Direct medical costs of type 2 diabetes mellitus in the Philippines: findings from two hospital databases and physician surveys.

OBJECTIVE: To estimate the annual direct medical cost of type 2 diabetes mellitus (T2DM) in hospitals and outpatient care clinics from a healthcare payer perspective in the Philippines. DESIGN AND PARTICIPANTS: (1) A review of electronic hospital records of people with T2DM in two tertiary hospitals-Ospital ng Makati (OsMak) and National Kidney and Transplant Institute (NKTI) and (2) a cross-sectional survey with 50 physicians providing outpatient care for people with T2DM. SETTING: Primary, secondary and tertiary healthcare facilities in Metro Manila. OUTCOME MEASURES: Cost of managing T2DM and its related complications in US dollars (USD) in 2016. RESULTS: A total of 1023 and 1378 people were identified in OsMak and NKTI, with a complication rate of 66% and 74%, respectively. In both institutions, the average annual cost per person was higher if individuals were diagnosed with any complication (NKTI: US$3226 vs US$2242 and OsMak: US$621 vs US$127). Poor diabetes control was estimated to incur higher per person cost than good control in both public outpatient care (poor control, range: US$727 to US$2463 vs good control, range: US$614 to US$1520) and private outpatient care (poor control, range: US$848 to US$2507 vs good control, range: US$807 to US$1603). CONCLUSION: The results highlight the high direct medical cost resulting from poor diabetes control and the opportunity for cost reduction by improving control and preventing its complications.

Estimating direct medical costs of type 2 diabetes mellitus in the Philippines: a protocol.

INTRODUCTION: Diabetes and its complications are a major cause of morbidity and mortality in the Philippines. The prevalence of diabetes in the Philippines has increased from 3.4 million in 2010 to 3.7 million in 2017. The government has formulated strategies to control this increase, for example, through its non-communicable disease prevention and control plan. However, there is scarce research on the financial burden of diabetes. Filling this gap may further help policymakers to make informed decisions while developing and implementing resource planning for relevant interventions. The primary objective of the current study is to estimate the direct medical costs associated with type 2 diabetes mellitus (T2DM). METHODS AND ANALYSIS: This is a 1-year retrospective cohort study of patients with T2DM in 2016. Data will be collected from: (1) hospital databases from public institutions to estimate the cost of diabetes treatment and (2) physician interviews to estimate the cost of management of diabetes in outpatient care. We will perform descriptive and comparative analyses on direct medical costs and healthcare resource utilisation, stratified by the presence of diabetes-associated complications. ETHICS AND DISSEMINATION: Research ethics board approval has been obtained from the Department of Health Single Joint Research Ethics Board and Cardinal Santos Medical Center Research Ethics Review Committee. Findings from the study will be reported in peer-reviewed scientific journals and local researcher meetings.

"Overgrowth: Missing a Tumor" Acromegaly without Imaging Evidence of Pituitary Adenoma and No Ectopic Source: A Case Report.

Growth hormone - secreting pituitary adenomas are the cause of acromegaly in 95% of patients. In rare circumstances, a pituitary adenoma on magnetic resonance imaging cannot be found; hence, a search for an ectopic source of GH production is done. Even rarer is an acromegalic patient without an ectopic source and without imaging evidence of pituitary adenoma. We report a case of acromegaly with no evidence of a pituitary adenoma and no evidence of an ectopic source after imaging studies; who underwent medical therapy with improving biochemical and clinical parameters.

Safety and effectiveness of insulin detemir in type 2 diabetes: results from the ASEAN cohort of the A1chieve study.

AIM: To determine the safety and effectiveness of insulin detemir (IDet) in type 2 diabetes patients from the ASEAN cohort of the A1chieve study. METHODS: Patients from Indonesia, Malaysia, Philippines and Singapore prescribed IDet at the discretion of their physicians were included. The primary outcome was the incidence of serious adverse drug reactions including major hypoglycaemia over 24 weeks. Secondary endpoints included changes in the frequency of hypoglycaemia, serious adverse events and effectiveness assessments. RESULTS: This sub-analysis included 1540 patients (insulin-naive, 1239; insulin-experienced, 301) with mean age ± SD 56.4 ± 10.9 years, BMI 25.4 ± 4.6 kg/m(2) and diabetes duration 6.9 ± 5.3 years. Insulin-naive patients received a baseline IDet dose of 0.24 ± 0.11 U/kg titrated up to 0.37 ± 0.21 U/kg by Week 24. The pre-study insulin dose in insulin-experienced patients was 0.41 ± 0.25 U/kg and baseline IDet dose was 0.31 ± 0.24 U/kg titrated up to 0.40 ± 0.20 U/kg by Week 24. Overall hypoglycaemia decreased from 1.73 to 0.46 events/patient-year from baseline to Week 24 (change in proportion of patients affected, p < 0.0001). At Week 24, 1 major hypoglycaemic event was reported in 1 insulin-experienced patient. IDet significantly improved glucose control (p < 0.001) at Week 24. The lipid profile and systolic blood pressure improved (p < 0.001) and body weight did not change significantly. Quality of life was positively impacted (p < 0.001). CONCLUSION: IDet was well-tolerated and improved glycaemic control without increasing the risk of hypoglycaemia or weight gain.

Adiponectin levels and its association with hyperglycaemia in adult Filipino participants in the 2003--04 National Nutrition and Health Survey.

Our objective was to determine the association of serum adiponectin levels with the presence of IFG or DM in Filipinos. This case control study used sera of adult participants in the Philippines' NNHeS: 2003-04. Subjects were divided into: normoglycaemic control, impaired fasting glucose, and type 2 diabetes mellitus. Seventy-seven prediabetic and 83 diabetic subjects were included in the prediabetic and diabetic groups, respectively. There was no significant difference in adiponectin values between control and prediabetic subjects. Diabetic subjects had significantly lower mean serum adiponectin levels (10.7 versus 14.2 microg/ml, p=0.0198) compared with age- and BMI-matched control subjects. Diabetic subjects were found most frequently (43.53%) in the lowest tertile (1.6-7.2 microg/ml) and least frequently (20%) in the highest tertile (14-84 microg/ml) of adiponectin values. We conclude that Filipinos with diabetes mellitus had significantly lower adiponectin levels compared with normoglycaemic subjects.