Diagnostic accuracy of Serum 1,5-anhydroglucitol as a surrogate measure of Glycemic variability among adult Filipinos with Type 2 Diabetes Mellitus: A retrospective cross-sectional study

Background@#Among the various glycemic indices in current use, glycemic variability has the greatest contribution in the development of microvascular and macrovascular complications in Type 2 Diabetes mellitus (T2DM). Most metrics that are currently used to measure glycemic variability are derived from continuous glucose monitoring (CGM) data. However, CGM is burdensome to the patient due to its relatively high cost as well as the need for multiple visits with the health care provider. With the use of serum 1,5-anhydroglucitol (1,5-AG) as a biomarker of glucose fluctuations, physicians and patients alike could have an easier surrogate measure of glycemic variability thus aiding in achieving target glucose control. This study aims to determine the diagnostic accuracy of 1,5-AG as compared to the glycemic variability metrics derived from CGM as a surrogate measure of glycemic variability among adult Filipinos with T2DM.@*Methods@#Retrospective analysis of data of adult patients aged 20 years old and above diagnosed with T2DM referred for CGM at the Diabetes, Endocrine, Metabolic, and Nutrition Center of Cardinal Santos Medical Center from January 2017 to October 2021 who underwent serum 1,5-AG level determination within 2 weeks of CGM were collected. Diagnostic accuracy was obtained by computing the sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and Youden index. Pearson correlation coefficient was used to determine the correlation of 1,5-AG and the different metrics. Analysis of variance (ANOVA) was used to check for statistical significance with 99% confidence interval and a p < 0.05 considered as statistically significant.@*Results@#This study involving 37 subjects showed a good diagnostic accuracy of serum 1,5-AG levels with the different measures of glycemic variability derived from CGM namely mean amplitude of glycemic excursion (MAGE), continuous overlapping net glycemic action at 1-hour intervals (CONGA-1), and mean of daily differences (MODD) with significant correlation among patients with HbA1c ≤ 7%. Subjects were on CGM for approximately 6 ± 1 day with statistically significant difference between the good and poor glucose control group (p<0.05). Determination of diagnostic accuracy between 1,5- AG and MAGE showed good accuracy (Sensitivity = 95.3%, Specificity = 100%, PPV = 100%, NPV = 75.43%, Diagnostic accuracy 96%, and a Youden Index of 92.3) with a statistically significant correlation among subjects with HbA1c level ≤ 7% (p=0.021). There is likewise good diagnostic accuracy between CONGA-1 and 1,5-AG level (Sensitivity = 99%, Specificity = 75.29%, PPV = 89.1%, NPV = 97%, Accuracy = 89.50% and Youden index of 58.41) with a statistically significant correlation among subjects with HbA1c ≤ 7% (p=0.038). Comparison with interday glycemic variability showed fair diagnostic accuracy between MODD and 1,5-AG (Sensitivity = 79.17%, Specificity = 78%, PPV = 97%, NPV = 32%, Accuracy = 76.89%, and Youden index of 49.07) and a statistically significant correlation among subjects with HbA1c ≤ 7% (p=0.009).@*Conclusion@#There is good diagnostic accuracy of serum 1,5-AG levels with the different measures of glycemic variability derived from CGM namely MAGE, CONGA-1, and MODD with significant correlation among patients with HbA1c ≤ 7%. Among diabetics with HbA1c ≤7%, 1,5-AG could be used as a surrogate measure of glycemic variability and excursions.

“Overgrowth: Missing a tumor” acromegaly without imaging evidence of pituitary adenoma and no ectopic source: A case report / Journal of the ASEAN Federation of Endocrine Societies

@#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.

Testing for autoimmunity and β-Cell function in a young patient with diabetes mellitus / Journal of the ASEAN Federation of Endocrine Societies

@#This is a case report of a 22-year-old Filipino male, morbidly obese, not known to have diabetes mellitus (DM) who presented with diabetic ketoacidosis on initial diagnosis. He had a phenotype of type 2 DM (T2D) but an initial presentation consistent with type 1 DM (T1D). Insulin therapy was eventually discontinued but he maintained good glycemic control with diet alone. C-peptide showed adequate increase after a mixed-meal diet and GAD65Ab was negative, thus he was diagnosed with ketosis-prone DM (KPDM). The increasing prevalence of obesity challenges the classic phenotype of patients with DM, with many patients presenting as an obese type T1D, and being diagnosed with T2D at a younger age. This complicates how to classify the patient’s diabetes, and the clinical profile is sometimes insufficient to make the proper diagnosis. In these cases, immunologic markers and assessment of β-cell function are important tools to differentiate between T1D and T2D, to direct management plans and to anticipate complications.

