DIABETES MELLITUS

In the Philippines alone, diabetes mortality rate in the total population increased by
92% over a ten-year period from 5.1/100,000 in 1986 to 9.8/100,000in 1995. The reports also
show that the rate of females dying of diabetes has been consistently higher than the rate of
males dying from diabetes. It should also be noted that, in addition to this alarming trend,
diabetes mortality tends to be underestimated because the coding rules of the ICD
(International Classification Diseases by WHO) preferentially select cardiovascular disease
and cancer as causes of death. Such underestimation in a local study by Panelo et al, showed
that death from diabetes has been reported as cardiovascular or renal disease.
Information on diabetes mortality in the country may be derived from the Diabetes
Prevalence Survey of 1982. The significant findings of the survey are:
 The prevalence of diabetes in the Philippines among those 20 to 65 years old
was 4.1%. In Metro Manila prevalence was 8.4%.
 Prevalence was higher in urban than in rural areas which was 6.8% and 2.5%,
respectively.
 In general, the disease was found to be equally common among men and
women.
 Prevalence increased with age, irrespective of geographic location. Significant
increase occurred in the fifth decade. The increase was about 96% above the
prevalence at age 20 to 29 years.
 Majority (63%) of those found to have diabetes were not aware that they had
the disease.
Diabetes Mellitus is defined as 8-hour fasting glucose level of 126mg/dL or higher. A
related disorder is called impaired fasting glycemia which indicates a fasting blood glucose of
between 110 to 125 mg/dL and which is thought to be a precursor of diabetes. (Gestational
Diabetes develops in some pregnant women and disappears when the pregnancy is over. A
history of gestational diabetes is a risk factor for eventual development of type II diabetes.)
Diabetes can be conveniently classified into two: (1)Type 1 diabetes is an autoimmune
disorder where beta cells are destroyed. The hormone, insulin, which is produced by beta cells
in the pancreas for the metabolism of sugar in the body, is sorely lacking in this type of
diabetes. (2)The II diabetes has multigenic causation. It can be prevented in some cases by
proper diet, weight control and regular exercise. This is the more common type of diabetes.
SIGNS AND SYMPTOMS
 polydipsia (excessive thirst)
 polyuria
 weight loss
 pruritis
Depending on the degree of metabolic disorder ensuing from the abnormal metabolism in
diabetes mellitus, complications can be classified into three: acute, chronic and the infectious.
RISK FACTORS
The known non-modifiable risk factors are:
 Family History - Type I diabetes is thought to be brought about by a combination of
generic predisposition and viral infection. According to the National Institute of
Diabetes Digestive and Kidney Disease, USA, “the child of a parent with non-insulin-
dependent diabetes has approximately 10 to 15 percent chance of developing non-
insulin dependent diabetes. If both parents have diabetes, the child risk of having the
disease increase.”
 Age - The prevalence of diabetes is observed to increase with age and in some instances
seems to follow aging.
 Sex - In the US, most of those diagnosed with diabetes are females, in the Philippines,
though, both sexes are equally affected.
 Menopause - Among middle-aged women, menopause is found to play a role in the
development of diabetes.
 Race - Type I diabetes is more common in whites than in non-white, although, type II
is more prevalent among colored races.
 Type A personality - Type A personality is directly and indirectly linked with diabetes.

The modifiable risk factors, which are the main concerns of the Program, are:
 Diet - High calories, high fat, high cholesterol, low fiber, and salty diet have been
demonstrated to correlate with the development of chronic non-communicable
diseases including diabetes.
 Body weight - Central fat distribution or truncal obesity, not necessarily frank obesity,
are known predisposing factors to diabetes. The 1982 Philippine survey also revealed
that as obesity increase the level of blood glucose also increases.
 Smoking – Habitual smoking predispose and aggravates diabetes.
 Alcohol - Habitual ingestion of alcohol has been found to predispose a person to
diabetes and its complications.
 Stress - Unmanaged stress or situation for which a person has not developed adequate
coping mechanism likewise predispose to diabetes.
 Sedentary living - Lack of physical activity and regular exercise has been linked to the
development of diabetes.
 Birth weight – Small for gestational age babies of malnourished mothers are observed
to be more likely to develop diabetes later in life than those born within normal birth
weight.
 Migration – Newly migrated families from rural to urban areas or from developing
countries to a developed country are observed to be vulnerable to the desease.
COMPLICATIONS OF DIABETES

