New PCEDM-led multi-sectoral CPG advocates for judicious screening for T2D
02 Aug 2025
A
multi-disciplinary panel of experts led by PCEDM developed the guidelines using
GRADE (Grading of Recommendations Assessment, Development and Evaluation
methodology). The guidelines aim to respond to the urgent need for standardized
yet flexible guidelines that address the unique challenges faced by Filipino
healthcare providers and patients, particularly in resource-constrained
settings. They caution that these do not replace sound clinical judgement.
The published CPG, being only part one (to follow: treatment, etc.), presents the core evidence and recommendations only for screening and diagnosing T2D, and monitoring complications, prioritizing clinical relevance, local feasibility, and equity of access.
Screening recommendation highlights
The CPG recommends that screening for diabetes be initiated with risk factor identification in all adults. For all apparently healthy adults, screening for risk factors through validated questionnaires, in addition to the usual patient assessment such as history-taking and physical examination. For the purposes of these guidelines, the recommendations, the authors say, do not cover type 1 diabetes, gestational diabetes or inpatient management.
They also recommend annual screening with laboratory tests only for ages 35 and older, or any individual with at least one risk factor (eg, obesity, hypertension, family history of diabetes.). Universal screening is, thus, discouraged as this would only identify few cases.
Fasting plasma glucose (FPG) is preferred by the CPG over HbA1c as a screening method (for ages 35 and older or those with risk factors) due to its accessibility and affordability in local settings, while oral glucose tolerance test (OGTT) is recommended for patients with a history of prediabetes, gestational diabetes, and polycystic ovary syndrome. HbA1c may be used if standardized assays are available, though its utility is limited by cost and access in many areas. It is also not recommended in certain conditions that “affect red blood cell life span and/ or hemoglobin glycation dynamics”, such as anemias, hemoglobinopathies, glucose -6-phosphate dehydrogenase deficiency, erythropoietin therapy, HIV positivity, chronic liver and kidney diseases, recent or recurrent blood transfusions, and pregnancy, among others.
For symptomatic individuals, the CPG recommends a single random blood glucose testing to confirm diabetes diagnosis for those presenting classic hyperglycemia symptoms (eg, polyuria, polydipsia & weight loss). Urinalysis and fasting capillary blood glucose are not recommended for the general population screening but may be considered in geographically isolated and disadvantaged areas, where other tests are unavailable. In such settings, a fasting capillary blood glucose level of 200 mg/dL can be used for presumptive diagnosis and immediate treatment initiation.
Screening for complications
The guidelines also provide evidence-based strategies for screening for complications, such as routine resting electrocardiograms (ECG) to screen for macrovascular complications of diabetes and yearly foot exams using a 10-gram monofilament to screen for peripheral neuropathy.
Exercise test and 2D echocardiography are not recommended for asymptomatic individuals. To screen for eye complications, they recommend ophthalmologic referral at the time of diabetes diagnosis, or retinal fundus photography with remote reading, if an ophthalmologist is not available, and suggest screening every one to two years in T2D patients without retinopathy.
To screen for diabetic kidney disease, the guidelines recommend random urine albumin:creatinine (UACR) and/or serum creatinine with eGFR at the time of diagnosis, with more frequent reassessment, depending on baseline status. According to the authors, these early screening strategies aim to reduce long-term disability and mortality.
Challenges to implementation
The Philippine healthcare system is characterized by variable access to care, fragmented delivery systems, and disparities in diagnostic and treatment resources, especially between rural and urban settings. These realities necessitate the localizing international guidelines like those from the American Diabetes Association and International Diabetes Federation to ensure feasibility and cost-effectiveness in the Philippines.
A major challenge in the management of T2D in the Philippines is the implementation of the guidelines across different levels of healthcare. The authors stresse that successful integration of the recommendations depends on coordinated dissemination through medical societies, academic institutions, and government agencies like the Department of Health (DOH).
They emphasize the importance of incorporating these guidelines into the Universal Health Care (UHC) framework and PhilHealth reimbursement policies. Thus, these guidelines were developed through a multi-sectoral approach ensuring representation from primary care providers, endocrinologists, nephrologists, cardiologists, other relevant medical societies, policymakers, and patient advocacy groups.
They suggest implementation strategies, such as simplified clinical algorithms in primary care, digital tools, continuing medical education (CME) activities, and public awareness campaigns. Barriers they identified include unequal access to laboratory tests, inconsistent availability of trained personnel, and limited health infrastructure in rural areas. Overcoming these barriers, they said, will require stakeholder collaboration, sustained funding, and policy alignment.
Periodic reviews and revisions
The authors recommend periodic review and updates based on emerging evidence and implementation feedback. The PCEDM thus plans to implement vigorous feedback mechanisms. Key performance indicators were set at individual, facility and regional/national levels to assess implementation and adherence to the CPG recommendations. The impact of guideline adoption, they say, will be assessed through trends in early detection rates of diabetes and pre-diabetes, changes in HbA1c values or diagnostic delays pre-vs-post CPG dissemination, provider adherence to recommended screening pathways, reduction in missed or delayed diagnoses and patient outcomes and satisfaction (through surveys & interviews).
