Introduction: There are a significant number of diabetic patients who remain uncontrolled despite basal insulin therapy due to lack of intensification of treatment. Different insulin titration algorithms are recommended by different treatment guidelines. This study compared two basal insulin titration algorithms in terms of time to achieve target glucose, adherence, hypoglycemia episodes, and HbA1c reduction. Methods: This is a 12-week randomized clinical trial conducted on insulin-naïve patients with uncontrolled type 2 diabetes mellitus from outpatient clinic of St. Luke’s Medical Center Quezon City. Patients on oral hypoglycemic agent/s with HbA1c seven percent and above were included in the study. They were randomized to either daily titration or twiceweekly insulin titration algorithms using basal insulin glargine. Results: Forty-one patients were included in the study. The daily titration algorithm achieved target capillary blood glucose (CBG) at stable insulin dose earlier (33 vs 41.3 days, p-value=0.042) than the twice-weekly titration. Better adherence was also seen among patients on daily titration algorithm as compared to twice weekly (94.94% vs. 91.12%, p-value = 0.009). There was no significant difference in incidence of hypoglycemia (p-value 0.0.62) for both algorithms. All patients from the two groups had significant HbA1c reduction at the end of the study period. Conclusion Daily titration algorithm achieved earlier target fasting plasma glucose and better patient adherence as compared to twice-weekly titration in the adjustment of basal insulin dose. HbA1c reduction and risk of hypoglycemia were similar in both titration algorithms.
Diabetes Mellitus, Type 2

Objectives: To compare mean basal metabolic rate (BMR) estimated using Harris-Benedict equation (HB) and Bioelectrical Impedance Analysis (BIA) and the BMR measured using Indirect Calorimetry (IC) among adult obese Filipino patients with prediabetes or type 2 diabetes mellitus (T2DM). Methodology: This was a multi-center, cross-sectional study based on review of outpatient medical records of adult, obese Filipino patients with pre-diabetes or type 2 diabetes mellitus who were seen prior to weight loss intervention at the Outpatient Clinic of St. Luke’s Medical Center-Quezon City and the Metabolic and Diabetes Center of Providence Hospital from August 2017 to January 2018. BMR was derived using three methods: Harris-Benedict equation, Bioelectrical Impedance Analysis and Indirect Calorimetry. Results: A total of 153 subjects were included in the study. Eighty subjects (52%) have pre-diabetes while 73 subjects (48%) were diagnosed with T2DM. The mean BMR measured using IC is 1299±252 kcal/day while estimated mean BMR predicted using HB equation and BIA were 1628±251 kcal/day and 1635±260 kcal/day, respectively. Compared to measurement by IC, HBE and BIA significantly overestimated the mean BMR by 329 and 336 kcal/day, respectively (p-value=<0.0001). IC measured BMR showed strong positive correlation with weight and moderate positive correlation with height. Multiple stepwise regression analysis yielded the BMR prediction equation: BMR (kcal/day) = -780.806 + (11.108 x weight in kg) + (7.164 x height in cm). Conclusion Among obese Filipinos with T2DM or prediabetes, HB equation and BIA tend to overestimate the BMR measured using IC.
Basal Metabolism ; Calorimetry, Indirect

Introduction: Type 2 diabetes mellitus has been linked to depression. However, this has been largely unrecognized and untreated. There are no current data available in the Philippine setting of the prevalence of the disease. Objective: The objective of the study was to determine the prevalence of depression among adult Filipino patients with type 2 diabetes mellitus and investigate the different clinical factors associated with it. Methodology: This is a single-center, analytic cross-sectional study conducted at a tertiary hospital, with 476 patients aged above 18 years old diagnosed with type 2 Diabetes Mellitus included. The Physicians Health Questionnaire 9 (PHQ-9) with a score of >5 was used to make a diagnosis of depression. Results: Prevalence of depression among patients with type 2 diabetes mellitus was 19.9%. Factors associated with increased odds of depression were having a post-graduate degree (p-value=0.012), presence of retinopathy (p-value=0.018), and higher MMA Score (lower adherence) (p-value=0.000). Conclusion Depression is prevalent among Filipino patients with type 2 diabetes mellitus. An integrated approach by the attending physicians and psychiatrists is required for the effective management of these patients
Depression ; Diabetes Mellitus, Type 2 ; Philippines

