Transformative diabetes care in the Philippines through improved healthcare access, updated clinical guidelines, and expanded health insurance coverage
02 Aug 2025
Cando
et al. (2024) provided a comprehensive overview of the burden, diagnosis,
management, and challenges of diabetes mellitus in the Philippines. Diabetes
mellitus, particularly type 2 diabetes (T2D), poses a growing threat to the
country’s healthcare system. The disease affects approximately 4.3 million
Filipinos, with an additional 2.8 million reportedly undiagnosed as of 2021.
This number is expected to increase, reaching 7.5 million by 2045, signaling a
significant public health concern. [DMS: CRR 2024;(18)2:102951]*
The country’s National Nutrition survey, the authors said, showed that impaired fasting glucose rose from 7.4 percent in 2013 to 27.7 percent in 2019, which reportedly reflects the poor metabolic health of Filipinos. They noted that a local cohort study confirmed growing rates of diabetes and prediabetes. [Diabetes Res Clin Pract 2009;86(2):130-133] This worsening trend is fueled by both clinical and molecular risk factors, such as obesity, sedentary lifestyles, dyslipidemia, and genetic predispositions.
Obesity, diet, physical activity
Clinically, obesity and poor diet are strongly linked to rising diabetes rates. Cando et al. noted that 36.6 percent of adults in the Philippines were overweight or obese as of 2019. Urban residents are reportedly especially vulnerable, likely due to the availability of processed foods and reduced physical activity. Furthermore, they also noted that the mean Alternative Healthy Eating Index score for Filipinos was under 20/100, substantially lower than that of neighboring countries. This poor diet quality is said to reflect the socio-economic challenges many Filipinos face, such as food insecurity and high poverty rates.
Physical inactivity is another significant risk factor. Over 40 percent of Filipino adults, the authors said, are physically inactive, a figure exacerbated during the COVID-19 pandemic. Additionally, dyslipidemia is highly prevalent, with 47 percent having high total cholesterol and over seventy percent exhibiting low HDL levels. Gestational diabetes mellitus (GDM) and polycystic ovarian syndrome (PCOS) also increase the risk of developing T2D, particularly among women.
Genes
From a molecular perspective, Cando et al. said that several genetic and epigenetic factors have been identified as contributors to diabetes susceptibility in the Filipino population. Studies reportedly found that specific gene variants such as CDKAL1 and SERPINF1 are strongly linked with the disease. Moreover, epigenetic research suggests that environmental and lifestyle factors can modify gene expression, which may partially explain why Filipino immigrants to the U.S. show higher diabetes rates.
Effects on the organs
Diabetes significantly impacts various organ systems. Microvascular issues like retinopathy and nephropathy are said to be prevalent. Diabetic retinopathy, in particular, is reportedly the leading cause of preventable blindness in some Philippine regions. The authors said that 42 percent of patients suffer from diabetic neuropathy, while diabetic nephropathy contributes to 38 percent of renal diseases nationally.
Macrovascular complications such as heart disease and stroke are also prominent. Diabetes increases the risk of coronary artery disease and cerebrovascular incidents. Cando et al. noted that in the 2008 DiabCare survey, 10.5 percent of diabetic patients reported angina, and 4.7 percent had experienced a stroke. According to the article, these figures show that diabetes is not just a metabolic disorder but a systemic one with far-reaching effects.
The nonvascular complications are equally concerning. These, the authors said, are said to include gastrointestinal and genitourinary issues, dermatologic conditions, and infectious diseases; likewise, patients are said to be more susceptible to infections and slower wound healing. Reportedly, 10.9 percent of diabetic patients in the same DiabCare survey suffered from either skin, urinary tract, or respiratory infections.
Management
When it comes to management, the Philippines is reported to largely follow the American Diabetes Association’s standards. As Cando et al. noted, both local and international guidelines recommend lifestyle modifications and metformin as first-line treatments. For patients with more severe hyperglycemia, pharmacological treatments are initiated earlier. However, the Philippine Clinical Practice Guidelines (CPG) have not been updated since 2014 [editor’s note: the updated CPG has now been made available in 2025]. This lag, they said, in updating reflects the need for modernization, particularly in integrating newer drug classes like SGLT-2 inhibitors and GLP-1 receptor agonists, which are reportedly effective but costly.
Access to medications is another challenge. While metformin and sulfonylureas are widely accessible, Cando et al. reported that newer medications are not readily available in public healthcare settings. The Philippine National Formulary includes only a limited selection of anti-diabetic drugs. Although insulin is available through the government's Insulin Access Program, usage remains low due to cost, needle phobia, and lack of education.
Complementary and alternative medicines like bitter melon (Momordica charantia), locally known as “ampalaya”, and the insulin plant (Costus igneus) are popular among Filipinos. According to the authors, while some studies suggest potential glucose-lowering effects, most clinical trials remain inconclusive due to small sample sizes and poor methodologies.
