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Lupine Publishers| A Prevalence Survey of Pediatric Type 2 Diabetes Mellitus Among Patients of Physicians in the Philippines

 Lupine Publishers| A Prevalence Survey of Pediatric Type 2 Diabetes Mellitus Among Patients of Physicians in the Philippines

Lupine Publishers| Journal of Diabetes and Obesity

Abstract

Objective: The primary objective of the study was to determine the prevalence of pediatric type 2 diabetes mellitus among patients of Filipino physicians.

Methods: A cross-sectional survey conducted from January to March 2014 among physician-members of the American Association of Clinical Endocrinologists-Philippine Chapter, Diabetes Philippines, Philippine Society of Endocrinology and Metabolism and Philippine Society of Pediatric Metabolism & Endocrinology.

Results: The prevalence of pediatric type 2 diabetes mellitus among patients of respondents was 0.091% with all patients aged 10 to 18 years old. More than half were symptomatic and most of them were managed by adult endocrinologists and adult diabetologists. 73% of the patients used metformin as their initial drug of choice.

Conclusion: There was a low prevalence of pediatric type 2 diabetes mellitus among patients of Filipino physicians.

Keywords: Prevalence; Pediatric type 2 diabetes

Introduction

The global prevalence of type 2 diabetes among the pediatric age group has significantly increased over the last 10 years which could be attributable to the growing problem of childhood obesity. Culturally, Filipino parents associate ‘fat’ or ‘overweight’ children as being healthier than the children with appropriate for age weight. With the increasing prevalence of type 2 diabetes among the younger adult Filipino population and among the working class of Filipinos, there is a need to look into the prevalence of type 2 diabetes mellitus among the pediatric age group. The Philippine DALY (disability adjusted life years) of diabetes taken from an analysis of Institute for Health Metrics and Evaluation (IHME) for 1990 to 2010 showed an increased of the DALY of more than 200% [1]. This also showed the increasing burden of diabetes. The prevalence rate of type 2 diabetes mellitus among the adult Filipino population is 9.7% and the prevalence rate of impaired glucose tolerance is 12.5%, but what is the prevalence of type 2 diabetes mellitus among the Filipino youth? [2, 3] The primary objective of the study was to determine the prevalence of pediatric type 2 diabetes mellitus among patients of Filipino physicians. The secondary objectives were to determine the medical specialization of the physician-respondents, their practice settings, patient treatment pathway from diagnosis to long term management and the most common treatment regimen given to pediatric type 2 diabetic patients.

Methodology

This is a cross-sectional survey conducted from January to March 2014. A validated survey questionnaire was distributed among physician-members of the American Association of Clinical Endocrinologists-Philippine Chapter, Diabetes Philippines, Philippine Society of Endocrinology and Metabolism and Philippine Society of Pediatric Metabolism & Endocrinology. The survey questionnaire was reviewed for content by a team of Quintiles’ representatives with expertise in clinical study feasibility, pediatric medicine and diabetology. The validation of the questionnaire was done by 3 member-physicians and their replies were not included in the final results. The survey questionnaire contained closedended questions to allow quantitative and qualitative results. The questions required “yes” or “no” type responses and number value responses.
The sample size was calculated at 95% level of confidence and the maximum tolerable error for the prevalence estimate was 0.05 and using the overall prevalence rate from the SEARCH for Diabetes in Youth Study Group which was 0.22 cases per 1000 youth [4]. Respondent driven sampling (RDS) was then utilized to obtain the prevalence of pediatric type 2 diabetes mellitus among patients of Filipino physicians [5]. It was estimated that the survey should obtain at least 95 physician-respondents (representing 20% of the physician-members of the diabetes-physician organizations) to obtain the sample size of 34 pediatric type 2 diabetes patients. A total of 120 English language survey questionnaires were distributed either through email or through mail. In March 2014, the responses from the completed survey forms were entered into Survey Methods, a web-based central repository [6]. Appropriate follow-ups were conducted to encourage the return of completed surveys. Data analysis was performed in April 2014 using Survey Methods.

