Diabetes: The War Continues

1    The Ministry of Health (MOH) will continue in our efforts to motivate Singaporeans to take charge of their health, to live their lives free from diabetes. For those who have diabetes, we will help them to manage their condition well.

2    Diabetes is a huge and growing burden for many countries across the world. Globally, more than 400 million adults lived with the condition in 2015 and this number is expected to rise to above 640 million, or one in ten adults by 2040[1]. In Singapore, diabetes is a serious health concern, with over 400,000 Singaporeans living with the disease. One in three Singaporeans has a lifetime risk of getting diabetes and the number of those with diabetes is projected to reach one million by 2050, if current trends continue. In April 2016, MOH declared War on Diabetes to rally a whole-of-nation effort to reduce the burden of diabetes in our population and keep Singaporeans healthy as we age. 

Preventing Diabetes

3    Type 2 diabetes is preventable. Changes to lifestyle and dietary preferences can reduce one’s risk of getting diabetes. The Health Promotion Board (HPB) has launched several initiatives to encourage the adoption of healthier meal options, such as the Healthier Dining Programme, Healthier Ingredient Development Scheme and the Healthier Choice Symbol identifier.[2] The ongoing Eat, Drink, Shop Healthy Campaign also serves to generate awareness and encourage consumers to adopt healthier food choices.

4    To give further impetus to the War on Diabetes, the Diabetes Prevention and Care Taskforce has worked with beverage manufacturers^[3] who have agreed to reduce the amount of sugar in packaged sugar sweetened beverages (SSBs). We are heartened to receive the strong support from industry players on sugar reduction efforts. The seven industry leaders – Coca-Cola, F&N Foods, Malaysia Dairy Industries, Nestle, PepsiCo, Pokka, and Yeo Hiap Seng – have committed to a maximum sugar content of 12% for all of their drinks sold in Singapore by 2020. These players make up 70% of the total pre-packaged SSB market in Singapore. This move could potentially reduce sugar consumption from SSBs by about 300,000kg per year.

5    The industry support to lower the sugar level in SSBs will pave the way for further partnership between the government and industry players to co-create solutions in reducing sugar consumption in Singapore. HPB will continue its efforts to reach out to Singaporeans and all beverage manufacturers to expand the range of healthier drink options in Singapore. This includes collaboration with industry players and research institutions to conduct R&D on healthier ingredients and food products. 

6    The Diabetes Prevention and Care Taskforce is studying additional measures on how to encourage further reductions in sugar consumption in Singapore, learning from the experiences of other countries. These include sugar tax, warning labels and advertising restrictions on SSBs with high sugar content. The Taskforce will be consulting stakeholders in the coming months to discuss these ideas and the implementation details.  

Healthier Eating

7    Besides reducing sugar intake, overall dietary improvement forms an important part in the development of healthy lifestyle habits. To provide consumers with more options for healthier dining, the Healthier Dining Programme (HDP) has been extended to include hawker centres and coffee shops since late 2016. As of March 2017, there are more than 1,600 F&B partner outlets island-wide on board the programme, including restaurants, cafes, food kiosks and caterers, and food courts. The number of healthier meals sold has increased three-fold from 7.5 million in 2014 to 26 million as of March 2017, including local favourites such as mee soto, idli and fishball noodles.

8    HPB is also working with food manufacturers to help them innovate and expand their range of healthier ingredients under the Healthier Ingredient Development Scheme (HIDS), such as the use of brown rice or wholegrains in rice and noodles, as well as healthier sugars and cooking oil. The scheme supports industry players in the areas of product development, marketing, publicity and trade promotions, so as to increase the adoption of healthier ingredients in the food service sector and improve consumers’ access to healthier meals. To date, there are six companies[4] whose applications have been approved under the HIDS. HPB aims to reach out to 20 to 30 ingredient suppliers by 2020, and we look forward to more companies coming on board.

9    To cater to those who prefer to prepare their meals at home, HPB has also been working closely with pre-packaged food manufacturers and supermarket chains to positively label food products that are the healthier option through the Healthier Choice Symbol (HCS) identifier. This will provide consumers with more options for healthier dining and encourage healthier eating habits. These healthier options have been well-received by consumers, and the market share of HCS products has increased from 15% in 2012 to 18% in 2016.

