Transcriptional profiles associated with coronary artery disease in type 2 diabetes mellitus.

Background: Coronary artery disease (CAD) is a common complication of Type 2 diabetes mellitus (T2DM). Understanding the pathogenesis of this complication is essential in both diagnosis and management. Thus, this study aimed to characterize the presence of CAD in T2DM using molecular markers and pathway analyses. Methods: The study is a sex- and age-frequency matched case-control design comparing 23 unrelated adult Filipinos with T2DM-CAD to 23 controls (DM with CAD). Healthy controls served as a reference. Total RNA from peripheral blood mononuclear cells (PBMCs) underwent whole transcriptomic profiling using the Illumina HumanHT-12 v4.0 expression beadchip. Differential gene expression with gene ontogeny analyses was performed, with supporting correlational analyses using weighted correlation network analysis (WGCNA). Results: The study observed that 458 genes were differentially expressed between T2DM with and without CAD (FDR<0.05). The 5 top genes the transcription factor 3 (TCF3), allograft inflammatory factor 1 (AIF1), nuclear factor, interleukin 3 regulated (NFIL3), paired immunoglobulin-like type 2 receptor alpha (PILRA), and cytoskeleton-associated protein 4 (CKAP4) with AUCs >89%. Pathway analyses show differences in innate immunity activity, which centers on the myelocytic (neutrophilic/monocytic) theme. SNP-module analyses point to a possible causal dysfunction in innate immunity that triggers the CAD injury in T2DM. Conclusion: The study findings indicate the involvement of innate immunity in the development of T2DM-CAD, and potential immunity markers can reflect the occurrence of this injury. Further studies can verify the mechanistic hypothesis and use of the markers.

Variants of SLC2A10 may be Linked to Poor Response to Metformin.

Purpose: A study among Filipinos revealed that only 15% of patients with diabetes achieved glycemic control, and poor response to metformin could be one of the possible reasons. Recent studies demonstrate how genetic variations influence response to metformin. Hence, the present study aimed to determine genetic variants associated with poor response to metformin. Methods: Using a candidate variant approach, 195 adult Filipino participants with newly diagnosed type 2 diabetes mellitus (T2DM) were enrolled in a case-control study. Genomic DNA from blood samples were collected. Allelic and genotypic associations of variants with poor response to metformin were determined using exact statistical methods. Results: Several polymorphisms were nominally associated with poor response to metformin (P uncorr < 0.05). The most notable is the association of multiple variants in the SLC2A10 gene-rs2425911, rs3092412, and rs2425904-with common additive genetic mode of inheritance. Other variants that have possible associations with poor drug response include rs340874 (PROX-AS1), rs815815 (CALM2), rs1333049 (CDKN2B-AS1), rs2010963 (VEGFA), rs1535435 and rs9494266 (AHI1), rs11128347 (PDZRN3), rs1805081 (NPC1), and rs13266634 (SLC30A8). Conclusion: In Filipinos, a trend for the association for several variants was noted, with further observation that several mechanisms may be involved. The results may serve as pilot data for further validation of candidate variants for T2DM pharmacotherapy.

Executive summary of the 2020 clinical practice guidelines for the management of hypertension in the Philippines.

Hypertension is the most common cause of death and disability worldwide with its prevalence rising in low to middle income countries. It remains to be an important cause of morbidity and mortality in the Philippines with poor BP control as one of the main causes. Different societies and groups worked and collaborated together to develop the 2020 Philippine Clinical Practice Guidelines of hypertension arising for the need to come up with a comprehensive local practice guideline for the diagnosis, treatment, and follow up of persons with hypertension. A technical working group was organized into six clusters that analyzed the 30 clinical questions commonly asked in practice, looking into the definition of hypertension, treatment thresholds, blood pressure targets, and appropriate medications to reach targets. This guideline also includes recommendations for the specific management of hypertension among individuals with uncomplicated hypertension, hypertension among those with diabetes, stroke, chronic kidney disease, as well as hypertension among pregnant women and pediatric populations. It also looked into the appropriate screening and monitoring of patients when managing hypertension, and identification of groups who are at high risk for cardiovascular (CV) events. The ADAPTE process was used in developing the statements and recommendations which were then presented to a panel of experts for discussion and approval to come up with the final statements. This guideline aims to aid Filipino healthcare professionals to provide evidence-based care for persons with hypertension and help those with hypertension adequately control their blood pressure and reduce their CV risk.

