a BMI of >27.50 kg/m2 was found to be a significant risk factor contributing to early-onset of diabetes. Myocardial infarction and nephropathy were more frequent in the late-onset group while retinopathy was more common in the early-onset group. Lastly, only retinopathy and neuropathy were significantly associated with longer duration of diabetes. @*Conclusion@#The mean age of Filipinos was at least 5 years younger than the studies done on Caucasians. Most patients in the early-onset group were obese and had worse metabolic profiles. Retinopathy was more common in the early-onset group, while myocardial infarction and neuropathy were more common in the latter.

The association of antenatal steroids and hypoglycemia in preterm neonates

@#<p style="text-align: justify;"><strong>Objective:</strong> Antenatal steroids have shown to decrease the rate of neonatal complications and morbidity; however, neonates are predisposed to significant hypoglycemia resulting in invasive interventions and prolonged nursery admissions. The risk of hypoglycemia in the preterm has been well studied, but the association of antenatal steroids and hypoglycemia in preterm neonates has not been well explored. Thus, we sought to determine the association of antenatal steroids given to mothers who delivered prematurely and the development of neonatal hypoglycemia.</p><p style="text-align: justify;"><strong>Methods:</strong> A cross-sectional study using chart review was done on mother-preterm neonate pairs admitted in the charity obstetrical ward of The University of Santo Tomas Hospital from January 1, 2018 to December 31, 2019. The subjects were mothers either given or not given antenatal steroids before preterm delivery and their respective neonates. The provision of antenatal steroids was the primary exposure, while neonatal hypoglycemia was the primary outcome. Measurement of association was done using odds ratios. Univariate and multivariate logistic regression analyses were done.</p><p style="text-align: justify;"><strong>Results:</strong> Of the 69 preterm neonates included in the study, hypoglycemia was observed in 14 neonates, among which 8 neonates were exposed to antenatal steroids. After examining the association using Fisher's exact formula and controlling for potential confounders, neonatal hypoglycemia was not significantly higher among neonates exposed to antenatal steroids.</p><p style="text-align: justify;"><strong>Conclusion:</strong> Antenatal steroids given to mothers who delivered preterm were not associated with the development of neonatal hypoglycemia. A prospective study model, larger population size and longer study coverage should be made to strengthen the outcome of the study.</p>

Prevalence and Clinical Outcomes of Patients with Diabetic Ketoacidosis/Hyperglycemic Hyperosmolar Syndrome and COVID-19: A Systematic Review

@#BACKGROUND AND OBJECTIVES. Several reports have shown that coexistence of diabetes mellitus and COVID-19 is one of the risk factors for poor outcome and increased mortality. Rapid metabolic deterioration with development of diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar syndrome (HHS) may result due to the acute insulin secretory capacity loss, stress condition and the cytokine storm. In this review, we aim to describe the prevalence of hyperglycemic crises(DKA/HHS) in patients with COVID-19 infection as well as their clinical outcomes. METHODS. An intensive search was done using the WebMD, PubMed, Medline and Google Scholar databases for articles published between December 2019 to October 2020 that identified the number of patients who developed DKA and/or HHS among those who were admitted for COVID-19. Their clinical outcomes were likewise described. RESULTS. This review included 4 articles in which individual quality was assessed. A total of 1282 patients were admitted for COVID-19 and the prevalence of DKA was 1.32%. HHS was not reported in any of the studies. Five (29.4%) of the patients with DKA and COVID-19 died and 12 (70.6%) recovered. CONCLUSIONS. A significant number of COVID-19 patients developed DKA and it is associated with a high mortality rate. This reimposes the need for an appropriate algorithm for the optimal management of concomitant COVID 19 and hyperglycemic crises to avoid morbidity and mortality. Additionally, there is paucity of large-scale studies describing the prevalence of DKA/HHS in patients with COVID-19.

Prevalence of hypoglycemia among type 2 diabetics undergoing hemodialysis in a university hospital

Background@#The overall increase in the number of people with diabetes mellitus has a major impact on the increasing number of patients with diabetic kidney disease (DKD). Hypoglycemia that is brought about by altered glucose homeostasis and the hemodialysis process in patients with DKD poses a great challenge to clinicians in achieving blood glucose control. This study has been undertaken to evaluate the prevalence of hypoglycemia among diabetics undergoing hemodialysis and determine the clinical factors predicting the development of hypoglycemia.@*Methods@#We conducted a prospective, cross-sectional study that included 75 patients with diabetes mellitus undergoing maintenance hemodialysis at the University of Santo Tomas Hospital, Center for Kidney Disease. The patients’ predialysis and hourly intradialytic serum glucose levels were measured until the end of the session. Hypoglycemia was considered as a blood glucose ≤70 mg/dL with/without symptoms.@*Results@#Elderly patients and in-hospital patients tend to develop hypoglycemia with a p-value of 0.0028 and 0.001, respectively. Old age (p-value 0.0093), female sex (p-value 0.0224), hypertension (p-value 0.0301), CAD (p-value 0.0058), frequency of hemodialysis (p-value 0.0000), no caloric intake during the dialysis session (p-value 0.0022) and admission (p-value 0.0007) predicted hypoglycemia in our study@*Conclusions@#In conclusion, the prevalence of hypoglycemia among patients with type 2 diabetes mellitus undergoing maintenance hemodialysis in our setting is 12%. There is an increased rate of hypoglycemia amongst the elderly as well as admitted patients. Our results identifi ed old age, presence of CAD, increased frequency of hemodialysis and hospital admission as the predictors of hypoglycemia.

