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