Diabetes

How much do you know about diabetes?

asian woman injecting insulin at her stomach area

What is Diabetes?

Diabetes is a condition in which the body produces insufficient insulin, a hormone that keeps the blood sugar level balanced, or the body does not respond properly to insulin, resulting in a high amount of sugar in the blood. 

There are three main types of diabetes: Type 1 diabetes (usually inherited and cannot be prevented), Type 2 diabetes (the most common type of diabetes and can be prevented) and gestational diabetes (happens during pregnancy)[1].

infographic about the statistics of diabetes in singapore 

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Diabetes is a worldwide epidemic, where the number of people with diabetes is huge and growing. About 440,000 Singapore residents who were 18 years and above had diabetes in 2014[2] and the number is estimated to grow to 1,000,000 in 2050[3]

Diabetes was the 4th and 8th most common condition of polyclinic attendances and hospitalisation respectively in 2014[4]. Life years lost due to mortality and ill-health related to diabetes was the 4th largest among all diseases in 2010[5]

The cost burden from diabetes, including medical expenses and productivity loss, was expected to rise from beyond $940 million in 2014 to $1.8 billion in 2050.

Trends of Diabetes in Singapore

The prevalence of diabetes among Singapore residents (Singapore citizens and Permanent Residents) has increased over the decade. This is largely attributed to our ageing population as the risk of diabetes increases with age. 

One in nine Singapore residents aged 18 to 69 years were affected by diabetes in 2010. The prevalence of people with diabetes was similar between the genders. 

Indians and Malays consistently had higher prevalence of diabetes compared to the Chinese across the years (Table 1). One in three diabetics were unaware that they had diabetes. Among the diabetics who were aware of their disease, one in three had poor control of their condition[6].

Table 1: Crude prevalence of diabetes (%) among Singapore residents aged 18 to 69 years[7]

Year

1998

2004

2010

Total

9.0

8.2

11.3

Age group

18 – 29

0.8

0.5

1.0

30 – 39

3.3

2.4

4.3

40 – 49

9.6

7.9

12.1

50 – 59

21.8

16.7

19.3

60 – 69

32.4

28.7

29.1

Gender

Male

8.5

8.9

12.3

Female

9.6

7.6

10.4

Ethnic group

Chinese

8.0

7.1

9.7

Malay

11.3

11.0

16.6

Indian

15.8

15.3

17.2

Table 2 shows that even after accounting for Singapore’s ageing population, the prevalence of diabetes in Singapore (10.5%) is higher than the world’s average (8.8%). Rising obesity is also a significant contributor to the rise in diabetes prevalence.

Table 2: International comparison on national prevalence of diabetes (%) among the residents aged 20 to 79 years[6]

Prevalence

Crude

Age-adjusted

World

8.8

8.8

North America and Caribbean

12.9

11.5

South and Central America

9.4

9.6

Western Pacific

9.3

8.8

Middle East and North Africa

9.1

10.7

Europe

9.1

7.3

South East Asia

8.5

9.1

Africa

3.2

3.8

Countries and Regions within Asia

Malaysia

16.6

17.9

Brunei

12.9

13.7

Singapore

12.8

10.5

China

10.6

9.8

Hong Kong

10.2

8.0

Taiwan

10.0

8.4

India

8.7

9.3

Korea

8.7

7.2

Japan

7.6

5.7

Myanmar

6.5

6.8

Indonesia

6.2

6.5

Philippines

6.1

6.9

Vietnam

5.6

6.0

The prevalence of impaired glucose tolerance (IGT) among Singapore residents remained between 12 and 15 percent over the decade (Table 3). The profile of those people with IGT was similar to those with diabetes. One in three people with IGT is estimated to develop diabetes in eight years[8].

Table 3: Crude prevalence of IGT (%) among Singapore residents aged 18 to 69 years

Year

1998

2004

2010

Total

15.0

12,0

14.4

Gender

Male

14.9

11.1

13.5

Female

15.2

12.9

15.2

Ethnic group

Chinese

14.3

11.7

14.2

Malay

20.2

13.7

14.6

Indian

14.0

12.4

15.5

Complications of Diabetes

Although diabetes is not fatal in the short term, undiagnosed diabetes or poorly controlled diabetes can eventually lead to disabilities and diseases, compromising the quality of life of individuals and their caregivers. 

The progression to these complications is quickened when diabetes is poorly controlled. Some diseases related to diabetes can also lead to premature death and disability.

infographic about the complications of diabetes

Every year in Singapore,

  • 2 in 3 new kidney failure cases were due to diabetes.

  • 1 in 2 people who had a heart attack had co-existing diabetes; and

  • 2 in 5 people who had stroke had co-existing diabetes[9].

Tips for Individuals with IGT or Diabetes to Prevent Diabetes or Delay Diabetic-related Complications

  • Be aware. Know your risk and screen for diabetes.

  • Eat right. Eat in moderation, choose more wholegrains, fruits and vegetables, and reduce intake of sugar and saturated fat[10].

  • Adopt an active lifestyle. Stay fit by engaging in at least 150 minutes of physical activity weekly[11].

  • Take control. Aim for a healthy weight and have regular check-ups with your family doctor.

  • Do not smoke. Smoking worsens the narrowing of blood vessels, reducing blood flow to many organs which can lead to serious complications.

