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%.

Effect of malunggay (Moringa oleifera) capsules on lipid and glucose levels

OBJECTIVES: To determine the effect of malunggay leaf capsules on LDL (primary efficacy outcome measure); weight, BMI, FBS, serum glucose 2 hours after a 75 g oral glucose load, cholesterol, HDL and triglycerides (secondary efficacy outcome measures); creatinine, ALT and CBC (secondary safety outcome measures); and to determine if these are associated with adverse events. STUDY DESIGN: randomized controlled trial PARTICIPANTS: Seventy nine Filipinos, 18-55 years old with LDL>2.6 mmol/L (100 mg/dL) but of low cardiovascular risk were randomized into malunggay and placebo groups. INTERVENTION: Malunggay capsules for 30 days versus placebo RESULTS: 33 and 35 participants in the malunggay and placebo groups, respectively, completed the treatment. There was a reduction of 13.76 mg/dL in the LDL of the malunggay group, compared to a 19.28 mg/dL reduction in the placebo group (p=0.564). CONCLUSION: Malunggay leaf capsules given for 30 days among adults with serum LDL >2.6 mmol/L (100 mg/dL) but with low cardiovascular risk decreased LDL levels to the same degree as placebo. There were no significant differences in the change in the secondary efficacy and safety outcome measures, and in the occurence of adverse events.

Prevalence of thyroid dysfunction among asymptomatic elderly Filipinos at the Philippine General Hospital / Journal of the ASEAN Federation of Endocrine Societies

The elderly are a peculiar group in terms of health management, as they often present with non-specific complaints which are challenging to interpret and may not present with the usual clinical picture of a disease. Objective. The study aims to determine the prevalence of thyroid dysfunction among asymptomatic, elderly Filipinos seen at the Philippine General Hospital (PGH). Methodology. Subjects aged 60 years and older seeking out-patient medical consult for non-thyroidal illness at the PGH were recruited. Patients with known thyroid or pituitary disease, previous thyroid or pituitary surgery, intake of medications known to affect thyroid hormone levels and critical illness were excluded. Fasting blood sugar (FBS), lipid profile, free thyroxine (FT4), thyroid-stimulating hormone (TSH), and anti-thyroperoxidase (anti-TPO) levels were taken. Based on FT4 and TSH levels, subjects were classified as overt hypothyroid, subclinical hypothyroid, euthyroid, subclinical hyperthyroid, or overt hyperthyroid. Results. One hundred eighty subjects were recruited, of whom 152 (84%) were female. Hypertension was the most common comorbidity (58.33%), followed by diabetes (36.67%). One hundred sixty-two (90%) were euthyroid, 12 (6.7%) subclinical hypothyroid, 4 (2.22%) subclinical hyperthyroid, and two (1.11%) overtly hyperthyroid. No one was overtly hypothyroid. There was a trend toward increasing prevalence of diabetes, hypertension, low HDL, obesity and overall cardiovascular risk among those with subclinical hypothyroidism. Conclusion. Subclinical hypothyroidism was the most prevalent thyroid dysfunction among asymptomatic elderly included in the study.

Prevalence of undiagnosed autoimmune thyroid disease and thyroid dysfunction in Filipino patients with autoimmune rheumatic disorders / Journal of the ASEAN Federation of Endocrine Societies

OBJECTIVES:(1) To determine the prevalence of autoimmune thyroid disease among patients with autoimmune rheumatic disorders seen at the Philippine General Hospital. (2) To determine clinical features that are associated with the occurrence of autoimmune thyroid disease in these patient.METHODOLOGY:This is a cross sectional analytical study that included 155 adult Filipinos diagnosed with an autoimmune rheumatic disorder. Clinical characteristics were recorded. Serum thyrotropin, thyroxine, triiodothyronine, anti-thyroid peroxidase antibody, anti-thyroglobulin antibody and urinary iodide excretion were determined. The prevalence of autoimmune thyroid disease was computed. Associations between clinical factors and autoimmune thyroid disease were determined.RESULTS:Overall 21.94% of the population had autoimmune thyroid disease. There was significant association between duration of the autoimmune rheumatic disorder and autoimmune thyroid disease (p-= 0.018). No significant association was noted with the other clinical factors although there was an almost significant association observed for the presence of goiter (p=0.054).CONCLUSION:Autoimmune thyroid disease commonly occurs in patients with autoimmune rheumatic disorders. As such, it is important to consider screening these patients for the coexistence of thyroid disease to help prevent the complications associated with thyroid dysfunction and avoid adding up to the morbidity of the existing autoimmune rheumatic disorder.

The Philippine thyroid diseases study (PhilTiDeS): Prevalence of thyroid disorders among adults in the Philippines / Journal of the ASEAN Federation of Endocrine Societies

