One in three Singaporeans are projected to develop diabetes in their lifetimes with the figure rising to one million people by 2050, according to the Ministry of Health.
It seems alarming but this situation can be greatly mitigated. In fact, there are several different ways to manage diabetes, and the “most correctable risk factor”, is maintaining a normal body mass index/weight, says endocrinologist Dr Nitish Mishra, from Singapore Medical Group Diabetes, Thyroid and Endocrine Clinic.
He adds: “The plan always used to be to treat the diabetes first then deal with weight. But if you look at recent recommendations from major societies, Both Improving diabetes and managing weight need to be targeted together.
“Once you get the weight down, diabetes control is more likely to improve. In certain cases, there’s a strong chance you can send diabetes into remission.”
Singapore’s War on Diabetes campaign is in its fifth year as the government continues to tackle the chronic disease that currently affects about 400,000 people here.
What’s even more worrying is that an increasing number of young people are presenting with Type 2 diabetes, says Dr Mishra. Traditionally, Type 2 diabetes is diagnosed in people in their 40s and 50s, but he now sees patients as young as 13.
“The age incidence for diabetes is going down and this is usually due to a combination of two to three risk factors. A family history of the condition, obesity or a sedentary lifestyle all increase your risk for Type 2 diabetes,” he says.
The risks of diabetes
One of the most prevailing reasons for eating and living healthily is to reduce the chances of getting diabetes. On top of that, diabetes is an independent risk factor for cardiovascular or heart disease.
Two out of three people with diabetes die from cardiovascular disease, says Dr Mishra, adding that studies show that up to 35 per cent of patients with heart failure also have diabetes.
Having diabetes does not mean that you automatically get heart disease, but Dr Mishra explains that the longer you have poorly-controlled diabetes, the risk of getting heart disease increases. When one has diabetes, their blood sugar level is high, and over time, this can damage the arteries that supply blood to the heart as well as the heart muscle function, leading to heart disease.
Other risk factors such as obesity, an unhealthy diet, high blood pressure, high cholesterol, smoking and drinking excessively, also contribute to heart disease.
Managing diabetes with weight loss
A recent study recommends that loss of 15 per cent or more of bodyweight can have a disease-modifying effect in people with type 2 diabetes. This is an achievable target and may lead to the reversal of diabetes in the first few years after diagnosis, says Dr Mishra.
However, he adds that about one in three people with diabetes have poor control of their condition, even with medicine, making weight loss difficult to achieve.
“Knowledge and socioeconomic circumstances play a big factor in diabetes control. The more knowledgeable you are about your diabetes, the more you are able to deal with it,” he says.
Those with lower income tend to also have a harder time controlling diabetes and may also have difficulty paying for medicines, he adds.
Targeting weight and blood glucose levels
In the past five to six years, new types of GLP-1 Receptor Agonists (GLP-1 RAs) medications, that support weight loss and lower blood glucose levels, have been introduced to the market.
Traditional diabetes medicines mainly lower glucose levels but may increase your body weight and this weight gain may worsen the diabetes control further and may affect the compliance to the medication.
GLP-1 RAs are drugs that stimulate insulin secretion. Dr Mishra explains: “It helps your insulin work better and lowers the levels of the glucagon hormone, which leads to increased glucose levels in diabetics.”
GLP-1 RAs delay gastric emptying, allowing food to stay in the stomach longer, and work on certain receptors in the gut and brain to keep one full, thus reducing appetite and aiding weight loss.
“Up until about a month ago, we only had an injectable form of GLP-1 RAs but due to excellent scientific advances, we now have an oral pill. This is the first time that a tablet can replicate what an injection does, making it an alternative for patients,” says Dr Mishra.
Another upside, he adds, is that they are also deemed to be protective for the heart – particularly in preventing heart attacks from blockages of the blood vessels.
Additionally, the side effects of GLP-1 RAs are usually mild. Common side effects include nausea, occasional vomiting, diarrhoea and constipation.
However, they are mostly present in the early phase when patients start the treatment. By the end of one month, most patients do not experience side effects, according to Dr Mishra.
“GLP-1 RAs address most of the issues related to weight and diabetes and is a very welcome addition to the treatment options for Type 2 diabetes patients, particularly the ones who are overweight or obese,” he adds.
“Diabetes is on a rise, with weight being a major contributor. Moreover, 13 per cent of people do not even know they have diabetes, so it pays to take charge of our health, watch what we eat and change our lifestyles to prevent it becoming a problem later in life.”
Dr Nitish Mishra is a senior consultant endocrinologist at SMG Diabetes, Thyroid and Endocrine clinic, based at Mount Elizabeth Novena Hospital. He did his specialist training in Endocrinology at Kings college Hospital in London and has worked in the UK NHS for many years before coming to Singapore in 2012.
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