DIABETES MELLITUS

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DIABETES MELLITUS: 14.

Dr Geh Min asked the Minister for Health (a) what is the estimated prevalence of diabetes mellitus in Singapore; (b) what is the incidence of new cases annually over the last 20 years; and (c) what percentage of patients with renal failure have diabetes and, conversely, what percentage of diabetics develop renal failure.

The Senior Minister of State for Health (Dr Balaji Sadasivan) (for the Minister for Health: ): Mr Speaker, Sir, the prevalence of diabetes mellitus in Singapore is measured through the six-yearly National Health Surveys. According to the latest

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survey in 2004, the age-standardised prevalence of diabetes among Singaporeans aged 18-69 years was 7.8%. This is significantly lower than 9.5% in 1998 and 10% in 1992.

Due to methodological constraints, it is an internationally accepted practice to measure the burden of diabetes in terms of 'prevalence' rather than 'incidence'. However, based on local studies and mathematical modelling, the incidence of diabetes, in population aged 18-69 years, has been estimated to be 7 per 1,000 population in 1992, 8 per 1,000 in 1998 and 6 per 1,000 in 2004. This translates to about 12,000 new cases every year, for the past few years.

Diabetes is the most common cause of renal failure in Singapore, accounting for more than half of the new cases. A similar trend is seen in many other countries such as the United States of America, New Zealand and Malaysia. However, most people with diabetes do not develop kidney disease that is severe enough to cause renal failure. Based on local data, only 0.1% or 1 in 1,000 diabetics will develop renal failure in a year.

The burden of diabetes is a reflection of our lifestyle, ethnic and genetic pre-disposition and an aging population. Diabetes, if not managed well, can lead to many serious complications including blindness, heart disease and renal failure. But we can prevent and reduce the risk of diabetes by adopting a healthy lifestyle. For those with diabetes, good blood sugar and blood pressure control is vital for avoiding complications.

Dr Geh Min (Nominated Member): I thank the Senior Minister of State for his reply. Although the figures showed that we seem to be keeping the incidence and prevalence of diabetes under control - at least it has not been increasing in the last few years - this is still a very big problem for Singapore and the region.

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And we have all the risk factors - urbanisation, affluence and the fact that we are in Asia.

I would like to ask the Senior Minister of State if we can do even more in the prevention by having a more upstream approach, perhaps, a bigger budget for research, education and public awareness as opposed to dealing with the problem mainly downstream, and whether we could have a more integrated and coordinated approach between, say, the Government and voluntary welfare organisations (VWOs). For instance, it seems to be that a lot of the voluntary welfare organisations may be better equipped to deal with the problem upstream in terms of community education, rather than provide facilities like NKF has been doing for patients who have become end-stage diabetic cases.

Mr Speaker: Dr Geh Min, could you make your question brief, please?

Dr Geh Min: I am just expanding on my question. For example, what about advertising? Perhaps, we should treat diabetes, because of its risk, like we treat cigarette-smoking. Advertisers should be required, if they are advertising sweets or sugar drinks or food, to put a warning on diabetes in it.

Dr Balaji Sadasivan: Mr Speaker, Sir, we can always do more to try and reduce the incidence of diabetes and its complications. My Ministry will work with VWOs in trying to prevent diabetes.

There are preventive measures at several levels. The first level is trying to prevent the onset of diabetes itself. And here, diet and a healthy lifestyle are important considerations. And then, at the second level, it is trying to prevent the complications of diabetes. This is through better management of the disease.

But these are multi-factorial diseases. The cause is complex, partly genetic,

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partly environmental. And so, it is the interplay of these factors that gives rise to this disease. Unlike lung cancer, where smoking is a major factor involved and, therefore, a simple advertisement by the Health Promotion Board's "Stop Smoking" is a good advertisement. With diabetes, it is a little more complex. There is no major single factor that we can advertise and promote as a means of stopping the onset of the disease. It is multi-factorial, similar to heart disease and stroke, and so the message is more about healthy living which the Health Promotion Board is promoting.

Mr Yeo Guat Kwang (Aljunied): Mr Speaker, Sir, the Senior Minister of State mentioned that there are 12,000 new cases a year. I would like to ask whether these new cases actually occurred in certain age groups and whether the Ministry of Health has some focused programmes to help these people who suffer such illnesses because I understand that about a few years ago, there was another survey by MOH which showed that a majority of those that have been diagnosed with diabetes actually did nothing about their follow-up and their condition deteriorated.

Dr Balaji Sadasivan: The incidence or prevalence of diabetes is higher in an older population as compared to a younger population. But prevention measures have to cover the entire population because the current thinking is that it takes many years of living a particular lifestyle that contributes to the development of diabetes. And that is why the healthy living message is targeted towards the general population rather than a specific population.

Dr Tan Sze Wee: Mr Speaker, I would like to ask the Senior Minister of State, as regards the prevalence of diabetes in the latest health survey of 2004, which was running lower than the previous health survey, whether it is possible to give a

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breakdown according to race. I am interested to understand why the prevalence rate came down, which runs counter to the prevailing rate which is supposed to rise.

Dr Balaji Sadasivan: Again, the prevalence rate can be affected by many things. One, better detection and, two, better preventive methods. Perhaps the Health Promotion Board has got its message across. Singaporeans are living healthier lifestyles and so the prevalence rate has come down. But before we reach that conclusion, we should wait a few more years and study the trend.

Mr Speaker: Dr Geh Min, last question.

Dr Geh Min: Although the prevalence rate may have come down slightly or at least remained fairly stable, I am told by endocrinologists that the prevalence of Type II Diabetes in younger people has gone up. Could he confirm this? I am also told that although, as we know, diabetes is a multi-factorial disease and that it is related to lifestyle, a lot of this Type II Diabetes in younger people is due to obesity. Although I realise that tackling the problem in an upstream way is harder than in, say, cigarette smoking, I would like to put to the Minister that it should still be done because, especially if people get it at a younger age,

they have a longer life expectancy in which to develop complications like renal failure, and they will be a great burden to themselves and to society.

Dr Balaji Sadasivan: Yes, I agree that our healthy living message must be targeted at the younger population as well as the older population. And this is why I mentioned earlier that we have not singled out one population for the message, but it is for everyone. Whether the prevalence of diabetes in young people is going up or not is hard to say, because when we start looking at age specific numbers, then it is harder to know whether it is statistically

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significant. However, there are several possibilities of why the prevalence rate may go up, one of which may be better detection. But it is necessary for us to have a longer period of observation before we can draw such conclusions.