Sugar Is Not the Villain: Understanding Diabetes Risk Factors, Prediabetes, and Early Screening

An Expert Opinion Series feature for Diabetes Awareness Week 2026

When people hear the word diabetes, sugar usually gets blamed first.

Cake. Soft drinks. Chocolate. Milk tea. Dessert after lunch.

But is sugar really the main problem?

According to endocrinologist Dr. Ronald D. Chua, sugar is only one part of a much bigger picture. Your family history, food portions, weight, activity level, sleep, stress, and screening habits can also affect your risk.

This Diabetes Awareness Week, let us put common diabetes beliefs to the test and learn what people can do before the condition becomes harder and more costly to manage.

‘Sugar is just one piece of a much bigger puzzle.’

— Dr. Ronald D. Chua

Diabetes is not only a dessert problem

Eating too much added sugar can affect your health. However, eating sweets alone does not fully explain why someone develops type 2 diabetes.

Dr. Chua says a person’s risk may come from a mix of genetics and daily habits.

These may include:

• having a parent or sibling with diabetes
• being overweight or obese
• getting little physical activity
• eating large food portions
• drinking sweetened beverages often
• getting poor sleep
• living with constant stress

Carbohydrates also matter. Food such as rice, bread, noodles, and pastries turns into glucose inside the body. This means a person may rarely eat dessert but still take in large amounts of carbohydrates throughout the day.

‘But I do not even like sweets!’

Dr. Chua often hears this from patients who are newly diagnosed with type 2 diabetes.

A person without a sweet tooth can still develop the condition.

Family history can raise a person’s risk even when they do not eat many desserts. Weight, movement, sleep, stress, and total food intake can raise that risk further.

The better question is not only, ‘How much sugar do I eat?’

Ask yourself:

• How much do I eat at each meal?
• How often do I move?
• What do I usually drink?
• Does diabetes run in my family?
• When was my last blood sugar test?

Can People with Diabetes Still Eat Rice?

Here is some good news for rice lovers: rice does not need to disappear from the table.

Dr. Chua says the bigger issue is the amount you eat and what you eat with it.

One cup of rice with vegetables and protein is very different from three cups of rice with little else on the plate.

Some people try to remove rice completely. They may follow the plan for a few days or weeks, then return to their old portions because the change feels too strict.

A more realistic approach is to:

• control the serving size
• add vegetables
• include protein such as fish, chicken, eggs, tofu, or beans
• avoid having several carbohydrate sources in one meal

For example, eating pancit with bread gives you two major carbohydrate sources at once. The same may happen when you eat rice with noodles or rice with a large serving of dessert.

The goal is balance, not deprivation.

Your drink may be dessert in disguise

Some sources of sugar are easy to see. Others hide in drinks and everyday food.

Dr. Chua points to several common examples:

• 3-in-1 coffee
• milk tea
• soft drinks
• bottled fruit juice
• sweetened iced coffee
• packaged snacks
• rice cakes or kakanin
• fast-food meals
• rice-heavy meals with few vegetables

A drink may feel light because you do not chew it. But it can still contain a large amount of sugar.

This does not mean you can never enjoy these drinks. It means you should treat them like sweets instead of regular sources of hydration.

Water remains the simplest everyday choice.

What should a balanced Filipino plate look like?

Dr. Chua recommends using Pinggang Pinoy as a simple guide.

For a standard plate:

• fill half with vegetables and fruit
• use one part for protein
• use the remaining part for rice or another carbohydrate source

More colors usually mean more food variety.

A practical Filipino meal may include:

• a smaller serving of rice
• grilled fish, chicken, tofu, eggs, or monggo
• a larger serving of vegetables
• fresh fruit in a controlled portion
• water instead of a sweetened drink

Healthy eating does not need to be expensive or complicated. Start with food that is available at home, in the market, or near your workplace.

Can You Have Diabetes Without Symptoms?

Diabetes can develop quietly.

A person may have high blood sugar for months or years without strong symptoms. They may feel normal and continue with their usual routine.

