Agency For Care Effectiveness To Release Appropriate Care Guides In Support Of War On Diabetes

1.    The Agency for Care Effectiveness (ACE) has published its first two Appropriate Care Guides (ACGs) on 3 July 2017. The inaugural ACGs on “Managing pre-diabetes” and “Oral glucose-lowering agents in type 2 diabetes mellitus (T2DM)” were developed in support of the Ministry of Health (MOH)’s “War on Diabetes”. They can be found at www.ace-hta.gov.sg. Hard copies of the ACGs will also be mailed to all doctors in Singapore.

2.    Diabetes is a serious health concern in Singapore, with over 400,000 Singaporeans living with the disease. In addition, about 430,000 Singaporeans, or 14% of Singaporeans aged 18 to 69 years, have pre-diabetes and are at risk of developing diabetes. Lifestyle changes, with modest weight loss and moderate physical activity, can potentially reverse pre-diabetes and its progression to diabetes. For those with diabetes, good disease management, including lifestyle changes and medication, can also prevent or delay complications such as heart attack, stroke, kidney failure, blindness, and lower limb amputation.

3.    With the ACGs, clinicians will be better equipped to manage patients with pre-diabetes and prevent their condition from progressing into diabetes, as well as prescribe more tailored medication for those with diabetes. They will complement the existing MOH Clinical Practice Guidelines (CPGs) on Diabetes, which were last issued in 2014.

4.    ACGs are published up to three times a year. Each ACG will be reviewed 3 years after publication, or earlier if new scientific evidence emerges that requires substantive changes to the recommendation. Where MOH CPGs are available, ACGs complement the CPGs by providing timely additions and updates as reflected in the evidence at the time of the ACG development. 

ACG on Oral Glucose-Lowering Agents in Type 2 Diabetes Mellitus

5.    Good control of diabetes prevents debilitating complications such as heart attack, stroke, kidney failure, blindness, and lower limb amputation. With good disease management, particularly in partnership with a regular family doctor, people with diabetes can continue to lead healthy, productive, and fulfilling lives.

6.    The ACG on “Oral glucose-lowering agents in type 2 diabetes mellitus (T2DM)” reiterates the message about individualised care, setting patient-centred glycaemic targets and selecting agents based on drug and patient profiles. It incorporates latest updates on drugs such as SGLT-2 inhibitors and DPP-4 inhibitors, their clinical and cost-effectiveness, safety and appropriate use in patients. 

ACG on Managing Pre-Diabetes

7.    The ACG on “Managing pre-diabetes” will equip clinicians with a systematic management pathway to improve follow-up of persons with pre-diabetes, through both lifestyle intervention and pharmacological measures. It provides guidance on tailoring lifestyle intervention, such as healthy diet and increased physical activity, to individual needs for effecting sustained behavioural changes. If intensive lifestyle intervention is insufficient to improve a patient’s blood glucose status, the ACG recommends doctors to consider metformin in overweight patients.