A retrospective cohort study in a university hospital evaluating the effect of maternal glucose containing intravenous fluid in neonatal glycemia

@#Abstract Maternal hyperglycemia during the peripartum period is highly correlated with fetal hyperinsulinemia and consequent neonatal hypoglycemia. Liberal use of intravenous glucose therapy prior to delivery can potentially cause maternal hyperglycemia, therefore, it is prudent to implement all preventive measures. This study aims to determine the occurrence of neonatal hypoglycemia with intravenous glucose therapy prior to delivery in maternal diabetes mellitus. This was a retrospective cohort study of neonates born from diabetic mothers at the University of Santo Tomas Hospital Clinical and Private Divisions from January 1, 2013 to December 15, 2017. Clinical information gathered was divided into maternal and neonatal characteristics. Maternal intravenous fl uid use, rate, and duration were noted; maternal and neonatal blood glucose results were obtained. There were 109 infants of diabetic mothers, of which 105 were delivered as singleton and 4 from twin pregnancies. Neonatal hypoglycemia was present in 14.68%. Comparing the risk factors, there was a higher amount of glucose infused to the mothers whose offspring developed hypoglycemia compared to those without hypoglycemia. Statistically, this did not demonstrate a signifi cant difference. The rate of glucose infusion and frequency of maternal insulin use were similar between the groups. Linear correlation was not evident when the total glucose infused and the rate of intravenous glucose infusion was compared to the neonatal glucose in the fi rst hour of life. Based on this study, routine administration of glucose-containing intravenous fl uid did not infl uence the incidence of neonatal hypoglycemia. It is recommended that further prospective studies be conducted.

Diagnosis of gestational diabetes mellitus using the international association of the diabetes and pregnancy study groups criteria and adverse pregnancy outcomes among a cohort of Filipino women: An association analysis

Introduction@#Locally, there is no unified set of diagnostic criteria for gestational diabetes mellitus (GDM) and this can lead to potential confusion on the part of the physician and the patient as well. Moreover, whether the adoption of the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) threshold values for GDM diagnosis among Filipino women is appropriate is still unclear. This study serves to give a clinically important insight whether utilizing the abovementioned diagnostic criteria is appropriate in the local setting or not. The study aims to determine the association of the threshold values set up by the IADPSG to diagnose GDM with adverse pregnancy outcomes among a cohort of Filipino women.@*Methods@#A retrospective analysis of medical files of the women diagnosed with GDM using the IADPSG criteria from January 2013 to March 2016 was done. The results of seventyfive gram oral glucose tolerance test (75-g OGTT) were recorded. The association between each IADPSG threshold values (fasting blood glucose of ≥92 mg/dL, one-hour post glucose load of ≥180 mg/dL, two-hour post glucose load of ≥153 mg/dL) used to define GDM and maternal and perinatal outcomes were determined. @*Results@#One hundred twenty women with GDM were included in the analysis. Each of IADPSG-defined cut-off values was not significantly associated with increased likelihood of having adverse maternal outcomes namely: hypertensive disorders of pregnancy, miscarriage, primary cesarean section, operative vaginal delivery, and maternal death. Similarly, the likelihood of perinatal outcomes namely: macrosomia, perinatal death, prematurity, birth injuries, congenital anomalies, neonatal hypoglycemia, jaundice, low APGAR score, acute respiratory distress syndrome, and infection were not significantly higher even if these cut-off values were met. Of note, high odds ratio was noted for neonatal hypoglycemia at FBS >92 mg/dL and <92 mg/dL and the low Apgar Score in first minute at >153 mg/dL and <153 mg/dL even though they were statistically not significant. @*Conclusion@#We did not find a statistically significant positive association between IADPSG threshold values and specified adverse maternal and perinatal outcomes.

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.

Oral hypoglycaemic agents for diabetes in pregnancy - an appraisal of the current evidence for oral anti-diabetic drug use in pregnancy

<p><b>INTRODUCTION</b>The use of oral hypoglycaemic drugs in pregnancy is not recommended because of reports of foetal anomalies and other adverse outcomes in animal studies and in some human cases. However, recent studies have suggested that some oral hypoglycaemic drugs may be used in pregnancy. This review will examine these studies critically.</p><p><b>METHODS</b>Literature review of articles obtained from a PubMed search of peer-reviewed journals on oral hypoglycaemic drug use in pregnancy.</p><p><b>RESULTS</b>In two prospective studies, one of which was a randomised controlled trial, glibenclamide was as effective and safe as insulin in gestational diabetes. In several studies, metformin did not increase foetal anomalies or malformations when used during pregnancy in women with polycystic ovary syndrome (PCOS). In one prospective study on infants born to mothers who used metformin in pregnancy, follow-up for 18 months showed no adverse effects. In several prospective and retrospective studies on women with PCOS, metformin was shown to prevent early pregnancy loss, decrease insulin resistance, reduce insulin and testosterone levels, and decrease the incidence of gestational diabetes when these women got pregnant while on metformin and continued to take it throughout their pregnancy. In a single small study, acarbose did not cause any adverse effects during pregnancy.</p><p><b>CONCLUSIONS</b>Recent evidence shows promising findings in the safety and efficacy of some oral hypoglycaemic agents in treating pregnant diabetics. However, larger clinical studies will be needed to ensure the safety and efficacy of these drugs in pregnancy.</p>