Effectiveness of War Against Diabetes

28 Mr Patrick Tay Teck Guan asked the Minister for Health whether he can provide an update on the war against diabetes and how successful has the Ministry been in the preventive, reactive and research programmes in diabetes prevention and management since the programme began.

The Senior Minister of State for Health (Dr Amy Khor Lean Suan) (for the Minister for Health): The War on Diabetes was launched in 2016 to mobilise the whole nation to tackle diabetes. Since then, we have made encouraging progress across prevention, early detection and management of the disease, but much more remains to be done.

For more effective prevention, we need to tackle risk factors such as unhealthy diets and inactive lifestyles. The Health Promotion Board (HPB) has been working with industry partners to expand the coverage of its Healthier Choice Symbol (HCS) Programme and the Healthier Dining Programme (HDP). There are currently more than 3,500 HCS products available across 100 food categories and their sales have been growing at 9% annually. As for the HDP, with more partners coming on board, 50% of the stalls across all hawker centres and coffee shops now have at least one healthier option in their menu.

To encourage food manufacturers to innovate and reformulate to produce healthier alternatives, HPB has extended the Healthier Ingredient Development Scheme (HIDS) in 2018 to three additional product categories, namely sugar-sweetened beverages, desserts and sauces. Since then, 11 suppliers have tapped on the grant to produce 62 lower sugar products, helping to improve the availability of healthier options across retail and dining outlets.

There are early indications that these efforts are producing some results. For example, more Singaporeans are becoming more physically active. More than 800,000 Singaporeans participated in season four of HPB's National Steps Challenge, four times that in season one.

Based on the 2018 National Nutrition Survey, our diet quality has also improved. Singaporeans are consuming more unrefined carbohydrates. Unsaturated fat is displacing saturated fat, which has decreased to 36% of total fat consumed in 2018 from 38% in 2010. However, sugar and salt intake are still causes for concern. Our daily sugar intake remains high at 60 grammes, with drinks, in particular pre-packaged drinks, being the largest single contributor of sugar. The average daily salt intake was 9 grammes in 2018, with 90% of Singaporeans exceeding the recommended intake of 5 grammes per day.

In November 2018, the Government decided to form a HealthySG Taskforce to further promote healthy living and activate the community to support the efforts. The HealthySG Taskforce has recommended several initiatives, including the adoption of technology-enabled, personalised coaching solutions and a lifelong virtual Health Booklet for individuals to track their personal health status. We will also implement a support programme for lower income families, to help them stay healthy.

Early detection of diabetes is important, and we encourage Singaporeans to go for regular, age-appropriate screening and follow up. To make screening more convenient, MOH has enhanced the Screen for Life (SFL) Programme and recently adopted non-fasting tests which facilitate opportunistic screening. More than 65,000 Singaporeans have benefited from cardiovascular and cancer screening in the 18 months following the enhancement of SFL subsidies in September 2017. This is almost 30 times higher than the number of Singaporeans who have come forward for screening over the preceding 18 months.

We have also made efforts to enhance the management of diabetes and reduce related complications. For example, we formulated a national strategy to reduce lower extremity amputations among diabetic patients through timely detection and clinical management. More recently, MOH issued an Appropriate Care Guide on foot assessment in people with diabetes. These guidelines help healthcare professionals better perform comprehensive foot assessment and treat diabetic complications in a timely manner.

We have also been conducting more local research to understand the effectiveness and impact of our interventions. For instance, Pre-DICTED, which stands for Pre-Diabetes Interventions and Continued Tracking to Ease out Diabetes, is a research programme by SingHealth to evaluate the effectiveness of a community-based intervention programme in reducing the conversion rate from pre-diabetes to diabetes. Data from this study can help us develop evidence-based, scalable and effective interventions for better clinical management and policies.

While there are early signs of progress in our war against diabetes, we cannot afford to let up our efforts. Many of these initiatives will only achieve the desired health outcomes in the long term. The Government will continue to work with key stakeholders and partners in the public, private and people sectors to sustain our efforts in this war.

Mr Patrick Tay Teck Guan (West Coast): I thank the Senior Minister of State for her answer as well as the update to this House. I am aware that in Khoo Teck Puat Hospital, there is actually a group of clinicians who have done quite a bit of very good work in the research into prevention and better management of diabetes cases. I am suggesting whether MOH can consider whether our public healthcare clusters, possibly in partnership with the Yong Loo Lin School of Medicine or Lee Kong Chian School of Medicine to develop a dedicated research centre, to look into areas to better prevent, manage, overcome and also win the war against diabetes.

Dr Amy Khor Lean Suan: Let me thank the Member for his very useful suggestion. Indeed, I agree with the Member that research is important to inform clinical management and policies as well as for an effective war on diabetes.

Currently, there is a fair amount of collaboration among researchers and clinicians within and across the healthcare, academic and research institutions on diabetes with funding from various sources, since the war on diabetes. This includes the GUSTO study which is a collaboration between A*STAR, KKH, NUHS and NUS as well as the Pre-DICTED study that I mentioned earlier, which is between SingHealth Duke-NUS Diabetes Centre with HPB and the Singapore Clinical Research Institute. In fact, there are also two research collaborations that have just been funded through the National Medical Research Council (NMRC) Open Fund – Large Scale Collaborative Grant.

So, I think that because there is currently sufficient research focus on DM locally, both in small and large scale research, a current-state mapping of the research landscape for diabetes will need to be done to understand the range of research that has already been funded, and to ensure that the full potential of any research centre to be set up could be achieved without significant overlaps, especially with the large scale research projects that have already been funded.

Also, as the researchers for these projects often come from multiple organisations – academia as well as the healthcare clusters, and so on – actually we could take this to be akin to a virtual centre for diabetes research, which tap on best researchers from Singapore. Nonetheless, we will further study the Member's suggestion and to see how useful and appropriate such a dedicated research centre would be.

Dr Chia Shi-Lu (Tanjong Pagar): Just two supplementary questions for the Senior Minister of State. I just wanted to ask whether the Ministry has any ideas to, perhaps, increase either subsidies or further funding support for patients with diabetes. Just to give an example, diabetes is part of the Chronic Disease Management Programme (CDMP) but not all of the chronic diseases are created equal. So, I was wondering since we have this war against diabetes, whether we could look at some package where there could be additional funding liberated either from patients' Medisave or, perhaps, from other targeted subsidies for patients with diabetes, because this would probably help to increase compliance.

The second supplementary question is related to my later question but I think I will just ask it here. We are all concerned to see that the sugar intake per day of Singaporeans, as of from a survey last year, is still at 60 grammes, and WHO standard is 25 grammes every day. So, it is quite a big jump. So, I was wondering whether MOH has any targets. Have we set any targets for the sugar intake per day for Singaporeans, and do we have any timeline to try and reach these targets?

Dr Amy Khor Lean Suan: Regarding the subsidies, to ensure affordability of treatment for diabetes, just to note that we have just recently, for instance, allowed the test strips for diabetes for Type 1 and Type 2 patients on insulin to be under the CDMP. That means that they can claim on Medisave and it also goes under CDMP, through CHAS funding, for instance.

So, as with healthcare affordability issues, the Ministry will continue to look into ensuring the affordability of treatment and access for the different conditions including for diabetes.

With regard to sugar, Members know that we have undertaken a public consultation on the measures to be taken to reduce Singaporeans' sugar intake, particularly from Pre-Packaged SSBs, which was just concluded in January this year. So, we are reviewing the feedback; we received feedback from over 4,000 members of the public as well as from the SSB and media industries. We will review the feedback and we will also take into account evidence from local and regional studies, and then make our decision.