Insulin analog use and pregnancy outcomes among women with Gestational Diabetes Mellitus (GDM): A retrospective analysis at the University of Santo Tomas Hospital

Introduction@#Approximately 40% of women with gestational diabetes mellitus (GDM) will require insulin when diet failed to reduce glycemic levels. Insulin analogs have been noted to result in an improved glycemic control and an acceptable safety profile in diabetes mellitus. Our general objective was to evaluate the efficacy, safety, and pregnancy outcomes of insulin analog versus human insulin in women with GDM.@*Methods@#Retrospective cohort analysis of women with singleton pregnancy and GDM from January 2013 to March 2016 at the University of Santo Tomas Hospital was performed. Women were grouped into Group A (diet-controlled), Group B (supplementary insulin analog), Group C (supplementary human insulin), and Group D (combination of supplementary insulin analog and human insulin). Maternal characteristics, glycemic data, and outcomes and neonatal outcomes were compared among the treatment groups. Parametric data were expressed as mean, standard deviation, frequency, and percentage. Chi-square and one-way analysis of variance were utilized to analyze data.@*Results@#Of 144 women with GDM, 59 received insulin analog and 19 received human insulin. Good glycemic control and low rate of hypoglycemia in Group B were comparable to other groups. Maternal outcomes (hypertensive disorders of pregnancy and primary cesarean section) in Group B were not increased and similar to other groups. Neonatal outcomes (birth weight, large for gestational age, neonatal hypoglycemia, neonatal jaundice, and acute respiratory distress syndrome) in Group B were also not increased and comparable to other groups. Rates of prematurity were higher in Groups A and B.@*Conclusion@#Our study demonstrated that insulin analog was comparable to human insulin in terms of non-increased rates of adverse pregnancy outcomes with the exception of prematurity, and can be safely used as a viable treatment option without increased risk of hypoglycemia while achieving optimal glycemic control throughout pregnancy in Filipino women with GDM.

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

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.

Pediatric endocrinology transition clinic profile at the University of Santo Tomas Hospital Outpatient Department - Clinical Division (USTH OPD-CD)

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To  determine the prevalence of depression in Filipino adult patients with type 2 diabetes mellitus (DM) and the risk factors associated in its development.<br /><strong>METHODS:</strong>This is a prospective cross-sectional  study. Adult  patients (age 19 and above) with type 2 DM being seen at the outpatient department of the Makati Medical Center from  January  to  March  2015  were included,  taking  into  account  the  following:  age,  gender,  marital  status,  body  mass index, waist circumference, blood pressure, duration of  diabetes,  presence  of  other  co-morbid  illnesses,  pill  burden,  insulin  use,  educational  attainment,  employment  status,  family  income, and glycemic status. They  were  then screened for depression using the standardized PHQ-9 questionnaire. Bivariate analyses through Chi-square Test (for categorical variables) and Analysis of Variance (for interval/ratio variables) were used to determine which among the risk factors are significant for the development of depression.Significant  risk  factors  were  treated  for  multivariate  and univariate analyses through ordinal logistic regression.<br /><strong>RESULTS:</strong> A  total  of  110  adult  patients  with  type  2  DM  were  enrolled  in  this  study.  There  were  no  drop-outs.  Sixty-nine  percent  of  the  patients  had  none  to  minimal  depression,  24% had mild depression, and 7% had moderate depression. None  of  the  patients  had  depression  that  warranted  anti-depressants  or  psychotherapy.After step-wise analysis, increased  BMI,  elevated  diastolic  blood  pressure  and  uncontrolled blood sugar were found to be associated with higher  PHQ-9  scores  while  unemployment  was  associated  with decreased PHQ-9 score.<br /><strong>CONCLUSION:</strong>The  prevalence  of  depression  among  Filipino  type  2  diabetic  patients  is  higher  than  in  non-diabetic patients. Being obese, having an elevated diastolic blood pressure, and the presence of uncontrolled blood sugar were significant predictors and were associated with an increased likelihood  of  developing  major  depressive  disorder.  Being unemployed appears to have the opposite effect.</p>

Pediatric endocrinology transition clinic profile at the University of Santo Tomas Hospital Outpatient Department - Clinical Division (USTH OPD-CD)

OBJECTIVE: To  determine the prevalence of depression in Filipino adult patients with type 2 diabetes mellitus (DM) and the risk factors associated in its development.METHODS:This is a prospective cross-sectional  study. Adult  patients (age 19 and above) with type 2 DM being seen at the outpatient department of the Makati Medical Center from  January  to  March  2015  were included,  taking  into  account  the  following:  age,  gender,  marital  status,  body  mass index, waist circumference, blood pressure, duration of  diabetes,  presence  of  other  co-morbid  illnesses,  pill  burden,  insulin  use,  educational  attainment,  employment  status,  family  income, and glycemic status. They  were  then screened for depression using the standardized PHQ-9 questionnaire. Bivariate analyses through Chi-square Test (for categorical variables) and Analysis of Variance (for interval/ratio variables) were used to determine which among the risk factors are significant for the development of depression.Significant  risk  factors  were  treated  for  multivariate  and univariate analyses through ordinal logistic regression.RESULTS: A  total  of  110  adult  patients  with  type  2  DM  were  enrolled  in  this  study.  There  were  no  drop-outs.  Sixty-nine  percent  of  the  patients  had  none  to  minimal  depression,  24% had mild depression, and 7% had moderate depression. None  of  the  patients  had  depression  that  warranted  anti-depressants  or  psychotherapy.After step-wise analysis, increased  BMI,  elevated  diastolic  blood  pressure  and  uncontrolled blood sugar were found to be associated with higher  PHQ-9  scores  while  unemployment  was  associated  with decreased PHQ-9 score.CONCLUSION:The  prevalence  of  depression  among  Filipino  type  2  diabetic  patients  is  higher  than  in  non-diabetic patients. Being obese, having an elevated diastolic blood pressure, and the presence of uncontrolled blood sugar were significant predictors and were associated with an increased likelihood  of  developing  major  depressive  disorder.  Being unemployed appears to have the opposite effect.