Results

There were 106 (88.3%) completed questionnaires received from the physician-members of the American Association of Clinical Endocrinologists-Philippine Chapter, Diabetes Philippines, Philippine Society of Endocrinology and Metabolism and Philippine Pediatric Society of Endocrinology and Metabolism. The field of specialization and the clinical practice setting of the respondents were Captured. The 106 respondents were seeing a total of 395,208 patients and about 71% (281,398) were type 2 diabetic patients. About 64% (61) of them had patients with pediatric type 2 diabetic patients (under 18-year old). The prevalence of pediatric type 2 diabetes mellitus among patients of respondents was 0.091%. The physician who initially diagnosed the patient as pediatric type 2 diabetic is the physician who would manage the condition of the patient. There were only 4 (6.55%) respondents out of 61 respondents who would refer the pediatric type 2 DM patient to another specialist. These 4 respondents had their practice setting in a general hospital – private (tertiary hospital) and there was an available pediatric endocrinologist in their setting.

Discussion

Pediatric type 2 diabetes mellitus is defined as children and adolescents with type 2 diabetes mellitus and less than 18 years of age [7]. There are 442 physician members of the different diabetesphysician organizations in the Philippines. Of the 442 memberphysicians, the study obtained completed surveys from 24% of the member-physicians including 11 responses from the 17 members of the Philippine Society of Pediatric Metabolism & Endocrinology. The prevalence of pediatric type 2 diabetes mellitus among Filipino patients of physician-respondents was 0.091% or 0.91 per 1000 patients of the physician-respondents. This is a higher prevalence rate compared to the total prevalence rate in SEARCH study which was 0.22 per 1000. The SEARCH study also published a prevalence of 0.52 per 1000 youth aged 10 to 19 years with type 2 diabetes mellitus [4]. The SEARCH study was a community-based study conducted in the Unites States to describe the clinical characteristics, incidence, and prevalence of diabetes among Asian, Pacific Islander, and mixed Asian–Pacific Islander youth. The Philippines prevalence rate was also higher than the data obtained from the First UK survey of pediatric type 2 diabetes and MODY, a cross-sectional postal questionnaire survey of all consultants involved in the care of children with diabetes in the United Kingdom [8]. The crude minimum prevalence of type 2 diabetes under 16 years in the UK was 0.21 per 100,000.

This study is not a community-based survey and hence might have underestimated the prevalence of pediatric type 2 diabetes mellitus. The study only looked at the patient population of physicians who were managing type 2 diabetes mellitus and determined the prevalence of pediatric patients with a diagnosis of type 2 DM. In the Philippines, most pediatric type 2 diabetes patients were managed by adult endocrinologists and adult diabetologists. Only a few were managed by pediatric endocrinologists. There are few pediatric endocrinologists in the Philippines and most of them practice in large tertiary hospitals in urban areas. This explains why most of the pediatric type 2 diabetics were managed by the adult endocrinologists and diabetologists. The age distribution of Filipino pediatric type 2 diabetes was the same as most of the available studies from US and Asia. All the patients were 10 years old to less than 18 years old with more patients seen among the > 15 to < 18 years old age group (65.74%) than with > 10 to < 15 years old (34.26%). In the study, First UK survey of pediatric type 2 diabetes and MODY, the median age of pediatric type 2 DM in UK was 12.8 (3.7–15.9) [9]. Pediatric type 2 diabetes usually present among overweight adolescent patients with family history of type 2 DM. More than half of patients seen were symptomatic with polyuria, polydipsia and polyphagia while the other half were asymptomatic and blood sugar screening was done because of family history of type 2 diabetes and/or the patient was obese.

