Pre-Diabetes Mellitus
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​Background

Pre-diabetes is asymptomatic but predisposes individuals to Type 2 Diabetes Mellitus (T2DM) and cardiovascular disease. Both Impaired Fasting Glucose (IFG) and Impaired Glucose Tolerance (IGT) are considered entities of pre-diabetes. Around 14% of Singaporeans have impaired glucose tolerance and without lifestyle changes, at least 35% of persons with pre-diabetes in Singapore will progress to Type 2 Diabetes Mellitus within eight years1,2.

Diagnosis  is made through a combination of Fasting Plasma Glucose and two-hour Post-Challenge Plasma Glucose.

  1. Pre-DM is usually diagnosed when screening individuals for diabetes. Screening  for diabetes should be considered in adults of any age who have one or more risk factors  for diabetes . ​

    • In those without risk factors, testing should begin at 40 years.

    • Those between 18-39 years old can consider doing the Diabetes Risk Assessment Tool (DRAT) to assess their risk of having diabetes. 

    • ​Those who have been found to be high risk using the DRAT assessment should undergo formal blood test screening . 

  2. ​Prevent or delay progression to T2DM.

  3. Prevent and screen cardiovascular disease (CVD).

  4. Aim for BMI < 23 kg/m2 (Asian population) or 5 -10% body weight loss from diagnosis.​​​​

  1. Behaviour: Educate & empower with patient-centred care

  2. Lifestyle interventions

    • Healthy plate​, reduce fat intake, avoid sugary drinks & food, reduce alcohol intake, stop smoking.

    • ≥ 150 min of moderate-intensity or ≥ 75 min of vigorous-intensity exercise/week.

    • Reduce sedentary behaviour.

  3. Regular follow-up ​ 

  4. Start Metformin for those whose glycaemic status does not improve despite lifestyle intervention/ unable to adopt lifestyle intervention.​ 

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The following data fields should be documented in your case notes as part of good clinical practice for all patients enrolled to your practice.

Submission of data fields marked with asterisks* is mandatory and required for subsidy claims and Healthier SG payments. ​

Diagnosis/ Assessment

Pre-DM Control

  1. HbA1c (%)* OR FPG (mmol/L or mg/dL)* OR OGTT (mmol/L or mg/dL)*

  2. Date*​

Lipid Profile
​
  1. LDL-C (mmol/L or mg/dL)*

  2. HDL-C (mmol/L or mg/dL) 

  3. Triglycerides (mmol/L or mg/dL) 

  4. Total Cholesterol (mmol/L or mg/dL) 

  5. Date* 

Blood Pressure

  1. Systolic BP (mmHg)*

  2. Diastolic BP (mmHg)*

  3. Date*

Weight

  1. BMI (kg/m2), calculated from height*, weight*

  2. Waist Circumference (in cm; optional to fill)

  3. Date*​

Kidney Assessment

  1. Serum creatinine (μmol/L) OR eGFR (ml/min/1.73m2) (for patients on Metformin)

  2. Date*