Since then, significant efforts have been made to address the health issue that continues to affect many. The initiatives aimed to foster a whole-of-society approach to alleviate the burden of diabetes and promote health as people age.
In 2021, Health Minister Ong Ye Kung said that the Republic had made progress in its war on diabetes, but obesity and insufficient physical activity were still problems.
Over the years, national initiatives such as Healthier SG and the Healthy 365 app have played a significant role in disseminating awareness and knowledge about preventing and managing pre-diabetes. These platforms focus on diabetes prevention strategies such as healthy eating, physical activity and weight management.
However, as a specialist in diabetes care, I have observed how, in our fast-paced environment, managing diabetes effectively has become a challenge for many.
Problems range from finding it hard to stick to a healthy diet, to fear over the pricks to monitor blood sugar levels.
Challenges in managing diabetes
A diabetes diagnosis can be categorised as either Type-1 or Type-2. The former is an autoimmune disease where the immune system attacks and destroys the insulin-producing cells. In Type-2, individuals can produce insulin, but their bodies are unable to use it to break down glucose effectively, leading to abnormal blood sugar levels.
Diabetic patients often worry about complications such as heart attack, stroke, kidney failure, blindness or leg amputations.
They speak of the emotional burden, the anxiety of needles and the pressure of daily glucose monitoring. This fear can lead to chronic stress, making it even more challenging to manage the condition effectively.
One of my patients, a single mother, grapples daily with the demanding task of balancing her professional duties and family obligations. Despite her best efforts, she finds it difficult to consistently monitor and manage her diabetes and this led to a poorly controlled diabetes condition that exposes her to future risks of complications.
This is not uncommon and highlights a significant issue in diabetes care: the balancing act of personal life, work commitments and health management.
Individuals often prioritise work and family over personal health, leading to irregular glucose monitoring and failing to adhere to dietary and medication guidelines.
This can lead to poorly controlled diabetes, increasing the risk of complications such as neuropathy, retinopathy and cardiovascular issues.
A diabetes diagnosis is also more than just a medical condition to manage – it can trigger an emotional spiral that affects individuals and their loved ones.
Support-driven approach
An international study designed to identify the attitudes, wishes and needs among people living with diabetes –known as the Dawn (Diabetes Attitudes, Wishes and Needs) study – found that only 18 per cent of patients believe they are successfully managing their diabetes as recommended by their doctors.
Adapting to diabetes also means making changes to diets – a departure from beloved food.
Navigating life after a diabetes diagnosis is a complex journey that requires not just personal strength, but also the collective support of family and community.
This often means reshaping one’s identity and reshuffling priorities.
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Managing diabetes extends beyond the courage and determination of the person living with the disease. It’s more effective when family and friends get involved in supporting the patient through the journey.
I’ve witnessed how such support has made significant impact on patients.
A teenager under my care, initially overwhelmed by the complexities of managing his diabetes, found immense support in his family’s dedicated involvement.
The journey was heartening to witness – his father became a steadfast presence, accompanying him to every doctor’s visit, while his mother embraced the challenge of cooking nutritious, diabetes-friendly meals that the whole family enjoyed.
There was significant improvement in both the boy’s health and his self-assurance in handling his condition, highlighting the profound impact of family support on health outcomes.
In Singapore, this sense of teamwork extends to community groups and healthcare providers working together to help those living with diabetes. Organisations like Diabetes Singapore and Touch Community services offer valuable resources, support groups and a network of care.
As a healthcare provider, it is imperative to recognise the real-life constraints of patients.
It’s not merely about prescribing medication or recommending lifestyle changes but understanding the personal factors that make diabetes management a daunting task.
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Tech-driven approach
Technological advancements have simplified various aspects of life, including personal healthcare. Consumer-grade tech applications are now available to help individuals track a variety of health signals such as cholesterol levels, blood pressure and calories burnt. But it doesn’t end there.
While most Singaporeans, particularly the younger, tech-savvy generation, are familiar with wearable devices such as Fitbit and Apple watches, healthcare technology has extended far beyond the functions that these have to offer.
But when it comes to managing a complex condition like diabetes, relying solely on consumer-grade apps and wearables for glucose monitoring can pose risks as the data may not be as precise or dependable as required for medical purposes.
There are now medical-grade wearable devices such as real-time Continuous Glucose Monitoring (rtCGM) systems transforming the landscape of diabetes care.
The device involves a discreet, wireless sensor placed just beneath the skin which provides users with glucose readings every five minutes, transmitted via Bluetooth to a compatible smart device.
A study found that such rtCGM devices have helped patients improve their average blood sugar levels as they are now more informed and equipped to make timely decisions based on real-time data at their fingertips. This is particularly beneficial for vulnerable groups such as children and the elderly, as it enables caregivers to respond swiftly to any health risks or emergencies.
I have had first-hand insight into the potential benefits of such advanced technologies for patients in working with companies in the healthcare sector such as Dexcom, agencies such as the Health Promotion Board and healthcare providers such as National University Hospital (NUH).
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The integration of artificial intelligence (AI) in diabetes management is another key development. Given the vast amount of data involved, AI has become a game changer in unlocking predictive capabilities that lead to more precise prognostic insights and the facilitation of personalised care.
In diabetes, AI can help in understanding how patients react to different trigger foods that can affect blood sugar levels, as individual responses can vary widely based on genetics, metabolism, insulin sensitivity and overall health.
For instance, the “virtual fork” is one technology that leverages AI algorithms to track what is being consumed and how one’s body reacts.
By collecting and analysing data on dietary habits and bodily reactions, the virtual fork such as the one offered by Singapore-based digital healthcare company Witz-U guides people with diabetes towards making informed and tailored choices for their specific health needs and goals.
It enables users to upload a photograph of their meal, after which, through the combined efforts of AI and a team of health coaches, specific ingredients that might be causing fluctuations in glucose levels are flagged.
This approach isn’t just about cutting out certain foods; it’s about finding what works best for your body, making managing diabetes a bit easier and a lot more personalised.
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From reactive to proactive
While we are unable to reverse diabetes, adopting a healthier lifestyle can prevent or help manage pre-diabetes.
This can involve maintaining a healthy body weight with a BMI of 18.5 to 22.9 (for Asians), consuming a balanced diet rich in fruit, vegetables and whole grains, and low in fats and sugar. It also involves regular physical activity of 150 minutes of moderate-intensity aerobic activity a week.
Unlike Type-2 diabetes, lifestyle changes cannot prevent Type-1 diabetes. But for those who receive this diagnosis, living a fulfilling life remains within reach by getting support from those around us and leveraging the tech that surrounds us.
As we continue to confront the challenges of diabetes, it is time to shift care from being reactive to proactive, from general to personal.
Dr Kevin Tan is a consultant in diabetes, endocrinology and internal medicine, and vice-president and past president of Diabetes Singapore.
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