BACKGROUND

Type 2 diabetes is the most common type of diabetes in the Philippines. Diabetic foot complications represent a prevalent and significant chronic concern for individuals with type 2 diabetes. This poses an immediate community health concern, as diabetic complications may threaten an individual's well-being.

This study intends to cross-culturally adapt the Diabetic Foot Knowledge Subscale (DFKS) and Foot Self-Care Behavior Scale (FSCBS) questionnaires into the Filipino language as an assessment tool among Filipinos with diabetes.

The study employed a psychometric research design, where it entailed Phase A and Phase B. Phase A involved the forward translation of the DFKS and FSCBS questionnaires, followed by the synthesis of the translations and backward translation. Subsequently, an expert committee reviewed the translations and concluded the final version. The final translated versions of the questionnaires ensured that it can be understood by an individual who has a Grade 6 level of reading proficiency. Phase B entailed the validity testing with the evaluation of the expert committee, and reliability testing of the said questionnaires with a sample size of 30 participants. A wash-out period of 24 hours was given for the test-retest reliability, followed by data analysis. The validity and reliability of the questionnaires were measured using the item and scale content validity indices and the internal consistency and test-retest reliability, respectively, to ensure their accuracy and appropriateness. The content validity of the questionnaires was evaluated individually by the experts using a Likert scale from 1-4, with 4 being the highest meaning the item was very relevant and succinct. Scores per item were between 3 and 4, which indicate that the translated version of the items were relevant and succinct or were relevant but needed minor revisions.

The validity scores for the translated DFKS and FSCBS questionnaires were obtained using the Scale Content Validity Index (S-CVI) with a score of 0.96 and 0.92, respectively. Moreover, all items in the questionnaires obtained an Item Content Validity Index (I-CVI) of 0.88-1.00. The DFKS also has an acceptable internal consistency with a Cronbach’s alpha of 0.72, while the FSCBS has a good internal consistency with a Cronbach’s alpha of 0.85. The test-retest reliability shows an acceptable Spearman’s correlation at 0.76 for the DFKS and a strong positive Pearson correlation coefficient at 0.73 for the FSCBS.

The validity of the two questionnaires was acceptable and the test-retest reliability showed a strong positive correlation among the items thereby making the cross-cultural adaptation of the questionnaires successful. The Filipino versions of the DFKS and FSCBS questionnaires accurately measure the knowledge and behavior of individuals with type 2 diabetes, respectively.

BACKGROUND AND OBJECTIVE

Type II Diabetes Mellitus remains a pressing public health concern among Filipino adults, particularly prevalent in urban households belonging to the middle to richest wealth population. As body composition influences glucose metabolism, understanding the potential of anthropometric parameters is vital in predicting fasting blood sugar. This study aims to generate and find the most appropriate model that can detect likelihood of elevated FBS using different anthropometric parameters.

The data set from 2018-2019, 2021 Expanded National Nutrition Survey of Department of Science and Technology - Food and Nutrition Research Institute, consisting of 14,655 adults aged 18–65 years from 33 highly urbanized cities (HUCs) was used in this study. While controlling for study variables, multiple logistic regression was used to determine significant predictors affecting the fasting blood sugar (FBS) status of these adults.

The above normal status of each anthropometric parameter, in the models for BMI (aOR=2.33; pCONCLUSION

There is no single anthropometric parameter that can truly discern the status of elevated FBS. However, it appears the use of waist circumference and waist-hip ratio have the potential to be an indicator especially in settings where the evaluation of the actual FBS of the individuals is not feasible. Future research suggests exploring possible interaction of BP, and FBS, diet quality and adequacy, and the effectiveness of having multiple anthropometric parameters in one model.

INTRODUCTION

Patients with diabetes are at higher risk of developing severe COVID-19 infection with a two-fold increased risk of mortality. This study described the risk factors affecting clinical outcomes of confirmed COVID-19 patients with diabetes mellitus at the University of Santo Tomas Hospital, Manila, Philippines.

This retrospective study included 204 patients with COVID-19 (34 with known type 2 diabetes and 2 with new-onset diabetes) from March to October 2020. Clinical characteristics and laboratory parameters were collected and analyzed in subjects with diabetes. A univariate logistic regression was used to calculate the odds ratios and 95% confidence interval (CI) for the patient’s risk factors associated with mortality or poor prognosis.

