Objectives: The study aimed to identify whether pre-operative glycosylated hemoglobin level (HbA1c) and fasting blood sugar (FBS) can be used as markers for the development of acute kidney injury (AKI) in the immediate post-operative period of type 2 diabetic patients after elective abdominal surgery.

Methods: This retrospective cohort pilot study included seventy-four diabetic patients who underwent elective abdominal surgery from 2015 to 2018. HbA1c and FBS, demographic data, comorbidities, type and indication of surgery, and treatment history were correlated with the development of AKI using logistic regression analysis.

Results: In this cohort, 12% of subjects developed AKI. Univariate and multivariate logistic regression analysis, however, showed that neither HbA1c and FBS nor other studied factors were predictive for the occurrence of AKI (OR 2.55, p= 0.26 and OR 0.64, p= 0.72 respectively).

Conclusion: Pre-operative HbA1c and one-time FBS values in diabetic patients undergoing elective abdominal surgery procedures were not statistically predictive of AKI in the present data. However, the observed trend towards the risk of AKI among the elevated HbA1c subset of patients should drive further studies with a greater sample size and of a prospective nature looking at other metabolic factors contributing to AKI.

Pre-operative Glycosylated Hemoglobin Level ; Fasting Blood Sugar ; Acute Kidney Injury

Background: Although elevated glucose levels are associated with adverse outcomes in the critically ill, HbA1c-based adjusted glycemic variables have not been extensively utilized as a tool to evaluate patients in the acute critical condition. Objective: This study aims to determine whether glycemic gap can predict adverse outcomes in patients with type 2 diabetes diagnosed with COVID-19. Methodology: A single center and retrospective study of adult patients with type 2 diabetes diagnosed with COVID- 19. Glycemic gap was calculated as the difference between the admission blood glucose and A1c‐derived average glucose. Logistic regression was used to determine association of glycemic gap and several adverse clinical outcomes. A decision curve analysis was used to determine the clinical utility of a clinical decision model based on this cut-off. Results: A total of 150 diabetic patients with COVID-19 were analyzed. Median baseline HbA1c was 7.5% (range 4.79–18.42), while median admitting blood glucose was 196 (range 71–506) mg/dL. From these, computed glycemic gaps ranged from -180.5 to 312.8 mg/dL, with a median of 13.75 mg/dL. On univariate analysis, for every unit increase in glycemic gap, odds of developing ARDS increased five times (cOR 4.798, 95% CI 2.08 to 11.09); odds of developing shock increased four times (cOR 4.48, 95% CI 1.48 to 13.44). No single cut-off value for glycemic gap was able to discriminate patients with favorable outcome from those with adverse outcome. The decision curve analysis graphically shows that glycemic gap has a positive net benefit for threshold risk of 50% or higher. Conclusion Higher glycemic gaps were significantly associated with increased risk for poor outcomes in diabetic patients with COVID-19. Glycemic gap should be correlated with clinical status and other laboratory parameters to make it a more powerful discriminant among COVID-19 infected patients.
Diabetes Mellitus, Type 2 ; COVID-19

OBJECTIVES: The study examined the prevalence of elevated thyroid stimulating hormone (TSH) and its association with dyslipidemia and non-alcoholic fatty liver disease (NAFLD) among Filipino adults undergoing executive check-up.

METHODS: Clinical characteristics such as age, vital signs, anthropometrics, FBS, lipid profile, liver function tests, TSH and hepatobiliary ultrasound were reviewed from the charts of 580 patients to determine the prevalence of elevated TSH, NAFLD, and dyslipidemia. Binary logistic regression analysis was performed to determine association between TSH levels, NAFLD, and dyslipidemia.

RESULTS: The prevalence of elevated TSH was 3.10%. Patients with increased total cholesterol was approximately 4.18 times as likely (95% CI 1.20 to 14.61%, p = 0.025) to have elevated TSH. However, after adjusting for age and sex, we had insufficient evidence to demonstrate an association between NAFLD and lipid levels with elevated TSH levels.

CONCLUSION: The prevalence of elevated TSH in this group of patients from a highly urbanized area was 3.1%. We had insufficient evidence to demonstrate an association between NAFLD, lipid levels, and elevated TSH levels after adjusting for age and sex.

Human ; Male ; Female ; Middle Aged ; Thyrotropin ; Non-alcoholic Fatty Liver Disease ; Prevalence ; Liver Function Tests ; Dyslipidemias ; Hypercholesterolemia ; Digestive System ; Cholesterol ; Lipids

Background: Adolescent onset diabetes is currently showing different facets as far as phenotypic and autoimmune characteristics, clinical course, age at onset of the disease and prevalence of its different types are concerned. Alarming increase in the prevalence of type 2 diabetes (T2DM) has been reported from pediatric diabetes centers in North America and elsewhere in the world. Autoimmunity has been identified not only in type 1 adolescent diabetics but also among patients diagnosed clinically as type 2. Previous studies have shown that race or ethnic differences in this population can be identified. With the foregoing studies, we strongly believed that if significant associations can be made among the clinical, immunological and biochemical variables in this study, these associations can serve as guide for physicians in the management of adolescent onset diabetes.Objectives: To describe the phenotypic and immuno-biochemical characteristics of adolescent onset Filipino diabetic. Specifically to correlate the body mass index, acanthosis nigricans and age at onset of diabetes with C-peptide and anti-GAD antibody levels and to find association between anti-GAD and C-peptide levels.Study Design: Descriptive AnalyticalParticipants: Twenty six adolescent diabetics from Makati Medical Center, camp COPE, and Philippine General Hospital Section of Pediatric Endocrinology service patients were included in the study.Results: A total of 26 subjects were included in the study. The mean age was 15.2 years old with male preponderance (17/26; 65%). Mean age at onset of diabetes mellitus was 12.34 years (range 10 - 18 years) BMI ranged from 13.95 to 39.5 (mean 32.4 kg/m2). Seven (27%) were obese and two (8%) were overweight. The waist circumference ranged from 54 - 126 cm (mean of 73.2), the hip circumference ranged from 54 to 114 cm while the waist to hip ratio ranged from 0.85 to 1.1 cm (mean of 0.97). In six cases (23%) acanthosis nigricans was present while 2 subjects has elevated pressure (8%). Using the NCEP III Criteria, only three subjects (11.5%) fulfilled the criteria for metabolic syndrome. Nine subjects were positive for the anti-GAD antibody while 17 subjects (65%) had normal values. C-peptide values and anti-GAD titers did not significantly vary among obese/ overweight adolescents and non obese. A statistically higher ne underweight / normal BMI than those who are obese had low C-peptide values (13 versus 6), while those with high C-peptide values, a higher frequency were overweight (6 versus 3). (p=0.41). There is a negative or inverse statistical correlation between C-peptides and anti-GAD titers, although the relationship is weak. (r = .127, p=.06).Conclusion: The mean BMI of the adolescent onset Filipino diabetics is 21.4 kg/m2, with mean waist circumference of 73.2cm and mean waist to hip ratio of 0.97cm. Eleven percent of the population has metabolic syndrome. Body mass index has no statistically significant correlation with anti-GAD antibody and C peptide level. However, higher number of patients who are underweight or with normal BMI has low C-peptide levels. Twenty three percent of the population has acanthosis nigricans and 75% of them are obese diabetics with elevated C peptide. A trend towards inverse relationship between anti-GAD antibody levels and C-peptide levels has been identified which needs further studies.
Human ; Adolescent Onset Diabetes ; Diabetes Mellitus