SPEECH BY MR GAN KIM YONG, MINISTER FOR HEALTH, AT PROJECT NEMO’S COMMEMORATION OF WORLD DIABETES DAY ON 9 NOVEMBER 2013, AT THE SINGAPORE FLYER

Mr Noel Cheah, Chief Operating Officer, NUH 

Professor A. Vathsala, Director, NEMO Programme

Dr Loh Ping Tyug and Dr Lim Chee Kong, Co-directors, NEMO Programme

Distinguished Guests,

Ladies and Gentlemen,

            I am pleased to join you this evening to commemorate World Diabetes Day.

About World Diabetes Day

2          Through the World Diabetes Day, we hope to raise public awareness on the importance of good diabetic prevention and control. The lighting-up of the Singapore Flyer blue this evening symbolises the blue ring that marks World Diabetes Day, as well as the commitment and contributions of the multi-disciplinary team of healthcare professionals such as physicians, nurses, dieticians, podiatrists, who collaborate and work towards preventing diabetes, and facilitating early intervention and optimal management for good diabetic control.

The Burden of Diabetes and End Stage Kidney Failure in Singapore

3          Diabetes is a chronic condition that causes considerable morbidity and mortality. In 2010, about one in nine (11.3%) Singaporeans aged 18-69 years are diagnosed with diabetes.[1] With an aging population, the number of diabetics is set to grow further. If not well-controlled, diabetes can lead to complications such as kidney disease, cardiovascular disease, visual impairment, and foot ulceration. These complications compromise patients’ quality of life, and may affect their self-confidence or discourage them from good diabetic control.

4          A complication of increasing concern is end stage kidney failure requiring kidney dialysis or kidney transplant. From 1999 to 2012, the age-standardised rates for end stage kidney failure in Singapore have risen from 154 per million population to 168 per million population.[2] In addition, nearly 65% of new end stage kidney failure diagnoses in 2012 were attributable to diabetes.[3] Diabetic end stage kidney failure can be averted if the disease is identified and treated early with good follow-up.

Early Primary Care Intervention with Project NEMO

5          Recognising the importance of maintaining good kidney function for diabetic patients, Project NEMO (which stands for Nephrology Evaluation Management and Optimisation) was introduced as a collaborative effort between NUH and NHGP in 2011. Besides good diabetic and hypertension control, the programme aims to detect diabetic kidney disease in its early stage and initiate early treatment to prevent or delay kidney failure.

6          Several components are central to the success of the programme. Primary care doctors at all nine polyclinics managed by NHGP are orientated to identify patients who show signs of early kidney disease and start them on renal-protective medication with subsequent optimisation of dosage, by using detailed and evidence-based treatment algorithms. To further support doctors, care coordinators are stationed at each polyclinic to arrange for educational and counseling sessions for patients to encourage lifestyle modifications for better diabetic control.

7          The NEMO programme also features an integrated IT system that provides an additional layer of surveillance and assists care coordinators in tracing laboratory results and medication prescriptions across all nine polyclinics. Since patients are closely monitored, those with unresponsive or rapidly progressing kidney disease are promptly referred to tertiary care to receive appropriate and timely intervention. By avoiding progression to end stage renal disease, these patients enjoy a better quality of life as well as potential cost savings from medical bills they would otherwise incur should their conditions deteriorate.

8          As of September 2013, close to 24,000 diabetic patients were screened for kidney disease, and approximately 4,200 of these were initiated on renal-protective medication. The results are encouraging. Of the 1,200 patients who have successfully completed the optimisation cycles, about 40% have achieved resolution of protein in the urine or improvement in albuminuria. I would like to take this opportunity to congratulate the project team on its initial success. I hope the good work by Project NEMO will inspire clinicians and healthcare professionals working in other areas to explore similar collaborations between the primary and tertiary care sectors to manage the health of our people in an integrated, holistic, and patient-centric manner.

Targeting Preventive Efforts Upstream and the Role of the Healthcare Provider

9          Chronic diseases such as diabetes will become increasingly prevalent as our population ages. The good news is that diabetes is not an inevitable or fatal disease. Good nutrition, regular physical activity, and maintaining a healthy weight, are effective lifestyle interventions can help reduce the risk of diabetes.[4] Early detection through screening helps ensure timely treatment and appropriate follow-up. It is important that Singaporeans are aware of the importance of diabetes prevention, and take responsibility for their own health, and the health of their loved ones.

10        We need to move our efforts upstream to tackle the root causes of diabetes so as to prevent its occurrence and ensuing complications. By shifting our focus to primary prevention and early intervention, we hope to identify individuals with a high risk of developing diabetes early, as they have a good chance of reversing their glucose levels to normal through effective lifestyle modification. We are currently studying ways to do this, even as we continuously review the quality of care diabetic patients receive, and support innovative programmes such as NEMO.

11        We hope to have more healthcare providers recognise, communicate, and champion the cause of primary prevention. As clinicians and healthcare professionals, you are on the frontline in our battle against diabetes and are better positioned to identify and assess the gaps and challenges that could be overcome, and develop interventions that will provide a win-win solution for patients, and the healthcare system as a whole. With the trust patients have in you, a simple reminder and encouragement from you will go a long way to help patients lead healthier lives. I would like to encourage more of you to be part of a supportive healthcare environment that fosters healthy living among patients.

Conclusion

12        On this note, I would like to conclude by congratulating once more the team at Project NEMO – the doctors at NUH and NHGP, and the care coordinators – on the success of the programme. I am confident that the NEMO programme will continue to yield positive results and benefit many more diabetic patients by leveraging on the close support and collaboration between the primary and tertiary healthcare sector.

13        Thank you, and I wish all of you a pleasant ride on the flyer and an enjoyable evening ahead.

[1] Source: 2010 National Health Survey.

[2] Source: Singapore Renal Registry Annual Report 1999 – 2012 (Preliminary) published by the National Registry of Diseases Office (NRDO).

[3] Ibid.

[4] Yamaoka K, Tango T. Efficacy of Lifestyle Education to Prevent Type 2 Diabetes. Diabetes Care 2005; 28(11):2780-2786.