Moderate COVID-19 infection occurred in 52.8% of type 2 diabetes mellitus (T2DM) patients and critical COVID-19 infection in 27.8%. All patients with critical COVID-19 infection presented with acute respiratory distress syndrome, half had concomitant septic shock and respiratory failure was observed in 27.8%. The average length of hospital stay was approximately 17.5 days. T2DM patients with established atherosclerotic cardiovascular disease (ASCVD) are 5.1 times (95% CI 1.2 to 21.4) more likely to develop severe or critical COVID-19 infection, and more likely to stay in the hospital for more than 14 days. HbA1c >8.5% is a potential risk (OR = 3.7, 0.6 to 21.6) for severe to critical disease. T2DM patients with concomitant coronary artery disease are 7.6 times (95% CI 1.3 to 43.4) more likely to stay longer (more than 14 days) as compared to those without existing coronary artery disease. Prior statin use was a significant risk factor for ICU admission (p-value 0.0341). Other potential risk factors affecting clinical outcomes are obesity (OR 3, 0.4 to 22.7), prior use of thiazolidinedione (OR 7.8, 0.5 to 126.7) or sodium-glucose transporter 2 (SGLT2) inhibitors (OR 7.5, 0.4 to 145) and prior use of anti-thrombotic (OR 4.6, 0.4 to 56.8). The recovery rate of T2DM patients hospitalized for COVID-19 infection was 86.1%.

Patients with T2DM are more vulnerable to COVID-19 infection. The presence of established ASCVD increases the likelihood of severe COVID-19 disease as well as longer length of hospital stay for more than 14 days. Early recognition and prompt treatment led to a favorable recovery rate.

BACKGROUND

Diabetes is a chronic metabolic condition that represents a major public health issue worldwide, with Type 2 diabetes comprising 80-90% of all cases1. It is estimated that individuals with diabetes will increase from 451 million in 2021 to 693 million by 2045, with around 4.3 million individuals affected in the Philippines as of 20212,3,4. While insulin therapy is vital for managing diabetes, acceptance among patients is frequently obstructed by concerns about side effects, potential disruptions to their lifestyle, and stigma associated with injections.

The objective of the study was to determine the barriers to insulin therapy among adult patients with Type 2 Diabetes mellitus of the Department of Family and Community Medicine of Quezon City General Hospital.

This is a cross-sectional study carried out between July and September 2024 involving 117 participants with Type 2 diabetes. Information was gathered through self-administered questionnaires consisting of the Insulin Treatment Appraisal Scale (ITAS) and the SCREEM-RES questionnaire.

Majority of the participants (67.06%) were aged between 60 and 65, predominantly female (56%) and unemployed with a monthly family household income of less than 8,000 pesos. ITAS revealed negative perceptions towards insulin treatment, primarily due to fear and perceived loss of control. Family resources among the participants was revealed to be inadequate, as reflected in the SCREEM-RES questionnaire.

Age, education, employment status, household income, high negative attitude towards insulin and inadequate family resources are found to be barriers to initiating insulin. The study highlights the need for improved education to foster a supportive environment for insulin use and emphasizes the importance of involving patients in their treatment decisions for effective diabetes management and better long-term health outcomes.

BACKGROUND

Diabetes mellitus (DM) is a significant and growing global health concern. Worldwide, 537 million adults have diabetes and 206 million of them are from the Western Pacific Region1. Local prevalence continues to remain high at 7.5%, with 4,303,899 adult Filipinos suffering from diabetes in 2021. DM significantly contributes to the growing burden of chronic kidney disease (CKD) worldwide with about 50% of end-stage renal disease (ESRD) being due to diabetic nephropathy alone. Likewise, 60% of Filipinos on maintenance dialysis have ESRD due to DM and hypertension. The primary care setting is the initial point of contact between healthcare providers and patients with type 2 diabetes, hence, the development of clinical practice guidelines that will provide guidance in caring for patients with stable complications of diabetes. The guideline is the first of 3 that are being developed by the Philippine Academy of Family Physicians for the diagnosis and management of adult patients with type 2 diabetes and stable microvascular complications – nephropathy, retinopathy and neuropathy.

This guideline aims to provide evidence-based recommendations on the diagnosis and management of adults with type 2 diabetes mellitus (T2DM) and early stage CKD and is divided into 5 main sections – Clinical Assessment, Diagnostic Tests, Pharmacologic Treatment, Non-pharmacologic Treatment and Patient Outcomes.