BACKGROUND:The national prevalence of goiters in the Philippines was 3.7% in 1987 and 6.7% in 1993. Since then, there has been no follow-up survey on goiter prevalence, nor has there been any national survey on the prevalence of abnormal thyroid dysfunction. The PhilTiDeS is a survey on the prevalence of both goiters and thyroid disorders in the Philippines.OBJECTIVES:To determine the prevalence of various categories of abnormal thyroid dysfunction among the Filipino non-pregnant adult population and to describe the prevalence of thyroid enlargement in the Philippines in relation to thyroid dysfunction status.MATERIALS AND METHODS:The PhilTiDes was a substudy of the 2008 National Nutrition and Health Survey (NNHeS), which covered all 17 regions and 80 provinces of the Philippines. It included all Filipino adults 20 years and older, who are non-pregnant and non-lactating. A standard questionnaire was used to collect data on previous diagnosis and current treatment for thyroid disorders, and neck examination by trained field personnel was done to assess the presence of goiter. Blood was extracted, processed and sent to an accredited laboratory for free T4 and TSH testing using micro-particle enzyme immunoassay.RESULTS: A total of 4897 persons had thyroid function tests. Of these, 417 (8.53%) had thyroid function abnormalities with the most common abnormality being subclinical hyperthyroidism occurring in 5.33%. The other categories had the following prevalence: true hyperthyroidism 0.61% ; true hypothyroidism 0.41%; and subclinical hypothyroidism 2.18%. Majority of the population 4480 (91.47%) had normal thyroid function tests. Of those with subclinical hyperthyroidism, 55% are females with mean age of 48 years (95% CI 45.9-50.1 years) compared with the volunteers with normal thyroid function who were younger (mean age of 43.1, 95% CI 42.5-43.6 years). Out of the 7,227 volunteers who responded to the survey and clinical examination, a total of 674 (8.9%) had goiters. Out of the 674 subjects with goiters, 379 had diffuse enlargement (56%) while the rest had nodular goiter (44%). Among the sub-population (n= 4897) who underwent thyroid function testing, 9% of those with normal thyroid function tests have goiters.CONCLUSION: The prevalence of thyroid function abnormalities in the Philippines is 8.53% with the greatest proportion of volunteers having subclinical thyroid disease. There is a low prevalence of both true or overt hyperthyroidism and hypothyroidism. In the larger survey, it was found that 8.9% of volunteers who were examined had goiters. The etiology of these goiters will need to be ascertained in future studies.

A meta-analysis on the effect of chromium picolinate on glucose and lipid profiles among patients with type 2 diabetes mellitus

BACKGROUND: The role of chromium in human nutrition was first reported in 1977 on a patient on total parenteral nutrition manifesting with neuropathy and impaired glucose tolerance attributed to chromium deficiency. After correction, nerve conduction and glucose tolerance tests normalized. Chromium is postulated to act as a cofactor for insulin action by enhancing insulin receptor phosphorylation and stimulating insulin receptor tyrosine kinase.OBJECTIVE: To compare the effect of chromium picolinate versus placebo on glycated hemoglobin (HbA1C), fasting blood sugar (FBS), 2-hours postprandial blood sugar (2HPPBS), fasting insulin (FI) and lipid profile among T2DM patients.METHODS: Literature search in Medicine, Cochrane and Herdin was made using terms such as chromium, chromium picolinate intake of >= 3 months among T2DM patients. Two reviewers independently screened abstracts and full articles. Results were plotted using Revman 4.2.RESULTS: Thirty four trials were found and six trials were included in the meta-analysis. The pooled data for 467 patients with T2DM reported lowering of HbA1c -0.34% (CI -0.45, 0.24 p0.06); FBS -16.6 mg/dl (CI -18.9, -14.41 p 0.30); 2HPPBS -17.33 mg/dL (CI -20.21, -18..81 p CONCLUSION: Chromium picolinate lowers HbA1c, FBS, 2HPPBS and FI moderately but it has no effect on lipids, However, the short duration of studies, variable quality and large heterogeneity across these data limits the strength of our conclusion, hence further studies are recommended.

Pituitary abscess manifesting with amenorrhea: A case report and review of literature

OBJECTIVE: To discuss a case of pituitary abscess presenting with amenorrhea and diabetes insipidus, and to enumerate the differential diagnosis for this conditionSIGNIFICANCE: By presenting this case, the author aims to increase awareness regarding the possibility of infectious causes of pituitary masses, thereby prompting early recognition and treatment of similar casesCASE REPORT: This is the case of a 42-year old woman admitted due to severe generalized headache, amenorrhea and polyuria of three months duration, preceded by a one-month history of remittent fever. Physical examination was normal except for bitemporal hemianopsiaLABORATORY TEST RESULTS: On admission, she had mild anemia, hypernatremia with elevated serum osmolality, and failure to concentrate urine. Hormonal examinations showed normal thyroxine and growth hormone levels, low basal serum cortisol, and elevated prolactin levels. Cranial CT scan showed widening of the sella turcica with a homogenous, isodense, slightly enhancing focus in the sellar and suprasellar area.COURSE: Initial considerations were chiasmatic glioma versus a pituitary adenoma. Transphenoidal surgery was done and intraoperatively, purulent fluid was noted. Aspirate gram stain showed 1-2 white blood cells per high power field but with no growth on culture. Subsequently, vision was fully restored but prolactin levels continued to be slightly elevated. Basal cortisol and urine specific gravity were persistently low. Repeat CT scan showed disappearance of the pituitary mass. Six months after the operation, the patient was able to go back to work but continues to take steroids and carbamazepine for the diabetes insipidus.REVIEW OF LITERATURE: There are about 100 cases of pituitary abscess in literature mimicking pituitary adenoma and presenting with headaches, amenorrhea, visual field cuts, hypopituitarism, fever and meningitis. As in this case, the abscess is frequently sterile. Pituitary abscess should be considered in patients with a primary diagnosis of pituitary adenoma with accompanying signs and symptoms suggestive of an infection. (Author)