The crucial role of early intervention in combating diabetes

Recognised as a silent threat, diabetes has emerged as a widespread public health concern. In 2021, the disease claimed the lives of 6.7 million individuals globally. In Singapore, more than 400,000 people are living with the condition while another 430,000 residents aged between 18 and 69 are classed as pre-diabetic. 

“Diabetes is projected to affect nearly one million Singaporeans by 2050 if left untreated,” noted Dr Kevin Tan, consultant endocrinologist at the Kevin Tan Clinic for Diabetes, Thyroid and Hormones. “By the same year, the financial burden of diabetes could climb to an estimated S$2.5 billion annually, up from S$1 billion in 2010.”

A SILENT DISEASE WITH SERIOUS HEALTH IMPLICATIONS

Diabetes is a chronic and progressive condition in which the body fails to produce sufficient insulin or cannot utilise insulin effectively. Insulin, a hormone synthesised by the pancreas, plays a pivotal role in regulating blood glucose levels. In instances of insulin resistance or insufficient insulin production, excess glucose accumulates in the bloodstream and can lead to outcomes such as damage to the eyes, nerves, kidneys and blood vessels. 

Type 2 diabetes, the most common form of diabetes locally, is associated with several risk factors, including obesity. According to Dr Tan, obesity is believed to account for 80 to 85 per cent of the risk of developing Type 2 diabetes. Other risk factors for the condition include age, a family history of the disease, physical inactivity, high blood pressure, high cholesterol, smoking and gestational diabetes. 

“Diabetes can result in a host of serious health complications, such as heart attacks, strokes, kidney failure and non-healing foot ulcers that can potentially become infected, leading to amputation of the affected limb,” said Dr Tan.

ELEVATED CARDIOVASCULAR AND KIDNEY-RELATED RISKS

Given the intricate interconnection of the cardiovascular, renal and metabolic systems, the complications triggered by diabetes in one system can swiftly impact others and culminate in a condition known as cardio renal metabolic (CRM) syndrome.

Explained Dr Low Lip Ping, a cardiologist at Low Cardiology Clinic and chairman emeritus of the Singapore Heart Foundation: “Over time, uncontrolled high blood sugar can damage blood vessels and the kidneys, resulting in elevated blood pressure levels.” 

Dr Jason Choo, senior consultant in the Department of Renal Medicine at Singapore General Hospital, further underscores that heightened blood pressure and diabetes independently or jointly represent the primary causes of chronic kidney disease (CKD) leading to end-stage kidney failure in adults, which account for approximately 80 per cent of all kidney failure cases worldwide. 

“CKD is characterised by irreversible and progressive loss of kidney function in filtering waste and fluids from your blood. In its advanced stages, CKD can cause dangerous levels of fluid, electrolytes, and waste to build up in the body,” he said.  

According to a study, an estimated 20 to 40 per cent of individuals with diabetes are projected to develop diabetic kidney disease (DKD). Notably, diabetes remains the leading cause of end-stage kidney failure in Singapore, accounting for 67 per cent of new cases. 

Dr Choo elaborated: “Diabetic kidney disease can advance more rapidly compared to non-DKD cases. Individuals with the former are at a higher risk of encountering CKD-associated complications, including hypervolemia, a condition where fluid overload in the body results in swelling, high blood pressure, heart problems and other issues.” 

Diabetes contributes to another alarming statistic: In Singapore, one out of every two individuals who suffers a heart attack is diabetic. Moreover, those with diabetes face a risk up to four times higher for stroke and are twice as likely to succumb to complications following a myocardial infarction – commonly known as a heart attack – compared to non-diabetics.

“Because coronary artery disease (CAD) is often asymptomatic in diabetic patients, some individuals could be diagnosed with CAD during comprehensive health screenings that include an electrocardiogram, an inducible myocardial ischaemia with exercise stress test (usually treadmill exercise), or an imaging procedure (echocardiography or nuclear) that can provide risk assessment for adverse health outcomes,” said Dr Low. 

He emphasised that proper screening and diagnosis of CAD is crucial for the prevention and early treatment of coronary events, especially in those with diabetes. 

Similarly, early detection and proactive management of DKD is crucial for slowing its progression and delaying associated complications, said Dr Choo. Without intervention, individuals may advance to end-stage kidney failure, necessitating dialysis treatment, with haemodialysis being the most commonly employed approach. Significantly, Singapore has the highest per capita incidence globally for diabetes-induced kidney failure. 

“Haemodialysis is not only painful and inconvenient, but expensive as well,” noted Dr Choo. “CKD places a heavy financial burden on patients and their families, and the process of dialysis can also exert an emotional and physical toll. Patients undergoing dialysis may experience depression and a diminished quality of life.”  

MANAGING DIABETES THROUGH LIFESTYLE CHANGES AND MODERN MEDICINE

While diabetes remains a chronic condition without a cure, individuals in the early stages of diabetes can take steps to delay its onset or slow its progression, along with mitigating the risk of associated complications such as CRM syndrome.

These measures involve maintaining healthy blood glucose levels through a balanced diet rich in vegetables, fruits, and whole grains, coupled with a consistent routine of regular exercise.

When these strategies prove insufficient, medication is harnessed for the effective management of diabetes, Dr Tan highlighted. 

“There are various classes of antidiabetic medication – ranging from oral to injectables – that have undergone rigorous examination in clinical trials, to enhance the management of diabetes and its associated complications,” he explained. 

Ultimately, the selection of medication hinges on the patient’s specific needs, medical history, and preferences. It is crucial for patients to consult with their healthcare professionals to ascertain the most suitable treatment plan.

According to Dr Tan, all adults aged 40 or above should undergo diabetes screening once every three years if their blood sugar results are normal, while individuals with borderline test results should opt for annual screenings.

“Early detection can facilitate timely treatment, enabling you to manage your condition with lifestyle changes and/or medication before complications involving the heart and kidney develop,” he advised. 

The Ministry of Health’s national screening programme, Screen for Life, offers subsidised screenings for Singapore citizens and permanent residents at Community Health Assist Scheme (CHAS) general practitioner clinics. Screen for Life is also fully subsidised for individuals enrolled under Healthier SG, at their enrolled clinic. Learn more about diabetes management.