Background: The weight loss benefit of semaglutide in patients with diabetes is well-documented, but its clinical utility in treating obesity among patients without diabetes is less described. We therefore assessed the efficacy and safety of subcutaneous semaglutide as treatment for obesity in patients without diabetes. Methodology: A comprehensive search of PubMed/MEDLINE, Cochrane and Google scholar was performed to identify trials on the efficacy and safety of subcutaneous semaglutide on patients with obesity without diabetes. Primary outcome was expressed as percent mean weight difference. Secondary outcomes including risk for gastrointestinal adverse events, discontinuation of treatment and serious adverse events were expressed as risk ratios. These were calculated using the random effects model. Results: The study included 4 randomized controlled trials having a total of 3,613 individuals with obesity without diabetes. The mean difference for weight reduction was -11.85%, favoring semaglutide [95% confidence interval (CI) (-12.81,-10.90), p<0.00001]. Secondary outcomes showed that the risk of developing gastrointestinal adverse events was 1.59 times more likely with semaglutide (RR 1.59, 95%CI [1.34, 1.88], p<0.00001). Risk for discontinuation due to adverse events was twice as likely in the semaglutide group (RR 2.19, 95%CI [1.36,3.55], p=0.001) and the risk for serious adverse events was 1.6 times more likely for semaglutide (RR1.60, 95%CI [1.24, 2.07], p=0.0003). Serious events were mostly of gastrointestinal and hepatobiliary disorders such as acute pancreatitis and cholelithiasis. Conclusion Among individuals with obesity without type 2 diabetes, subcutaneous semaglutide is effective for weight loss with an 11.85% reduction from baseline compared to placebo. This supports the use of semaglutide for weight management in obesity. However, risk of gastrointestinal adverse events, discontinuation of treatment and serious adverse events were higher in the semaglutide group versus placebo.
Obesity ; Weight Loss

COVID 19 infection has taken millions of lives to date but knowledge regarding its occurrence is still new and evolving. Among the consistent data gathered over the past few months since it was declared as a pandemic by the WHO is that patients with underlying comorbidities, notably diabetes mellitus, hypertension, and obesity have worse clinical course and outcomes. The time frame when this study was conducted was during the period when the Philippines experienced the so- called “first wave” of the coronavirus in the local setting. This was also the time when any established drug therapy for COVID-19 infection was yet to be supported by any randomized controlled trials. Of the 12 patients enrolled in the case series, all of them had one or more underlying illnesses; the most common of which were hypertension, Vitamin D deficiency/insufficiency and cancer. Majority of the patients had an HbA1c level between 7.0%-8.0%, while an average HbA1c level of 7.5% was seen in those who expired. A greater proportion of patients (33%) were classified under obese category 1; this was followed by 25% of patients who are overweight. However, 50% of the patients who expired were morbidly obese. Treatment regimens for both diabetes mellitus and COVID-19 were also taken into consideration. Basal plus rescue dose regimen was the most common therapy comprising 50% of the patients. Only one patient was placed on insulin drip. For COVID-19 regimen, 40% of patients received combination antiviral therapy (ritonavir/lopinavir/oseltamivir) plus hydroxychloroquine. Half of the mortality seen in this study were given the combination of antiviral plus hydroxychloroquine. Thirty-Five percent of patients eventually expired, and these were also the set of patients who were placed on renal replacement therapy, inotropic support and mechanical ventilation during the course of their illness.
Diabetes Mellitus ; COVID-19