10    Such collaboration with food manufacturers to develop healthier staple food ingredients of better quality and greater varieties suited to local taste, will improve consumer access to healthier meals, whether they choose to dine out or prepare their meals at home. Complementing these efforts, campaigns such as the Eat, Drink, Shop Healthy Campaign will further encourage Singaporeans to make healthier choices in their daily consumption of food and drinks and their purchase of groceries through on-ground promotional activities and rewards. 

Exercise

11    Singaporeans can also play an active role in the War on Diabetes by adopting an active lifestyle and incorporate physical activity into their daily lives.

12    In 2015, HPB introduced the National Steps Challenge™ to leverage smartphone and wearable technology to encourage more Singaporeans to be more active physically by taking more steps, and rewarding them for sustained behavioural change when they reach different physical activity milestones. Across two seasons, half a million participants were reached, with a two-fold increase in sign-ups in Season 2. Data from the first season showed that four in five participants who were previously inactive became sufficiently active after joining the challenge. The National Steps Challenge Season 3 will be launched in October 2017 to motivate even more people to commit to being more active in their daily routine.

13    To promote leisure time physical activity, HPB will also continue to offer free community exercise and sports programmes at public spaces, such as Sundays@the Park and Sunrise in the City, to encourage an active lifestyle among residents. HPB will also work with public agencies such as MOE, SportSG and the People’s Association to promote physical activity at schools and in the community, such as the Active Family programme.

Screening

14    MOH and HPB earlier announced the launch of the Diabetes Risk Assessment (DRA) tool and the enhanced Screen for Life (SFL) subsidies on 1 September 2017.

15    There is a need for early detection and appropriate intervention to prevent or delay the onset of diabetes and related complications. The current recommendation under HPB’s Screen for Life programme is for those aged 40 and above to go for diabetes screening once every three years. However, age is not the only risk factor and some below 40 years old may also be at risk of diabetes due to other factors. The DRA tool, which will be accessible from HealthHub, will help individuals, especially younger adults aged 18 to 39 years, assess their current risk for undiagnosed diabetes, as well as whether they should go for diabetes screening.

16    Under the enhanced SFL screening, all eligible Singaporeans can go for recommended screening such as for diabetes, and follow up at Community Health Assist Scheme (CHAS) GP clinics. They will pay a small fixed fee of $5 or less for their screening test and first post-screening follow up consultation. CHAS cardholders will pay $2, and Pioneers will not need to pay. HPB will be sending out invitation letters progressively, to notify Singaporeans of their eligibility. 

Managing Diabetes

17    The control of diabetes, and prevention or delay of complications, can be enhanced through equipping patients for self-care and the holistic management of diabetes patients by their regular family doctor. MOH is developing strategies to better support family doctors, to manage diabetes more effectively in the community. For instance, we are working with GPs to bring their clinics together to form Primary Care Networks (PCNs). As part of a PCN, GPs are better resourced to provide more support services such as diabetic eye and foot screening, and nurse counselling, to develop team-based care to patients with diabetes and more complex chronic conditions.

18    MOH is reviewing key flagship programmes to prevent and retard diabetes-related complications, such as eye and kidney diseases. As a common complication of diabetes is chronic kidney disease and kidney failure, MOH is progressively introducing a national ‘Holistic Approach in Lowering and Tracking Chronic Kidney Disease’ (HALT-CKD) programme across all polyclinics. The programme aims to slow the progression of chronic kidney disease (CKD) and halt the current rising trend of kidney failure rate, and better identify and control risk factors that contribute to CKD deterioration, such as blood pressure and diabetes control. It is currently being implemented progressively across all polyclinics. 

[1] Source: International Diabetes Federation (IDF) Diabetes Atlas – 7th Edition 2015 

[2] For more information, please visit https://www.hpb.gov.sg/healthy-living/food-beverage.

[3] Sugar-sweetened beverages (SSBs) is a key area of focus in reducing sugar consumption among Singaporeans. This is because 60% of our total sugar intake comes from sugary beverages such as soft drinks, juices, coffees and teas, with the remaining made up by sugar from foods (e.g. cakes, desserts, and confectionaries). Singaporeans, on average, currently consume more than 1,500 teaspoons of sugar from pre-packaged SSBs annually

[4] These companies focus mainly on the production of healthier oil and wholegrain noodles.