Background: Work life of individuals with diabetes differs from that of those without diabetes. Work may interfere with diabetes self-management tasks, resulting in intentional hyperglycemia at work (IHW) and poor glycemic control. Diabetes also can affect work productivity due to work-related diabetes distress (WRDD) and impaired work ability (WA). Methodology: A cross-sectional study was done at the Specialized Medical Hospital Mansoura University, which included 323 working patients with diabetes. They were subjected to personal interviews to collect socio-demographic data, occupational, diabetes and other pertinent medical histories. Questionnaires for measuring IHW, WRDD and WA were completed. Clinical and A1c data were obtained from their records. Results: The prevalence of always high IHW, poor/very poor glycemic control, high WRDD and poor/moderate work ability was: 23.8%, 60.1%, 34.7% and 74.6%, respectively. The predictors of always high IHW were: 1) Below university education; 2) Treatment with insulin only or combined with oral drugs and 3) High WRDD. The predictors of poor/very poor glycemic control were urban residence, always and almost high IHW. The predictors of high WRDD were mentally-requiring jobs or both mentally- and physically-requiring jobs, duration of diabetes greater than 14 years and treatment with insulin. The predictors of poor/moderate WA were 'high' WRDD, 'almost high' and 'high a few times' IHW ratings. Conclusions Most of the studied population suffered mainly from poor/very poor glycemic control and poor/moderate work ability, while a lower proportion had high WRDD. This highlighted the need for workplace modifications and interventions to help workers with diabetes control their diabetes, improve their work ability and reduce WRDD to increase productivity.
Glycemic Control

Background: Worldwide, diabetes mellitus (DM) is a serious health issue with a global prevalence of 9.8% in 2021. According to the latest 2018 Expanded National Health and Nutrition survey done by the DOST-FNRI, the prevalence of diabetes in the Philippines have more than doubled from 3.4% in 2003 to 7.9% in 2018. The latest research conducted regarding diabetes care in the Philippines was in 2008 which showed that 85% of patients with diabetes failed to achieve the HbA1c general target of <7%. Objectives: A population-based cross-sectional study to update the current status of diabetes care in the Philippines, specifically to determine glycemic control, trends in DM management, prevalence of complications and lastly their clinico-socio demographic profile. Methods: 340 patients with diabetes were included from the clinics of the Institute for Studies on Diabetes Foundation, Inc. physicians. The following data were collected: clinico-socio demographic profile, HbA1C-based glycemic control, trend in the use of glucose lowering agents, and prevalence of diabetes complications. Results: The mean age of the 340 patients with diabetes in this study was 62 years old. Almost sixty-seven percent (66.8%) were females. The mean body mass index was 26 kg/m2. The mean duration of diabetes was 12.63 years. Close to sixty- eight percent (67.6%) had tertiary education, 58.8% were unemployed and 65% had above minimum income. The most commonly used single oral agent was biguanide (72.9%), followed by dipeptidyl peptidase-4 inhibitors (64.3%). The most common dual therapy combinations were biguanide plus dipeptidyl peptidase-4 inhibitors (43.2%), biguanide plus sulfonylureas (27.2%), and biguanide plus sodium-glucose co-transporter-2 inhibitors (11.1%). Basal insulin was the most commonly used injectable agent. The present study showed that 47.4% of patients achieved an HbA1c of <7%. For the microvascular complication group alone, most had neuropathy (30.4%) followed by nephropathy (17.3%) and by retinopathy (5.4%). For the macrovascular complication group, the most common was coronary artery disease (82%) followed by peripheral artery disease and DM foot (27%). Overall, the most frequent DM complication identified was neuropathy (30.4%) , nephropathy (17.3%) and coronary heart disease (16.1%). Discussion Compared to the 2008 study, oral glucose lowering agents’ usage shifted from sulfonylureas to more use of dipeptidyl peptidase-4 inhibitors. There was a decline in the use of thiazolidinediones, α-glucosidase inhibitors and non-use of meglitinides. For insulin use, there was a shift from the use of premixed insulin to more basal insulin usage. There was marked improvement in the diabetes care situation in the Philippines from the 2008 study to the 2020 study. Glycemic control defined as HbA1c level of <7.0 increased from 15% to 47.4%. Coronary artery disease was the most common macrovascular complication while neuropathy was the most common overall and microvascular complication.
Diabetes Complications ; Glycemic Control