A critical component of diabetes care is self-management. The authors noted that Filipino patients show varied adherence to self-care behaviors such as diet, exercise, and blood glucose monitoring. In one cross-sectional study they reported in the outpatient department of a public tertiary hospital in the country , only 50 percent followed healthy eating guidelines, while just 46 percent maintained physical activity. Blood glucose monitoring was the least followed, with 75 percent checking levels only 1–3 times per week. Medication adherence was reportedly high at over 76 percent, but barriers like low health awareness, poor provider-patient communication, and limited access to services were common. [J ASEAN Fed Endocr Soc 2013;28(2): 134]
Burden
The economic burden of diabetes in the Philippines is reported to be substantial. The average diabetes-related expenditure, as Cando et al. reviewed, rose from USD61 in 2010 to USD450.8 in 2021. Healthcare, they said, is largely funded through out-of-pocket payments, making diabetes management unaffordable for many. PhilHealth, the national health insurance provider, offers some support, but its Primary Care Benefit package is limited to indigent and sponsored members. The PhilPEN program provides basic services at the barangay level but lacks coverage for more advanced needs.
The cost of complications exacerbates the financial burden. As Cando et al. reported, a study revealed that patients with complications spent significantly more—up to five times higher annually—than those without. These costs are mainly attributed to dialysis, surgery, and non-diabetes-related drugs. [BMJ Open 2021;11(10): Article e049737]
Current initiatives and the future
In terms of national initiatives, Cando et al. also said that the Department of Health has implemented several programs, including the National Diabetes Prevention and Control Plan and the Insulin Medicine Access Program (InMAP). Localized projects like the First Line Diabetes Care (FiLDCare) and community-based education programs have shown promise. Reportedly, these initiatives led to improved HbA1c levels and increased awareness, but their reach is said to remain limited due to geographic and infrastructural challenges.
The authors also touched on how the COVID-19 pandemic further strained the diabetes care system. The government, they noted, issued policies allowing electronic prescriptions and encouraged telemedicine, but these solutions were limited by internet access and digital literacy, reflecting the fragility of diabetes care infrastructure, particularly in times of crisis.
The authors stressed that diabetes care in the Philippines must be transformed through improved healthcare access, updated clinical guidelines, and expanded health insurance coverage. They saw that the implementation of the Universal Health Care (UHC) Act and support from international frameworks like the WHO’s Global Diabetes Compact are pivotal, but they noted that real progress will require not only policy shifts but also systemic improvements in healthcare delivery, education, and research.
Cando et al. said that there is also a pressing need for more diabetes-focused studies in the country to inform evidence-based policymaking. They encouraged public and private sector collaboration, increased health budget allocations, and the promotion of healthier lifestyles. Without these changes, the growing burden of diabetes will continue to strain the healthcare system and diminish the quality of life for millions of Filipinos.
The country’s National Nutrition survey, the authors said, showed that impaired fasting glucose rose from 7.4 percent in 2013 to 27.7 percent in 2019, which reportedly reflects the poor metabolic health of Filipinos. They noted that a local cohort study confirmed growing rates of diabetes and prediabetes. [Diabetes Res Clin Pract 2009;86(2):130-133] This worsening trend is fueled by both clinical and molecular risk factors, such as obesity, sedentary lifestyles, dyslipidemia, and genetic predispositions.
Obesity, diet, physical activity
Clinically, obesity and poor diet are strongly linked to rising diabetes rates. Cando et al. noted that 36.6 percent of adults in the Philippines were overweight or obese as of 2019. Urban residents are reportedly especially vulnerable, likely due to the availability of processed foods and reduced physical activity. Furthermore, they also noted that the mean Alternative Healthy Eating Index score for Filipinos was under 20/100, substantially lower than that of neighboring countries. This poor diet quality is said to reflect the socio-economic challenges many Filipinos face, such as food insecurity and high poverty rates.
Physical inactivity is another significant risk factor. Over 40 percent of Filipino adults, the authors said, are physically inactive, a figure exacerbated during the COVID-19 pandemic. Additionally, dyslipidemia is highly prevalent, with 47 percent having high total cholesterol and over seventy percent exhibiting low HDL levels. Gestational diabetes mellitus (GDM) and polycystic ovarian syndrome (PCOS) also increase the risk of developing T2D, particularly among women.
Genes
From a molecular perspective, Cando et al. said that several genetic and epigenetic factors have been identified as contributors to diabetes susceptibility in the Filipino population. Studies reportedly found that specific gene variants such as CDKAL1 and SERPINF1 are strongly linked with the disease. Moreover, epigenetic research suggests that environmental and lifestyle factors can modify gene expression, which may partially explain why Filipino immigrants to the U.S. show higher diabetes rates.
Effects on the organs
Diabetes significantly impacts various organ systems. Microvascular issues like retinopathy and nephropathy are said to be prevalent. Diabetic retinopathy, in particular, is reportedly the leading cause of preventable blindness in some Philippine regions. The authors said that 42 percent of patients suffer from diabetic neuropathy, while diabetic nephropathy contributes to 38 percent of renal diseases nationally.
