Screening for Diabetes in Singapore

Diabetes is a chronic condition that affects millions of people worldwide. It is characterized by elevated blood sugar levels, which, if left unmanaged, can lead to serious complications such as heart disease, kidney failure, and blindness.

Recognizing the symptoms of diabetes is crucial for early intervention, and in this article, we will explore the importance of screening early and often. To maintain good health and catch diabetes early, it is generally recommended that individuals undergo diabetes testing at least once every three years, especially if they have risk factors or a family history of the disease. Regular testing ensures that any changes in blood sugar levels are detected promptly, allowing for timely intervention.

Before going into the specifics of diabetes testing, let's first understand the symptoms that may indicate the presence of diabetes.

Symptoms of Diabetes

Symptoms of diabetes include:

1. Slow-healing wounds or frequent infections.

2. Being hungrier and thirstier than usual.

3. Having to urinate more frequently.

4. Blurred vision.

5. Fungal infection, itching of skin and genitals.

6. Losing weight in spite of eating more.

7. Numbness of hands and feet.

Often, diabetes is asymptomatic - this is why regular diabetes health screening is important to identify diabetes.

If you suspect you may have diabetes or are at risk due to family history or other factors, it's essential to get tested early. Testing not only helps in confirming the diagnosis but also plays a critical role in preventing complications associated with diabetes.

Early detection of diabetes is important for effective management and prevention of complications. Many individuals may not experience noticeable symptoms in the early stages of diabetes, making regular testing even more critical. By identifying diabetes early, individuals can make lifestyle changes, such as adopting a healthy diet and increasing physical activity, which can help manage the condition.

Risk factors for diabetes

There is a higher chance of developing type 2 diabetes if you have any of these risk factors:

• You are aged 40 and above.

• Your parent or sibling has type 2 diabetes.

• You are overweight.

• You are inactive.

• You have high blood pressure (greater than 140/90mmHg).

• You have high levels of triglycerides.

• You have low levels of high-density lipoprotein (HDL) (also known as “good cholesterol”).

• You have had gestational diabetes previously.

• You smoke.

• You have prediabetes.

Tests 

To identify if you have diabetes, you need to get your blood sugar (glucose) tested by having a small sample of your blood drawn from your arm. This will then be sent to a lab for testing or you may opt for screening through a point of care testing done via finger prick.

There are four different types of tests for type 1 and type 2 diabetes in Singapore:

1. Fasting blood sugar test

2. Casual blood sugar test

3. Glycated hemoglobin (HbA1C) test 

4. Oral Glucose Tolerance (OGTT) test

Fasting blood sugar test

This test measures your blood sugar after an overnight period of not eating (fasting). A fasting blood sugar level of 99 mg/dL or lower is normal. However, 100 to 125 mg/dL (5.6 to 6.9 mmol/L) indicates you have prediabetes, and 126 mg/dL (7.0 mmol/L) or higher indicates you have diabetes.

Casual blood sugar test

A casual blood sugar test also measures your blood sugar at the time you’re tested, the same as fasting blood sugar test, except that you do not need to fast overnight. You can take this test at any time. A blood sugar level of 200 mg/dL (11.1 mmol/L) or higher indicates you have diabetes.

Glycated hemoglobin (HbA1C) test.

This test can be done via a blood draw or as a point of care test requiring only a finger prick. The point of care test takes just 15 minutes for the results to be out.

The MOH has approved the use of the Haemoglobin A1C, or “HbA1c'' blood test as an alternative initial screening test for diabetes. The HbA1c test, also known as the glycated haemoglobin test, takes a blood sample from your arm to produce a reading. From the MOH’s 2010 National Health Survey data, HbA1c results of 6.0% and below likely means a diagnosis of No Diabetes, while HbA1c of 7.0% and above likely means you have diabetes.

If your HbA1c test returns a reading of between 6.1% and 6.9%, it could indicate that your body may not be able to regulate your blood sugar properly.

Oral Glucose Tolerance (OGTT) test

Although this is the most complex, the OGTT is the current gold standard test for diabetes. A modified version of the glucose tolerance test is often used to screen for and diagnose gestational diabetes, this is a type of diabetes that develops during pregnancy. The glucose tolerance test happens in several steps:

1. There needs to be an 8-hour fasting period before you take the test

2. At the clinic, they will take a blood sample to measure your baseline blood sugar.

3. You will drink a syrupy glucose solution containing 75 grams of sugar. 

4. Two hours later, your blood glucose level will be measured again.

Where to get tested in Singapore

In Singapore, there are various healthcare facilities, clinics, and diagnostic centers where individuals can undergo diabetes testing. General practitioners, diabetes clinics, and specialized laboratories are equipped to perform the necessary tests.

Most general practice (GP) clinics in Singapore should be able to draw a blood sample from your arm and send it to a lab, who can do any one of the four tests for diabetes, which we will discuss in detail below.

Check with the clinic if their regular health screening already includes a test for diabetes, or ask if they offer any one of the four blood glucose tests.

Looking to get tested by a diabetes specialist clinic? 

Cost of diabetes tests

At General Practice Clinics, Oral Glucose Tolerance (OGTT) tests would normally cost from $20 - $50, while health screening costs would be from $50 - $500. Then, there are the Screen for Life Clinics for adults above 40 years old that would roughly be between $0 to $5.

You can go for diabetes health screening as part of a customizable health screening plan in Singapore for $299. With this, you can screen for conditions relevant to you – including diabetes – and receive useful, actionable advice post-screening.

Understanding the results

According to the MOH Clinical Practice Guidelines, you have diabetes if you fulfill any of the following criteria:

• Fasting Glucose test: ≥ 126 mg/dL (≥ 7.0 mmol/L)

• Casual Glucose test: ≥ 200 mg/dL (≥ 11.1 mmol/L)

• Oral Glucose Tolerance Test (OGTT): ≥ 200 mg/dL (≥ 11.1 mmol/L)

• Glycated hemoglobin (HbA1C) test: ≥ 126 mg/dL (≥ 7.0 mmol/L)

Singapore HbA1c guidelines

Table 1: Singapore HbA1c guidelines. Source link

HbA1c Screening Result	Action	Recommended Diagnosis
6.0% and below. Low probability of diabetes.	No further tests needed if there are no symptoms of diabetes. Further testing recommended if diabetes symptoms are present.	No Diabetes Maintain healthy lifestyle and weight. Repeat test in 3 years.
6.1% to 6.9% Further testing required	Proceed to Fasting Glucose test, or OGTT.	Pre-diabetes / Increased risk of diabetes Manage accordingly.
7.0% and above High probability of diabetes.	No further tests needed.	Diabetes Seek treatment

What to do if you are diagnosed with diabetes

If you’ve been diagnosed with diabetes, or believe that you might have it, you might want to look into NOVI Magnum. We’ve designed this program to include support from a number of different healthcare professionals, including physicians, dietitians, and health coaches, to provide comprehensive care.

With NOVI Magnum, you will have your very own care team – your doctor and health coach will take the time to understand your goals, health status and current lifestyle during your first meeting so they can personalize the care you receive. They will work together with you to create a holistic treatment plan that best suits your unique situation.

The program also includes a continuous glucose monitor (CGM) and access to our own app, NOVIFY. By logging your food intake and physical activity, you and your care team will understand your body better. Understand what foods in your diet cause your blood sugar to spike, and how you can better control it.