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This article is adapted and translated from Lian He Zao Bao. Originally written by Kang Xiu Jin.

Diabetes can be managed by leading a healthy lifestyle, adhering to healthy dietary patterns, a healthy diet and regular exercise. Adults under 40 years old should also complete an online diabetes risk assessment to determine if they are at risk of diabetes.

Common Questions on Diabetes

Question:
Is diabetes a disease only for the elderly?

Must you lose weight in order to control diabetes?

Answer:

I believe that excessive bodyweight is one of the main factors in Singapore’s rise in pravelence of diabetes mellitus. 40-50% of the adult population are obese or overweight. Apart from lack of exercise, and sedentary lifestyle, unhealthy dietary patterns and social pressure from friends are factors that contribute to the rise in excessive body fat.

That’s why diabetes can affect both young and elderly. In the case of Type 2 diabetes, prevalence increases with age due to the increased insulin resistance and impaired pancreatic functions associated with age.

The National Health survey done in 2010 (NHS 2010) reported that 12.3% of Singaporean males and 10.4% of females are likely to develop diabetes. However, this does not mean that ladies less at risk compared to males and can ignore the warning signs.

Diabetes is still a serious chronic illness that can potentially affect one’s heart, blood vessels, kidney, legs and eyes, so do not treat it lightly. With a healthy lifestyle, proper diet and frequent exercise, diabetes can be controlled and potentially be prevented.

I would like to emphasise that you should control diabetes before it controls you!

Cytokine blocks body signal to intake Insulin

It is undeniable that excessive body weight  will worsen diabetes and make it harder to control blood sugar. Adipose tissue in people with excessive body fat are stressed as they  are required to process excessive nutrients inflammation which releases pro-inflammatory cytokines. These pro-inflammatory cytokines are associated with insulin resistance which can lead to the development of diabetes.

Furthermore, being overweight and obese increases the risk of complications such as heart disease, kidney problems, stroke and other related problems that affects one’s lifestyle. Therefore, achieving a healthy body weight will definitely improve  one’s health. A study in Finland reported that losing weight has reduced the risks of diabetes in people by 58%.

Many believe that Type 2 diabetes will definitely show some early symptoms first. Although many early-stage patients appear with early symptoms such as frequent urination, often feeling thirsty and tired. However, there are many more that do not suffer from early stage symptoms when they were diagnosed with diabetes, which is the reason for encouraging people above 40 to do a physical check with a doctor.

For those of age below 40years old, an online check will be more than sufficient to know one’s risk of being diagnosed with diabetes.

Living a healthy lifestyle using mobile applications

I often say, if one is to want to effectively achieve control diabetes, they need to start with building sustainable healthy lifestyle habits, here are a few suggestions:

• Using “nBuddy Diabetes” app to record your daily intake of food

• Ensure every day’s calorie intake is healthy and limit intake of sugar

• Choosing “nBuddy Diabetes” app function, choosing a healthy diet of food with a green thumbs up and have not more than 2 times of “red meat” a week.

• Go for a walk 4 times a week, starting with 3,000 steps at the beginning and slowly increase  10,000  steps.

• Weigh yourself twice a week (best to be Wednesdays and Sundays)

• Check your blood sugar levels twice a week

Walking is a physical activity that everyone can do anytime, anywhere. Thus it is a highly recommended activity for those diagnosed with diabetes. The recommendation would be to go for a walk 30 minutes daily, 5 times a week.  This exercise can ay, for example, splitting the 30minutes a day into 10 minutes 3 times in a day.

NUH’s “nBuddy Diabetes” app shows that frequent users of the app are likely to benefit from positive health outcomes.  Users that record their food intake daily are able to lose 6 to 8kg in overall body weight, far exceeding other users’ results when they only record their intake once a week. As for users that are able to follow the app’s instructions and limit carbohydrate intake on 6 days of the  week, they reported better long term glycemic control with lowered Hba1cPeople diagnosed with diabetes are also advised to check their Hba1c levels once every 3 months,with  normal levels range around 5% to 6%, and diabetic people should aim to have their haemoglobin level below 7%.

