Opening Ceremony Of The 12th Congress Of The Asean Federation Of Endocrine Societies(AFES)

30 Nov 2003

By Dr Balaji Sadasivan

Venue: Raffles City Convention Centre

I am have great pleasure in joining you today at the opening ceremonyof the 12th Congress of ASEAN Federation of Endocrine Societies (AFES2003). I am glad to note that this conference has brought together manyexperts from around the world as well as participants from around theregion.

2 Endocrinology is the study of conditions arising from the functionand pathology of numerous endocrine glands, many of which areresponsible for the precise functioning of the human biological clock.I am pleased to note that this Congress will also touch on wideraspects of calcium, pituitary, adrenal physiology as well as paediatricendocrinology. However in my speech today, I intend to use a commonendocrine condition i.e. diabetes mellitus, to illustrate some of mypoints.

Nature vs Nurture

3 Classic longitudinal epidemiological studies like that of thePima Indians of Arizona have helped synthesise our understanding of theinteractions between familial and genetic predisposition (Nature) withsedentary lifestyles and obesity (Nurture) in the higher prevalence ofdiabetes among certain groups of people.

4 Similarly in Singapore our rapid transition from a migrant settlementto a thriving city-state has brought about some undesirable problems.In the year 2001, diabetes was the 6th leading cause of death inSingapore with 2.3% of all deaths being attributable to diabetes alone.There has been a rising trend of the prevalence of diabetes from 4.7%in 1984 to 8.6% in 1992 and we hope that the figures have stabilised atthe 9%, found in the 1998 National Health Survey. Although there areethnic variations in the prevalence of DM, the rising prevalence of thedisease and its attendant debilitating co-morbidities from bothmacro-vascular and micro-vascular complications are likely to riseamong the whole population.

Aging Population

5 Singapore faces the problem of a rapidly aging population. Bythe year 2020, we expect a doubling of the proportion of people aged 65years and above. The findings that one in three persons aged 60-69years had diabetes (32%) compared with only a 3% prevalence amongpersons aged 30-39 years, is disturbing. At the other end of thespectrum, a study among children in Singapore shows rising incidence ofboth Type 1(insulin dependent) and Type 2 diabetes. Childhood obesityhas been attributed to play a predominant role in this rising trend.

6 Another 'tip of the ice-berg' phenomena that we discovered in the1998 National Health Survey was that two thirds(62%) of residents withdiabetes were not even aware of the condition, which was picked upincidentally upon screening. The study also showed that less than halfof the known diabetics had good blood sugar control thus putting themat higher risk of rapid progression to the adverse sequelae of poorglycaemic control (i.e. diabetic retinopathy, lower limb amputations,ischaemic heart disease and end stage renal disease)

Prevention And Control Strategies

7 My Ministry has embarked on a series of programmes to arrestthe problem of diabetes and other related life-style diseases (i.e.hypertension, hyperlipidemia). Our 3-prong strategy includes primaryprevention to encourage the population to adopt healthy preventivelifestyles to control the risk factors that predispose to diabetes. The2nd line of defence involves effective screening to detect persons withdiabetes, for early optimal management and treatment. Lastly, tertiaryprevention involves retarding the progression of the disease andaggressively treating its existing co-morbid conditions.

Primary Prevention 

8 Primary prevention involves increasing awareness based on theepitome of, ?prevention better than cure?. This involves galvanisingmulti-agency co-operation and targets both the general population andthe high risk group. The programmes and initiatives, aims to manageobesity in both children and adults. This is achieved throughprogrammes aimed at increasing activity levels, maintaining healthyweight and adopting healthier dietary habits.

9 The Health Promotion Board (HPB) has awarded Health Ambassador awardsto health-conscious individuals who champion health promotionactivities, such as A.C.T.I.V.E days (All Companies Together In VariousExercises ) within their individual organisations.

10 Ask the, 'man on the street' about Singaporean?s favourite past-timeand he will say it is, food! There is even a programme calledMakansutra, (i.e. 'makan' denoting eating), on television thatcapitalises on our gastronomic predilection. Well, as they say, if youcan't beat them, then join them! Hence, the HPB has organisedprogrammes like, 'Healthier Hawker Trails,' to help educate and empowerthe public to make and ask for healthier choices and alternatives (lesssugar, oil and salt) when having their favourite hawker food. Bycreating greater awareness, hopefully, we can sensitise the hawkers andfood stall-holders to cater to the more health-conscious among thepopulation.

Secondary Prevention

11 In view that the overall prevalence of undiagnosed diabetes in thepopulation aged 18-69 years and 40-49 years is 6.6% and 8.0%respectively, my Ministry has recently launched clinical practiceguidelines on health screening, including that for diabetes. This iscritical in view that some overseas studies have shown that close tohalf of patients newly diagnosed with Type 2 diabetes already hadsignificant latent micro-vascular tissue damage. Hence earlier pick-upand aggressive dietary and lifestyle manipulation together withmedications, we believe, may help retard the progression of thecomplications arising from poor glycaemic control from the latentunrecognised phase of this disease entity.

Tertiary Prevention

12 My Ministry has likewise produced clinical practice guidelines onthe management of diabetes and is working with polyclinics and GPs toimprove the management of diabetes in the primary care setting.

Other Initiatives

13 Apart from diabetes, there are a number of diseases of the otherendocrine glands that are equally important. I am told by theorganising Chairman that thyroid disorders contribute to 1/3 of allendocrine referrals to endocrine departments of restructured hospitalsin Singapore with an estimated 4-7% of the population having some formof thyroid disorders. Osteoporosis is another condition which can leadto substantial morbidity and cost. In 2001, there were 2,397 admissionsfor hip fractures of which 83% occurred in the elderly aged 65 yearsand above. These are major areas which I am sure the experts at thismeeting will help shed new insights on.

Role Of Endocrinologists

14 We recognise the importance of endocrinologist and encourage them topursue their speciality areas with passion. Our desire to evolve into aregional medical hub also hinges on the availability of such expertise,and on regional co-operation. However, we need to maintain a finebalance between specialisation and over-specialisation which may leadto the fragmentation of care given to patients. Disorders such asdiabetes are often associated with problems in multiple organs such asthe heart, kidneys and eyes. It is therefore essential that suchpatients are cared for holistically.

Conclusion

15 I would like to thank the organising Chairman, Dr Daphne Khoo andher team, for a work, well done. I wish all participants a successfulconference and an enriching stay in Singapore. Thank you.