ACUTE CHRONIC INFECTIONS

Severe Microvascular (small blood Infection of the skin,
glyperglycemia vessels of the eyes, kidneys eyes, ears, nose,
Hyperosmolar Coma and nerves) throat, lungs, gallbladder,
Ketoacidosis Kidneys and
Lactic Acidosis Macrovascular (large genito-urinary tract
Hypoglycemia Blood vessels for the
Brain, heart and limbs)

Neuropathy
Cataracts, glaucoma

GOAL
Our goal is to reduce the health and social impact of diabetes among the Filipinos:
 By making at least 90% of Filipinos aware of what diabetes is by year 2004 to 2010
and thereafter and,

 By reducing the rate of increase of prevalence of diabetes to 5% per year starting 2004
to 2010.

OBJECTIVES
In order to reduce the impact of diabetes on the health and socio-economic life of the
Filipinos, the program shall ensure that the following objectives are met:

 The development of strategies and programs including awareness campaigns and the
continuing education of health personnel and concerned individuals, to prevent
diabetes mellitus and its complications;
 The adoption of cost-effective and appropriate screening methods for the detection of
diabetes mellitus in its early or pre-symptomatic changes;
 The investigation into the epidemiology, etiology, diagnosis, treatment, prevention,
and control of diabetes mellitus;
 The evaluation of measures employed, including drug and diet therapies, in control
of diabetes mellitus;
 Establishment of mechanism to reduce the socio-economic impact of diabetes mellitus
on affected individuals and families;
  The granting of incentives and support for organizations of affected individuals and
families;
 The establishment of coordinated health system which shall involve clinicians,
researchers, allied health professionals, community-based health workers, and lay
volunteers for dealing with diabetes mellitus and its complications;
 The participation of local government units, alongside concerned government
agencies and non-government organizations, in the implementation of programs on
diabetes prevention and control;
 The periodic review of research needs and potential in the control of diabetes mellitus;
 The systematic utilization of public and private resources to achieve the objectives
enumerated above; and,
 The recommendations of the Commission for Legislation.

POLICIES
 Programs resources and agencies shall be focused on the primordial and primary levels
of prevention. This is to make the program cost efficient and effective.
 The program shall primarily focus on the age group 0-21 years. Secondary target are
adolescents and adults not yet suffering from diabetes. Tertiary is for those known to
have diabetes, regardless of age.
 Self-care, self-reliance and co-responsibility for the health of one’s family and
community shall be among the values to be promoted. Thus, the program shall
discourage dole-outs and subside particularly in the provision of medical services, and
instead support the organizations of families affected or threatened by diabetes into
cooperative or self-help groups.
 Medical and other health services by the Program shall involve the active participation
of families and communities.
 The lead agency for the implementation of the Program, the Department of Health,
shall work closely with all levels in the education sector, both public and private. It
shall likewise develop active linkage with agencies and enterprises involved in
communication sciences and behavior modification in order to effect the desired
program outcomes within the given time frame.
More specifically, the DOH shall coordinate diabetes program implementation with the
Department of Education, Culture and Sports, Department of Interior of Local Government,
Department of National Defense, Department of Labor and Employment and the
Department of Social Welfare and Development.
Within the DOH, diabetes program components shall be integrated with programs and
projects that are fully operational and effective.
STRATEGIES
Phasing-in of Implementation
The 12-year Program shall be phased into three: (a) preparing the groundwork in the
first 3 years; (b) weakening the bastion of diabetes in the next 3 years; (c) controlling diabetes
and assimilating healthy lifestyle into the Filipino culture in the last 6 years. Each phase shall
be concluded by an evaluation and planning activity in order to increase the chances of
success in the proceeding phase. It is the achievement of the goals or outcomes for each stage,
which indicate the beginning of the next phase.
Phases of the National Diabetes Prevention and Control Program

