Singapore’s fight against diabetes has been making headlines, especially following the nation’s declaration of war against the disease in 2016.

“We are still seeing a rising prevalence of diabetes in Singapore, with one in three Singaporeans expected to develop diabetes in their lifetime.” said Assoc Prof Bee Yong Mong, Head and Senior Consultant, Department of Endocrinology, Singapore General Hospital and former Head, SingHealth Duke-NUS Diabetes Centre.

A/Prof Bee explains, “There are two important risk factors for diabetes; one is our ageing population and the other is the rising obesity rates in Singapore. Based on local data, it is estimated that by 2035, about 32% of Singaporeans will be aged 65 and above. We have also yet to tackle the rising obesity rate here. These factors make it difficult to manage diabetes.”

The true magnitude of the problem
Diabetes is not a leading cause of death in Singapore, but in reality, many heart attacks, strokes and kidney failures trace back to this disease. Co-existence of diabetes also complicates the treatment of many other diseases including COVID-19, making it costly for both the patient and our healthcare system.

Most individuals with pre-diabetes or early stage diabetes do not show any symptoms. Left untreated, patients may experience complications including eye disease (diabetic retinopathy and maculopathy), kidney disease and nerve disease (diabetic peripheral neuropathy).

In 2009 the Tanoto Foundation Professorship in Diabetes Research was established, to deepen understanding into the causes of diabetic complications and to uncover genes that make people susceptible to these complications. Over the last few years, the Chair of the Professorship, Prof Karl Tryggvason, has been able to accumulate extensive knowledge to unravel how diabetes affects cellular functions, understand disease mechanisms and what causes tissue damage.

The results of Prof Tryggvason‘s work are now being used to address a number of conditions including heart infarction, kidney failure caused by genetic disorders and diabetes, blindness caused by degeneration of retina cells and burns. More recent research done by Prof Tryggvason has led to the identification of novel genes that may enable scientists and clinicians to identify diabetic patients that are more likely to be affected by kidney, eye and general blood vessel diseases.

“Prof Tryggvason’s research, among others, has helped us gain valuable insights into the disease so early interventions can be implemented with planned education and outreach.” said Assoc Prof Goh Su-Yen, Head, SingHealth Duke-NUS Diabetes Centre and Senior Consultant, Department of Endocrinology, Singapore General Hospital. The Diabetes Centre brings together different specialists and allied health professionals across SingHealth to organise care around patients throughout the diabetes continuum of care; from prediabetes to late-stage diabetes with complications.

Prevention is better than cure
Besides the scientific aspect of the disease, more can be done to equip patients with knowledge, skills and tools to better manage their conditions and to prevent complications.

Last year, the EtonHouse Community Fund made a gift to the KK Women’s and Children’s Hospital to fund Glucose Monitoring Systems (GMS) for 60 children with diabetes from less advantaged families. With the GMS, the children and their caregivers are able to respond to fluctuations in blood glucose levels quickly, preventing hypoglycaemia (low blood glucose) or hyperglycaemia (high blood glucose). It also empowers them to follow established diabetes care plans for the child. The SingHealth Polyclinics (SHP) has also started the ‘Self Care Support Programme’ to help SHP patients in need better afford self-monitoring devices for home use. 

“Pre-diabetes and early stage diabetes can be reversed or controlled through intensive lifestyle modifications or the use of medication,” shared A/Prof Bee. “The challenge clinicians often face is in nudging patients to adopt healthier lifestyle choices. A significant proportion of patients lack the understanding of the importance of balancing food composition and nutrition when it comes to controlling diabetes.”

Timely intervention can save lives, and in some cases, limbs. “The close collaboration between the primary care physicians from SingHealth Polyclinics and the vascular surgeons, podiatrists and endocrinologists from SingHealth hospitals has resulted in the steady decline in lower extremity amputation (LEA) rates over the past 5 years. The age-adjusted minor LEA (e.g. toe and foot amputations) rates have declined by 38% between 2015 and 2019,” said A/Prof Bee.

However, he highlighted that there is now an urgent need to reach out to specific segments of the population such as individuals and families from the lower socio-economic strata.

“These individuals with diabetes tend to present late to healthcare providers and often have advance diabetic complications. We will need to work with all stakeholders, including community partners, to improve their health outcomes,” he said.

It is estimated that, by 2050, the number of individuals with diabetes in Singapore will reach one million, inflicting an estimated yearly cost burden of over $1 billion on our nation. Philanthropic support is critical to ensure that all segments of the population, including the more vulnerable, can receive timely diagnosis and care, thereby reducing their likelihood of developing diabetic complications.  

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