Mr S Tiwari, Executive Director, Diabetes Singapore
Ladies and Gentlemen
It is my pleasure to join you today in observing Limb Loss and Limb Difference Awareness Month. I would like to thank Diabetes Singapore for organising this event, and for your efforts in raising diabetes awareness and providing education and support to individuals with diabetes, their family members and the public. Also grateful to all the partners for the support that they’ve given to organise this important event. I think this is something meaningful, and hopefully through these efforts, we can look at better awareness in care for our diabetic patients.
Lower extremity amputation burden in Singapore
2. Diabetes is the most common cause of non-traumatic amputations of the leg or foot, also referred to as lower extremity amputations (LEAs). In 2021, close to 9 in 10 individuals who had a lower limb amputation in Singapore had diabetes. Singapore also has one of the highest age-sex-adjusted diabetes-related LEA rates in the world, with about 12.1 LEAs performed in 2021 for every 100,000 Singaporeans, as compared to 6.4 which is the average rate among the Organisation for Economic Co-operation and Development’s (OECD) countries.
3. To address this, the Ministry of Health (MOH) has been working with various stakeholders on efforts to reduce LEAs among patients with diabetes, as part of our overall efforts for War on Diabetes.
Improving Diabetic Foot Care Services
4. Firstly, regular diabetic foot screening is crucial to enable early detection and intervention of complications to prevent LEAs. Hence MOH worked with the former National Diabetic Foot Workgroup to develop a clinical guidance on Foot Assessment in People with Diabetes Mellitus. This national guidance aims to support healthcare professionals in performing regular and comprehensive foot assessments for patients with diabetes, to identify and manage risk of diabetic foot complications in a timely manner. The clinical guidance was published in June 2019 and has since been progressively rolled out across healthcare institutions in Singapore. The public hospitals have also started multidisciplinary teams for timely management of active diabetic foot cases escalated from primary care. Together, they provide holistic care for the patient, for better care and improved outcomes.
5. Under Healthier SG, care protocols will be developed to guide family doctors in managing diabetes and other chronic conditions. They will cover key points on recommended health screenings, medications, lifestyle adjustments, and escalation to specialist and acute care when necessary. So maybe a shout out to all of you, especially if you are above 60, to enrol and make sure that you are part of the Healthier SG programme, because this will ensure that someone is keeping track of your health. The family doctor will support individuals with diabetes in adhering to recommended care, to keep their diabetes under control, such as going for regular foot screening, and help them to prevent or delay disease progression.
6. I am glad to note that family doctors in the community can refer their patients to community-based providers like Diabetes Singapore, which provides diabetic foot screening at their Jurong and Boon Keng clinics, as well as mobile clinics. In the past few years, Diabetes Singapore has provided around 2,000 foot screenings per year. Diabetes Singapore also provides nurse counselling, screening for diabetes-related eye and kidney complications, and health checks to support individuals with diabetes. I look forward to Diabetes Singapore’s continued support to General Practitioners and individuals with diabetes under Healthier SG.
Improving Diabetes Patient Education and Empowerment
7. It is also important to strengthen patient education by the care teams, to empower patients with the knowledge to self-manage diabetes, outside of their doctor visits. To this end, MOH has worked with various stakeholders to develop the National Diabetes Reference Materials (NDRM) to equip care teams with a set of consistent resources on HealthHub, so as to raise patients’ and caregivers’ diabetes knowledge over time and motivate patients for sustained lifestyle changes.
8. We will be publishing Tier 2 of the NDRM in the four official languages. The English materials will be published in April 2023, and we will progressively roll out the materials in vernacular languages thereafter. The Tier 2 materials will cover more in-depth content and include topics such as foot care, physical activity, healthy eating, emotional wellbeing and tips specific to support Type 1 Diabetes patients. We encourage healthcare providers to use the Tier 2 NDRM as a reference when managing patients with diabetes. Through patient education and patient empowerment on self-management, we hope to encourage individuals to take charge of their health and achieve positive outcomes.
9. Good diabetic foot management requires coordinated efforts from all stakeholders and empowerment of individuals with diabetes to proactively manage their condition. I look forward to the efforts to improve awareness of the importance of diabetes care, as well as the quality of life for individuals living with diabetes. I also encourage community partners such as Diabetes Singapore to continue in their efforts to improve diabetes awareness and care. I wish everyone a fruitful time today. Thank you.