Diabetes and Pre-employment Clearance

Last November 10, the Maritime Association of Doctors and Clinics (MARDOCS) invited me to talk on diabetes and obesity. MARDOCS had their first convention which gathered manning agencies doctors, nurses and staff of pre-employment clinics at the Hyatt Manila.

Diabetes and obesity are important concerns for the seafaring industry as these conditions continue to increase in the workforce. Endocrinologists like myself often receive referrals to evaluate seafarers who are diagnosed diabetic, or who for the first time have been found to have glucosuria, or elevated fasting blood sugar / HbA1c. Are you aware of Administrative Order No. 2007-025 from the Department of Health which discusses the “Revised Guidelines for Conducting Medical Fitness Examinations for Seafarers”?

DOH AO 2007-025 defines “Fit for Sea Duty” as a seafarer who is “able to perform safely the duties of his position aboard a ship in the absence of medical care, without danger to his health or to the safety of the vessel, crew and passengers.” Fasting blood glucose is NOT required for new applicants and serving seafarers less than 40 years old though a routine urinalysis is.  Glucosuria on urinalysis often triggers measurement of fasting blood glucose though, in most of the referrals I receive. Lab work-up for seafarers 40 and above include fasting blood glucose, creatinine, uric acid, total cholesterol, triglyceride and ECG.

Under this guideline, the following endocrine conditions require further investigation and complete assessment:

  • Acromegaly
  • Adrenal insufficiency, uncontrolled
  • Uncontrolled type 2 diabetes mellitus
  • Diabetes mellitus requiring insulin
  • Hyperthyroidism, diffuse toxic goiter, toxic nodular goiter, thyrotoxicosis, thyroiditis
  • Obesity, incapacitating or body mass index of 34 and above with or without co-morbid pre-existing conditions
  • Osteoporosis
  • Pheochromocytoma

In my presentation, I defined diabetes, impaired fasting glucose, impaired glucose tolerance and prediabetes. I enumerated the risk factors for diabetes and who should be screened. I also talked about the use of HbA1c in diagnosing diabetes, in addition to fasting blood glucose and the glucose tolerance test. I’m often “rushed” to give endocrine clearance for seafarers with elevated blood sugars, so I also had a slide explaining when we can reasonably expect glucose to go down when an oral hypoglycemic agent is started. More importantly, I shared with them the current glycemic targets recommended by the American Diabetes Association. Finally, I defined obesity and compared the BMI cut-offs according to the WHO and the Asia Pacific classification.

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