1. WHAT IS PRE-DIABETES?

Pre-diabetes is a condition in which blood sugar levels are higher than normal but not high enough to be in the diabetes range. This is defined by:

  1. Fasting plasma glucose between 6.1 – 6.9 mmol/L (110 – 125 mg/dL) and/or
  2. 2-hour plasma glucose post oral glucose tolerance test (OGTT) between 7.8 and 11.0 mmol/L (140 – 199 mg/dL).

2. WHY SHOULD YOU DO SOMETHING ABOUT PRE-DIABETES?

One in 7 Singaporean adults has pre-diabetes. Pre-diabetes can cause serious health problems as it increases the risk of developing type 2 diabetes, heart disease and stroke.

3. CAN TYPE 2 DIABETES BE PREVENTED AMONG INDIVIDUALS WITH PRE-DIABETES?

Yes. Evidence has shown that healthy lifestyle modifications, which cover both nutrition and physical activity, can effectively slow the progression to type 2 diabetes, and in some cases, reverse pre-diabetes.

4. WHAT IS THE PRE-DICTED PROGRAMME?

Pre-DICTED stands for Pre-Diabetes Interventions and Continued Tracking to Ease-out Diabetes (Pre-DICTED). It is a diabetes prevention programme developed by SingHealth Duke-NUS Diabetes Centre in collaboration with Health Promotion Board.

The Pre-DICTED programme aims to recruit participants with pre-diabetes and monitor their condition for 3 years to
(i) study the effectiveness of lifestyle interventions with addition of anti-diabetic medication such as metformin, when required, in diabetes prevention and
(ii) determine if the interventions are feasible for the local population.

5. WHO CAN SIGN UP FOR THE PROGRAMME?

You may be eligible to participate in the programme if you:

  1. Are a Singapore Citizen or permanent resident
  2. Are aged between 18 and 64
  3. Have a body mass index (BMI) ≥ 23 kg/m2
  4. Have been diagnosed with pre-diabetes within the last 6 months

6. WHAT ARE THE GOALS FOR THE PARTICIPANTS?

The goals for the participants of the programme include:

  1. Achieving and maintaining a weight loss of ≥5% of body weight
  2. Engaging in moderate-intensity physical activity (e.g. brisk walking) of ≥150 minutes a week

Participants will be assigned to either the standard care group or the treatment group. Each participant has an equal chance of being assigned to either group.

Participants who are assigned to the standard care group will continue with the current standard of care for pre-diabetes. Participants who are assigned the treatment group will undergo structured lifestyle modifications with stepwise addition of metformin if necessary.

7. PARTICIPANTS IN THE STANDARD CARE GROUP WILL RECEIVE "CURRENT STANDARD OF CARE". WHAT DOES THIS ENTAIL?

The current standard of care for pre-diabetes includes referral and follow up by primary care providers, and incorporates the following features:

  1. Education on what is pre-diabetes
  2. Importance of lifestyle modifications to prevent progression to diabetes
  3. Rescreening of glucose tolerance at regular intervals

8. PARTICIPANTS IN THE TREATMENT GROUP WILL UNDERGO "STRUCTURED LIFESTYLE MODIFICATIONS". WHAT DOES THIS ENTAIL?

Participants in the treatment group will attend a series of 12 group-based nutrition workshops and exercise sessions over a period of six weeks (i.e. twice a week). Participants will be coached on healthy eating habits and participate in group exercises. These workshops are based on Health Promotion Board's (HPB) Pre-Diabetes Intervention Programme. They are locally designed to be culturally appropriate.

In addition, cash incentives will be offered to those who achieve and maintain ≥ 5% weight loss from their baseline weight.

9. WHERE ARE THE NUTRITION WORKSHOPS AND EXERCISE SESSIONS HELD?

The workshops and exercise sessions will be held at Health Promotion Board, 3 Second Hospital Avenue, Singapore 168937.

The schedule and venues will be made available to the participants in advance so that they can plan for their schedule accordingly.

10. WHAT IS METFORMIN? WHY IS IT USED IN THE PRE-DICTED PROGRAMME?

Metformin is an anti-diabetic medication commonly used to treat patients with type 2 diabetes. It has also been shown to be effective in preventing diabetes among individuals with pre-diabetes. In the Pre-DICTED Programme, metformin may be added on to participants in the treatment group after 6 months or more of lifestyle modifications if they are deemed to have very high risk of developing type 2 diabetes.

11. WHAT DOES THE THREE-YEAR PROGRAMME ENTAIL FOR EACH PARTICIPANT?

Besides individual counselling (standard care group) or group lifestyle intervention sessions (treatment group), the three-year programme includes baseline health screening, followed by 6-monthly testing visits for all participants. During such visits, there will be monitoring of body weight, waist circumference, blood pressure as well as blood tests for glucose and cholesterol levels.

12. CAN A PARTICIPANT WHO IS ASSIGNED TO THE STANDARD CARE GROUP REQUEST TO JOIN THE TREATMENT GROUP?

All participants will have to be randomly assigned to the standard care group or treatment group. This process is necessary as it minimises selection bias in the study.

To understand more about the randomisation process, you can contact our Coordinator at DID (9115 6276) or email predicted@singhealth.com.sg.

13. WHAT HAPPENS IF PARTICIPANT'S CONDITION WORSENS AND IS DIAGNOSED WITH DIABETES DURING THE PERIOD OF THE PROGRAMME?

If any of the participants is diagnosed with diabetes in any of the testing visits, we will refer them to a GP or to a polyclinic for diabetes treatment.

14. WHY DO PARTICIPANTS NEED TO BE TRACKED FOR THREE YEARS?

The three years follow-up has been well established in many international studies. It may be challenging and costly to track the participants for longer period.

15. WHAT WILL HAPPEN TO THE PARTICIPANTS AFTER THE 3 YEARS? WHO WILL THEY BE REFERRED TO FOR LONG-TERM FOLLOW-UP CARE?

All participants can continue to see their primary care providers such as GPs and Polyclinics after the programme. If they do not have any primary care providers, for instance those who self-referred to the programme, they will be referred to primary care providers for long term follow-up care.

16. IS THERE A FEE FOR PARTICIPATION IN THE PROGRAMME?

All participants will be asked to make an upfront payment of $20 as a form of deposit contract. The entire amount will be quadrupled (i.e. $80) and returned to the participant if he/she completes the 3-year programme. We hope that this deposit contract will help the participants to stay committed to the programme so that the best possible outcome (i.e. prevention of diabetes) can be achieved for the participants. This amount will be forfeited if the participant drops out of the programme before the end of 3 years or project closeout.

17. HOW CAN MEMBERS OF THE PUBLIC INDICATE THEIR INTEREST TO TAKE PART?

Those who fulfil the eligibility criteria could sign up by contacting the Pre-DICTED team through email at predicted@singhealth.com.sg or to call the study coordinator at DID (9115 6276)

18. CAN PARTICIPANTS WITHDRAW FROM THE PRE-DICTED PROGRAMME AFTER ENROLMENT?

Yes, participants can withdraw from the programme at any time by informing or writing to the Programme Coordinator officially via email to predicted@singhealth.com.sg to express their intention to drop out from this programme.

Alternatively, they may send an official written request to withdraw from this programme to the below address:

Pre-DICTED Programme Coordinator
SingHealth Duke-NUS Diabetes Centre,
Singapore Health Services Pte Ltd,
5 Hospital Drive,
#10-SHS-04
Singapore 169609

They will receive an acknowledgement letter to confirm that they are withdrawn from the programme. The $20 deposit will be forfeited.