A perspective on diabetes and the Filipino culture

Diabetes Mellitus (DM) is a common endocrine disease marked by increased blood sugar levels resulting from the reduced action of the hormone insulin either due to the resistance of the body to its effect, or to the reduced ability to make insulin—or both.

There are several forms of diabetes but most people are familiar with type 1 DM, where the body is completely and permanently unable to make insulin, thereby requiring multiple injections in order to survive; and type 2 DM which starts with the resistance of the body to insulin action, eventually leading to progressive inability of the body to make enough insulin to control blood sugar over time.

Type 2 DM may be controlled with proper nutrition, exercise and oral medications during the first several years, however, majority of patients would still need insulin eventually to avoid complications as type 2 DM progresses through time. Whereas lifestyle has nothing to do at all with how Type 1 DM develops, it does have a major role in the development and progression of the most common form of DM which is type 2.

Based on its research about the current trends of risk factors, the International Diabetes Federation projects that by 2025 the Philippines will be in the top 10 list of countries with the highest number of cases of type 2 DM. Are there Filipino cultural practices that affect how we can prevent and control diabetes, and lessen the burden of complications like heart disease, stroke, kidney disease, blindness and amputation that go with it?

Filipinos just love food, that is why it is constantly a part of our gatherings. In other countries, there are no free snack stands or buffets for attendees to conventions or wakes. In other cultures, coming unannounced to visit would mean you have no set place in the dining table. But this never happens in a Filipino household. It would be impolite and inhospitable not to offer refreshments to guests. So this incessant opportunity to have snacks poses a challenge to those struggling to reduce their daily food intake to reduce their blood sugars.

We are also famous for our fiestas. It seems that for every day of the year, there is a festival being celebrated somewhere in the Philippines with varieties of food for the celebration. The food we enjoy so much are mostly dishes that are rich in carbohydrates, sugar, syrup, thick sauce and high in fat—all loaded with calories.

Do Filipinos enjoy exercise? The traditional outdoor games we played as children before the electronic games and the Internet took over our free time—show how we enjoy our agility. It is (a) sad (trend) to see empty neighborhood streets and school campuses where children used to play patintero, tumbang preso, habulan, etc. The overweight child of today is the adult diabetic Filipino of tomorrow.

The closely-knit relationship among family members is one of the strengths of the Filipinos. By involving all family members in taking care of a single member who might be at risk—or who is already diabetic, we get better outcomes. There is nothing wrong with having food and festivities for as long as we know the right portions and kinds of nutritious food we should prepare.

Family members should remind one another to engage in a healthy lifestyle to achieve/maintain recommended body weight and to do the proper screening tests to detect diabetes early. They must make sure the diabetic patient visits the clinic regularly; and that medications are taken to control diabetes, blood pressure and cholesterol levels to avoid complications.

The strong sense of bayanihan and malasakit (unity and empathy) is another Filipino characteristic that can be used to improve diabetes care. We reach out to our friends in our localities, religious groups, school organizations/alumni associations, etc.

Members of the community may help each other prevent diabetes, screen for risk factors, maintain lifestyle measures and reach treatment targets. A community-based model for preventing and controlling diabetes exists in other countries, and one is locally being done by endocrinologists at the UP College of Medicine.

By nature, our ethnicity predisposes us to developing type 2 DM, but it is also the nurturing nature of Filipinos that may help keep diabetes at bay.

Dr. Aimee Andag-Silva is a board-certified internist and endocrinologist, and assistant professor, College of Medicine, De La Salle Health Sciences Institute. The A to Z of Health Information advocacy is a joint initiative of a group of medical specialists and supported by AstraZeneca Philippines aimed at raising public awareness on various diseases and providing health information and updates to the healthcare community.