World Diabetes Day

05 Nov 2006

By Mr Heng Chee How

Venue: Singapore International Convention And Exhibition Centre (SICEC)

Professor Arthur Lim,

Patron, Diabetic Society of Singapore (DSS)

Mr Yong Chiang Boon,

President of DSS

Dr Warren Lee,

Chairman of DSS

Dr Kevin Tan, Vice-President of DSS and Chairman of the WDD 2006 Organising Committee

ladies & gentlemen

Introduction

Thank you for this opportunity to address you on World Diabetes Day.  World Diabetes Day has been observed since 1991.  In that year, the International Diabetes Federation and the World Health Organisation introduced a global awareness campaign in response to the "escalating incidence of diabetes around the world".  Today, it is marked worldwide in more than 150 countries.  I think this widespread attention to diabetes demonstrates how much of health challenge diabetes has become around the world.

Why Diabetes is a Major Public Health Challenge

Why is diabetes such a big health challenge?  Firstly, because it creeps up on us.  Symptoms take a long time to manifest themselves and the disease can lie undetected until it is too late and the patient suffers from complications and damage to various vital organs, such as the kidneys, eyes and the heart.  As people schedules become ever more hectic, they may not pay enough attention to their health, thereby letting the onset of diabetes slip pass them. So its prevalence is much higher than people think. Some estimates suggest that half of the people with diabetes are unaware of their condition.  It is for good reason that diabetes is called "the silent killer".

Secondly, where diabetes may once have been considered a "rich man's problem", it is no longer so.  It strikes people of all ages and income groups.  More than 200 million people worldwide have diabetes and they can be found in countries at varying stages of economic development, and within each country across all income groups.  Type 2 or "adult" diabetes has been found in children as young as 6 and in people with occupations varying from professional athletes to white collar workers. 

Thirdly, diabetes is increasingly prevalent in Asia.  According to the International Diabetes Federation, in 2003, 3 of the 5 largest diabetic populations in the world were India (35.5 million), China (23.8 million) and Japan (6.7 million).  The affected population in Asia as a whole is also growing. 

An article in the Dec 2002 edition of the Time Magazine entitled "Silent Killer" wrote about this spread of Diabetes in Asia.  It says that "There is some evidence that certain ethnic groups - primarily Chinese, Indian and Malay - are more disposed to diabetes than others."  To the extent that the article is right, then Singapore, given our racial composition, must indeed take this disease very seriously. 

Our National Health Survey of 2004 found that 8.2% of residents aged 18 to 69 had diabetes and about 250,000 people overall suffered from the disease.  While the prevalence of diabetes as a percentage of the adult population is still not as high here as it is in some of the worst-afflicted countries, where it can be as high as 30% (Nauru), we cannot be complacent.

Hence, I find the theme for this year's World Diabetes Day,  "Diabetes care for everyone", most fitting.  In the same spirit, my Ministry has made the prevention, treatment and management of chronic diseases, including diabetes, a priority.  I would like to share with you our plan. 

Medisave for Chronic Disease Management Programme

MOH launched a Chronic Disease Management Programme on 1 Oct 2006.  The twin features of this programme are the central role we hope Family Physicians can play to help patients deal more effectively with chronic disease, and the use of Medisave to pay part of treatment cost.  That the programme kicked off with the treatment of diabetes testifies to the seriousness with which we reckon this disease.

What do we hope to achieve through such a programme?  Two key things : lowered cash outlay and improved care.  We recognise that medical care for diabetes is costly because it is lifelong.  This is even more so for those with complicated conditions and who need more expensive drugs.  We want to avoid a situation where diabetic patients forego medication or visits to the doctor because of cash flow difficulties.  Allowing Medisave use will help more patients deal with this.  

At the same time, we want to ensure that the Medisave money spent on diabetes treatment is well spent.  When patients invest time and money, and take personal responsibility to manage their illness, they deserve holistic, high quality care.  Hence, our focus on improving the standard of care: Medisave-accredited providers must follow evidence-based guidelines and also report clinical data to the Ministry.

Thus, when a patient walks in to a public hospital, polyclinic, or GP clinic participating in the programme, there is much more going on than Medisave deductions and that circular orange decal displayed on the clinic door.  The doctor will be managing the patient's condition through a systematic disease management programme, which will improve care.  Key clinical indicators like blood sugar level will be regularly monitored and key investigations like annual foot and eye screenings performed so that doctors have all the information necessary to understand how well patients are coping with the disease, and give appropriate advice early.

Importance of Patient Self-Management

I would like to encourage patients to work with their doctors, particularly their Family Physicians, to actively manage their condition through regular monitoring, appropriate medical treatment and lifestyle adjustments.  Doctors may also refer patients to support organizations like the Diabetic Society of Singapore and the National Kidney Foundation Prevention Centres for support and assistance.  There, they share experiences with and derive ideas and support from other patients, who could be newly-diagnosed diabetics adapting to life with the illness or veteran patients improving their HbA1c while holding down regular jobs.  These sessions are, with their doctor's endorsement, Medisave-claimable. 

To help patients take charge of their health, we have also produced a kit called "AIM - Be In Charge Of Your Health".  Inside, there is a Record Book to capture key information about the patient's physical condition, a pamphlet providing important information on diabetes, and a collection of answers to Frequently Asked Questions.  Patients should approach their family physicians for a copy of this very useful patient folder.  Ask for the bright orange folder.

Next Steps

I am happy to say that this Chronic Disease Management Programme has received tremendous support from patients and their families, members of the public and healthcare professionals.  It is really encouraging.  As a Ministry, we will continue to monitor progress and fine-tune arrangements.

Looking ahead, we will be extending the Chronic Disease Management Programme in two ways.  Firstly, come January 2007, Medisave claims will be allowed for Hypertension, Lipid Disorders and Stroke.  Beyond that, we will review our experience and assess if other diseases should be added to the list in due course.

Secondly, we will embark on a nationwide clinical quality improvement initiative.  Beginning with diabetes, we will be tracking clinical and process indicators to improve the standards of care.  These indicators will be shared with physicians to motivate adherence to evidence-based guidelines and practices in caring for their patients.  The indicators will also give us a sense of how our healthcare system as a whole is performing in terms of the outcomes of chronic disease management.

The Chronic Disease Management Programme is an important project to raise medical standards and improve treatment of chronic diseases for our population.  Its success and the benefit to patients that brings depend on the enthusiastic and sustained participation of all stakeholders. I therefore urge you to give this endeavour your utmost support.

I wish you a meaningful World Diabetes Day.  Thank you.