The method of guideline development followed the ADAPTE process. The Technical Working Group identified 19 key questions after consultation with colleagues and patients. Recommendations were adopted from high-quality clinical practice guidelines whenever applicable for most of the key clinical questions. On the other hand, the De Novo method of evidence review was used to answer key clinical questions for which recommendations from reviewed guidelines were not available. A modified GRADEPro was used in assessing the quality of evidence – high, moderate, low or very low. Following external review by a nephrologist, the draft recommendations were sent to the members of the consensus panel. Voting on whether to include or not by the consensus panel was facilitated to determine the strength of each recommendation – strong, moderate or weak.

After reviewing 3 high-quality clinical practice guidelines and the current evidence, the technical working group was able to develop 40 recommendations for the 19 key clinical questions.

Introduction: There has been an increasing awareness of the effects of combining bromocriptine-QR with other medications for diabetes mellitus type 2. This study aimed to assess the efficacy and safety of bromocriptine-QR as an adjunctive therapy for patients with uncontrolled type 2 diabetes mellitus. Methodology: This systematic review is registered at the International Prospective Register of Systematic Reviews (CRD42022360326). Literature search was done via MEDLINE, NCBI, Google Scholar, Science Direct, Europe PMC and Cochrane Library databases. We included randomized controlled trials with participants 18 years old and above with uncontrolled type 2 diabetes mellitus. The primary outcome of interest is the efficacy and safety of bromocriptine-QR as an adjunctive therapy for glycemic control. Case reports, case series, reviews and animal studies were excluded. The risk of bias was reviewed using the Cochrane Risk of Bias tool. Meta-analysis was performed using Review Manager 5.4 and presented as a weighted mean difference and 95% confidence interval for changes from the baseline level. Results: Nine studies were included in the systematic review with a total of 2709 participants. The baseline HbA1c in the bromocriptine-QR group was 7.42% and 7.51% in the control group. The bromocriptine-QR group was favoured, outperforming the control group in terms of reducing hemoglobin A1c(HbA1c), with a statistically significant difference (weighted mean difference -0.6%; 95% CI [-0.83,-0.36]; p<0.00001). The most common side effects were nausea (33.75% vs 6.92%), fatigue (13.11% vs 5.94%), and headache (11.17% vs 6.87%). Conclusion Administration of bromocriptine-QR at a dose range of 1.6 to 4.8 mg/day as an adjunctive therapy reduced HbA1c and FBG in patients with uncontrolled type 2 diabetes mellitus (T2DM). However, there were also statistically greater odds of the occurrence of adverse events such as nausea, vomiting, and headache compared to controls.
Diabetes Mellitus, Type 2

Objective: This study aimed to evaluate the effects of combination of curcumin and piperine supplementation on Fasting Plasma Glucose (FPG), Homeostatic Model of Insulin Resistance (HOMA-IR), Body Mass Index (BMI) in patients with prediabetes and type 2 Diabetes Mellitus (T2DM). This review was done to identify potential herbal remedies that may help improve glycemic parameters, leading to better health outcomes in combination with current antidiabetic treatment. Methodology: This systematic review was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). It was conducted in 2023 with sources and databases from MEDLINE, EBSCO-Host, ScienceDirect and ProQuest. This paper included randomized-controlled trials exploring the effects of the combination of curcumin and piperine on patients with prediabetes and T2DM. Systematic reviews, observational studies, case reports, case series, conference abstracts, book sections, commentaries/editorials, non-human studies and articles with unavailable full-text and written in non-English language, were excluded. The key terms for the literature search were “curcumin,” “piperine,” “prediabetes” and “Type 2 Diabetes Mellitus.” We use Cochrane Risk of Bias (RoB) 2 for quality assessment of the included studies and Review Manager (RevMan) 5.4 to do the meta-analysis. Results: A total of three studies were included in this systematic review. Two studies from Neta et al., and Cicero et al., showed no significant difference in HOMA-IR, BMI and FPG levels between the curcumin, piperine and placebo groups. One study from Panahi et al. demonstrated a significant difference in BMI levels between the curcumin and piperine and placebo groups (p <0.01). The meta-analysis showed that FPG levels, HOMA-IR and BMI improved among patients with diabetes given in curcumin and piperine with reported mean differences (MD) of = -7.61, 95% CI [-15.26, 0.03], p = 0.05, MD = -0.36, 95% CI [-0.77 to 0.05], p = 0.09, and MD = -0.41, 95% CI [-0.85 to 0.03], p = 0.07, respectively). Conclusions The supplementation of curcumin and piperine showed a numerical reduction in FPG, HOMA-IR and BMI, but were not statistically significant. Further research is needed as there is a paucity of studies included in the review.
Curcumin ; Prediabetic State ; Diabetes Mellitus, Type 2