Macrovascular complications such as heart disease and stroke are also prominent. Diabetes increases the risk of coronary artery disease and cerebrovascular incidents. Cando et al. noted that in the 2008 DiabCare survey, 10.5 percent of diabetic patients reported angina, and 4.7 percent had experienced a stroke. According to the article, these figures show that diabetes is not just a metabolic disorder but a systemic one with far-reaching effects.
The nonvascular complications are equally concerning. These, the authors said, are said to include gastrointestinal and genitourinary issues, dermatologic conditions, and infectious diseases; likewise, patients are said to be more susceptible to infections and slower wound healing. Reportedly, 10.9 percent of diabetic patients in the same DiabCare survey suffered from either skin, urinary tract, or respiratory infections.
Management
When it comes to management, the Philippines is reported to largely follow the American Diabetes Association’s standards. As Cando et al. noted, both local and international guidelines recommend lifestyle modifications and metformin as first-line treatments. For patients with more severe hyperglycemia, pharmacological treatments are initiated earlier. However, the Philippine Clinical Practice Guidelines (CPG) have not been updated since 2014 [editor’s note: the updated CPG has now been made available in 2025]. This lag, they said, in updating reflects the need for modernization, particularly in integrating newer drug classes like SGLT-2 inhibitors and GLP-1 receptor agonists, which are reportedly effective but costly.
Access to medications is another challenge. While metformin and sulfonylureas are widely accessible, Cando et al. reported that newer medications are not readily available in public healthcare settings. The Philippine National Formulary includes only a limited selection of anti-diabetic drugs. Although insulin is available through the government's Insulin Access Program, usage remains low due to cost, needle phobia, and lack of education.
Complementary and alternative medicines like bitter melon (Momordica charantia), locally known as “ampalaya”, and the insulin plant (Costus igneus) are popular among Filipinos. According to the authors, while some studies suggest potential glucose-lowering effects, most clinical trials remain inconclusive due to small sample sizes and poor methodologies.
A critical component of diabetes care is self-management. The authors noted that Filipino patients show varied adherence to self-care behaviors such as diet, exercise, and blood glucose monitoring. In one cross-sectional study they reported in the outpatient department of a public tertiary hospital in the country , only 50 percent followed healthy eating guidelines, while just 46 percent maintained physical activity. Blood glucose monitoring was the least followed, with 75 percent checking levels only 1–3 times per week. Medication adherence was reportedly high at over 76 percent, but barriers like low health awareness, poor provider-patient communication, and limited access to services were common. [J ASEAN Fed Endocr Soc 2013;28(2): 134]
Burden
The economic burden of diabetes in the Philippines is reported to be substantial. The average diabetes-related expenditure, as Cando et al. reviewed, rose from USD61 in 2010 to USD450.8 in 2021. Healthcare, they said, is largely funded through out-of-pocket payments, making diabetes management unaffordable for many. PhilHealth, the national health insurance provider, offers some support, but its Primary Care Benefit package is limited to indigent and sponsored members. The PhilPEN program provides basic services at the barangay level but lacks coverage for more advanced needs.
The cost of complications exacerbates the financial burden. As Cando et al. reported, a study revealed that patients with complications spent significantly more—up to five times higher annually—than those without. These costs are mainly attributed to dialysis, surgery, and non-diabetes-related drugs. [BMJ Open 2021;11(10): Article e049737]
Current initiatives and the future
In terms of national initiatives, Cando et al. also said that the Department of Health has implemented several programs, including the National Diabetes Prevention and Control Plan and the Insulin Medicine Access Program (InMAP). Localized projects like the First Line Diabetes Care (FiLDCare) and community-based education programs have shown promise. Reportedly, these initiatives led to improved HbA1c levels and increased awareness, but their reach is said to remain limited due to geographic and infrastructural challenges.
The authors also touched on how the COVID-19 pandemic further strained the diabetes care system. The government, they noted, issued policies allowing electronic prescriptions and encouraged telemedicine, but these solutions were limited by internet access and digital literacy, reflecting the fragility of diabetes care infrastructure, particularly in times of crisis.
The authors stressed that diabetes care in the Philippines must be transformed through improved healthcare access, updated clinical guidelines, and expanded health insurance coverage. They saw that the implementation of the Universal Health Care (UHC) Act and support from international frameworks like the WHO’s Global Diabetes Compact are pivotal, but they noted that real progress will require not only policy shifts but also systemic improvements in healthcare delivery, education, and research.
Cando et al. said that there is also a pressing need for more diabetes-focused studies in the country to inform evidence-based policymaking. They encouraged public and private sector collaboration, increased health budget allocations, and the promotion of healthier lifestyles. Without these changes, the growing burden of diabetes will continue to strain the healthcare system and diminish the quality of life for millions of Filipinos.