Dr Kalpana, President of Diabetes Singapore
Ladies and Gentlemen
1. It is my pleasure to join all of you today to commemorate World Diabetes Day and let me congratulate Diabetes Singapore as you turn 50 this year. And I am thankful for your many years of contribution.
2. You have been a key partner for the Ministry of Health (MOH) in our fight against diabetes. Working closely to support our General Practitioners (GPs), Diabetes Singapore is always striving to meet the care needs of patients in the community and throughout the COVID-19 pandemic, your centres and mobile van services remained accessible to all patients. And I certainly hope you can organise the activities that you just presented for a good cause.
The Harm of Diabetes
2. Diabetes is a major public health concern. Globally, nearly half a billion people around the world are living with the disease. Locally, one in three individuals in Singapore is at risk of developing diabetes in their lifetime. If nothing is done, by 2050, it is estimated that about one million Singaporeans will be living with diabetes.
3. What are the implications for these individuals? A lifetime of daily medication, injection if you are lucky, if not, blindness, amputation, kidney dialysis and premature deaths. It is debilitating and painful for the patient as well as their families.
4. Tackling diabetes therefore has become very critical, especially in the light of COVID-19 pandemic because those with diabetes face an increased risk of developing severe COVID-19 complications and having poorer health outcomes. As COVID-19 progressively becomes an endemic disease, diabetes patients are subject to heightened risks.
5. That is why we declare a War on Diabetes, and the Prime Minister spoke about it during his 2017 National Day Rally. So, let me give an update on the progress of this war.
Progress of War on Diabetes
6. This is a long war, and any significant results will show up many years later. Age-standardised diabetes prevalence therefore has remained stable from 2017 to 2019. It has not worsened, it is just stable, but these things really take time. It is about 8%, just under 8%. Nevertheless, since we started this whole-of-nation effort, we are seeing some initial signs of improvements.
7. First, in terms of healthy living, especially exercise and diet. Based on the 2019 Global Burden of Disease Report for Singapore, 26% of the disease burden caused by diabetes is due to dietary risk, and 50% by being overweight.
8. Across all ages, more Singaporeans engaged in leisure-time regular exercise, from 29.4% in 2017 to 33.4% in 2020. So every 100 Singaporeans, you will find about four more being more active. The increase in proportion of the adults aged 50 to 74 who exercised regularly was particularly prominent and encouraging, from 23.5% in 2017 to 31.4% in 2020.
9. To get Singaporeans to be more active, the Health Promotion Board (HPB) has created additional community spaces for more physical activity sessions, and has resumed on average about 430 weekly physical activity sessions. Season 6 of the National Steps Challenge has also started. I think another major factor is that more people are exploring all our beautiful park connectors, the green corridor, and also our various gardens, and also, walking and cycling trails. And all of these were painstakingly put in and developed by our agencies, such as National Parks Board as well as the Land Transport Authority .
10. In terms of diet, there are also positive signs. The Eat Drink Shop Healthy Challenge, with more than 900,000 participants, has shown that the average Healthier Choice Symbol items purchased per participant has grown from 5 items per week in January to 5.7 items per week in October 2021. Two data points doesn’t create a trend but we will continue to monitor this.
11. The retail market share of healthier food products sold in supermarkets and retail outlets increased by more than 1.5 times to 27% compared to five years ago. And this include Low GI products which help those at risk and living with diabetes to better manage their blood sugar levels. One in three F&B outlets now offer healthier options for dining out.
12. Before the end of next year, and with the support of the industry, and this is a very important development, we will implement mandatory nutrition labels and advertising prohibitions on pre-packaged beverages and this will help reduce sugar and saturated fat intake.
13. Since we announced these labelling measures, so we don’t have to wait till end of next year to see these results, because since we announced this initiative, major manufacturers such as Coca-Cola, Pepsi, Yeos, F&N, Pokka, MDI and Nestle, they have reformulated their products to significantly reduce sugar levels. In response, consumers have also shifted to buying healthier versions of the products, or smaller packet sizes.
