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Diabetes screening and prevention



1 in 9 Singaporeans has diabetes. 1 in 3 individuals with diabetes does not know he or she has it. Regular glucose screening is the most effective way for you to detect diabetes. Type 2 diabetes is the most common form of diabetes in Singapore. It can be prevented by adopting a healthy diet, increasing physical activity, quitting smoke and maintaining an ideal weight.


What is diabetes?

Diabetes is a condition where your body cannot manage sugar properly, resulting in too much sugar in your blood. The chronic high blood sugar of diabetes mellitus is associated with long-term sequelae resulting from damage to various organs especially kidney, eye, nerves, heart and blood vessels.


There are different types of diabetes, namely, type 1 diabetes, type 2 diabetes, gestational diabetes, and other specific types.


Type 1 diabetes occurs when the pancreas loses its ability to produce insulin, the hormone which helps to regulate your blood glucose level. While the exact cause of type 1 diabetes is still unknown, it is thought that genetics and viruses may play a part in its development.


Type 2 diabetes is the most common form of diabetes in Singapore and can be prevented and managed by making healthy lifestyle choices.

 

What is pre-diabetes?

Pre-diabetes is when your blood sugar levels are higher than normal but not high enough to be diagnosed with diabetes. Pre-diabetes is asymptomatic but predisposes individuals to cardiovascular disease.

 

How common is diabetes and pre-diabetes in Singapore?

In Singapore, there has been an increase in the proportion of people affected by diabetes from 8.2% in 2004 to 11.3% in 2010. It has become Singapore’s tenth leading cause of death. 1 in 3 individuals with diabetes does not know he or she has it.


Around 14% of Singaporeans have impaired glucose tolerance (IGT), a kind of pre-diabetes, and without lifestyle changes, at least 35% of persons with pre-diabetes in Singapore will progress to diabetes within 8 years.

 

Who should go for diabetes screening?

If you develop typical diabetes symptoms, such as increased thirst, frequent urination, extreme hunger, unexplained weight loss etc, please consult a doctor as soon as possible.


If you do not have symptoms and any risk factors for diabetes, screening testing should begin at 40 years. If you have one or more risk factors, you should start screening whenever you have a chance.


The risk factors for diabetes are:

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

• First degree relative with diabetes

• High risk race/ethnicity

• Women who delivered a baby 4kg or more; or were diagnosed with Gestational Diabetes Mellitus

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

• HDL cholesterol level <1.0mmol/L (male), <1.3mmol/L (female) and/or a triglyceride level ≥2.2mmol/L

• Women with polycystic ovary disease

• Impaired fasting glycemia (IFG) or impaired glucose tolerance (IGT) on previous testing

• History of cardiovascular disease

 

How to prevent Type 2 diabetes?

Lifestyle changes can help prevent one from developing type 2 diabetes, especially for persons with pre-diabetes. According to some studies, adopting a healthy diet and increased physical activity reduces progression to type 2 diabetes by 31-37% over 2 to 6 years.


Lifestyle modification goal: A BMI of < 23 kg/m2 and/or a 5-10% body weight loss should be gradually achieved and maintained by implementing a negative caloric balance.


The lifestyle modification details are as below:


1) Health diet


Healthy and balanced diet plays a key role in preventing diabetes. People who are overweight or obese to achieve weight loss by reducing calorie intake.


These are tips to adopt a healthy diet:


(i) Portion a healthy plate

• Fill half the plate with mainly vegetables and a small portion of fruits.

• Fill a quarter of the plate with lean meat, fish, poultry (skinless), eggs, low-fat dairy or soy

products.

• Fill a quarter of the plate with whole grains such as brown rice, rolled oats, whole grain

bread and cereals. Avoid sweetened beverages and foods

• Opt for water instead of soda or sweetened drinks (e.g. fruit juices).


(ii) Eat less fat

• Avoid pastries, fried food and food containing coconut milk or cream.

• Use less oil when cooking and use healthier oils instead of butter, ghee and palm oil

(e.g. sunflower oil, rice bran oil, olive oil).


(iii) Limit alcohol intake

• No more than one standard drink per day for females.

• No more than two standard drinks per day for males.

[A standard drink is one can (330 mL) of beer, half a glass (100 mL) of wine, or one nip (30 mL) of spirits and hard liquor.]


2) Increased physical activity


Obesity and a sedentary lifestyle are major risk factors for developing type 2 diabetes and can be modified by an increase in physical activity.


You are advised to:


• perform at least 150 minutes of moderate intensity exercise or 75 minutes of vigorous intensity

exercise every week.

• allow for no more than 2 consecutive days without exercise.

• engage in exercises that require intensity and accelerate the heart rate.


3) Smoking cessation


Smokers are advised to stop smoking as smoking impairs glucose metabolism, insulin sensitivity and secretion. Smoking damages your blood vessels, decreases blood flow to your legs and feet, and increases your risk of having a heart attack.


But it is never too late to stop smoking. If you stop now, your body will start to repair itself. Smoking cessation services are available in various polyclinics, hospitals, pharmacies and other private centers. If you need help to quit, get an appointment to see a smoking cessation consultant at any of these services. You can also call Quitline (1800–438 2000).


You can change many of the factors that influence diabetes. Act now!

 

Reference

  1. Diabetes Mellitus, MOH Clinical Practice Guidelines 2014

  2. Topics on Diabetes, prediabetes and smoking cessation from https://www.healthhub.sg/

  3. Managing pre-diabetes-a growing health concern, Appropriate Care Guide (ACE), MOH Singapore, 3 July 2017