Validation of the Novel Basal Metabolic Rate Prediction Equation Among Adult Overweight and Obese Filipino Patients

@#BACKGROUND: Various methods and equations are available to predict the basal metabolic rate (BMR). A published study comparing the Harris-Benedict Equation, Bioelectrical Impedance Analysis, and Indirect Calorimetry (IC), was done among Filipinos, and was able to obtain a novel formula for BMR. The purpose of this study is to validate this novel formula. METHODS: This is a multi-center, cross-sectional, validation study of the novel BMR equation, done among adult overweight and obese Filipinos, who were seen at St. Luke’s Medical Center and Providence Hospital in Quezon City, Outpatient Clinics from August 2019 to March 2020. Purposive sampling was done, and upon giving consent, subjects had undergone interview, anthropometrics measurement, and IC. RESULTS: 174 samples were enrolled. Mean age is 43 years old, majority are females. 27% have no co-morbidities; of those with co-morbidities, half have diabetes mellitus (DM). Mean weight is 74.30 kg; mean BMI is 29.78 kg/m2 . The mean computed BMR is 1174.70 kcal/day, which is 145.83 significantly lower than the BMR derived with calorimetry: 1320.53 kcal/day (P-value 0.000). However, the scatterplot reveals the linearity of positive direction for both values. 31% of the computed BMR fell within the +/-10% estimate of the actual BMR. Stratification of the results between those with DM and without, lowered the difference between the calculated and actual BMR to 46 kcal/day (from 145.83) among the DM subgroup, and increased the estimated accuracy to 38% falling within the +/- 10% estimate of the actual values. CONCLUSION: The novel BMR formula is linearly reflective of the basal metabolism of adult overweight and obese Filipinos, but the numerical values are lower compared to actual calorimetry results, yielding more accuracy when applied among patients with diabetes.

Validation of the modified Filipino version of the American Diabetes Association Diabetes Risk Test and the St. Luke’s Internal Medicine Diabetes Risk Test to identify population at risk for Type 2 Diabetes Mellitus among adults

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.

Factors leading to poor adherence to titration of once-daily basal insulin among patients with Type 2 Diabetes Mellitus

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.

The efficacy of daily compared to twice weekly Basal Insulin Titration Algorithms among patients with Type II Diabetes Mellitus: A 12-week randomized controlled trial

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.

The correlation of Body Mass Index with fasting C-peptide Levels of newly diagnosed Type 2 Diabetes Mellitus Filipino patients

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.