1.Prevalence and risk factors of gestational diabetes mellitus at the University of Santo Tomas Hospital.
Lim-Uy Stefanie W. ; Andag-Silva Aimee A. ; Cunanan Elaine C.
Philippine Journal of Internal Medicine 2010;48(1):24-31
BACKGROUND: Gestational diabetes mellitus (GDM) has been as sociated with adverse maternal and fetal outcomes that extend beyond the postpartum period. Knowledge of its prevalence and risk factors can lead to possible preventive strategies.
OBJECTIVE: To determine the prevalence and risk factors for GDM at the University of Santo Tomas Hospital-Clinical Division (USTH-CD).
METHODS: A cross-sectional study was performed between January to December 2009 at the USTH-CD. Simple and multivariate logistic regressions were used to estimate the odds ratios with 95% confidence intervals, and to control for confounding variables.
RESULTS: We reported the prevalence of GDM at USTH-CD to be 7.5%. The risk for GDM was significantly associated with increasing BMI (OR 1.54; 95% CI 1.06, 2.24), family history of diabetes (OR 6.27; 95% CI 2.63, 14.96) and hormonal contraceptive use (OR 8.48; 1.55, 46.52). Mothers with GDM were also at increased risk of delivering via cesarean section (OR 2.76; 95% CI 1.13, 6.72). The 1-minute APGAR score of infants born to mothers with GDM were also lower (OR 0.31; 95% CI 0.12, 0.83).
CONCLUSION: Higher BMI, family history of diabetes and hormonal contraceptive use were strongly associated with GDM. Presence of GDM increases the risk of having cesarean deliveries and a poor fetal 1-minute APGAR score. The presence of these findings may be helpful in identifying those at risk for GDM who might benefit from heightened surveillance during pregnancy.
Human ; Male ; Female ; Middle Aged ; Adult ; Cesarean Section ; Contraceptive Agents ; Diabetes, Gestational ; Infant, Newborn ; Mothers ; Parturition ; Postpartum Period ; Prevalence ; Risk Factors
2.Prevalence of Hyponatremia in Hypothyroid Patients during Radioactive ¹³¹I Ablation for Differentiated Thyroid Cancer: Single Institution Experience.
Juan Carlo P DAYRIT ; Elaine C CUNANAN ; Sjoberg A KHO
Endocrinology and Metabolism 2016;31(3):410-415
BACKGROUND: Hyponatremia developing in hypothyroid patients has been encountered in clinical practice; however, its prevalence has not been well established. METHODS: Thirty patients diagnosed with differentiated thyroid cancer, rendered hypothyroid after surgery and levothyroxine withdrawal, and who are for radioactive iodine (RAI) ablation were included. Serum sodium concentrations were measured twice, at the time of admission for RAI ablation, and before discharge after increased oral fluid intake. The outcome measures were to determine the prevalence of hyponatremia among hypothyroid patients prior to RAI ablation and after oral hydration post-RAI, and to correlate the serum sodium levels pre-RAI and post-RAI with thyroid-stimulating hormone (TSH) concentration and age. RESULTS: Thirty patients were included, with ages from 23 to 65 years old (median, 40). Two patients (6.7%) were hyponatremic prior to RAI ablation, and eight patients (26.7%) had mild hyponatremia (130 to 134 mEq/L) after RAI and hydration. There was no significant correlation between TSH levels and serum sodium levels prior to or after RAI. There was also no significant correlation between pre- and post-RAI sodium concentration and age. CONCLUSIONS: The prevalence of hyponatremia pre-RAI was 6.7%, and 26.7% post-RAI. No significant correlation was noted between TSH concentration and age on pre- or post-RAI sodium concentrations. Routine measurement of serum sodium post-RAI/isolation is still not advised. Measurement of sodium post-RAI may be considered in patients who are elderly, with comorbid conditions or on medications.
Aged
;
Humans
;
Hyponatremia*
;
Hypothyroidism
;
Iodine
;
Outcome Assessment (Health Care)
;
Prevalence*
;
Sodium
;
Thyroid Gland*
;
Thyroid Neoplasms*
;
Thyrotropin
;
Thyroxine
3.Oral hypoglycaemic agents for diabetes in pregnancy - an appraisal of the current evidence for oral anti-diabetic drug use in pregnancy.
Francis L W HO ; Choon Fong LIEW ; Elaine C CUNANAN ; Kok Onn LEE
Annals of the Academy of Medicine, Singapore 2007;36(8):672-678
INTRODUCTIONThe use of oral hypoglycaemic drugs in pregnancy is not recommended because of reports of foetal anomalies and other adverse outcomes in animal studies and in some human cases. However, recent studies have suggested that some oral hypoglycaemic drugs may be used in pregnancy. This review will examine these studies critically.