Introduction: Type 2 diabetes mellitus (DM) is one of the leading non-communicable causes of death in the Philippines with a prevalence of 5.4% and its pathogenesis includes insulin resistance correlated with excess weight and BMI. Asian-based studies have shown that serum C-peptide is strongly associated with newly diagnosed diabetes and has a linear increasing trend with BMI, hence, this study aimed to determine the correlation of body mass index (BMI) with fasting C-peptide levels in Filipino patients with newly diagnosed type 2 DM. Also, to determine the correlation of fasting C-peptide, markers of insulin secretion and sensitivity (Homeostasis Model Assessment of beta cell function and insulin resistance: HOMA-IR, HOMA-B) with other metabolic parameters in newly diagnosed diabetics: waist circumference, HbA1C, fasting blood sugar (FBS), lipid profile. Methods: This cross-sectional study included 35 treatment naïve, newly diagnosed type 2 DM Filipino patients evaluated with anthropometric measurements, fasting C-peptide, and other metabolic parameters. The correlations among fasting C-peptide, BMI, waist circumference, FBS, HbA1c, lipid profile, HOMA-IR, and HOMA-B were determined using Pearson correlation. Results: A significant positive relationship were observed between BMI and HOMA-IR(r=0.335); C-peptide and waist circumference (r=0.363); C-peptide and HOMA-B(r=0.357); HOMA-IR and C-peptide (r=0.892); HOMA-IR and waist circumference (r=0.438); HOMA-IR and triglycerides (r=0.543). HOMA-B was negatively correlated with FBS and HbA1C (r=- 0.771, and r=-0.641, respectively). No correlation was seen between BMI and C-peptide (p=0.61). Conclusion Body mass index (BMI) is not correlated with fasting C-peptide levels in newly diagnosed type 2 DM Filipino patients. The positive relationship between C-peptide, waist circumference, and HOMA-IR merits further evaluation with larger studies.
C-Peptide ; Diabetes Mellitus, Type 2 ; Body Mass Index ; Insulin Resistance

Introduction: Given the increasing burden of diabetes worldwide as well as in the Philippines, understanding factors affecting diabetes management is crucial. We investigated the factors leading to poor adherence to titration of longacting, once a day, basal insulin among patients with type 2 diabetes mellitus (DM) seen at the outpatient department (OPD) clinics of St. Luke’s Medical Center, Quezon City. Methods: This qualitative study included semi-structured individual interviews and focus group discussions (FGD). A total of 43 type 2 DM patients using once a day, basal insulin participated. 22 patients had one-on-one interviews while 21 patients were divided into three separate FGDs. Data were analyzed using thematic analysis. Results: More than half (53.5%) of the type 2 DM patients included in this study did not have any method of titration of their once-daily basal insulin despite being taught by their attending physicians. The categorized themes identified were the following: patient-centered, treatment-related, healthcare system-related, and psychological/social factors. Conclusion Lack of income or financial support, fear of insulin injection and its side effects, high cost of insulin, inaccessibility of medical assistance from healthcare facilities, negative attitude/fear of titration, and difficulty complying to lifestyle changes were some of the identified factors leading to poor adherence to the titration of once-daily basal insulin in this study. Good, constant communication between the patient and the doctor appears to improve adherence to insulin dose titration. Future studies may adapt the themes and concepts identified to improve adherence to titration of once-daily basal insulin among patients with type 2 DM.
Diabetes Mellitus ; Insulin ; Hypoglycemia ; Blood Glucose ; Patient Education as Topic ; Delivery of Health Care

Introduction: In 2017, the American Diabetes Association (ADA) have introduced and recommended a Diabetes Risk Test for immediate detection of diabetes mellitus. Given the growing number of diabetics worldwide and in our country, early diagnosis and control of diabetes is vital. This study aimed to validate the modified filipino version of the ADA Diabetes Risk Test and the SLIM (St. Luke’s Internal Medicine) Diabetes Risk Test. Methods: Phase I of this study involved questionnaire formulation, forward-back-forward translation, pilot testing and cognitive debriefing, and initial validation process (content validity, face validity, and test-retest reliability). There were 30 participants in the pilot testing, six experts for content validity, 40 patients in face validity, and 30 subjects for the test-retest reliability. Results: The modified filipino version of the ADA Diabetes Risk Test and the SLIM Diabetes Risk Test formulated were considered relevant by majority of the subjects from the pilot testing and face validity and had content validity score from experts ranging from 80-100%. Items 1-4, and 8 of the questionnaires showed a kappa of one (p-value of <0.001) while the rest of the questions had kappa scores ranging from 0.60 to 0.86. Conclusion The St. Luke’s Internal Medicine (SLIM) Diabetes Risk Test, a 12-item questionnaire, was developed from the modified Filipino version of the ADA Diabetes Risk test incorporating other risk factors for diabetes to cater for adult Filipino patients. Phase I of this study showed that this questionnaire has acceptable content validity with moderate to perfect test-retesting reliability. Phase II of this study testing the criterion validity to determine diagnostic accuracy is ongoing.
Risk ; Risk Factors ; Diabetes Mellitus, Type 2 ; Surveys and Questionnaires ; Cross-Sectional Studies