Prevalence of diabetes mellitus and pre-diabetes in the Philippines: A sub-study of the 7th National Nutrition and Health Survey (2008)

INTRODUCTION: Diabetes mellitus is rapidly increasing worldwide but the greatest increase is expected in developing countries including the Philippines. It is of public health concern to monitor countrywide prevalence of diabetes as it leads to significant cardiovascular-related mortality as well as significant complications such end stage renal disease, blindness, lower leg amputations and blindness.METHODOLOGY: This is a national survey to estimate the prevalence of diabetes and pre-diabetes using the criteria of the World Health Organization through a stratified multi-stage sampling design representing each of the 17 regions in the country.RESULTS AND DISCUSSION: The national prevalence of diabetes in the year 2008 was 7.2% (6.5-7.9); impaired glucose tolerance 7.0% (6.1-7.8) and impaired fasting glucose was 2.2% (2.2-3.1). There was a greater prevalence of individuals with diabetes in the urban areas at 8.5% (7.5-9.5) compared to the rural areas at 5.7% (4.6-6.8). Diabetes is slightly more preponderant among females at 7.4% (6.4-8.3) compared to males at 7.0% (6.1-8.0).CONCLUSION: The prevalence of diabetes mellitus in the Philippines is rising with the prevalence in 2008 at 7.2%. The prevalence of pre-diabetes exceeds that of diabetes mellitus at approximately 10.2%.

Tuberculous abscess of the thyroid / Journal of the ASEAN Federation of Endocrine Societies

Tuberculosis (TB) of the thyroid gland is rare, with acute abscess formation being the least common form of presentation. As such, TB of the thyroid may be overlooked as an initial clinical impression. A careful approach by history, physical examination, laboratory testing and radiologic imaging may aid in defining the etiology of the thyroid abscess, but these remain nonspecific. An accurate diagnosis may only be made by histologic examination. We present a case of a tuberculous abscess of the thyroid gland in a 37-year-old female. TB of the thyroid should also be considered when evaluating patients presenting with a painful thyroid nodule.

Angiotensin I-converting enzyme gene polymorphism and diabetic nephropathy in Filipino type 2 diabetes mellitus patients / Journal of the ASEAN Federation of Endocrine Societies

Objective. Previous studies have demonstrated the role of genetic susceptibility in the pathogenesis of diabetic nephropathy. The study aimed to determine the frequencies of angiotensin I-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism in a pilot population of Filipino type 2 diabetic patients and normal controls. Methods. An analysis of the ACE gene polymorphism was performed in 42 diabetic patients with and without nephropathy, and 24 normal controls. The analysis was done using polymerase chain reaction, restriction enzyme digestion, and gel electrophoresis techniques to determine the polymorphism (II, DD or ID). Independent T-tests and chi-square tests were used to compare clinical characteristics, and logistic regression analysis was done to determine odds ratio for development of nephropathy. Results. The ID polymorphism of the ACE gene was more frequent (52.4%) in patients with diabetic nephropathy (n=21). In those without nephropathy (n=21), II was more common (61.9%). ID was the more frequent genotype in the normal controls (n=24) (58.3%). The odds of developing diabetic nephropathy were increased by 4.8 times in those with ID polymorphism, and 2.9 times in those with DD. Conclusion. The D allele was more common in patients with diabetic nephropathy, similar to the observation in South Indian patients. Since the study involved only a small pilot group, studies on a larger population is needed to establish the hypothesized role of the D allele in susceptibility to diabetic nephropathy in Filipinos.

Changes in ovarian function after radioactive iodine among patients with differentiated thyroid carcinoma at St. Luke's Medical Center / Journal of the ASEAN Federation of Endocrine Societies

OBJECTIVE: To determine the prevalence of menstrual and reproductive dysfunction among subjects who have undergone radioiodine treatment for thyroid carcinoma.METHODOLOGY: This study enrolled adult women with Differentiated Thyroid Carcinoma who received the treatment at age 40 years and below. Data was processed using SAS program and evaluated using Fischer's test and Wilcoxon test.RESULTS: The study enrolled 46 women. Three reported cycle irregularities, 4 reported changes in amount of bleeding and 1 had amenorrhea. The prevalence rate of menstrual abnormalities was 15.2%. These women received a significantly higher dose of radioactive iodine (RAI) (120 vs. 110 mCi, p = 0.0064). Eleven women tried to conceive and there were 5 births to 5 different subjects after radiation. There were no congenital anomalies and 1 miscarriage. Four women were menopausal with an average age of 44.4 years old.CONCLUSION: This study showed that the prevalence of menstrual disturbances after high dose radioactive iodine treatment among thyroid cancer patients is 15.2%. The affected group received a significantly higher dose of radioactive iodine compared to the unaffected group.

Prevalence of thyroid dysfunction among patients taking glutathione supplementation: A cross-sectional study preliminary report

BACKGROUND: Glutathione due to its favorable side effect of skin whitening has been used by cosmetic centers and by individuals buying it as an over the counter supplementation. Because of this, this compound is prone to misuse. To date, there are limited studies on the adverse effects of exogenous supplementation of glutathione.OBJECTIVE: To determine the prevalence of thyroid dysfunction among individuals taking oral and intravenous glutathioneDESIGN: Cross-sectional studyMETHODS:Healthy Filipino subjects, 21 to 50 years of age, currently taking oral or intravenous glutathione, with no preexisting/ known thyroid disease and history of radiation exposure, and not taking medications with known effect on thyroid function were included in the study. Blood extraction for thyroid function test and thyroid ultrasound were conducted.RESULTS: A total of 36 subjects were analyzed with a mean age of 36.3±8 years, 86 percent were female. High dose glutathione (1000mg or more per day) was taken in by nine subjects (25%) while 27 subjects (75%) took doses below the recommended range (less than 1000ng per day). The prevalence of abnormal thyroid function was 5.56 percent (n=2). Both cases were taking low dose glutathione supplementation. No abnormal thyroid function was seen with higher doses of glutathione. No significant relationship was found between the duration of glutathione supplementation with thyroid function status. Thyroid stimulating hormone (TSH) levels were slightly higher among those taking high dose glutathione (mean=1.08 versus 1.04, p=.81). There was no significant differences in the duration and dose of supplementation with the size of the gland.RECOMMENDATION:The direct effect of L-glutathione supplements on thyroid function must be established using a longitudinal prospective study design. We also propose a group to serve as a negative control during the comparisons.