METHODSLiterature review of articles obtained from a PubMed search of peer-reviewed journals on oral hypoglycaemic drug use in pregnancy.
RESULTSIn two prospective studies, one of which was a randomised controlled trial, glibenclamide was as effective and safe as insulin in gestational diabetes. In several studies, metformin did not increase foetal anomalies or malformations when used during pregnancy in women with polycystic ovary syndrome (PCOS). In one prospective study on infants born to mothers who used metformin in pregnancy, follow-up for 18 months showed no adverse effects. In several prospective and retrospective studies on women with PCOS, metformin was shown to prevent early pregnancy loss, decrease insulin resistance, reduce insulin and testosterone levels, and decrease the incidence of gestational diabetes when these women got pregnant while on metformin and continued to take it throughout their pregnancy. In a single small study, acarbose did not cause any adverse effects during pregnancy.
CONCLUSIONSRecent evidence shows promising findings in the safety and efficacy of some oral hypoglycaemic agents in treating pregnant diabetics. However, larger clinical studies will be needed to ensure the safety and efficacy of these drugs in pregnancy.
Administration, Oral ; Contraindications ; Evidence-Based Medicine ; Female ; Humans ; Hypoglycemic Agents ; administration & dosage ; therapeutic use ; Pregnancy ; Pregnancy in Diabetics ; drug therapy ; Safety Management ; Singapore
4.A randomized double-blind comparison of fixed versus calculated radioiodine dose in the treatment of Graves' hyperthyroidism.
Miranda-Padua Maria Louella ; Cunanan Elaine C. ; Kho Sjoberg A. ; Marcelo Millicent ; Torres Juan F. ; Monzon Orestes P. ; San Luis Teofilo ; Milo Mario ; Mercado-Asis Leilani B.
Philippine Journal of Internal Medicine 2014;52(3):1-7
INTRODUCTION:Radioactive iodine(I131) therapy is an established definitive treatment for Graves' hyperthyroidism.However,the optimal method of determining the radioiodine treatment dose remains controversial.
OBJECTIVE: To compare the efficacy of fixed dose versus calculated dose regimen in the treatment of Graves' hyperthyroidism among Filipinos
METHODOLOGY: Diagnosed Graves' disease patients underwent thyroid ultrasound to estimate thyroid size. Patients were randomized to either fixed or calculated dose of radioiodine treatment. For fixed dose group,the WHO goiter grading was utilized: Grade 0 (5mCi), Grade 1 (7mCi), Grade2 (10mCi), Grade 3 (15mCi). For calculated dose group the following formula was used:
Dose(mCi)= 160uCi/g thyroid x thyroid gland weight in grams x 100 / 24-hour RAIU(%)
Thyroid function test (TSH,FT4) was monitored every three months for one year.
RESULTS: Of the 60 patients enrolled, 45 (fixed dose; n= 27, calculated dose; n= 18) completed the six months follow-up study. Analysis was done by application of the intention-to-treat principle. The percentage failure rate at third month in the fixed vs. calculated dose group was: 26 v. 28% with a relative risk (RR) value of 0.93. At six months post-therapy, there was a noted reduction in the failure rates for both study groups (11 vs. 22%, respectively), with a further reduction in the relative risk value (0.67), favoring the fixed dose group.
CONCLUSION: Fixed dose radioiodine therapy for Graves' disease is observed to have a lower risk of treatment failure (persistent hyperthyroidism) at three and six months post-therapy compared to the calculated dose.
Human ; Male ; Female ; Middle Aged ; Adult ; Iodine Radioisotopes ; Iodine ; Intention To Treat Analysis ; Graves Disease ; Hyperthyroidism ; Goiter ; Thyroid Function Tests ; Treatment Failure
5.The difference in risk factors between adults With early-onset (<40 Years Old) versus late-onset (≥40 Years Old) type 2 Diabetes in a University Hospital From January 2015-December 2017
Marilyn Katrina C. CARO ; Elaine C. CUNANAN
Journal of Medicine University of Santo Tomas 2022;6(2):1009-1017
Background:
Diabetes will remain a threat to global health. No longer just a disorder of mature age, there is now a well-recognized trend towards the young. Early diagnosis leads to early intervention and prevention of complications in this susceptible but vital portion of the population.
Objective:
To compare the risk factors predisposing adults to early-onset (<40 years old) versus late-onset (≥40 years old) type 2 diabetes at the University of Santo Tomas Hospital from January 2015-December 2017.
Methods:
This is a retrospective review of medical records. All adult patients who fulfilled the inclusion criteria from January 2015 to December 2017 were included in the study. Data from charts were reviewed and analyzed.
