Filipinos with diabetes suffered a lot during the prolonged quarantines at the height of Covid-19's onslaught in the country. In an article published in the widely circulated, peer-reviewed international medical journal The Lancelet, two Filipino doctors wrote of their direct experience with diabetes patients.

Janine Patricia G. Robredo and Diandra Lourdes D. Cembrano presented facts and figures that may not have circulated in Philippine media.

Dr. Robredo (daughter of former Vice President Leni Robredo) is currently pursuing further studies in the Department of Global Health and Social Medicine, Harvard Medical School in Boston, Massachusetts.

Dr. Cembrano is connected with the Philippine Orthopedic Center in Quezon City.

Daily Tribune is printing excerpts from their jointly written article, "Out on a limb: Living with diabetes in the Philippines during the pandemic":

"People with diabetes from remote areas missed prescription refills and follow-up consultations, resorted to home remedies, and relied on neighbors with similar experiences for medical advice.
"These compensatory alternatives served as cost-saving mechanisms for families affected by unemployment and job loss, which affected the purchasing power of people with diabetes and their families for medicines and related essentials.

"Access programs to anti-hyperglycemic agents were also temporarily halted, further exacerbating the financial burden of diabetes mellitus care. Even with telemedicine and private care as alternatives, these remained largely inaccessible to many patient groups.

"Tertiary institutions, which were mostly government facilities, were designated as Covid referral centers. This interrupted non-Covid services, resulting in non-compliance to prescription, poor glycemic control, delays to consultation, and increased risk for diabetes-related morbidity and mortality.

Diabetic foot ulcers
"Orthopedic centers that treat people with diabetic foot ulcers were among those that had to adjust. Non-operative outpatient management, including initiation of offloading devices and wound monitoring, was consequently temporarily suspended.

"In the Philippines, diabetic foot ulcers progressed to severe soft tissue infections that required amputations, and ongoing work from the authors of this correspondence suggests a three-fold increase in emergency major amputations from 2017 to 2020, and another two-fold increase from 2020 to 2021.

Fourth leading cause of mortality
"Deaths due to diabetes, both related and unrelated to Covid-19, also increased by 7.8 percent from 2019 to 2020, and by 17.5 percent from 2020 to 2021.

"Diabetes continues to be the fourth leading cause of mortality in the Philippines.

"Chronic complications are very debilitating with far-reaching consequences. Families, particularly households of manual laborers, also absorb the burden, and the high costs of treatment can push them further into poverty.

"More than financial aid provision, it is crucial to increase efforts on preventive and health-promoting strategies. Telemedicine must be integrated into local health systems, but primary-care units first need the capacity to deliver services in general and more consistently reach patients in remote areas.

"These reforms require substantial but worthwhile government investments in infrastructure and human health resource development. Interagency collaboration is likewise necessary to support implementation and facilitate improved access to diabetes care and related services.

"Finally, there must be a conscious effort to reorient the structure of health delivery towards a system that empowers patients to take active roles in their own care and creates a culture of accountability that would hold the self, the structures, and the institutions responsible to achieve better health outcomes."