Objectives: This study aimed to investigate the association of hyperglycemia and AGE on the phenotypes and biological functions of neutrophils to understand their roles in diabetes-related atherosclerosis. Methodology: Healthy subjects (HS) (n=5) and type 2 diabetic patients grouped according to glycemic control [good control, HbA1c 7% or less, n=6 (well controlled diabetic, WCD); poor control, HbA1c more than 9%, n=6 (poorly controlled diabetic, PCD)] were included in the study. Neutrophils were isolated from peripheral venous blood samples. To determine in vitro effects of high glucose and AGE, neutrophils derived from HS were exposed to 5 mM glucose, 25 mM glucose, 100 μg/mL BSA and AGE-BSA. We determined basal and PMA-stimulated production of ROS, expression of CD11b and CD66b, release of MPO, cell migration to IL-8 and adhesion to an endothelial cell layer. Results: In diabetic subjects, cells from WCD produced significantly higher basal and PMA-stimulated ROS (p=0.014), while cells from PCD showed significantly increased expression of CD11b, CD66b and MPO production (p=0.021, 0.034, 0.05, respectively). The release of MPO was significantly increased after PMA stimulation in cells incubated in AGE-BSA, compared to those incubated in unmodified BSA. We observed significantly enhanced migration towards IL-8 and adherence to endothelial cells in neutrophils exposed to high glucose. Conclusions Our findings indicate the activated status of neutrophils from diabetic patients. Neutrophils from healthy subjects exposed to conditions simulating hyperglycemia showed increased adhesive capacity. We made the novel finding of enhanced neutrophil migration toward IL-8 and adherence to endothelial cells upon exposure to high glucose conditions. These altered neutrophil functions may lead to the development and progression of atherosclerosis in diabetes.
Neutrophils ; Glycemic Control ; Atherosclerosis

Background and Objective: The family plays an important role in the management of patients with Diabetes Mellitus. In this study, the authors determined the association between family function using the APGAR questionnaire with glycemic control among Type 2 diabetic patients. Association between demographic and clinical characteristics with glycemic control was also assessed. Methods: This was a cross-sectional study of 237 adults ages 18 years old and above with Type 2 Diabetes Mellitus seen in Healthway clinics in Las Piñas between April 2021 to May 2021. Data from participants were obtained through a self-administered questionnaire and review of recent HbA1c results. The questionnaire contained 3 sections which included sociodemographic and clinical characteristics of the participants, their recent HbA1c result, and Family APGAR score. Multiple logistic regression analysis was done to determine the association of glycemic control with family function, demographic, and clinical factors. Results: Four variables were noted to be significantly associated with glycemic control- family function (p<0.0001), duration of being diabetic (p=0.021), diabetes regimen (p=0.013), and comorbidity status (p=0.021). Respondents with functional families as evaluated from their Family APGAR scores were 6 times more likely to have good glycemic control (OR 6.204) compared to those with dysfunctional families. Respondents with ≤10 years duration of diabetes (OR 4.051) and on both oral and insulin therapy (OR 9.639) are more likely to have good glycemic control. Respondents with comorbidities (OR 0.465) are less likely to achieve good glycemic control Conclusion Family APGAR score, duration of diabetes, type of diabetes regimen, and presence of comorbidities should be highlighted in diabetic management as they may influence glycemic control. This supports the need to include family assessment (especially family function) in the routine care of diabetic patients, and to address family issues which may hinder achievement of glycemic targets.
Glycemic Control ; Diabetes Mellitus

