Over 400,000 people are currently living with diabetes, and this number is projected to reach one million by 2050. ST PHOTO DESMOND WEE
SINGAPORE - Singapore already has one of the highest rates of diabetes in the world, and as the population ages, this will trend even higher in the future.
Over 400,000 people are currently living with diabetes, and this number is projected to reach one million by 2050.
In response, there has been significant efforts in advancing diabetes care through national health campaigns and community initiatives that raise awareness of diabetes, facilitate early detection, and empower patients and caregivers to monitor and manage the condition.
We can enhance diabetes management with technology to enable more targeted, personalised, and even preventive care, and better empower individuals in their care journey. Research also plays a crucial role in deepening our understanding of the patient journey, including challenges such as medication compliance, care delivery and predictors of health outcomes.
Managing diabetes can be overwhelming for many patients, as it requires constant monitoring to prevent complications like kidney disease or heart problems. The complexities of medication management, blood sugar tracking, and understanding medical advice can seem daunting.
For individuals with Type 1 diabetes, which is an autoimmune disease, achieving stable and healthy glucose levels is an even bigger challenge. These patients are wholly dependent on externally delivered insulin, and often suffer big swings in glucose levels due to challenges in mimicking the precise control that a normal pancreas offers.
Miss a cue and dire consequences can ensue. It is said that patients suffering from Type 1 diabetes make 120 more health-related decisions per day, compared with non-diabetic persons, adding significant mental burden.
Technology enables proactive self-management
Continuous glucose monitoring (CGM) devices have proliferated, to the extent that even non-diabetics are taking advantage of the convenience and real-time feedback to monitor their glucose levels in relation to diet and exercise.
For patients with diabetes, these have been transformative as they no longer need to make multiple finger pricks a day. Patients can now monitor their blood sugar trends throughout the day and make necessary adjustments to their lifestyle and medications.
Monitoring schedules are no longer a hassle and can now be integrated into daily routines, where real-time adjustments can be made.
Technological advancements like Automated Insulin Delivery (AID) systems offer even greater functionality. The AID system for the management of Type 1 diabetes consists of a CGM device, which communicates with an insulin pump that has an algorithm to enable automated insulin delivery to help maintain optimal glucose levels.
Introducing automation into care has been found to be effective in improving disease control for individuals with Type 1 diabetes. This is a game changer compared with life without these devices, which would mean manual monitoring through constant mental calculation and close vigilance to food intake, insulin doses and physical activity.
These closed-loop AID approaches provide a more flexible and convenient method for continuous insulin dosing and minimise the risk of blood sugar levels dipping too low (hypoglycaemia) or going too high (hyperglycaemia).
While technological innovations such as CGM are promising, they are only meaningful if they are accessible to the broader population, either through clinical trials or subsidies.
Hence, the clinical and cost-effectiveness of innovations need to be carefully reviewed before insights from research can translate these proven solutions to patient care so that more can benefit at scale in future.
Given the benefits and convenience this technology offers patients, eligible adults and children with Type 1 diabetes receiving care at public healthcare institutions can now receive up to 80 per cent subsidies for the Dexcom G6 CGM system.
In addition, public healthcare institutions have been actively rolling out patient education resources on their social media channels to offer clear instructions and guides to help with the practicalities of living with diabetes.
Collaboration drives innovation in diabetes care
While driving innovation and achieving breakthroughs is often an uphill task, the reward is when these innovations make an impact on the lives of our patients and even our loved ones.
The delivery of diabetes care is unique in each country, and no single perfect model exists.
Therefore, it is important for professionals in healthcare to determine what would be the best approaches, be they community-based initiatives, glucose monitoring measures, or therapeutic interventions, for our local context.
This endeavour requires the collaboration of various stakeholders across public and private sectors, all working together to bring the greatest benefit to patients.
Further, given the capabilities in biomedical and medical technology research built up over the decades with long-term investments, Singapore stands poised to build solutions and solution providers, for both health and economic benefit.
One such example is the pilot trial of an artificial intelligence (AI) platform by start-up Mesh Bio. Called HealthVector Diabetes, the platform uses data analytics to predict the risk of Type 2 diabetes patients developing chronic kidney disease so that early intervention can be taken.
The platform is being trialled at Tan Tock Seng Hospital, Singapore General Hospital and selected polyclinics for potential wider adoption.
Transforming public health at scale
The Singapore Clinical Research Institute (SCRI) has been supporting the Health Economics and Outcomes Research for our researchers, evaluating the long-term impact of healthcare interventions on patients and health systems.
Medication adherence is a critical aspect of managing Type 2 diabetes. However, research has shown that about one in three people does not adhere to their prescribed medication.
This often stems from concerns about the safety and effectiveness of the drugs, or the absence of noticeable symptoms, leading patients to believe they do not need the medication. Poor adherence can result in poorly controlled blood sugar levels, significantly raising the risk of severe complications.
A senior pharmacist at the National Healthcare Group Pharmacy (NHGPh) and a family physician at the NHG Polyclinics, supported by SCRI epidemiologists, did a study on medication adherence on patients who had received regular care at five NHG Polyclinics.
The study sought to build out a locally relevant algorithm for determining medication adherence for diabetic patients, and can serve as a tool to help identify the risk factors and patients for suboptimal medication adherence. In the longer run, this may enable more timely interventions for at-risk patients.
Another effort supported by SCRI underscores the importance of data-driven research in enhancing diabetes management.
In the GLiMPSE clinical trial led by SingHealth, SCRI’s biostatistics team evaluated the effect of the use of the intermittently scanned continuous glucose monitoring (is-CGM) system against the more traditional self-monitoring of blood glucose levels, and how both methods led to improved outcomes for patients with Type 2 diabetes over a year of observation. Their analysis provided insights to help patients adopt more effective self-management strategies.
A hopeful future for diabetes care
The future of diabetes care in Singapore is promising.
Through collaboration with stakeholders across the healthcare ecosystem, clinicians and clinical researchers can leverage technology to empower patients to take control of their condition, reduce complications, and enhance overall quality of life. Research can also inform healthcare practices.
In a country where one in three people is at risk of developing diabetes, these innovations offer hope for the future of diabetes care.
- Adjunct Associate Professor Danny Soon is the chief executive of the Consortium for Clinical Research and Innovation, Singapore, and executive director of the Singapore Clinical Research Institute. He is also a member of the management committee of Diabetes Singapore.