Echocardiographic Epicardial Adipose Tissue thickness as a marker of insulin resistance / Journal of the ASEAN Federation of Endocrine Societies

Objective@#The main objective of this study is to determine if epicardial fat thickness can be an early marker of insulin resistance. The specific objectives are to determine the specific thickness of epicardial fat that will correlate with insulin resistance and to correlate epicardial fat thickness with co-morbidities, anthropometric measurements and other clinical variables. @*Methodology@#Patients were enrolled into the study by purposive sampling. Insulin assay, fasting blood sugar (FBS) and 2D echocardiogram measuring the epicardial fat were requested. HOMA-IR was computed and correlated with epicardial fat thickness. SPSS version 19 and Epi info v3.5.1 were used for statistical analysis. Linear regression analysis was performed on all variables to identify correlates with epicardial fat thickness. @*Results@#A total of 22 subjects were included in the study. Insulin resistance determined using HOMA-IR, as well as BMI and fasting insulin level showed significant correlation with epicardial fat thickness (p-value <0.01). Based on the analysis, 9.5 mm was found to be the most sensitive and specific measurement for epicardial fat thickness that is correlated to insulin resistance with sensitivity of 100% and specificity of 86%. @*Conclusions@#Epicardial fat thickness through routine 2D echocardiogram is significantly directly correlated with insulin resistance and 9.5 mm is the cut–off value for predicting insulin resistance.

A review of the 2005 Clinical Practice Guidelines for the Management of Dyslipidemia in the Philippines / Journal of the ASEAN Federation of Endocrine Societies

@#Cardiovascular disease is a leading cause of mortality in the Philippines with an upward trend in the prevalence of atherosclerosis-related risk factors. In the national survey done in 2008, the prevalence of dyslipidemia is also increasing. As such, there is a need to increase awareness of the risk factors for cardiovascular disease among health care professionals. The development of Philippine guidelines were part of the strategy to improve overall cardiovascular risk and dyslipidemia management that is relevant to the Philippine setting. This article summarizes the 2005 Dyslipidemia guidelines, discusses some updates since its release and emphasizes equity issues when considering management of dyslipidemia in a Filipino patient.

Safety and efficacy of insulin detemir among adult Filipino patients with Type 2 Diabetes: The Philippine cohort of the Global A1chieve Study / Journal of the ASEAN Federation of Endocrine Societies

Objective@#To present the results from the Philippine cohort of the A1chieve study receiving insulin detemir (IDet) ± oral antidiabetic drugs. @*Methodology@#A1chieve is a multinational, 6-month, observational study of 66,726 people with type 2 diabetes mellitus (T2DM), both insulin users and non-insulin users, started on IDet, insulin aspart or biphasic insulin aspart in 28 countries across four continents. This subgroup analysis evaluates the safety and effectiveness of IDet in 988 subjects from the Philippines. @*Results@#At baseline the mean age, duration of diabetes and mean BMI were found to be 57±11.9 yrs, 6.9±5.3 yrs and 26±4.8 kg/m2 respectively. Majority of subjects were insulin-naive (84.3%) and glycemic control was poor in all the groups at baseline. At the end of 24 weeks, there were significant improvements following IDet initiation with a 2.1% reduction in mean HbA1c. The HbA1c target of <7% was achieved by 46.8% subjects at the study end. Although not statistically significant, there was a modest decrease in body weight in all the groups. There was no increase in the incidence of hypoglycemia among baseline insulin-naive subjects, while a significant reduction in hypoglycemia was seen among prior insulin users. @*Conclusions@#IDet appears to be an effective and safe option for individuals with T2DM in the Philippines. HbA1C was lowered to target, and there was no increase in incidence of hypoglycemia and body weight with IDet.