Objectives: To evaluate if magnesium supplementation, in addition to standard therapy, improves fasting blood sugar (FBS) and/or glycosylated hemoglobin (HbA1c) in patients with type 2 diabetes mellitus (T2DM) compared to placebo or other comparator. Methodology: We searched MEDLINE/PubMed, Cochrane Library, Acta Medica Philippina, Health Research and Development Information Network (HERDIN) and references of reviewed journals from 1966 to July 2015 using the following search terms: “magnesium” OR “magnesium supplementation” OR “magnesium replacement”, AND randomized controlled trial AND diabetes OR diabetes mellitus OR non-insulin dependent diabetes mellitus OR diabetic OR diab* (with MeSH, where available). Studies were retrieved and rated independently using the standards provided by The Cochrane Collaboration. High quality trials were included in a systematic review and meta-analysis. Results: Of the 689 records screened, 10 studies were included in the qualitative synthesis and 7 studies in the meta-analysis. Pooled data showed a non-significant trend towards improvement in glycemic control in the magnesium-treated group (mean difference -0.19, CI -0.58 to 0.21). There was a stronger but still non-significant trend in T2DM patients with hypomagnesemia (mean difference -1.16, CI -2.92 to 0.6). Conclusion Routine magnesium supplementation for improvement in glycemic control in T2DM patients cannot be recommended based on data from included studies in this meta-analysis.
Magnesium ; Glycemic Control ; Meta-Analysis

Objectives: This study aims to evaluate the effectiveness of initial insulin therapy versus oral hypoglycemic agents in glucose control among newly diagnosed Type 2 diabetes patients. Methodology: This is a systematic review and meta-analysis of RCTs with quality grade B searched using the medical subject headings (MeSH): diabetes mellitus type 2, insulin, oral hypoglycemic agent, with adults newly diagnosed with type 2 DM as subjects and given insulin (± metformin) vs. OHA. Results were summarized as graphs and forest plots using the random effects due to foreseen sources of heterogeneity using Review Manager version 5.1. Results: Presence of substantial heterogeneity prevents us from making a conclusion. All four studies showed lower post treatment BMI among participants in the insulin treatment arm. An opposite finding was expected as insulin is known to cause weight gain. Main adverse effect was hypoglycemia. Conclusion Among newly diagnosed type 2 DM patients, there is insufficient evidence for or against the use of insulin compared to oral hypoglycemic agents as initial management in terms of improvement in glycemic control, decrease in insulin resistance, and improvement in beta cell function.
Diabetes Mellitus, Type 2 ; Glycemic Control

Objective: To determine the association between serum 25-hydroxyvitamin D (25(OH)D) and measures of glycemic control, hemoglobin A1c (HbA1c) and fasting plasma glucose (FPG), in adult patients with diabetes mellitus. Methodology: This is an analytical cross-sectional study of 270 patients with diabetes admitted to a tertiary hospital. Serum 25(OH)D levels were categorized as follows: sufficient (>30 ng/mL), insufficient (20 to 30 ng/mL), and deficient (<20 ng/mL). The correlation of HbA1c and FPG with serum 25(OH)D and other variables was determined using Spearman’s rho (ρ) coefficient. The risk factors associated with HbA1c ≥7% and FPG ≥126 mg/dL were determined using logistic regression analysis to generate crude and adjusted odds ratios. The null hypothesis was rejected at 0.05 α-level of significance. Results: The median serum 25(OH)D was 18.92 (range 3.56–56.3) ng/mL. Ninety percent (245 patients) had vitamin D levels below 30 ng/mL. This study showed that vitamin D level is significantly but weakly correlated with patient’s age (ρ=0.339) and duration of diabetes (ρ=0.147), whereas it had inverse correlations with BMI (ρ=-0.134), HbA1c (ρ=-0.261), and FPG (ρ=-0.198). Conclusion In this study, we found a possible association between vitamin D levels and measures of glycemic control among this group of adult Filipino patients with diabetes mellitus, but further investigations in other cohorts of individuals with diabetes are needed.
Vitamin D ; diabetes mellitus ; glycemic control

