Singapore and The War on Diabetes
Monday, 13 November 2017
Stephen F. Burns, Associate Professor, Physical Education and Sports Science Academic Group, National Institute of Education
Diabetes has been receiving considerable attention in Singapore. In April 2016, the Ministry for Health announced a ‘War on Diabetes’. In his National Day message this year, Prime Minister Lee Hsien Loong called upon Singaporeans to fight this debilitating disease. But what is diabetes, why has it come to the forefront in discussions on health and, more importantly, what can be done about it?
Diabetes is characterised by high blood sugar levels which are controlled by the hormone insulin. There are two main types of diabetes. Type 1 diabetes typically occurs in childhood and results from an inability to produce insulin in the body – it affects approximately 1% of Singaporeans. Type 2 diabetes (T2D) results from a resistance to respond to insulin and a reduced ability to produce insulin and is strongly related to an unhealthy- lifestyle. It is this form of diabetes that the government is most interested in tackling.
The National Health Survey conducted in 2010 revealed that 11.3% of Singaporeans aged 18-69 years had T2D and a further 14.4% had elevated blood sugar levels (pre-diabetes) . For both men and women, T2D prevalence increased with age, with a sharp rise from 40 years onwards. Most disturbingly, 51.4% of individuals surveyed and diagnosed with T2D were unaware of their status. In 2016, T2D accounted for 1.7% of all deaths and 9.2% of all Polyclinic attendances. It can cause heart disease, stroke, kidney failure, blindness, and lower limb amputation. These facts paint a grim picture and current projections suggest that the number of individuals with T2D will increase from 440,000 Singaporeans in 2014 to >1 million in 2050.
Nevertheless, favourable evidence from randomised, controlled clinical trials show that the risk of developing T2D is substantially reduced by simple lifestyle changes. One multi-ethnic study of >3,000 middle-aged, overweight individuals in the US with pre-diabetes found that lifestyle modifications, such as focusing on weight loss and increasing physical activity, were more effective than pharmacological intervention in reducing progression to T2D over ~4 years of follow-up . Similar findings were seen in a clinical trial in India, where lifestyle intervention of ≥30 minutes of physical activity per day, and a diet designed to maintain appropriate body weight, reduce intake of total and saturated fat, simple sugars and refined carbohydrates, and increase fibre intake were as effective as early pharmacological intervention . Several other well-designed clinical studies support these data.
Simple steps help prevent T2D. One can start with keeping the body mass index (weight in kg divided by the square of height in metres) at ≤23 kg/m2. Completing ≥150 minutes of moderate intensity physical activity each week, such as brisk walking, or ≥75 minutes per week of more vigorous physical activity, such as jogging, can make a difference . Physical activity accumulated throughout the day is as effective for controlling blood sugar and body weight as longer single bouts of daily activity if total energy expenditure is equal . Thus, 10 minutes of walking before breakfast, lunch, and dinner can help. Finally, for diet, reduce intake of saturated (animal) fats, added sugars (e.g. soft drinks) and refined carbohydrates (e.g. white rice) and increase intake of fruits and vegetables. These changes can help combat T2D and reduce the risk of heart disease, stroke, obesity, and certain types of cancers.
1. Ministry of Health (2010). National Health Survey 2010 Singapore. Epidemiology and Disease Control Division, Ministry of Health, Singapore. ISBN:978-981-08-8540
2. Knowler WC, Barrett-Connor E, Fowler SE et al (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine, 346:393-403.
3. Ramachandran A, Snehalatha C, Mary S et al (2006). The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1). Diabetologia, 49:289-97.
4. Burns SF (2016). Physical activity and type 2 diabetes mellitus. Epidemiological News Bulletin, Singapore, 42(3):94-99.
5. Yap MC, Balasekaran G, Burns SF (2015). Acute effect of 30 min of accumulated versus continuous brisk walking on insulin sensitivity in young Asian adults. European Journal of Applied Physiology, 115:1867-1875.