1989 to 2001 2005 to 2010

2002 to 2004
Phase Preparatory Maintenance
Intensive Phase
Phase Phase

Other Create and increase Counter initiatives Sustain, improve

Activities public awareness and influence and update
on diabetes; Identify, favoring pertinent
organize & mobilize development of communication
partners; source diabetes; strategies;
funds; promote healthy upgrade health
intensify studies lifestyle; services and
and researches provide full-scale networks for
logistic support; diabetes;
implement school upgrade education
curricula materials

Major Train health Implement Monitor and evaluate;

Activities workers; deisgn services at the strengthen specialty
multi-level school community, schools, facilities;
curricula; initiate workplace & institutionalize
legislative agenda hospital; training; design
support expansion succeeding
of diabetes consortia; program plans
monitor, continue
training

Expected Information Influence of factors Filipino adopt

Outcome resources and active favoring diabetes healthy lifestyle
support for the and its and are able to access
program are complication diabetes-related
adequately is weakened services
available
 The central points of the preparatory phase (1999 to 2001) are (a) the creation of sustained
public awareness about the epidemic called diabetes, (b) identification, organization and
mobilization of institutional partners and resources required for diabetes control and, (c)
intensification of the study of the causation, epidemiology and effects of diabetes in the
Philippines. The aim of the first phase is to generate the information, resources and multi-
sectoral support necessary to rouse the health workers, diabetes program managers and the
public into more definite actions against diabetes.
In the second phase (2002 to 2004) all efforts shall converge in weakening the factors
favoring the development and increasing incidence of diabetes among the Filipinos. All
activities to refuse, oppose or reverse the adoption of unhealthy habits by Filipinos shall be
set in motion. Contravening activities, promotion of healthy alternative lifestyle and service
provision of diabetes shall be implemented at the different levels of health care (primary,
secondary and tertiary). Bias in favor of primordial and primary prevention shall be upheld.
The third phase (2005 to 2010) shall ensure that (a) the information and education on the
etiology, epidemiology, prevention and control of diabetes shall have been incorporated into
school curricula at different levels of education, (b) organization and mechanism to counter
the promotion of adverse habits and lifestyle are in place within and outside the health sector,
and (c) a significant proportion of the control of its complications. The main activities in the
third phase are sustenance, fine-tuning and updating of communication strategies and health
services for diabetes prevention and control.
In order to ensure that the people and community-driven diabetes prevention and health
services occur in a continuum, the National Diabetes Prevention and Control Program
recommends and supports the implementation of a standard package of services specific to
four (4) different venues, community, hospital, school and workplace
Program Activities by Inter-linked Venues
Community-Based Program Hospital-Based Program
Public Information & Education
Advocacy Screening Management
Physical Fitness Counselling of Diabetes
Screening Referral Management
Counseling Follow-up of Complications
Referral & Follow-up Diagnosis
Organization of Diabetes/Community
School-Based Program Program for the Workplace
Health Education Health Education
Physical Fitness Program Exercise & Sports Program
Healthy Foods Promotion Stress Management
Screening and Identification Screening
Clinic Services & Referral Counselling
Organization of Diabetes Clinic Services & Referral
  Community-based program – It is anchored on the RHU-BHS network established in
municipalities and cities. It shall also work for a strong linkage between government
and non-government health facilities at the community level, with the main health
office of the local government as the central coordinating body for the diabetes
program. For the implementation and management of the community-based
component, the DOH, Department of Interior and Local Government (DILG) and
the different leagues of local government units shall have to collaborate effectively.

Most community-based activities are focused on primordial and primary prevention.

Focus is more on the community as a whole and on the family, rather than on the
individual.

REFERENCE:
 Community Health Nursing Services in the Philippine Department of Health

Submitted by: KENNETH NATHANIEL B. SANTIAGO

BSN – 2A