Health alert: One in 3 will develop diabetes

11.3 per cent of those aged 18-69 already had the disease in 2010

By Salma Khalik, The Straits Times, 24 Feb 2012

A TIME bomb is ticking here - and its name is Diabetes.

One in three Singaporeans will develop this condition by the time they are 69, making it one of the most pressing health issues here, said Professor Chia Kee Seng, the dean of the Saw Swee Hock School of Public Health.

'It is no longer a question of 'if I will get diabetes', but 'when I will get diabetes',' he said.

In fact, in 2010, 11.3 per cent of people aged 18 to 69 were already living with this condition, in which a high level of sugar in the blood can damage the organs. In 2004, it was 8.2 per cent.

The disease is fairly widespread among those aged 70 and above.

The 11.3 per cent figure earns Singapore the dubious honour of having one of the highest incidences of this illness among developed countries.

In Europe, it is generally around 6 to 9 per cent; worldwide, it is 8.5 per cent.

Dr Stanley Liew, an endocrinologist at Raffles Hospital, said the rise of diabetes here mirrors the rise in obesity from 6.9 per cent in 2004 to 10.8 per cent in 2010.

The reasons for concern are two-fold:

- Diabetes worsens the older a population gets: On top of this, doctors here are seeing an earlier onset of the disease. In 2004, 8 per cent of those aged 40 to 49 had it; six years later, it had gone up to 12 per cent in that age group.

- Diabetes causes a host of health complications ranging from blindness to kidney failure, poor circulation leading to limb amputations, heart attacks and strokes.

Associate Professor Tai E Shyong, who heads endocrinology at the National University of Singapore, said: 'It's a concern for most doctors, and indeed, for health- care organisations.'

Diabetes is the top cause of blindness here. It is also linked to two limb amputations a day and 60 per cent of kidney failures, up from 50 per cent a decade ago.

In 2009, 46.4 per cent of people who had their first heart attacks here were diabetic, said the Health Promotion Board (HPB). Internationally, the figure is 30 to 40 per cent, noted cardiologist Aaron Wong of the National Heart Centre.

Singapore's high figure stems from the higher incidence of diabetes here, he added. A person with runaway blood-sugar readings stands the same risk of getting a heart attack as one who has already survived one attack.

Diabetics also have poorer recovery from heart attacks, as uncontrolled diabetes narrows the arteries, making it difficult to get enough blood to the heart following an attack.

Dr Goh Su-Yen, the head of endocrinology at Singapore General Hospital, added that diabetics are 50 per cent more likely to have a heart attack than someone without the disease.

Diabetics must control their blood sugar levels. Studies show that every percentage-point increase raises the risk of cardiovascular disease by 11 per cent.

Said Dr Goh: 'If you already have diabetes, there is still plenty that can still be done to reduce the risk of developing complications.'

Proper and early treatment and screening for possible complications will cut overall risks of these complications.

Those about to develop the condition can avert it with 30 minutes of daily moderate exercise. This, with a 5- to 10-per-cent weight loss, can cut the risk by 58 per cent, she said.

More men than women here have the condition, with Indians almost twice as likely to get it as the Chinese; it is also high among Malays.

Half the people with diabetes remain unaware of it. They are the ones in whom complications such as stroke and kidney failure will emerge in about a decade.

Dr Liew said: 'Interventions to prevent and control diabetes are more cost-effective than treating patients after diabetic complications have occurred.'

Prof Tai said 'significant efforts' are being made here to prevent diabetes, such as by encouraging people to eat right and exercise more.

'We know from clinical trials that if we get this right, we can reduce new cases by as much as half,' he said.

Free tests will stem rising tide of diabetes
By Salma Khalik, The Straits Times, 1 Mar 2012

THE Government has made a major commitment to health care: to double its annual spending from $4 billion to $8 billion over the next five years.

A large chunk will go towards boosting much needed infrastructure such as hospitals and nursing homes, and in increasing and retaining skilled manpower in this resource-tight sector. Significant amounts will also go towards keeping health care affordable, by bumping up subsidies.

All that is necessary. But it is fire-fighting. More needs to be done to prevent the fire in the first place.

The Health Promotion Board has done a lot in this area: encouraging healthier lifestyles, raising awareness of chronic diseases, and promoting health screening among older people.

There have been some results, as more people are getting diagnosed earlier for some chronic diseases such as hypertension and high cholesterol levels, and for cancers like breast and colorectal cancers.

But in spite of years of plugging at the problem, the number of people who still do not know that they are suffering from diabetes is staggering.

The 2010 national health survey found that 49.4 per cent - or one out of every two - of diabetics was blithely unaware of the time bomb ticking inside them.

Their condition was discovered during the survey by a fasting blood test and again, two hours after drinking a glucose solution - to ensure that the results are accurate and not due to a recently ingested high-sugar meal.

On a national basis, this translates into 200,000 adults aged 18 to 69 who are diabetic but are not aware of it.

Uncontrolled, the high levels of sugar in their blood will wreak havoc with their body in about a decade. It raises their risk of getting heart attacks, strokes, kidney failure, gangrene in their limbs requiring amputation and blindness.

Well controlled, they can live out their lives in relatively good health.

The earlier the disease is discovered, the easier it is to deal with - since the sugar levels in their blood would be relatively low and the damage to their bodies still minimal.

The cost of the rising incidence of diabetes to the nation is huge, since these people are more at risk of many other medical problems. Many patients occupying hospital wards today for a range of problems have had their illness aggravated because of diabetes.

Unlike non-diabetic patients, they are both more likely to get ill and, when that happens, are slower to heal.

Dr Stanley Liew, an endocrinologist at Raffles Hospital, said: 'Interventions to prevent and control diabetes are more cost effective than treating patients after diabetic complications have occurred.'

The Ministry of Health (MOH) is fully aware of that, and has been trying for years to get people to screen for the disease. But it is a silent killer with hardly any symptoms in the early stages. So few would fault a seemingly healthy 40-year- old for not testing for diabetes.

One solution is for the Government to pick up the tab for such screening, and for doctors to provide the service annually to all their adult patients.

If it is done on a national scale, few thousands of people would discover they have the disease early.

People with impaired glucose tolerance, also known as prediabetes, can stop themselves from getting diabetes with proper diet and exercise, said Dr Goh Su-Yen, head of endocrinology at Singapore General Hospital (SGH).

'They may even be able to return their blood glucose levels to the normal range,' she said.

The trick is to find out really early.

Only screening on a national level can throw up all such cases.

Unlike the other two silent killers - high cholesterol levels and high blood pressure - which have been decreasing over the years, diabetes is on the increase. Hypertension is also easy to diagnose and can be done in a doctor's office at no extra charge.

The Government has always been wary about providing free health care, believing that cost sharing with the patient is the best way to go. That is likely true when it comes to treatment.

But it is difficult to convince young people who think they are healthy that they should spend money on screening.

Getting their family doctor to do the test free each year could see the number not realising they have the disease fall dramatically.

The first step to beating a disease is knowing that they have it in the first place.