Introduction: In 2021, the International Diabetes Federation, reported 536 million people with diabetes, mainly from countries with lower income. Methods: A cross-sectional descriptive study was employed using the Finnish Diabetes Risk Score (FINDRISC), a validated questionnaire which determines the risk of developing diabetes. The questionnaire was conducted online to be accomplished by students enrolled in universities located in Quezon City. Results: Among the 178 college students in Quezon City, with average age of 20 years old, 28.1% are at risk of developing T2DM. The factors contributing to the risk were: (1) Lack of physical activity of at least 30 minutes a day (51.7%); (2) lack of daily intake of vegetables and fruits or berries (52.8%); and (3) family history of DM (74.7%). Conclusion The study found that one in every four college students in Quezon City is at risk of developing T2DM in the next ten years.
Diabetes Mellitus, Type 2

BACKGROUND

Diabetes mellitus type 2 (T2DM) is one of the leading chronic conditions that greatly impacts Filipino families. Medication non-adherence is a significant challenge in achieving optimal treatment outcomes for individuals with this condition.

This study determined the level of medication adherence and explored the associated factors contributing to nonadherence among patients with T2DM at Cebu South Medical Center (CSMC) Family Medicine outpatient clinic.

A cross-sectional study was done in CSMC Family Medicine outpatient clinic from August to October 2023. A selfadministered questionnaire divided into three domains of non-adherence was adopted. Means, frequencies, and percentages were used to analyze level of adherence, sociodemographic and clinical factors. Logistic regression analysis was used to determine association of factors to medication non-adherence.

There was a total of 69 participants. Overall, there was partial adherence to T2DM medications. There was a high prevalence of partial adherence (39.1%) in the cost-related non-adherence (CRNA) domain. Factors that showed non-significant increased odds of non-adherence included older age (AOR 1.363, 95% CI 0.345-5.386), female sex (AOR 1.544, 95% CI 0.386-6.176), low income (AOR 1.05, 95% CI 0.352-3.135), increased frequency of daily medication intake (AOR 1.436, 95% CI 0.44-4.664), and less than 10 years duration of T2DM (AOR 1.99, 95% CI 0.46-8.637).

Adherence to diabetes medication may be affected by medication costs and financial status as reflected in the overall partial adherence, the high prevalence of partial adherence in CRNA domain, and the increased odds of non-adherence with low income. More studies should be done to investigate other possible contributing factors for non adherence to diabetes medication such as diabetes knowledge, patient’s self efficacy, and healthcare provider communication.

BACKGROUND

Type 2 DM is a chronic disease and is increasing in prevalence and incidence worldwide. In developing nations like the Philippines, it affects patients and their families. Family-oriented interventions, like family counseling, meetings, interviews, and home visits, can support commitment to change and enhance medication adherence, health behavior, and knowledge ensuring adherence to the multifaceted diabetes type 2 management. Patients and families should be permitted to make decisions about lifestyle modifications and medication interventions and finding the appropriate family-focused intervention that works for managing type 2 diabetes is essential. With this information, family physicians can provide more effective care to patients hence, improving their quality of life.

This review’s objective was to determine the effectiveness of family-focused intervention among patients with type 2 diabetes in terms of glycemic control (HbA1c and FBS) and in terms of improving the quality of life.

This is a meta-analysis that included clinical trials randomized involving adult participants that were diagnosed to have type 2 DM. The interventions tested was family-based interventions and the primary outcomes included are HbA1c and FBS. A systematic review was conducted for secondary outcome, patients’ quality of life. Reviewers used the RevMan5 software in the analysis of data.

Seven studies met the inclusion criterion. The overall mean difference in post-treatment HbA1c was −0.54%(95%CI [-0.82,-0.25];p=0.0003) for the 1,265 participants included, showing an overall significant benefit of reducing HbA1c favoring intervention, especially on the 3-month follow-up. On subgroup analysis, the results were as follows: 3-months, -0.45%(95%CI [-0.73,-0.16];p=0.002); 6-month, -0.15%(95%CI[-0.51,0.22];p=0.44), and 12-month, -0.77%(95%CI[-1.75,0.21], p=0.12). The overall difference in mean change in FBS showed a result of -7.8(95%CI[-17.52,1.92],p=0.12) showing benefit, though not statistically significant, favoring intervention in decreasing FBS.

Family-focused interventions among Type 2 DM patients shows significant benefit on improving glycemic control and QOL.