Prevalence of periodontitis and its association with glycemic control among patients with type 2 diabetes mellitus seen at St. Luke's Medical Center

BACKGROUND: Studies have shown that diabetes increases the prevalence and severity of periodontitis. Furthermore, among patients with Type 2 Diabetes Mellitus (DM), poorer glycemic control was found to be associated with poorer periodontal health.OBJECTIVE: To determine the prevalence of periodontitis and its association with glycemic control among Filipino patients with Type 2 DM.DESIGN: Cross-sectional studyMATERIALS AND METHODS: Diagnosed Type 2 DM patients 35 years and above were recruited from the out-patient clinics of St. Luke's Medical Center from June-October 2009. Periodontitis was evidenced by the presence of ?3mm probing depth and ?3mm periodontal attachment loss at the same site. Periodontitis severity was classified based on probing depth and furcation involvement. Glycemic control was assessed by laboratory assay for HbA1c grouped into RESULTS: A total of 192 subjects were analyzed. Prevalence of periodontitis among the Type 2 DM population studied was 68.23%. In this study, we found out that for those whose length of time since last dental check-up was >1 year, the odds of having periodontitis is 3.8 times higher (95% CI 1.45-9.76, p-value 0.007) among subjects with HbA1c ?7% compared to those with HbA1c CONCLUSION: Our findings suggest that periodontitis is prevalent among the Filipino Type 2 DM population studied. In this study, it is the interaction of both HbA1c ?7% and length of time since last dental check-up >1 year that resulted in a statistically significant association with periodontitis.

Prevalence of secondary hyperparathyroidism among outpatient type 2 diabetic patients undergoing hemodialysis in a tertiary hospital

BACKGROUND: Secondary hyperparathyroidism (SHPT) can lead to significant morbidity, mortality, and additional healthcare resource ut i l i zat ion in chronic k idney disease. Baseline prevalence data is highly required. This study aims to determine the prevalence of secondary hyperparathyroidi sm (SPTH) in pat ient s wi th Type 2 diabetes undergoing hemodialysis.MATERIALS AND METHODS: We reviewed all medical records of patients whose chronic kidney disease (CKD) was due to Type 2 diabetes mellitus and are undergoing chronic hemodialysis from 2000 to 2009. Excluded were those who underwent hemodialysis due to acute renal failure or for chronic renal failure due to other causes other than diabetic nephropathy (e.g. hypertensive nephropathy, chronic glomerulonephritis, etc). Data collected include age, sex, body mass index, bone markers, intact PTH, and urea reduction rate.RESULTS: The age and sex adjusted period prevalence of secondary hyperparathyroidism was 28.9%, commonly seen in the 5th to the 6th decade of life. Patients with SPTH had higher serum intact PTH, higher total calcium level (mean 9.05 versus 8.6, p=.026) and a higher urea reduction rate (mean 54.1 versus 45.2, p=.045). There was a longer duration of hemodialysis sessions among those with secondary hyperparathyroidism (mean 2.4 years versus 1.78 years, p=.004). Dialysis was likewise more adequate.CONCLUSION: Prolonged diabet ic kidney di sease is associated with secondary hyperparathyroidism for which a more aggressive monitoring of calcium and phosphorus imbalance is required.

Adiponectin levels and its association with hyperglycaemia in adult Filipino participants in the 2003--04 National Nutrition and Health Survey.

Our objective was to determine the association of serum adiponectin levels with the presence of IFG or DM in Filipinos. This case control study used sera of adult participants in the Philippines' NNHeS: 2003-04. Subjects were divided into: normoglycaemic control, impaired fasting glucose, and type 2 diabetes mellitus. Seventy-seven prediabetic and 83 diabetic subjects were included in the prediabetic and diabetic groups, respectively. There was no significant difference in adiponectin values between control and prediabetic subjects. Diabetic subjects had significantly lower mean serum adiponectin levels (10.7 versus 14.2 microg/ml, p=0.0198) compared with age- and BMI-matched control subjects. Diabetic subjects were found most frequently (43.53%) in the lowest tertile (1.6-7.2 microg/ml) and least frequently (20%) in the highest tertile (14-84 microg/ml) of adiponectin values. We conclude that Filipinos with diabetes mellitus had significantly lower adiponectin levels compared with normoglycaemic subjects.