Diabetes is a fast growing problem in Singapore. There are over 400,000 Singaporeans with diabetes today, and the number is projected to increase to 600,000 in just 15 years.  In April this year, the Ministry of Health declared a “war on diabetes”.

 

“We are facing a tsunami of sorts, in the form of diabetes mellitus,” said Dr Bee Yong Mong, head of SingHealth Duke-NUS Diabetes Centre. “It’s no longer a matter of ‘if I will get diabetes’, but a question of ‘when I will get diabetes’, as 30 per cent of adults between the ages 60 and 69 have the condition.”

 

What is more worrying is that diabetes care remains sub-optimal for many. It is a chronic condition that can be managed at the primary care level, but according to Dr Bee, polyclinics are currently shouldering the bulk of care. Polyclinics and General Practitioners (GPs) also have different benchmarks for diabetes care. At the hospital, care is fragmented as patients with multiple diabetic complications are treated for each condition separately.

 

 

As a result, Singapore currently has the highest rate of diabetes hospital admissions and one of the highest re-admission rates in the world. In response, SingHealth has launched several initiatives to close the gap.

 

 

Centring care around the patient is one of the key strategies behind the management of diabetes patients. The set-up of the Diabetes and Metabolism Centre (DMC) in May 2015 brings together specialists from different SingHealth institutions and specialties under one roof to enable a more coordinated approach to care for each patient.

 

“Patients with diabetes often have different complications that need to be handled by different specialists. This means they need to manoeuvre a complexity of services, setting multiple medical appointments at multiple institutions, which can be costly, inconvenient and time-consuming,” said Dr Bee. “Now, they can enjoy the convenience of seeing their endocrinologist, nephrologist, vascular surgeon, ophthalmologist, dietician, podiatrist and specialist nurses all at DMC.”
 
Another important area of focus is caring for the 25 percent of inpatients admitted to the Singapore General Hospital (SGH) with diabetes. These patients are at a high risk of developing potentially serious health complications, resulting in a longer stay in the hospital (more than eight days, compared to less than six for patients without diabetes). They are also at higher risk of dying.

 

 

To reduce the health risk for this group of patients, SGH formed an Inpatient Glucose Management (IGM) multidisciplinary team consisting doctors, nurses and allied health professionals. Through the help of the IT engineers, the team set up a system to proactively identify inpatients with abnormal blood glucose results. This is followed by early interventions by the IGM team to optimise the diabetes treatment. This approach has resulted in an improvement in the proportion of patients with blood sugar levels within the appropriate target range. 

 

 

Proper management of diabetes from the point of diagnosis can halt disease progression and prevent unnecessary complications that require a hospital admission.

However, one in three persons with diabetes is not aware that they have the condition.

 

To ensure early disease detection and intervention, SingHealth is partnering GPs through its Regional Health System to offer free health screening for the immediate family members (parents, siblings and children) of those who are have Type 2 diabetes under the “STOP Diabetes” campaign.

 

“Studies have shown that immediate family members of Type 2 diabetes patients are two to six times more likely to have the disease. By reaching out through our GP partners to detect diabetes early, we can then ensure that timely and active steps are taken to help those at risk to delay or even prevent complications,” said Dr Emily Ho, Director of SingHealth Regional Health System and Consultant, Department of Endocrinology, SGH.

 

In addition, a universal screening programme has also been rolled out to pregnant women, who are susceptible to gestational diabetes. 
 

 

With SingHealth institutions caring for over 80,000 diabetic patients yearly, there are tremendous research opportunities in the disease that will enable us to understand how to prevent, diagnose and treat it more effectively. These patients form the source of a comprehensive database that can be built for information to be collected and analysed.

 

Leveraging the electronic medical records system, DMC has made it mandatory for specific data such as when the condition was diagnosed, the type and details of the complications to be captured. Working with the SingHealth Health Services Research Centre, DMC hopes to use the data for analysis and  to translate this knowledge into initiatives that will improve diabetes care.

 

“All these initiatives will allow us to address the issue of diabetes affecting our population over its entire disease spectrum. So far, we have tried to handle the late-stage issues posed by this chronic condition. What we really want and need to do is to tackle the disease from the start and prevent the need to handle an onslaught of cases with the serious complications of end-stage of diabetes,” said Dr Bee.

 

Separately, the data collected is also stored in the SingHealth Diabetes Database, which provides an overview of the profile of diabetes patients in the cluster including their demographics, physical characteristics, laboratory results as well as the percentage of patients suffering from kidney impairment and requiring amputation. Access to data allows for care reminders to be automatically generated to patients to educate them on preventive care, screening for complications or immunisations.