World Diabetes Day Singapore 2003 Celebrations

16 Nov 2003

By Dr Balaji Sadasivan

Venue: Singapore International Convention And Exhibition Centre, Suntec City

I am pleased to be here to officiate at this year's World Diabetes Day Singapore celebrations. This event has been running for the last decade as a focus point on diabetes each year. I would like to commend the Diabetic Society of Singapore for organizing this event and for their continuing efforts to provide diabetes awareness, diabetes education and counseling to people with diabetes, their family and the public.

Diabetes - A Growing Problem

Diabetes is a chronic disease that is reaching epidemic proportions worldwide. There are currently more than 190 million people with diabetes worldwide. The World Health Organisation (WHO) estimates that this will rise to 330 million by 2025, largely due to population growth, ageing, urbanization and a sedentary lifestyle. Diabetes is currently the fourth main cause of death in most developed countries. The prevalence of diabetes in our population is 9% according to the 1998 National Health Survey. This is expected to grow as our population ages.

The Cost of Diabetes

Diabetes, if not well managed and controlled, can progress steadily to devastating complications like blindness, nerve damage, kidney failure and heart disease. The treatment of diabetes and its complications imposes a huge burden on healthcare services. It is estimated that diabetes accounts for between 5-10% of a nation's entire health budget. As a result, since 2001, particular attention has been paid to diabetes complications during World Diabetes Day. This year the theme is on Diabetes and the Kidney.

Diabetes and Kidney Disease

Diabetic nephropathy, or more simply, diabetic kidney disease, is one of the main complications of diabetes. It occurs in about one-third of all diabetics, or approximately 60 million people worldwide. This complication adds enormously to the morbidity, mortality and cost of diabetes treatment. If left unchecked, diabetic nephropathy will ultimately develop into kidney failure. Diabetes is currently the leading cause of kidney failure in developed countries as well as in Singapore each year. More than 40% of new cases of End-Stage Renal Disease (ESRD) worldwide every year are attributed to diabetes. In Singapore, there were 650 new cases of end-stage renal disease in 2000, and 47% of these were due to diabetes. The only available treatment for these patients would be to undergo dialysis or kidney transplantation and the cost of treatment is very high.

One reason why diabetes is such a major cause of kidney failure worldwide is because there are often no symptoms of diabetic nephropathy until the kidneys fail completely. It is thus extremely timely that attention is drawn to the link between diabetes and kidney disease in order to try to prevent what is essentially a preventable and costly outcome.

Preventing Diabetic Nephropathy

Although there is no cure for diabetic nephropathy, the good news is that steps can be taken to prevent this complication or limit its progression. For non-diabetics, they should maintain a healthy lifestyle through a balanced diet, regular exercise and not smoking. Early detection of diabetes through regular health screenings, especially for those with immediate family members with diabetes, is also important as at least 50% of all people newly diagnosed with diabetes are unaware of their condition. Some are only diagnosed many years after the onset of the condition, when various diabetic complications are already present. I would thus urge those present today, who have not been screened recently, to go for the free health screenings available at today's event.

For those who have diabetes, studies have shown that good blood sugar control will minimise the risk and limit the progression of diabetic nephropathy. Intensive blood pressure control using ACE inhibitors, optimal control of blood cholesterol and smoking cessation can also reduce the risk of progression of kidney disease. Most importantly, diabetics should undergo annual urine screening for microalbumin, which is the earliest sign of diabetic nephropathy, as part of the management of their condition. More than 40% of people with Type 2 diabetes have microalbuminuria. Detecting it early is important so that treatment can be done to slow down the progression to kidney failure.

Conclusion

The problems posed by diabetic nephropathy are alarming. The rising prevalence of diabetes and high blood pressure, high cost of kidney dialysis and shortage of kidneys for transplantation point to the urgent need to stem the tide of patients with diabetic nephropathy. Although many people with diabetes may not get diabetic nephropathy, and having diabetic nephropathy does not necessarily mean that the kidneys will fail, people need to be aware of the risk factors of this complication and the measures that can be taken to decrease or delay their chance of developing it. I would thus encourage those present to find out more about diabetes and diabetic nephropathy by touring the exhibits and displays as well as by attending the health talks later. I am positive that you will find it to be a rewarding experience.

Thank you.