Results:
The early-onset group had a mean age of 34 years, while the late-onset group had a mean age of 51 years. The early-onset diabetics were mostly obese, had higher HbA1c, worse lipid profiles, and had a positive family history of diabetes. Only a BMI of >27.50 kg/m2 was found to be a significant risk factor contributing to early-onset of diabetes. Myocardial infarction and nephropathy were more frequent in the late-onset group while retinopathy was more common in the early-onset group. Lastly, only retinopathy and neuropathy were significantly associated with longer duration of diabetes.
Conclusion
The mean age of Filipinos was at least 5 years younger than the studies done on Caucasians. Most patients in the early-onset group were obese and had worse metabolic profiles. Retinopathy was more common in the early-onset group, while myocardial infarction and neuropathy were more common in the latter.
Risk Factors|philippines|early Diagnosis
6.The Philippine thyroid diseases study (PhilTiDeS): Prevalence of thyroid disorders among adults in the Philippines.
Carlos-Raboca Jospehine ; Jimeno Cecilia A ; Kho Sjoberg A ; Andag-Silva Aimee A ; Jasul Jr Gabriel V ; Nicodemus Jr Nemencio A ; Cunanan Elaine C ; Duante Charmaine A ; PhilTiDes Working Gr The Philippine Society of Endocrinology and Metabo
Journal of the ASEAN Federation of Endocrine Societies 2012;27(1):27-33
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.
Human ; Male ; Female ; Middle Aged ; Adult ; Goiter, Nodular ; Health Surveys ; Hyperthyroidism ; Hypothyroidism ; Immunoenzyme Techniques ; Philippines ; Prevalence ; Thyroid Diseases ; Thyroid Function Tests ; Volunteers
7.Diagnosis of gestational diabetes mellitus using the international association of the diabetes and pregnancy study groups criteria and adverse pregnancy outcomes among a cohort of Filipino women: An association analysis
Kristine S. de Luna ; Elaine C. Cunanan
Philippine Journal of Internal Medicine 2017;55(4):1-8
Introduction:
Locally, there is no unified set of diagnostic
criteria for gestational diabetes mellitus (GDM) and this can
lead to potential confusion on the part of the physician and
the patient as well. Moreover, whether the adoption of the
International Association of the Diabetes and Pregnancy
Study Groups (IADPSG) threshold values for GDM diagnosis
among Filipino women is appropriate is still unclear. This study
serves to give a clinically important insight whether utilizing
the abovementioned diagnostic criteria is appropriate in
the local setting or not. The study aims to determine the
association of the threshold values set up by the IADPSG to
diagnose GDM with adverse pregnancy outcomes among
a cohort of Filipino women.
Methods:
A retrospective analysis of medical files of the
women diagnosed with GDM using the IADPSG criteria from
January 2013 to March 2016 was done. The results of seventyfive gram oral glucose tolerance test (75-g OGTT) were
recorded. The association between each IADPSG threshold
values (fasting blood glucose of ≥92 mg/dL, one-hour post
glucose load of ≥180 mg/dL, two-hour post glucose load
of ≥153 mg/dL) used to define GDM and maternal and
perinatal outcomes were determined.
Results:
One hundred twenty women with GDM were
included in the analysis. Each of IADPSG-defined cut-off values was not significantly associated with increased
likelihood of having adverse maternal outcomes namely:
hypertensive disorders of pregnancy, miscarriage, primary
cesarean section, operative vaginal delivery, and maternal
death. Similarly, the likelihood of perinatal outcomes namely:
macrosomia, perinatal death, prematurity, birth injuries,
congenital anomalies, neonatal hypoglycemia, jaundice,
low APGAR score, acute respiratory distress syndrome, and
infection were not significantly higher even if these cut-off
values were met. Of note, high odds ratio was noted for neonatal
hypoglycemia at FBS >92 mg/dL and <92 mg/dL and the low
Apgar Score in first minute at >153 mg/dL and <153 mg/dL
even though they were statistically not significant.
Conclusion
We did not find a statistically significant positive
association between IADPSG threshold values and specified
adverse maternal and perinatal outcomes.
Diabetes, Gestational
8.The association of antenatal steroids and hypoglycemia in preterm neonates.
John Ryan G. VIAR ; Elaine C. CUNANAN
Journal of Medicine University of Santo Tomas 2021;5(1):604-610
Objective: Antenatal steroids have shown to decrease the rate of neonatal complications and morbidity; however, neonates are predisposed to significant hypoglycemia resulting in invasive interventions and prolonged nursery admissions. The risk of hypoglycemia in the preterm has been well studied, but the association of antenatal steroids and hypoglycemia in preterm neonates has not been well explored. Thus, we sought to determine the association of antenatal steroids given to mothers who delivered prematurely and the development of neonatal hypoglycemia.