Objective: To determine the efficacy of metformin and insulin in the management of gestational diabetes mellitus (GDM). Methodology: Randomized controlled trials (RCT) were retrieved from the databases. All references cited in the articles were also searched by hand to identify additional publications. Studies included were limited to trials on metformin and insulin in the management of GDM in singleton pregnancies. Four RCTs were analyzed in the study. The risk of bias was assessed using Preferred Reporting Items for Systematic reviews and Meta-Analyses Cochrane Collaboration’s tool (Rob 2). Random effects meta-analysis was carried out to pool the data. All analyses were conducted in Review Manager 5.3.5 (2014). Results: Meta-analysis of four RCT involving 807 participants (405 were treated with metformin and 402 were treated with insulin) shows that there was no significant difference between metformin and insulin in achieving glycemic control as to fasting blood sugar (FBS), postprandial blood glucose (PPBG), and glycosylated hemoglobin, mean difference (MD) −0.43 (95% confidence interval [CI] −2.77–1.91; P = 0.72), MD −2.13 (95% CI −5.16–0.90, P = 0.17), MD −0.09 (95% CI −0.20–0.02, P = 0.10), respectively. For maternal outcomes, there was a statistically significant 69% decreased risk of hypoglycemia in the metformin group (risk ratio [RR] 0.31, 95% CI 0.20–0.49; P < 0.001). There was no difference in terms of risk of preterm birth (RR 1.11, 95% CI 0.75–1.64, P = 0.60); hypertensive disorders (RR 1.06, 95% CI 0.71–1.60, P = 0.77); polyhydramnios (RR 1.04, 95% CI 0.51–2.14, P = 0.91); and risk of cesarean delivery (RR 0.90, 95% CI 0.75–1.08, P = 0.27). For neonatal outcomes, there was statistically significant 34% reduction on the risk of neonatal hypoglycemia (RR 0.66, 95% CI 0.46–0.94; P = 0.02) in the metformin group. There was no statistical difference in terms of mean birthweight (MD − 81.34, 95% CI −181.69–19.02, P = 0.11). Metformin has decreased the risk of newborns weighing more than 4000 g, babies with birthweight >90th percentile by 27% (RR 0.73, 95% CI 0.28–1.90, P = 0.52), and 20% (RR 0.80, 95% CI 0.54–1.18,P = 0.26), respectively, but these were not statistically significant. There was no significant difference in terms of risk of birthweight <10th percentile (RR 1.17, 95% CI 0.60–2.31, P = 0.65); APGAR <7 (RR 1.17, 95% CI 0.65–2.08, P = 0.60), birth trauma (RR 0.77, 95% CI 0.23–2.58, P = 0.67), and jaundice requiring phototherapy RR 1.04, 95% CI 0.66–1.65, P = 0.85). Neonatal intensive care unit admission (RR 0.89, 95% CI 0.64–1.23, P = 0.48), respiratory distress syndrome (RR 0.73, 95% CI 0.36–1.50, P = 0.39), transient tachypnea (RR 0.78, 95% CI 0.27–2.19, P = 0.63), and any congenital anomaly (RR 0.58, 95% CI 0.20–1.67, P = 0.31) were decreased in the metformin group but was not statistically significant. Conclusion There was no significant difference between metformin and insulin in achieving glycemic control as to FBS and PPBG among patients with GDM. There was a statistically significant reduction in the risk of maternal and neonatal hypoglycemia in the use of metformin.
Diabetes, Gestational ; Glycemic Control ; Insulin ; Metformin