Background: The dose of levothyroxine (LT4) after total thyroidectomy is usually computed based on actual body weight. However, metabolism through deiodination of thyroid hormones usually occur in the lean body compartment. An optimal dose to reduce delay in achieving target levels is essential to improve quality of life, reduce risk factors and cost. Objectives: Comparison of the efficacy of two methods of computation for the initial levothyroxine dose in patients with differentiated thyroid cancer based on actual body weight vs. lean body mass in achieving thyroid-stimulating hormone (TSH) goals. Methodology: Randomized, single-center, 12-week open label controlled trial among adult patients with differentiated thyroid cancer post total thyroidectomy who underwent radioactive therapy at St. Luke’s Medical Center Quezon City from July-December 2018. Participants were divided into 2 groups - Actual Body Weight (ABW) and Lean Body Mass (LBM). Levothyroxine dose was computed based on ABW vs. LBM and TSH determined at 6th and 12th weeks after. Results: 52 participants (ABW n=26; LBM n=26) were included. ABW group had significantly higher mean LT4 dosage (2.2 mcg/kg) compared to the LBM group (1.4 mcg/kg) (p-value<0.001). ABW group had lower TSH levels at 6th week (5.7 uIU/mL) than LBM group (18.4 uIU/mL) but the difference was not significant. (p-value=0.064). A significantly lower TSH level was observed at week 12 in the ABW group (1.6 uIU/mL) compared to the LBM group (3.8 uIU/mL) (p-value=0.010). However, both methods were not associated with achievement of TSH goal at 6th and 12th week (p-value=0.512 and 0.780, respectively). Conclusion Among patients with differentiated thyroid cancer who underwent 1st time RAI therapy, ABW method of computation for LT4 dosage is better compared to the LBM method due to the lower TSH trend seen at 6th week and statistically significantly lower mean TSH at week 12, although, both method of computations did not achieve target TSH levels at the 6th nor 12th week.

Objectives: To compare the level of insulin resistance and β-cell function between lean and overweight/obese Filipino patients with newly diagnosed type 2 diabetes mellitus (T2DM). Methodology: This was a cross-sectional analytical study including newly diagnosed T2DM Filipino patients from St. Luke’s Medical Center - Quezon City. The patients were classified as either lean or overweight/obese. Age, sex, smoking history, anthropometric measures and blood pressure were obtained. Insulin resistance and β-cell function were determined using the homeostasis model assessment (HOMA). The original model (HOMA1) and the updated model (HOMA2) were used. Results: A total of 80 subjects were included. There were 40 subjects in each group. The overweight/obese subjects had significantly higher mean insulin resistance (HOMA1-IR 9.8±11.7, HOMA2-IR 3.0±2.0) compared to the lean group (HOMA1-IR 2.9±1.5, HOMA2-IR 1.3±0.5). This was consistent in both HOMA1 and HOMA2 (p-values=0.001 and <0.001, respectively). The mean β-cell function of the overweight/obese patients was significantly higher than the lean subjects when using HOMA1 (lean=57.8±35.5, overweight/obese=93.6±66.4, p-value=0.003), but not in HOMA2 (lean=57.6±30.5, overweight/obese=74.8±45.7, p-value=0.051). Overweight/obesity increased HOMA1-IR by 4.0 and HOMA1-B by 46.1 (p-values= 0.002 and <0.001, respectively). Through the use of HOMA2, overweight/obesity increased HOMA2-IR by 1.4 and HOMA2-B by 29.1 (p-values<0.001). Being overweight/obese was also associated with significantly higher odds for developing greater insulin resistance (HOMA1-IR adjOR = 5.6, 95%CI= 1.7-19.2, p-value=0.005; HOMA2-IR adjOR=10.9, 95%CI=3.4-34.9, p-value<0.001) and lower odds for a decreased β-cell function (HOMA1-B adjOR = 0.2, 95%CI = 0.05-0.9, p-value=0.033; HOMA2-B adjOR=0.2, 95%CI=0.04-0.9, p-value=0.043) compared to being lean. Conclusion Newly diagnosed overweight/obese T2DM had higher mean insulin resistance and β-cell function compared to lean T2DM. Overweight/obesity was also associated with higher odds of developing insulin resistance and lower odds for a decreased β-cell function compared to being lean. The overweight/obese T2DM group also had worse metabolic profile manifested by higher FPG, HbA1c, SGPT and blood pressures compared to the lean T2DM group.
Diabetes Mellitus, Type 2 ; Insulin Resistance ; Overweight