Researchers from NHCS recently launched a multinational clinical trial - Asian Diabetes Outcome Prevention Trial (ADOPT) to help prevent heart disease among high risk diabetic patients across Asia.

Singapore declared ‘War on diabetes’ in 2016 to combat the alarming rise in diabetes. In Singapore, the number of adults with diabetes is projected to increase from 440,000 to 1 million in less than 30 years. Diabetes accelerates the development of heart disease by as much as 14 years earlier, compared to those without diabetes. When a patient with diabetes is further burdened with heart failure, it leads to reduced quality of life, disability, hospitalisation, poor clinical outcome and poses tremendous burden in the healthcare expenditure. Treating patients with diabetes and cardiovascular complications is 112% higher in cost
than treating diabetic patients without complications.

Research on Lean Diabetes among Asian Heart Failure Patients

Recent research by NHCS has discovered a unique ‘lean diabetes’ pattern in Asian patients with heart failure. These individuals develop diabetes despite a low body mass index (BMI), strikingly different from the conventional obesity-induced diabetes among Caucasians. The team found that these lean diabetic patients with heart failure were at high risk of hospitalisation and death. Particularly, even when their BMI was low, patients with large waistto-height ratios were at the highest risk of poor outcomes. The landmark findings were published in several high impact scientific journals1-2.

“Realising the dismal prognosis of lean diabetic patients with heart failure and the lack of proven therapies to improve their prognosis, the research team firmly believes that prevention of future cardiac disease among highrisk diabetic asymptomatic individuals is critical,” explained Professor Carolyn Lam, Senior Consultant from Department of Cardiology, and Director of Women’s Heart Health at NHCS.

Launch of Clinical Trial to Prevent Heart Disease in Diabetics

ADOPT aims to test if an intensive treatment strategy can reduce the onset of cardiovascular disease including stroke among high risk individuals with diabetes, compared to standard care. Specifically, ADOPT aims to
1. strategically identify diabetic individuals with high risk of heart disease using a biomarker – N-terminal pro-B-type natriuretic peptide (NT-proBNP); and
2. intensify preventive therapy using three established classes of commonly available medications which target blood pressure and blood sugar for primary prevention of cardiovascular (heart or blood vessel) events in these high-risk diabetic patients.

“In Singapore, the cost of treating diabetes is expected to rise to S$2.5 billion by 20503, given the current standard of care. Managing cardiovascular complications substantially adds to the direct costs of treating diabetes. If proven effective, this treatment regime could also potentially help save significant healthcare cost in Singapore and beyond,” expressed Dr Chanchal Chandramouli, Research Fellow from National Heart Research Institute Singapore (NHRIS), who is also a key co-investigator and Steering Committee Member of ADOPT.

The ADOPT study will be conducted in 30 centres across six Asian regions including Singapore, Malaysia, China, Taiwan, India and United Arab Emirates. The team aims to recruit 2,400 volunteers with follow-up over a duration of four years. The team has recruited the first patient in late August, at Changi General Hospital – one of the ADOPT sites in Singapore.

This investigator-initiated trial has received support from the National Medical Research Council of Singapore, philanthropic and commercial partners.

1 Chandramouli C, Tay WT, Bamadhaj NS, et al. Association of obesity with heart failure outcomes in 11 Asian regions: A cohort study. PLoS Med. 2019;16(9):e1002916. Published 2019 Sep 24. doi:10.1371/journal. pmed.1002916
2 Tromp J, Tay WT, Ouwerkerk W, et al. Multimorbidity in patients with heart failure from 11 Asian regions: A prospective cohort study using the ASIAN-HF registry [published correction appears in PLoS Med. 2018 May 25;15(5):e1002583]. PLoS Med. 2018;15(3):e1002541. Published 2018 Mar 27. doi:10.1371/journal.pmed.1002541
3 Khalik, S. (2016). Study: Cost of diabetes to Singapore to soar beyond $2.5b. The Straits Times.

This article is from Murmurs Issue 37 (May – August 2020). Click here to read the full issue.