Reference intervals in thyroid function tests in the third trimester in pregnant Filipino women

BACKGROUND: Pregnancy has been associated with differences in thyroid function.1 Maternal thyroid dysfunction has been shown to be associated with fetal and obstetric complications and prompt management is of importance. It has thus been recommended by the British and American Thyroid Association11,12 that trimester-specific thyroid function test reference ranges be used in the assessment of thyroid dysfunction. Normative values across the trimesters of pregnancy have been conducted in several countries13,17,19 and in the Philippines. Reference rangesin the first and second trimesters of pregnancy were conducted by Patal and Hamin et al. which showed values of TSH 0.14-3.84 uIU/mL, FT4 10.44-21.58 pmol/L, FT3 2.4-5.82 pmol/L in the first trimester and TSH 0.10-4.30 uIU/mL, FT4 9.10-19.40 pmol/L, FT3 2.70- 5.190 pmol/L in the second trimester, respectively.OBJECTIVE: To establish third trimester reference intervals for free thyroid hormones (free triiodothyronine [FT3], free thyroxine [FT4]) and thyrotropin [TSH] from thyroid peroxidase antibody [TPOAb]-negative Filipinopregnant women.DESIGN: This is a prospective, cross-sectional study which included consecutive 200 healthy third-trimester pregnant Filipino women attending Philippine General Hospital (PGH) out-patient services. Serum TSH, FT4, FT3, and TPOAb were measured.MAIN OUTCOME MEASURES: Reference intervals are based on 2.5th and 97.5th percentiles for TSH, FT4, and FT3 among TPOAb-negative third-trimester pregnant Filipino patients.ANALYSIS: All numerical data were entered in MS Excel and analyzed using STATA 12. FT3, FT4 and TSH were expressed as mean ±SD, range at 2.5th to 97.5th percentiles.RESULTS: The reference ranges for TSH, FT4 and FT3 in TPOAb-negative third-trimester pregnant population are as follows: TSH= 0.2-3.0 uIU/mL; FT4 = 9.16-18.64 pmol/L and FT3= 2.09-3.7 pmol/L.CONCLUSION: Reference ranges for thyroid function tests for the third trimester of TPOAb-negative pregnant Filipino women were determined in this study and are as follows: TSH= 0.2-3.0uIU/mL; FT4 = 9.16-18.64pmol/L and FT3= 2.09-3.7pmol/L.

Clinical experience with BIAsp 30: Results from the Philippine cohort of the global a1chieve study

OBJECTIVE: To evaluate the safety, effectiveness and health-related quality of life (HRQoL) parameters of A1chieve study participants in the Philippine cohort, who were treated with BIAsp 30.METHODOLOGY: A1chieve is a non-interventional, six-month, observational study of 66,726 people with type 2 diabetes mellitus (T2DM), including both insulin users and non-insulin users, started on insulin detemir, insulin aspart, or BIAsp 30 in 28 countries across four continents. The present study evaluates the safety, effectiveness and HRQoL in 1,252 subjects from the Philippine cohort of the A1chieve study who were treated with BIAsp 30.RESULTS: At baseline, the mean age, duration of diabetes and mean BMI were found to be 55.5±11.7 years, 7.2 ± 5.6 years and 25.4 ± 5.3 kg/m2, respectively. Seventy-eight percent (78%) of subjects were insulin naïve and 22% were prior insulin users. At baseline, glycemic control was poor (HbA1c = 9.9%) in the entire cohort. Overall there was a 2.7% reduction in mean HbA1c and 44.2% subjects achieved the HbA1c target of CONCLUSION: BIAsp 30 is safe and efficacious for initiating and intensifying insulin therapy for Filipino T2DM patients.

Impact of waist circumference measurement variation on the diagnosis of metabolic syndrome

INTRODUCTION: While waist circumference (WC) is widely used as an index for visceral fat accumulation and purportedly the primary pathology responsible for the metabolic syndrome (MS), its proposed cut-off value varies depending on the disparate diagnostic criteria used as well as on the gender, race and ethnic group being evaluated. Due to the strong association between MS and central obesity, waist circumference should be incorporated into the routine physical exam when assessing cardiovascular disease and diabetes risk. Currently however, there is no standard location for the measurement of WC. On literature review, we found no scientific rationale for preferring any one WC site to the others hence, this study.OBJECTIVE: This study aims to (1) determine waist circumference measurement var iat ions among MS patients, (2005 NCEP-ATP III/AHA/NHLB criteria), at three levels: (A) umbilical level, (B) midline level (between the inferior margin of the ribs and the superior border of the iliac crest) and (C) level of the superior border of the iliac crest.RESEARCH DESIGN AND METHODS: Across - sectional analytical study among adult patients, aged 40 to 69 years, diagnosed with MS using 2005 NCEP-ATP III/AHA/ NHLB criteria seen at the Philippine General Hospital, as part of the Asia-Oceania Survey on Metabolic Syndrome and Diabetes initiated by the Japan Diabetes Society.RESULTS: A total of 187 MS individuals were included in the study (56% females). Both males and females were obese stage 1 (25.5 kg/m2 and 26.7 kg/m2 respectively). The mean WC measurements at level A in men was 92.9 cm (81.36 - 104.44 cm) and 93.83 cm (83.4 - 104.26 cm) in women; at level B, the mean WC in men was 90.73 cm (75.49 - 105.97 cm) and 91.51 cm (80.62 - 102.4 cm) in women; and at level C, the mean WC in men was 93.5 cm (81.97 - 105.03 cm) and 95.12 cm (85.11 - 105.13 cm) in women. Results showed that WC measurements at three levels did not significantly differ among MS patients when stratified to age and sex. However, when waist circumference was measured at three levels among all patients with MS, there was significant difference in WC taken at level B and level C (Sig = 0.009). Waist circumference at level A was similar and less variable to WC level B than WC at levelC.CONCLUSIONS: Among patients with MS as defined by NCEPATP III/AHA/NHLB criteria, waist circumference at level B (midpoint level between the lower ribs and superior border of the iliac crest) was smaller than waist circumference at level A (umbilical level) and smaller than level C (superior border of the iliac crest) (WCB