“Sin­ga­pore has ramped up ef­forts to stem the spread of di­a­betes”

BioSpectrum (Asia) - - Content - Prof Tai E Shy­ong De­part­ment of Medicine, NUS Yong Loo Lin School of Medicine, and NUS Saw Swee Hock School of Pub­lic Health, Sin­ga­pore

Di­a­betes is reach­ing epi­demic pro­por­tions in Sin­ga­pore and in the Asia Pa­cific. By 2040, the vast ma­jor­ity of peo­ple liv­ing with di­a­betes will re­side in Asia (with the largest num­bers in In­dia and China). Priyanka Ba­j­pai spoke to Prof Tai E Shy­ong of De­part­ment of Medicine, NUS Yong Loo Lin School of Medicine, and NUS Saw Swee Hock School of Pub­lic Health, Sin­ga­pore about the cur­rent sce­nario of di­a­betes in Sin­ga­pore and Asia-Pa­cific and the role of the gov­ern­ment to re­duce the num­ber of cases re­lated to Di­a­betes.

What is the cur­rent sce­nario of di­a­betes in Sin­ga­pore and Asia-Pa­cific?

In Sin­ga­pore, Di­a­betes mel­li­tus is al­ready the lead­ing contributor to the bur­den of dis­ease, largely from the com­pli­ca­tions as­so­ci­ated with di­a­betes (heart dis­ease, eye dis­ease, kid­ney dis­ease, stroke, am­pu­ta­tions). In Sin­ga­pore, the preva­lence of di­a­betes is ex­pected to in­crease by as much as 30-50% in the next 2-3 decades. It is also in­creas­ing all over Asia.

Ef­forts to pre­vent di­a­betes to re­duce this in­crease are crit­i­cal. In ad­di­tion, for the mil­lions of peo­ple who al­ready have dis­ease, we need to find a way to mit­i­gate the devel­op­ment of com­pli­ca­tions that could lead to death or dis­abil­ity.

What is our ef­fort to sup­port the gov­ern­ment in re­duc­ing di­a­betic cases?

While the gov­ern­ment of Sin­ga­pore has ramped up ef­forts to stem the spread of di­a­betes via greater aware­ness (e.g. the Prime Min­is­ter of Sin­ga­pore sin­gled­out di­a­betes for na­tional fo­cus), pub­lic health ini­tia­tives (e.g. health screen­ings) and pre­ven­tion (e.g. Health Pro­mo­tion Board’s health progammes like Na­tional Steps Chal­lenge), re­search or­gan­i­sa­tions and in­te­grated aca­demic health sys­tems like the Na­tional Univer­sity Health Sys­tem (NUHS) fo­cus on re­search­ing novel so­lu­tions to treat and pre­vent di­a­betes.

This is where ini­tia­tives such as NUHS’ Meta­bolic Dis­ease Sum­mit Re­search Progamme (SRP) come in. One of the key ini­tia­tives is to de­velop mod­els of care and build tools that will trans­form the health­care sys­tem to op­ti­mally deal with chronic non-com­mu­ni­ca­ble dis­ease. The SRP uses new and in­no­va­tive mod­els of care to en­gage and em­power those liv­ing with di­a­betes to take charge and live bet­ter lives. An ex­am­ple of such ini­tia­tives un­der the SRP in­clude the Year-ofCare model, a pi­lot project which will be pi­o­neered at the Na­tional Univer­sity of Sin­ga­pore and Na­tional Univer­sity Hos­pi­tal in Septem­ber 2017. The strat­egy in­volves sev­eral com­po­nents. First, di­a­betes pa­tients will be sent re­sults of their blood sugar, choles­terol, weight, kid­ney func­tion etc. a week be­fore their doc­tor’s ap­point­ment in hopes of nudg­ing / spurring the pa­tients to get more en­gaged about dis­cussing so­lu­tions for their con­di­tion (by talk­ing to fam­ily, friends or on­line searches). At the same time, providers (doc­tors, nurses, phar­ma­cists) are trained to equip them with the skills re­quired to have open con­ver­sa­tions to en­cour­age pa­tients to share their con­cerns and set goals, to­gether with the provider, to im­prove their health con­di­tion. These are then doc­u­mented and we ac­ti­vate the ser­vices and sup­port re­quired to help pa­tients achieve those goals. This par­a­digm treats the con­sul­ta­tion as a meet­ing of two ex­perts. The provider is the ex­pert in the med­i­cal con­di­tion. The pa­tient is the ex­pert in their lives. We hope that the lessons learned will even­tu­ally in­form care trans­for­ma­tion in Na­tional Univer­sity Poly­clin­ics (NUP) and even­tu­ally na­tion­wide.

We are also work­ing ac­tively in the devel­op­ment of new tech­nolo­gies to help per­sons liv­ing with di­a­betes or at risk of di­a­betes. These range from for­mu­lat­ing novel types of foods to re­place the highly re­fined car­bo­hy­drates that form a large part of the Asian diet, devel­op­ment of dig­i­tal tools that can be im­ple­mented in the care path­ways to sup­port pa­tients in their daily lives and new drugs for the treat­ment and pre­ven­tion of di­a­betes (DY­NAMO for di­a­betic kid­ney dis­ease as an ex­am­ple).

In your opin­ion, what the gov­ern­ment should do to re­duce cases?

The Sin­ga­pore gov­ern­ment is tak­ing an “all of gov­ern­ment” ap­proach to the “war on di­a­betes” and we are happy to be part of that process.

Prof Tai E Shy­ong De­part­ment of Medicine, NUS Yong Loo Lin School of Medicine, and NUS

Saw Swee Hock School of Pub­lic Health, Sin­ga­pore

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