Methods: A cross-sectional study using chart review was done on mother-preterm neonate pairs admitted in the charity obstetrical ward of The University of Santo Tomas Hospital from January 1, 2018 to December 31, 2019. The subjects were mothers either given or not given antenatal steroids before preterm delivery and their respective neonates. The provision of antenatal steroids was the primary exposure, while neonatal hypoglycemia was the primary outcome. Measurement of association was done using odds ratios. Univariate and multivariate logistic regression analyses were done.
Results: Of the 69 preterm neonates included in the study, hypoglycemia was observed in 14 neonates, among which 8 neonates were exposed to antenatal steroids. After examining the association using Fisher's exact formula and controlling for potential confounders, neonatal hypoglycemia was not significantly higher among neonates exposed to antenatal steroids.
Conclusion: Antenatal steroids given to mothers who delivered preterm were not associated with the development of neonatal hypoglycemia. A prospective study model, larger population size and longer study coverage should be made to strengthen the outcome of the study.
9.A retrospective cohort study in a university hospital evaluating the effect of maternal glucose containing intravenous fluid in neonatal glycemia
Gelinemae G MALAZA ; Elaine C CUNANAN
Journal of Medicine University of Santo Tomas 2019;3(1):290-294
Abstract Maternal hyperglycemia during the peripartum period is highly correlated with fetal hyperinsulinemia and consequent neonatal hypoglycemia.
Liberal use of intravenous glucose therapy prior to
delivery can potentially cause maternal hyperglycemia, therefore, it is prudent to implement all preventive measures.
This study aims to determine the occurrence of neonatal hypoglycemia with intravenous glucose therapy prior to delivery in maternal diabetes mellitus.
This was a retrospective cohort study of neonates
born from diabetic mothers at the University of Santo
Tomas Hospital Clinical and Private Divisions from
January 1, 2013 to December 15, 2017. Clinical
information gathered was divided into maternal and
neonatal characteristics. Maternal intravenous fl uid
use, rate, and duration were noted; maternal and
neonatal blood glucose results were obtained.
There were 109 infants of diabetic mothers, of
which 105 were delivered as singleton and 4 from twin pregnancies. Neonatal hypoglycemia was
present in 14.68%. Comparing the risk factors, there
was a higher amount of glucose infused to the mothers whose offspring developed hypoglycemia compared to those without hypoglycemia. Statistically,
this did not demonstrate a signifi cant difference. The
rate of glucose infusion and frequency of maternal
insulin use were similar between the groups. Linear
correlation was not evident when the total glucose
infused and the rate of intravenous glucose infusion
was compared to the neonatal glucose in the fi rst
hour of life.
Based on this study, routine administration of glucose-containing intravenous fl uid did not infl uence
the incidence of neonatal hypoglycemia. It is recommended that further prospective studies be conducted.
Diabetes, Gestational
;
10.Prevalence of hypoglycemia among type 2 diabetics undergoing hemodialysis in a university hospital
Maria Concepcion H GUNGON ; Elaine C CUNANAN
Journal of Medicine University of Santo Tomas 2020;4(2):510-517
Background:
The overall increase in the number of
people with diabetes mellitus has a major impact on
the increasing number of patients with diabetic kidney
disease (DKD). Hypoglycemia that is brought about
by altered glucose homeostasis and the hemodialysis
process in patients with DKD poses a great challenge
to clinicians in achieving blood glucose control. This
study has been undertaken to evaluate the prevalence
of hypoglycemia among diabetics undergoing hemodialysis and determine the clinical factors predicting
the development of hypoglycemia.
Methods:
We conducted a prospective, cross-sectional study that included 75 patients with diabetes
mellitus undergoing maintenance hemodialysis at the
University of Santo Tomas Hospital, Center for Kidney
Disease. The patients’ predialysis and hourly intradialytic serum glucose levels were measured until the
end of the session. Hypoglycemia was considered as
a blood glucose ≤70 mg/dL with/without symptoms.
Results:
Elderly patients and in-hospital patients
tend to develop hypoglycemia with a p-value of
0.0028 and 0.001, respectively. Old age (p-value
0.0093), female sex (p-value 0.0224), hypertension
(p-value 0.0301), CAD (p-value 0.0058), frequency of hemodialysis (p-value 0.0000), no caloric intake
during the dialysis session (p-value 0.0022) and admission (p-value 0.0007) predicted hypoglycemia in
our study
Conclusions
In conclusion, the prevalence of hypoglycemia among patients with type 2 diabetes mellitus
undergoing maintenance hemodialysis in our setting
is 12%. There is an increased rate of hypoglycemia
amongst the elderly as well as admitted patients. Our
results identifi ed old age, presence of CAD, increased
frequency of hemodialysis and hospital admission as
the predictors of hypoglycemia.
Renal Dialysis
;
Hypoglycemia
;
Kidney Failure, Chronic