Screening for diabetes mellitus among asymptomatic overseas Filipino workers

ABSTRACT

BACKGROUND: Diabetes mellitus is becoming prevalent in developing countries like the Philippines. Mass screening is not recommended and is not cost effective. Targeted screening is a more practical way to detect people with disease.Overseas employment is one of the most common occupations in the country. Primary medical examination is done in pre-employment clinics with routine panel of diagnostics, urinalysis included. Fasting blood sugar(FBS) and oral glucose tolerance test (OGTT) are not part of the panel of pre-employment medical examination for overseas Filipino workers (OFW). They are mostly done when they are referred to endocrinology or diabetes clinics when suspicion arises or glucosuria is noted on urinalysis. However, there are patients who consulted endocrinology clinics but deny any symptoms of diabetes.                                                                                                                                                                 OBJECTIVE: The objective of this study is to determine the prevalence of diabetes among OFW by employing FBS and OGTT among those who had urinalysis and referred to endocrinology clinic.RESULTS: Among the 192 OFWs with glucosuria, doing FBS detected 21 percent, 51 percent and 28 percent with diabetes mellitus (DM), impaired fasting glucose (IFG) and normal fasting glucose respectively. By doing OGTT among the OFW with normal FBS, 46 percent were reclassified as diabetic or have impaired glucose tolerance (IGT). OGTT among those with IFG also detected 71 percent with diabetes or IGT. Overall the patients with glucosuria have a DM prevalence that is more than ten times that of the general population done by the National Nutrition and Health Survey in 2003.Among the 149 OFWs without glucosuria, FBS detected 36 percent, 54 percent, and 10 percent with DM, IFG and normal fasting sugar respectively. OGTT among those with normal FBS detected 67 percent of them to have diabetes or prediabetes. Doing the same among those with IFG reclassified 60 percent to have DM or IGT. Similarly the prevalence of DM is about ten times of the national survey.CONCLUSION: Among OFW with or without glucosuria referred for suspicion of diabetes FBS confirmed many to have diabetes and pre-diabetes. This prevalence is doubled by employing OGTT as part of the screening test.