  • Limit alcohol intake. Alcohol interferes with the meal plan and blood glucose control.

What Are the Risk Factors and Common Symptoms of Diabetes?

Risk factors of diabetes are[12]:

  • overweight/obesity (body mass index ≥ 25.0 kg/m2)

  • first degree relative with diabetes

  • high risk race/ethnicity

  • women who have delivered a baby (who weighed ≥ 4 kg) or were previously diagnosed with gestational diabetes

  • hypertension (blood pressure ≥ 140/90 mmHg) or on therapy for hypertension

  • high-density lipoprotein cholesterol level <1.0 mmol/l for male and <1.3 mmol/l for female and/or triglyceride level ≥ 2.2 mmol/l

  • women with polycystic ovarian syndrome

  • IGT or impaired fasting glycaemia (IFG) on previous testing

  • history of cardiovascular disease

Common symptoms of diabetes are:

  • frequent hunger

  • frequent thirst

  • frequent urination

  • unexplained weight loss

  • constant and extreme fatigue

  • blurred vision

  • wounds that heal slowly and poorly

At-risk individuals, such as those with a family history of diabetes or who are overweight (body mass index ≥ 23 kg/m2), should go for screening before 40 years old. Regular screening should be carried out every 3 years for people whose screening results have been found to be normal[13]. Regular health screening for diabetes is recommended once every three years for people who are 40 years or older.

infographic about the prevalence of diabetes in singapore as age increases

The screening test is free for Pioneer Generation and Community Health Assist Scheme (CHAS) cardholders. Diabetes screening under HPB’s Screen for Life programme is available at GP clinics and polyclinics[14]. You can refer to this clinic locator for the list of CHAS clinics near you.

Since people with IGT have a higher risk of developing diabetes compared to people with normal glucose tolerance, you should be alert once IGT is detected. Studies have shown the cost effectiveness[15] and risk reduction effects[16] of lifestyle modification among people with IGT. Through close monitoring and follow-up, the glucose level of those with IGT can be improved and returned to the normal level.

Early detection, regular monitoring and timely treatment of diabetes can prevent complications and reduce the impact of diabetes on individuals and their caregivers.

​​
infographic about how 1 in 3 people have diabetes without knowing 

To learn more about diabetes in Singapore, check out the "10 Things You Need to Know about Diabetes".

If you are between the ages of 18 and 39, find out your risk by taking the Diabetes Risk Assessment. Take the first step towards beating diabetes.

Diabetes and High Blood Pressure

Both Type 2 diabetes and high blood pressure (hypertension) share common risk factors such as obesity, an unhealthy diet and physical inactivity. It is therefore not surprising that people with Type 2 diabetes have a higher chance of developing high blood pressure.

In addition, uncontrolled diabetes causes narrowing of the blood vessels (atherosclerosis) which in turn can lead to high blood pressure.

Having both high blood pressure and diabetes greatly increases your risks of having a heart attack, stroke, diabetic eye disease and kidney disease. So do your best to keep your blood pressure within the normal range to prevent these diseases.

Related: How Does High Blood Pressure Affect Men and Women Differently?

Check Your Blood Pressure Regularly

If you have diabetes, ask your doctor to check your blood pressure regularly to make sure it stays below 140 over 80 mmHg. Make small changes to your lifestyle, such as eating healthily and staying active, to keep your blood pressure within the desirable range.

Related: High Blood Pressure: Healthy Eating Guide

Use This Checklist to Control Your Blood Pressure

Related: Ambulatory Blood Pressure Monitoring

Treating High Blood Pressure

While some people can control their Type 2 diabetes and high blood pressure with lifestyle changes, most require medication.

People with diabetes and high blood pressure are often prescribed medications to lower their blood pressure. There are many types of anti-hypertensive medications. Some produce side-effects, so keep track of how you feel and let your doctor know.


References

  1. IDF Diabetes Atlas, 7th Edition, 2015, International Diabetes Federation

  2. Extrapolation based on National Health Survey 2010, Ministry of Health, Singapore

  3. Projection done by Saw Swee Hock School of Public Health, Singapore

  4. Health Facts Singapore, Ministry of Health, Singapore

  5. Singapore Burden of Diseases Study 2010, Ministry of Health, Singapore

  6. Poor control is defined as having HbA1c ≥ 8%

  7. National Health Survey 1998, 2004, 2010, Ministry of Health, Singapore

  8. Wong MS et al. (2003). The Singapore impaired glucose tolerance follow-up study. Diabetes Care, 26, p. 3024-3030.

  9. National Registry of Diseases Office, 2014, Singapore

  10. My Healthy Plate, Health Promotion Board, Singapore

  11. Diabetes Toolkit, American Medical Association

  12. Diabetes Mellitus, MOH Clinical Practice Guidelines 1/2014, Ministry of Health, Singapore

  13. Report of the Screening Test Review Committee, Academy of Medicine, Singapore

  14. FAQs on Screen for Life, Health Promotion Board, Singapore

  15. Li R et al. (2010). Cost-Effectiveness of Interventions to Prevent and Control Diabetes Mellitus: A Systematic Review. Diabetes Care, 33(8), p.1872-1894.

  16. Baker MK et al. (2011). Behavioural Strategies in Diabetes Prevention Programs: A Systematic Review of Randomised Controlled Trials. Diabetes Research and Clinical, 91 p.1-12.

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