Sustainable lifestyle habits have been found to be dependent on the diabetes diagnosed person’s calorie and carbohydrate intake. Providing personalised dietary intake advice via mobile applications will assist  diabetics to adopt a healthy lifestyle. For example, choosing wholegrains instead of refined grains. . When dining outside, adhere to the Health Promotion Board’s “My Healthy plate” of half a plate of vegetables, a quarter plate of protein and carbohydrates each.

With the current epidemic, local medical services are heavily affected. From another perspective, this is a chance for medical professionals to adopt remote treatment for patients with chronic illnesses like diabetes. For example, usage of medically approved mobile apps, helping patients to be self-monitor and change their lifestyle habits and dietary intake on their own.

Skinny diabetes

Many believe  that only overweight or obese people can be diagnosed with diabetes, however this is untrue  For those that have successfully lost weight and can managecontrolling their blood sugars, they still have diabetes. Should they re-adopt back unhealthy lifestyle practices, the blood sugar level will rise uncontrollably leading to ketosis which results in tremendous weight loss. Other may experience rapid weight loss not due to healthy balanced diet but rather as a result of underlying chronic illness affecting their appetite , causing them to unintended weight loss.

About 10% to 15% of people with type 2 diabetes are within a healthy weight range. We call it “lean diabetes”, and it is a “mixture” of type 1 or type 2 diabetes, meaning the body doesn’t produce enough insulin.

Early lessons for children to adopt healthy eating habits

For those with a healthy weight but still diagnosed with diabetes, your skeletal muscles may have accumulated a dangerous amount of fats. 

Family history of diabetes is one of the biggest risk of diabetes, however the bigger problem  lies within one’s dietary habits. Therefore, those diagnosed with diabetes or a family history of diabetes, should bring up their kids with the right dietary intake and a healthy amount of exercise from young, reducing unhealthy lifestyle choices, such as refusing to eat vegetables or not wanting to exercise, etc.

Therefore, I recommend that people with diabetes or a family history of diabetes should raise their children not only to eat healthy and exercise from an early age but to avoid unhealthy dietary practice and sedentary lifestyles. 

Landmark studies have shown that lifestyle interventions focusing on weight loss, dietary modification  and physical activities are able to prevent progression of diabetes. Although this is the case, the widespread implementation will be hindered due to a few limitations. In-person coaching for large areas lacks manpower, is time-consuming and very costly.

Smartphone app-based lifestyle intervention programmes are the focus of the solutions, but how effective can they be?

D’LITE Study research 

Well, according to the Diabetes Lifestyle Intervention using Technology Empowerment (D’LITE) studies where 2 groups of adults tried out 2 different programs for 6months. 148 total Adults with prediabetes were randomly allocated into 2 groups, 1 empowered by self-monitoring features of the Nutritionist Buddy Diabetes app (nBuddy Diabetes) with in-app dietician coaching for 6 months and the other group receiving standard diet counselling at baseline.

Results from the D’LITE Intervention shows that the group using the nBuddy Diabetes App were able to achieve a significantly greater weight loss, corresponding to weight loss percentage 5.2% vs 1.5% (P<0.001) with a moderate Cohen d effect size, as compared to the control group at the 6^th month. The same group also has significantly reduced calorie, carbohydrate, sugar, total fat and saturated fat intake post-intervention.

Mobile health applications prove some effect

Smartphone app-based lifestyle programme with in-app dietitian health coaching can lead to clinically significant weight loss and improved glycemia and can potentially improve the prevention of diabetes among an Asian multi-ethnic population. 

Trajectory from pre-diabetes towards type 2 diabetes can be altered by weight loss through lifestyle interventions. Landmark studies have established that interventions focusing on weight loss, diet modification and physical activity can prevent diabetes progression. Widespread implementation of traditional face-to-face diabetes prevention efforts is limited by low uptake, high attrition and withdrawal rates

To read up more on the study done:

https://www.frontiersin.org/articles/10.3389/fnut.2021.780567/full