When symptoms appear, blood sugar may already be high.

Possible signs include:

• frequent thirst
• frequent urination, especially at night
• unexplained weight loss
• tiredness
• blurry vision
• wounds that heal slowly

Dr. Chua advises people not to wait for these signs before speaking with a doctor.

Screening becomes even more important when you have risk factors.

People who may need earlier screening include those who:

• are overweight or obese
• have a parent or sibling with diabetes
• have high blood pressure
• have heart disease
• have high triglycerides or low HDL cholesterol
• have polycystic ovary syndrome
• get little physical activity
• had gestational diabetes
• were previously told they have prediabetes

For people without these risk factors, screening should generally begin at age 35.

Two common tests are Fasting Blood Sugar and HbA1c. Your doctor can tell you which test fits your case.

What Is Prediabetes and Can It Be Reversed?

Prediabetes means your blood sugar is higher than normal but has not yet reached the diabetes range.

Think of it as a yellow traffic light.

It is a warning to slow down, check your habits, and act. It is not a sign that nothing can be done.

At this stage, food changes, regular physical activity, weight management, medical advice, and medicine for selected patients may delay or prevent type 2 diabetes.

This is one of the best times to act.

Why waiting can cost more

People sometimes set diabetes aside because they do not feel sick.

But high blood sugar can slowly damage the body.

Unmanaged diabetes may affect:

• the heart and blood vessels
• the kidneys
• the eyes
• the nerves
• the feet
• wound healing

A condition that could have started with food changes, regular movement, check-ups, and simple medicine may later require more consultations, tests, medicines, hospital care, or time away from work.

Early screening is not only a health decision. It can also help a person avoid bigger medical and financial problems later.

Three changes you can start this week

Dr. Chua recommends keeping it simple.

1. Move more

Aim for a total of at least 150 minutes of moderate physical activity each week.

You can try:

• brisk walking
• jogging
• swimming
• cycling
• dancing
• Zumba
• active household work

Start at a level that fits your health and current ability. Speak with your doctor before starting a new exercise plan if you have a medical condition.

2. Rethink your plate

Add more vegetables. Watch your rice, bread, and noodle portions. Drink less sweetened coffee, milk tea, soft drinks, and juice.

You do not need to change everything in one day. Pick one habit and work from there.

3. Check your numbers

Speak with your doctor if you have diabetes risk factors or have not had your blood sugar checked recently.

A test may feel scary, but knowing gives you choices.

Knowing early gives you more control

Some people avoid testing because they are afraid of the result.

But not knowing does not remove the condition. It only delays the chance to act.

Finding diabetes or prediabetes early may give you simpler options, better control, and more time to protect your health.

As Dr. Chua puts it:

‘Knowing early is a form of power, not a burden.’

This Diabetes Awareness Week, do not stop at asking how much sugar you eat.

Check your plate. Check your habits. Check your family history. Most of all, check your numbers.

Why Preventive Screening Matters

At ILB, we believe prevention is one of the most powerful investments in health. Regular screening can help identify diabetes and prediabetes before complications develop, giving individuals and employers the opportunity to take action earlier.

Whether through annual checkups, preventive consultations, or corporate wellness initiatives, early detection remains one of the simplest ways to protect long-term health and manage healthcare costs.

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About the Expert

Dr. Ronald D. Chua, MD, MBA, FPCP, FPCEDM, CCD is a specialist in Internal Medicine, Endocrinology, Diabetes, and Metabolism.

He completed his fellowship training in Endocrinology, Diabetes, and Metabolism at East Avenue Medical Center. He is a Fellow of the Philippine College of Physicians and the Philippine College of Endocrinology, Diabetes and Metabolism. He is also a Certified Clinical Densitometrist.

Dr. Chua serves as a hospital consultant and teaches at the Ateneo School of Medicine and Public Health. His professional work includes diabetes care, endocrinology, clinical teaching, and medical research.

This article provides general health information. It does not replace a personal consultation, diagnosis, or treatment plan from a qualified healthcare professional.