A selection of items related to diabetes laid on a wood table

The Singapore government has issued a clarion call — it officially declared war on diabetes, calling the disease one of the biggest drains on the healthcare system, and one which costs the country over $1 billion a year to manage.

Prevalence of Diabetes

During the 2016 Committee of Supply debates in Parliament, Health Minister Gan Kim Yong revealed that over 400,000 people have diabetes in Singapore. Of these, one in three is not aware he/she has the disease, and of the rest who do know, one in three has poor control of it. If left unchecked, nearly one million people in Singapore will have diabetes by 2050.

Prevent, Screen, Control

Active asian couple going on a run together in a park

To help Singaporeans “live life free from diabetes” and for patients to “control their condition to prevent deterioration”, Minister Gan announced the establishment of a new Diabetes Prevention and Care Taskforce.

Its immediate goal is to implement a multi-year action plan to combat the disease. The plan aims to promote a healthy lifestyle to reduce the number of new cases, strengthen early screening and intervention in order to identify the disease among those at risk. It also plans to support better diabetes control programmes to slow progression and reduce associated complications.

Adjunct Associate Professor Daniel Chew, Head and Senior Consultant of the Endocrinology Department of Tan Tock Seng Hospital (TTSH), tells Lifewise that the decision is timely. “Many people involved in the care of patients with diabetes recognise the severity of the problem, which has grown worse over the years.”

“Medical advancements mean that diabetes patients can live longer with their conditions. The fear is most may do so in poor health if diabetes is not well-controlled,” he says. “We have reached a tipping point.”

In line with MOH’s (Ministry of Health) rally to encourage residents to “prevent, screen and control” diabetes, the National Healthcare Group (NHG) is working towards more seamless integration between the acute hospital, primary care, and community sectors to provide patients with a robust support network for screening and disease management, as well as to promote wellness.

As Professor Philip Choo, Group CEO of NHG has said, “We need to move away from transactional medicine, where patients are told what to do. We need to encourage patients to take greater ownership of their health, promote behavioural changes and better lifestyle habits, as well as early detection of diseases through appropriate health screening and case-finding.”

What Causes Diabetes in Singapore?

There are two types of diabetes — Type 1, in which the body produces little or no insulin, and Type 2 (Diabetes Mellitus), where the body develops a resistance to insulin (insulin resistance) and is unable to use it properly.

Both conditions result in high blood sugar levels which can lead to multi-organ complications. While the exact cause of Type 1 diabetes is unknown, Type 2 is often the result of poor diet and a sedentary lifestyle.

Researchers from the NHG Health Services & Outcomes Research department studied more than 22,000 patients from TTSH and NHG Polyclinics over a 10-year period. They found obesity to be the single largest contributor to developing Type 2 diabetes.

Other factors include gender and ethnicity — with Malay and Indian males at higher risk. Smokers are also more likely to develop diabetes than their non-smoking counterparts.

The Full Spectrum

If left untreated or uncontrolled, diabetes can lead to several health complications.

Vascular Dementia: Brain cells die due to poor blood supply, leading to a loss of brain function.

Blindness (Diabetic retinopathy): Diabetes can damage the blood vessels of the retina, potentially leading to blindness. Diabetes also increases the risk of other vision conditions such as cataracts, and more seriously, glaucoma.

Arterial Disease: High blood sugar causes a shutdown of the process that maintains and protects healthy blood vessels from damage. This results in the hardening and narrowing of vessels throughout the body.

Nerve Damage (Neuropathy): Excess sugar in the body can injure the walls of tiny blood vessels (capillaries) that nourish nerves, especially in the legs. Such damage can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers. It gradually spreads upward — leading to a loss of feeling in the affected limbs. When nerves are damaged, the gastrointestinal tract can also be affected. This results in nausea, vomiting, diarrhoea and constipation. Men may also suffer from erectile dysfunction.

Depression: Patients with diabetes may be at higher risk of depression, although the link is not well-understood. Depression can have a serious impact on an individual’s wellbeing, and affect the ability and motivation to care for his or her condition.

Heart Disease: Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke, narrowing of the arteries (atherosclerosis) and high blood pressure (hypertension).

Kidney Disease (Nephropathy): The kidneys contain millions of tiny blood vessel clusters that filter waste from the blood. Diabetes can damage this filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, for which dialysis or a kidney transplant is required.

Skin Infections: Diabetes can cause a number of skin conditions including fungal and bacterial infections, skin-spotting and a variety of spots, rashes and bumpy or oddly-textured skin patches.

Foot Disease: Nerve damage in the feet and poor blood flow to the body’s lower limbs increase the risk of various foot complications. Left untreated, cuts and blisters can become serious infections which often heal poorly and may ultimately require toe, foot or leg amputation.

The Upside

Asian male preparing a healthy meal

While genetics play a part in a person’s risk of developing diabetes, studies have shown that a healthy weight through good diet and exercise can more than makeup for genes. “Diet and exercise are lifestyle choices which are controllable,” says A/Prof Chew.

How About Reversing Diabetes

The complications of diabetes are less common and less severe in individuals with well-controlled blood glucose levels. Sustained lifestyle changes and smoking cessation have a significant impact on slowing the progression of diabetes.

In the meantime, tried-and-tested interventions such as dietary modifications and exercise have proved to be effective. A/Prof Chew has had patients who have successfully reversed the progression of diabetes — from relying on prescribed diabetes medication to only requiring dietary control. “The reality is that we are all at risk if we don’t watch what we eat and continue with a sedentary lifestyle,” he says.

For diabetes patients who require insulin, ongoing research has helped improve the efficacy and safety of insulin. “Research is also being conducted to detect specific genetic defects that may be responsible for diabetes development in certain individuals,” says Dr Darren Seah, Family Physician and Head of the Family Medicine Development at NHG Polyclinics.

“While this has yet to yield a cure, it has started to improve the appropriateness of therapy among some of our patients with diabetes.”

Carbohydrate Metabolism

Carbohydrate metabolism is an important biochemical process that ensures a constant supply of energy to the body.

Our body uses carbohydrates from food as our main supply of fuel. Carbohydrates from starchy foods such as rice, noodles or bread are broken down by the body into sugar (glucose). Glucose travels through the bloodstream to supply cells, muscles and organs with energy that enables us to function. The body also stores glucose in the form of glycogen. Insulin is the hormone responsible for helping cells use or store glucose.

Help Fight the War on Diabetes

  1. To prevent Type 2 diabetes, avoid unnecessary weight gain and maintain a healthy body weight by observing a healthy diet and engaging in physical activity.

  2. Lose weight if you’re overweight or at-risk of being overweight. Studies have shown that modest amounts of weight loss in overweight and obese people with diabetes improve blood glucose control, and lower the risk of developing heart disease and stroke.

  3. If you are struggling with weight loss or proper weight management, use My Healthy Plate to achieve a balanced diet with all the nutrients you need each day. Remember to engage in at least 150 minutes of moderate to vigorous physical activity each week.

Download the HealthHub app on Google Play or Apple Store to access more health and wellness advice at your fingertips.

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