Opening Address by Dr Amy Khor, Senior Minister of State for Health, at The Singapore Diabetes in Pregnancy Conference & Integrated Platform for Research in Advancing Metabolic Health Outcomes of Women and Children (IPRAMHO) Asia Meeting, 12 January 2018

Professor Kenneth Kwek, Deputy Group CEO, SingHealth

Associate Professor Ng Kee Chong, Chairman, Medical Board, KK Women’s and Children’s Hospital

Professor Ounjai Kor-anantakul, Chair Maternal & Fetal Medicine Committee of Asia-Oceania Federation of Obstetrics & Gynaecology

Professor Tan Kok Hian, Chairman, Organising Committee of the Singapore Diabetes in Pregnancy Conference & President of Perinatal Society of Singapore

Associate Professor Yong Tze Tein, President, College of Obstetricians & Gynaecologists Singapore

Distinguished guests

Ladies and Gentlemen

Good afternoon.

1.            I am honoured to speak at the Inaugural Singapore Diabetes in Pregnancy Conference & Integrated Platform for Research in Advancing Metabolic Health Outcomes of Women and Children (IPRAMHO) Asia Meeting today. To all our overseas guests, a very warm welcome to Singapore! I hope everyone has had a fruitful session thus far.

Epidemiology

2.            With a global prevalence of 8.5% among adults aged over 18 years in 2014^[1] diabetes is fast becoming a serious health concern in many countries, including Singapore. In fact, the Western Pacific Region (WPRO), which Singapore is a part of, already has the highest number of people living with diabetes at almost 159 million.

3.            In Singapore, diabetes is the second highest cause of ill health and death. One in three Singaporeans is at risk of developing diabetes in their lifetime.  Worryingly, one in three diabetic cases is undiagnosed, and even among those who know they have diabetes, one in three has poor control of their condition. Recognising this, we embarked on a War on Diabetes in 2016 to create a more supportive environment for our population to lead lives free from diabetes, and for those with the condition to manage it well. However, the Government cannot do this alone. We need the whole of society – all of you, from healthcare institutions, industry players, research and academia, and non-profit organisations to join us in this battle. I believe that our combined efforts can enable individuals to live healthily, prevent the onset of diabetes, or to detect the condition early and manage it well.             

4.            One particular area of concern is the increasing prevalence of gestational diabetes (GDM) among women, which is likely to contribute further to the diabetes epidemic We currently face a high prevalence of GDM in Singapore, where an estimated one in five pregnancies is complicated by the condition. This is worrying given that the International Diabetes Federation estimates that one in seven births are affected by GDM worldwide. In countries like the USA, GDM only affects 3 to 5 % of all pregnancies per year^[2]. Mothers with GDM also face a higher risk of developing diabetes in the future, while their children born from such pregnancies will also be more likely to develop childhood obesity and Type 2 diabetes (T2DM) later in life.

Pre-pregnancy

5.            Prevention is our best defence against diabetes. Being overweight not only increases one’s risk of diabetes, but also women’s risk of developing GDM during their pregnancies. Therefore, it is extremely important that women adopt and maintain healthy lifestyles such as engaging in regular physical activities and having a balanced diet.

6.            As part of our initiatives to combat diabetes, the Health Promotion Board (HPB) is increasing the availability and variety of Healthier Choice Symbol (HCS) products in supermarkets to encourage families to prepare meals with healthier ingredients. For those who eat out, there are lower-calorie, lower-sugar options now more readily available through HPB’s partnership with food and beverage operators such as restaurant chains, food courts, hawker centres and coffee shops under the Healthier Dining Programme (HDP). HPB has also implemented initiatives such as the “My Healthy Plate” and the “Eat Drink Shop Healthy Campaign” to increase caloric literacy and reward consumers for switching to the healthier options.

7.            HPB also launched the National Steps Challenge to nudge our population towards adopting a more active lifestyle. Across two seasons of the Challenge, over 500,000 participants have been motivated to become more physically active. A new third season was launched in October 2017. We had successfully motivated 500,000 participants across Season 1 and 2. As of 31 December 2017, just 2 months into Season 3, we have received over 600,000 sign-ups for this season.

Pregnancy

8.            For women who develop GDM during pregnancy, we have invested more resources to better support them through early intervention and management of their condition. Research is the cornerstone of our investments and efforts. The GUSTO study conducted by the National University Health System (NUHS), KK Women’s and Children’s Hospital (KKH), and the Agency for Science, Technology and Research (A*STAR), in 2014 found that routine GDM screening among all pregnant women detected almost twice as many cases compared to a high-risk screening approach. Another modelling study carried out by Duke-NUS Graduate Medical School and KK Women’s and Children’s Hospital in 2015 based on longitudinal data from the  GUSTO^[3] study found that routine GDM screening is also cost-effective for Singapore.  

9.            We have translated these research findings into policy, by making routine GDM screenings readily available for all pregnant women under the care of all our public healthcare institutions since March 2017. Through this programme, more GDM cases can be detected earlier, and be better managed to prevent maternal and infant complications. This underscores the key role of research in supporting evidence-based policies that tackle key population health issues.

10.         The impetus of research must not wane. We must lay strong foundations for our young to lead healthier lives - as early as the time of conception in the womb - with research as a key enabler. I am therefore happy to note that KKH was awarded a five million dollar centre grant from the National Medical Research Council in June 2017 to build up core research capabilities studying metabolic diseases, known as the Integrated Platform for Research in Advancing Metabolic Health Outcomes of Women and Children (or IPRAMHO for short). This is a unique collaborative centre grant proposition where our polyclinic clusters have come together to work with KKH on collaborative metabolic health research in women and children.

11.         IPRAMHO’s research areas are currently in the metabolic health of women and children including gestational and child diabetes, maternal obesity and fetal, infant and child obesity.  I look forward to their research findings to help us further achieve good health outcomes for everyone.

Post-delivery

12.         Besides early identification, it is equally important that women with GDM are also screened for diabetes post-delivery, and on a regular basis thereafter. Hence, proper handover of their care to their primary care physicians post-delivery is essential to ensuring that their condition remains well managed. I am happy that the College of Obstetricians and Gynaecologists, Singapore (COGS) has taken the initiative to develop guidelines for their fellow specialists on the management of GDM, such as adopting the three-point International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria for diagnosing GDM. Adopting the three-point IADPSG criteria instead of the conventional two-point WHO 1999 criteria will increase the detection rate of GDM. MOH will also support primary care physicians by publishing an Appropriate Care Guide (ACG) later this year, with concise and up-to-date information on screening and detection of GDM and longer-term post-delivery follow-up. I encourage all primary care physicians to make full use of this resource in your care management.

Conclusion

13.         In closing, I would like to thank KKH and all the participating institutions in their efforts to support our War on Diabetes and uphold the vision of enabling Singaporeans to lead healthier lives. I hope the fruitful discussions and sharing sessions throughout this conference will inspire you to collectively work towards the betterment of the health of our women and children. I wish you all a fruitful and successful meeting.

Thank you.

^[1] World Health Organization, 2017; Diabetes Factsheet.

^[2] Centers for Disease Control and Prevention. National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2007. Atlanta: Department of Health and Human Services, Centers for Disease Control and Prevention, 2008.

^[3] Growing Up in Singapore Towards Healthy Outcomes (GUSTO) is a cohort study which recruited expectant mothers of Chinese, Malay and Indian ethnicity in their first trimester with longitudinal tracking through the antenatal period, birth, and the child’s first 4 years of life to examine the potential roles of foetal, developmental and epigenetic factors in early pathways to metabolic and neurodevelopmental outcomes.