Most of the respondent physicians prescribed metformin as the first line of treatment as well as maintenance therapy for pediatric type 2 diabetes patients. In the Philippines, only Metformin and Insulin have been approved as pharmacologic therapies for pediatric type 2 diabetes. In the clinical practice guidelines for pediatric type 2 diabetes, the American Academy of Pediatrics has recommended clinicians must ensure that insulin therapy is initiated for children and adolescents with T2DM who are ketotic or in diabetic ketoacidosis and in whom the distinction between T1DM and T2DM is unclear and for these patients, insulin therapy should be initiated [10]. The clinical practice guidelines also state that in all other instances, clinicians should initiate a lifestyle modification program, including nutrition and physical activity, and start metformin as first-line therapy for children and adolescents at the time of diagnosis of T2DM

Conclusion

There is an alarming increase in the prevalence of Type 2 Diabetes in the Philippines [11]. Our study shows that the prevalence of Filipino pediatric type 2 diabetes mellitus among patients of Filipino physicians is low.

Acknowledgement

The authors wished to thank Adeline Sng and Jessica Lee for their assistance for data encoding. This paper was presented in part at the Annual meeting of the American Association of Clinical Endocrinologists (AACE) Annual Meeting in Nashville, Tennessee, May 2015. This research is partially funded by the AACE Philippines Research Advocacy.

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Lupine Publishers| Carbohydrates for Diabetes?

 Lupine Publishers| Carbohydrates for Diabetes?

Lupine Publishers| Journal of Diabetes and Obesity

Opinion

Would you like a piece of bakes potatoes? NOOOO, I am Diabetic. An answer that we usually face with people with Diabetes Type Two. And mostly whenever we ask them who told you that you are not allowed to eat carbohydrates, the answer is our Endocrinologist! As Clinical Dietitian, I am facing this case on daily basis average. Now, let me tell you that this is not the way. Diabetes type two diets should contain 45-50% of Carbohydrates Does this mean that 50% of my food can be from chocolates and candies? Neither this is the case. Another question to be added: Does this diet help with Obesity? The answer is YES! There are a lot of weight loss diets that are rounding in the field these days. As per my experience, the Diabetes Diet is the only diet that help in weight loss and in the same time to be continued as a healthy lifestyle. (NOTE: in case no other health complications and other Therapeutic diets to be followed).

For a 2000 kcal daily intake, this balanced diet consists of

a) Carbohydrates (45-50%): an average of 8 servings of Carbohydrates per day coming from whole grains, 4 servings of fruits ,6 servings of vegetables and 2 servings of low-fat milk. These foods are good source of vitamins, minerals, dietary fibers and energy.
b) Proteins (10- 20%): an average of 8 servings of Meat of which 80% coming from Lean protein like cottage cheese, skinless chicken) and plant-based sources like legumes (noting that legumes have carbohydrates along with proteins to be counted and managed).
c) Fats (25-35% ): these fats on average of 5 servings where trans-fat (like margarines and spreadable ) should be eliminated and saturated fats to be less than 7% (like chicken skin) and the best sources to come from raw olive oil , nuts and fish to be taken three times per week to get the needed Omega
d) Alcohol: one to two drinks per day, 15 to 30 g of alcohol are associated with decreased risk of coronary heart disease. However, these to be considered an addition to the regular food and manage Carbohydrates servings instead.
So, having Breakfast, Lunch, Dinner and two snacks between the three meals will help to keep a balanced diet and full throughout the day with adequate amounts of liquids to stay hydrated. Now, how can I manage Obesity with this diet? Starting with the Total Energy Expenditure, we start by reducing the Energy Intake by 500 kcal per day. As a result, losing 2.2 pounds per week or 9 pounds per month as an average. Although usually as start of this diet and changing the lifestyle into healthier one and quitting bad habits, we see more weight loss in less time. Along with time, and when weight loss takes place, the Energy Expenditure of the body decreases. And the body gets accustomed to the amount of Energy Intake. In this case, we continue the Energy Intake reduction, so the weight loss continues! Adding physical activity is a big benefit that will help in weight loss and later body weight maintenance. When Diabetes type two can be managed by Diet, why to suffer from its short- or long-term complications? Why to take medications and suffer their side effects when you can manage it by healthy lifestyle! Stay Healthy and Happier.

NOTE: Diet is always customized as per every person’s case.

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