With the goal of bridging global evidence with Filipino healthcare realities, the CPG will be updated every three years (ie, 2028) and will be regularly assessed by the DOH for relevance and applicability with updates issued, as necessary, according to the authors. It will be publicly accessible through official websites of healthcare societies and through the Compendium of DOH-Approved Clinical Practice Guidelines. The evidence base and final manuscript will be made accessible through both print and electronic media platforms managed by the DOH, the PCEDM and other contributing organizations.
Addressing the knowledge gap
According to the authors, there is still a significant lack of data for many aspects of diabetes in the country. Currently epidemiological data focuses on the prevalence of the condition. They list several research gaps, including but not limited to the following: the cost-effectiveness of screening based on each risk factor and the long-term follow-up of people screened with the clinical risk score questionnaire in the Philippines, the identification of prevalent risk factors in people diagnosed with diabetes during national health surveys to monitor changes in the population's risk profile and the optimal frequency for screening diabetes using fasting blood sugar levels.
Key research needs they identified regarding diagnosis include the utility of the 1-hour OGTT, the validity of HbA1c testing, the correlation of HbA1c with plasma glucose, point of care HbA1c devices, CBG vs OGTT, CBG accuracy in GIDA settings, and the validation of RBS >/= 200 mg/dL with symptoms.
They also note the paucity of data on the prevalence of microvascular (neuropathy, nephropathy, retinopathy) complications and diabetes-related cardiovascular diseases; the accuracy of retinal photography readings by trained non-ophthalmologists; eGFR calculators; optimal testing intervals for urine albumin:creatinine ratio and serum creatinine as best defined for Filipino T2D patients; the accuracy of microalbumin and protein-creatinine ratio as a commonly used test for early kidney damage detection; and the monofilament cut-off value.
They recommend that research be directed toward cost-effectiveness studies, real-world outcomes, and tools that improve adherence at both the provider and patient levels, as effective management of diabetes requires a balance between ideal practices and what is feasible within the constraints of the Philippine system.
The current guidelines emphasize that success in diabetes management depends not only on clinicians but also on policymakers, patients, and the broader community. It calls for national support, training of healthcare workers, and expanded access to diagnostic tools and medications. While the primary intention is to improve patient care, this may also serve as a guide in the procurement of medications, planning of health programs and priorities for persons with diabetes, or formulating diabetes screening strategies for at-risk populations.
This CPG serves as a revision to the 2013 version, accounting for new evidence, international benchmarks, and local practices. It is primarily intended for the use by general practitioners or family medicine specialists, endocrinologists, and allied healthcare professionals.
The published CPG, being only part one (to follow: treatment, etc.), presents the core evidence and recommendations only for screening and diagnosing T2D, and monitoring complications, prioritizing clinical relevance, local feasibility, and equity of access.
Screening recommendation highlights
The CPG recommends that screening for diabetes be initiated with risk factor identification in all adults. For all apparently healthy adults, screening for risk factors through validated questionnaires, in addition to the usual patient assessment such as history-taking and physical examination. For the purposes of these guidelines, the recommendations, the authors say, do not cover type 1 diabetes, gestational diabetes or inpatient management.
They also recommend annual screening with laboratory tests only for ages 35 and older, or any individual with at least one risk factor (eg, obesity, hypertension, family history of diabetes.). Universal screening is, thus, discouraged as this would only identify few cases.
Fasting plasma glucose (FPG) is preferred by the CPG over HbA1c as a screening method (for ages 35 and older or those with risk factors) due to its accessibility and affordability in local settings, while oral glucose tolerance test (OGTT) is recommended for patients with a history of prediabetes, gestational diabetes, and polycystic ovary syndrome. HbA1c may be used if standardized assays are available, though its utility is limited by cost and access in many areas. It is also not recommended in certain conditions that “affect red blood cell life span and/ or hemoglobin glycation dynamics”, such as anemias, hemoglobinopathies, glucose -6-phosphate dehydrogenase deficiency, erythropoietin therapy, HIV positivity, chronic liver and kidney diseases, recent or recurrent blood transfusions, and pregnancy, among others.
For symptomatic individuals, the CPG recommends a single random blood glucose testing to confirm diabetes diagnosis for those presenting classic hyperglycemia symptoms (eg, polyuria, polydipsia & weight loss). Urinalysis and fasting capillary blood glucose are not recommended for the general population screening but may be considered in geographically isolated and disadvantaged areas, where other tests are unavailable. In such settings, a fasting capillary blood glucose level of 200 mg/dL can be used for presumptive diagnosis and immediate treatment initiation.
Screening for complications
The guidelines also provide evidence-based strategies for screening for complications, such as routine resting electrocardiograms (ECG) to screen for macrovascular complications of diabetes and yearly foot exams using a 10-gram monofilament to screen for peripheral neuropathy.