Background: A daily habit of yogic practice or walking, along with an oral hypoglycemic agent (OHA) could be beneficial for better control of type 2 diabetes mellitus (T2DM). We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to find out the efficiency of yoga or walking on glycemic control in T2DM. Methodology: The present systematic review and meta-analysis were completed according to the PRISMA guidelines. The risk of bias in included studies was evaluated, by using the revised Cochrane risk-of-bias tool for randomized trials. Meta-analysis was implemented using RevMan software. Forest plots were used to illustrate the study findings and meta-analysis results. Results: Sixteen studies were included in this systematic review, where 1820 participants were allocated to one of the following interventions: yoga, walking, and without any regular exercise (control group). Participants were between 17–75 years of age. Compared to the control group, the yoga group had a significant reduction in fasting blood glucose (FBG) by 31.98 mg/dL (95% CI,–47.93 to –16.03), postprandial blood glucose (PPBG) by 25.59 mg/dL (95% CI, –44.00 to –7.18], glycosylated hemoglobin (HbAlc) by 0.73% (95% CI, –1.24 to -0.22), fasting insulin by 7.19 μIU/mL (95% CI, –12.10 to –2.28), and homeostatic model assessment for insulin resistance (HOMA-IR) by 3.87 (95% CI, –8.40 to -0.66). Compared to the control group, the walking group had a significant reduction in FBG by 12.37 mg/dL (95% CI, –20.06 to –4.68) and HbA1c by 0.35% (95% CI, –0.70 to –0.01). Compared to the walking group, the yoga group had a significant reduction in FBG by 12.07 mg/dL (95% CI, –24.34 to – 0.20), HbA1c by 0.20% (95% CI, –0.37 to –0.04), fasting insulin by 10.06 μIU/mL (95% CI, –23.84 to 3.71) and HOMA-IR by 5.97 (95% CI, –16.92 to 4.99). Conclusions Yoga or walking with OHA has positive effects on glycemic control. For the management of T2DM, yoga has relatively more significant effects on glycemic control than walking.
Yoga ; Walking ; Diabetes Mellitus, Type 2 ; Glycemic Control ; Insulin Resistance

Background: Diabetes mellitus is a chronic disease which has been increasing both in incidence and global impact. In the Philippines, cases of diabetes mellitus increase at an alarming rate. Previous study in Nigeria among Type 2 Diabetic patients with non-alcoholic fatty liver disease (NAFLD) has observed an increased prevalence of 69%. However, there is no definite association between severity of NAFLD and glycemic control (HbA1c). Objectives: To investigate the prevalence of NAFLD and its association with glycemic control of Type 2 Diabetes Mellitus (T2DM) patients at Batangas Medical Center (BatMC) – Out Patient Department (OPD). Methods: A single center, cross sectional study was performed on 80 T2DM patients, who underwent OPD consultation between November 2020 to October 2021. Clinicodemographic profile, duration of T2DM, diagnostic tests including HbA1c and ultrasound of the liver were taken. Chi-Square test of homogeneity and Fisher’s Exact test/Fisher-Freeman-Halton test were utilized for comparison of categorical variables from a single population to determine whether there is a significant association between the severity of NAFLD and patients characteristics and glycemic control. Results: 80 T2DM patients were included in the analysis, there was an equal number of male (50%) and female (50%). Majority of the patients were in the age of 50 – 59 years old (33%), with a BMI of 25 and above (81%), had been diagnosed with T2DM for > 5 years (72%) and maintained with oral hypoglycemic agents (68%). The prevalence of NAFLD by ultrasonography among T2DM patients was 81%. 80% of these patients had mild NAFLD and 20% had moderate NAFLD; but none had severe NAFLD. The average HbA1c level of 8.9% had a mild NAFLD compared to patients with moderate NAFLD with an average HbA1c level of 10.1%. With a p=0.053, NAFLD severity and glycemic control do not show any statistically significant association. Subgroup analysis was not performed in the study due to limited sample size. In addition, results of association are not sufficient evidence for any conclusion; hence, there appear to be no group of interest. Conclusion The result of this study confirmed that the prevalence of NAFLD in T2DM was high at 81% but there is no sufficient evidence to conclude a statistically significant association between the level of glycemic control and the severity of NAFLD.
Diabetes Mellitus, Type 2 ; Non-alcoholic Fatty Liver Disease ; Glycemic Control ; Dyslipidemias ; Obesity ; Metabolic Syndrome