14. In partnership with the Ministry Of Education and Early Childhood Development Agency, HPB has implemented healthy meals programmes in all our mainstream schools and 80% of our pre-schools and this is to inculcate healthy eating habits from young. A key initiative is to help cut down the sugar intake of children. The importance of leading a healthy lifestyle to prevent chronic diseases such as diabetes are also part of our school curriculum today.
15. I should sound a word of caution here. While we have made some progress, on the whole, unfortunately, obesity and insufficient physical activity are still problems amongst our population. Across all ages, our obesity prevalence has risen from 8.6% in 2017 to 10.5% in 2020. We have also returned to the previous level seen in 2010, after having decreases over the past decade. Our 2018/2019 National Nutrition Survey showed that Singaporeans consumed on average 12 teaspoons of sugar daily, much more than what is nutritionally required.
16. So while we see some signs of change over the last three years since we waged War on Diabetes, it will take time for the changes to percolate throughout the population and show a long-lasting effect. And in the meantime, lack of activity, sugar intake, obesity, continue to be a population-wide problem. But in the meantime, COVID-19 has also affected the way Singaporeans live their lifestyles. For some Singaporeans, deprived of social activities, their lifestyle may have become more sedentary, which will set us back in the War on Diabetes and negate these initial results, so we have to just keep pushing on.
17. Let me now talk about screening. We are seeing more people screening for diabetes early. This is important, because early detection means you have the time and the chance, to turn things around, reverse the progression of the disease and prevent the development of complications.
18. We have made screening more accessible and affordable through the national Screen for Life programme, which includes screening and the first follow-up visit at CHAS GP clinics.
19. From 2017 to 2020, about two-thirds of residents aged 40 to 74 years were screened for diabetes, hypertension and hyperlipidemia within the recommended frequency. What we are heartened to see is a slight improvement in the screening participation for those aged 40 to 49 years from 60.7% in 2017 to 62.5% in 2020.
20. For the younger population aged 18 to 39 years, I encourage you to take the Diabetes Risk Assessment on HealthHub to find out if you are at risk of developing diabetes. Those identified to be at higher risk, will also be eligible for the Screen for Life programme and speak to your GP if need be.
21. One early indicator of more frequent and regular screening is the percentage of diabetes patients that has been diagnosed for the first time. A higher percentage means that they have been screened early and detected early, with the possibility of reversing course. So that percentage has gone up from 22.7% in 2017 to 23.2% in 2019, very slight, but it is the right direction.
22. Finally, there has been improvement in disease management. Complication rates from diabetes have declined from 2015 to 2019. For kidney failure, the rate of newly diagnosed cases declined from 4.2 to 3.6 per 1,000 patients with diabetes; severe diabetic retinopathy from 6.2 to 4.5; major lower limb amputations rate from 116 to 66 per 100,000 during the same period, which is a significant reduction.
23. To anchor and strengthen chronic disease management in the community, we have established Primary Care Networks (PCNs) to support GP clinics in delivering more holistic team-based care to patients with diabetes and other chronic diseases. And I thank Diabetes Singapore for supporting all our PCNs.
24. We will be launching a public campaign under the Patient Empowerment for Self-care Framework at the end of this year. We will encourage patients to take better care of themselves, raise awareness on eye and foot complications, and go for regular complications screening. The campaign will also raise awareness on the National Diabetes Reference Materials hosted on HealthHub.
25. In conclusion, the theme for this year’s World Diabetes Day is “Access to Diabetes Care”. Improving access has been a key focus in our strategy for the War on Diabetes across the three strategic thrusts – Healthy Living and Prevention, Early Detection and Intervention, and Better Disease Management – three topics that I have just spoke about.
26. The War on Diabetes requires the nation to come together to achieve the desired health outcomes in the long run, so let’s not lose sight of such longer wars as we battle COVID-19 here and now. I wish Diabetes Singapore a successful World Diabetes Day 2021 and I also want to just thank you sincerely, for your support and understanding. It has been almost two years of very difficult times. We have to implement all kinds of rules, which also make operations difficult. Even good causes are difficult to implement sometimes because of the rules. But I think you show a lot of understanding and pushed ahead with whatever you need to do and continue to persevere in this war and in this partnership and in this battle against diabetes. So thank you very much. So let’s continue to work very closely together and make sure we continue to make progress in winning this war. Thank you.