Exercise test and 2D echocardiography are not recommended for asymptomatic individuals. To screen for eye complications, they recommend ophthalmologic referral at the time of diabetes diagnosis, or retinal fundus photography with remote reading, if an ophthalmologist is not available, and suggest screening every one to two years in T2D patients without retinopathy.
To screen for diabetic kidney disease, the guidelines recommend random urine albumin:creatinine (UACR) and/or serum creatinine with eGFR at the time of diagnosis, with more frequent reassessment, depending on baseline status. According to the authors, these early screening strategies aim to reduce long-term disability and mortality.
Challenges to implementation
The Philippine healthcare system is characterized by variable access to care, fragmented delivery systems, and disparities in diagnostic and treatment resources, especially between rural and urban settings. These realities necessitate the localizing international guidelines like those from the American Diabetes Association and International Diabetes Federation to ensure feasibility and cost-effectiveness in the Philippines.
A major challenge in the management of T2D in the Philippines is the implementation of the guidelines across different levels of healthcare. The authors stresse that successful integration of the recommendations depends on coordinated dissemination through medical societies, academic institutions, and government agencies like the Department of Health (DOH).
They emphasize the importance of incorporating these guidelines into the Universal Health Care (UHC) framework and PhilHealth reimbursement policies. Thus, these guidelines were developed through a multi-sectoral approach ensuring representation from primary care providers, endocrinologists, nephrologists, cardiologists, other relevant medical societies, policymakers, and patient advocacy groups.
They suggest implementation strategies, such as simplified clinical algorithms in primary care, digital tools, continuing medical education (CME) activities, and public awareness campaigns. Barriers they identified include unequal access to laboratory tests, inconsistent availability of trained personnel, and limited health infrastructure in rural areas. Overcoming these barriers, they said, will require stakeholder collaboration, sustained funding, and policy alignment.
Periodic reviews and revisions
The authors recommend periodic review and updates based on emerging evidence and implementation feedback. The PCEDM thus plans to implement vigorous feedback mechanisms. Key performance indicators were set at individual, facility and regional/national levels to assess implementation and adherence to the CPG recommendations. The impact of guideline adoption, they say, will be assessed through trends in early detection rates of diabetes and pre-diabetes, changes in HbA1c values or diagnostic delays pre-vs-post CPG dissemination, provider adherence to recommended screening pathways, reduction in missed or delayed diagnoses and patient outcomes and satisfaction (through surveys & interviews).
With the goal of bridging global evidence with Filipino healthcare realities, the CPG will be updated every three years (ie, 2028) and will be regularly assessed by the DOH for relevance and applicability with updates issued, as necessary, according to the authors. It will be publicly accessible through official websites of healthcare societies and through the Compendium of DOH-Approved Clinical Practice Guidelines. The evidence base and final manuscript will be made accessible through both print and electronic media platforms managed by the DOH, the PCEDM and other contributing organizations.
Addressing the knowledge gap
According to the authors, there is still a significant lack of data for many aspects of diabetes in the country. Currently epidemiological data focuses on the prevalence of the condition. They list several research gaps, including but not limited to the following: the cost-effectiveness of screening based on each risk factor and the long-term follow-up of people screened with the clinical risk score questionnaire in the Philippines, the identification of prevalent risk factors in people diagnosed with diabetes during national health surveys to monitor changes in the population's risk profile and the optimal frequency for screening diabetes using fasting blood sugar levels.
Key research needs they identified regarding diagnosis include the utility of the 1-hour OGTT, the validity of HbA1c testing, the correlation of HbA1c with plasma glucose, point of care HbA1c devices, CBG vs OGTT, CBG accuracy in GIDA settings, and the validation of RBS >/= 200 mg/dL with symptoms.
They also note the paucity of data on the prevalence of microvascular (neuropathy, nephropathy, retinopathy) complications and diabetes-related cardiovascular diseases; the accuracy of retinal photography readings by trained non-ophthalmologists; eGFR calculators; optimal testing intervals for urine albumin:creatinine ratio and serum creatinine as best defined for Filipino T2D patients; the accuracy of microalbumin and protein-creatinine ratio as a commonly used test for early kidney damage detection; and the monofilament cut-off value.
They recommend that research be directed toward cost-effectiveness studies, real-world outcomes, and tools that improve adherence at both the provider and patient levels, as effective management of diabetes requires a balance between ideal practices and what is feasible within the constraints of the Philippine system.
The current guidelines emphasize that success in diabetes management depends not only on clinicians but also on policymakers, patients, and the broader community. It calls for national support, training of healthcare workers, and expanded access to diagnostic tools and medications. While the primary intention is to improve patient care, this may also serve as a guide in the procurement of medications, planning of health programs and priorities for persons with diabetes, or formulating diabetes screening strategies for at-risk populations.
This CPG serves as a revision to the 2013 version, accounting for new evidence, international benchmarks, and local practices. It is primarily intended for the use by general practitioners or family medicine specialists, endocrinologists, and allied healthcare professionals.