Diabetes poses fatal risks and substantial financial toll healthcare systems, but lifestyle modifications and timely intervention can help.

Diabetes is a significant health concern in Singapore, with the condition projected to affect nearly 1 million locals by 2050.

“Diabetes is a chronic, progressive condition characterised by high blood sugar levels. It is a metabolic disease where the body either does not produce sufficient insulin, or is insulin resistant and cannot utilize insulin efficiently. In both instances, there is excess glucose in the bloodstream, which over time leads to diabetes,” says Dr Kevin Tan, Consultant Endocrinologist with the Kevin Tan Clinic for Diabetes, Thyroid and Hormones.

“Patients with type-2 diabetes (T2DM) are at serious risk of health problems including heart disease, chronic kidney disease (CKD) and more,” he adds.

Diabetes is also increasingly seen in young patients. According to the Ministry of Health (MOH), 430,000 Singaporeans aged 18 to 69 are pre-diabetic. Unfortunately, 35% of individuals with pre-diabetes are likely to progress to type-2 diabetes within 5 years 

Dr Kevin Tan, Consultant Endocrinologist with the Kevin Tan Clinic for Diabetes, Thyroid and Hormones.

Dr Kevin Tan, Consultant Endocrinologist with the Kevin Tan Clinic for Diabetes, Thyroid and Hormones.

Risk factors and comorbidities

Certain factors such as obesity have been found to increase the risk of developing diabetes. In fact, 80% to 90% of diabetics are overweight or obese, with obesity accounting for 80% to 85% of the risk of developing diabetes due to the release of pro-inflammatory chemicals by fat cells, making the body less sensitive to insulin.

Other risk factors include age (over 40), family history of the disease, physical inactivity, hypertension, high cholesterol, smoking, and previous gestational diabetes.

Diabetic individuals are also two to four times more likely to develop coronary heart disease and twice as likely to develop high blood pressure.

“Diabetics are at greater risk of heart disease because they often have elevated levels of low-density lipoprotein (bad cholesterol) and triglycerides (fatty blood), which promote arterial plaque formation, otherwise known as atherosclerosis. Diabetic individuals also have a greater risk of hypertension because arterial plaque forces the heart to work harder to pump blood throughout the body, resulting in elevated blood pressure,” explains Dr Tan.

Unfortunately, diabetes and hypertension are a dual threat for heart attacks, strokes and heart failure. Heart disease has been found to be the leading cause of death among diabetics, responsible for approximately 65% of deaths in this group.

Apart from heart problems, diabetic individuals are 3.5 times more likely to develop chronic kidney disease (CKD),  and are at increased risk of hyperuricemia and gout.

“Diabetics have a higher risk of CKD because diabetes damages the blood vessel walls and tissues in the kidneys, impairing their ability to filter excess water and waste from the blood. In individuals with CKD, uric acid may not be cleared effectively from the kidneys, leading to the formation of uric acid crystals in the joints and soft tissues, thus putting diabetic patients at higher risk of hyperuricemia and gout,” Dr Tan emphasizes.

The financial burden of diabetes

Aside from the dire health consequences of diabetes, type 2 diabetes imposes a substantial financial toll on Singapore’s healthcare system, which surpassed S$1 billion in 2010.

Dr Tan  warns that if current trends persist, annual healthcare expenditure for diabetes, including direct and indirect expenses, could soar to S$2.5billion by 2050.

“Direct costs generally include expenses related to medical treatment for diabetes and its associated comorbidities, constituting about 30% to 40% of the total costs, with the remaining 60% attributed to indirect costs from absenteeism, loss of productivity, and premature mortality,” elaborates Dr Tan.

“If effective intervention is not introduced, the economic burden of diabetes will almost certainly increase by 40% to about S$10,000 per working patient, over the next three decades,” he adds.

Symptoms and management

For most patients, diabetes is usually asymptomatic until blood sugar levels become significantly elevated. Symptoms of diabetes may include:

  • Increased thirst and hunger
  • Frequent urination
  • Fatigue
  • Blurred vision
  • Genital itching
  • Numbness in the extremities
  • Serious health complications such as heart attacks, strokes, kidney failure and gangrene that can potentially lead to the amputation of the affected limb

“Lifestyle modification and early detection remain the cornerstone of diabetes management and prevention. Diet changes and weight loss can not only prevent the development of diabetes, but it can also help diabetic patients achieve and maintain normal sugar levels at any stage of the disease. This may sound unbelievable, but it is true! That’s why I always advocate a healthy diet rich in vegetables, fruits, and whole grains, while reducing foods that are high in refined sugar, carbohydrates, and trans fats,” Dr Tan advises.

He further recommends incorporating at least 30 minutes of moderate exercise per day, maintaining a healthy weight (BMI < 24.9), and undergoing diabetes screenings every three years (for individuals 40 or older).

“Early detection facilitates timely treatment, enabling patients to manage their diabetes with medications or lifestyle changes before it progresses to other complications such as heart and kidney disease,” he says.

Fortunately, in cases where lifestyle modifications alone do not suffice in controlling blood sugar levels, there are several medications that doctors can prescribe.

“Medications such as metformin reduce the amount of sugar released from the liver, to enhance glucose absorption and insulin, which then helps to lower blood sugar levels. There are also recent advancements such as sodium -glucose cotransporter-2 (SGLT2) inhibitors, a class of drugs that lower blood sugar levels by preventing your kidneys from reabsorbing sugar created by your body, by disposing excess sugar through the urine. This class of drugs have been shown to not only manage diabetes, but also slow down progression of kidney disease and reduce the incidence of heart failure-related mortalities and hospitalisation,” Dr Tan says.

To check if your blood sugar levels are under control, visit the “For Your Sweetheart” website here to redeem a free hBa1c finger prick test by downloading a voucher from any participating clinic, while stocks last.

Featured photo by Dreamstime.
Dr Kevin Tan photo courtesy of Dr Kevin Tan.