Not sure if you got the memo, but diabetes is a major problem here in Singapore. Consider the following sobering statistics:
Close to 10% of Singaporeans have diabetes. For Singaporeans above 60 years old, that percentage goes up to 30%.
In addition to the over 400,000 people living with the disease, the Ministry of Health believes that about a third of diabetics don’t know they are ill. By 2050, the number of those with diabetes is expected to hit 1 million.
About 1,200 diabetics undergo amputations every year, the highest rate of lower limb amputation in the world due to diabetes.
Singapore had the 2nd highest proportion of diabetics among developed nations in 2015.
In 2010, it was estimated that every working-age diabetic spent $7,678 a year to treat the ailment. That sum, according to a National University of Singapore/University of California study, is expected to rise to $10,596 a year.
It’s scary. It’s real. But diabetes is an ailment that CAN be managed, both medically and financially. Here’s a guide to diabetes treatments and costs in Singapore.
Types of diabetes & what they entail
There are two major types of diabetes: Type 1 (a.k.a. juvenile onset diabetes) and Type 2 (a.k.a. adult onset diabetes). Gestational diabetes (which hits during pregnancy) is also common here, but it is a short-lived condition.
Type 1 diabetes (juvenile onset)
Only 10% of diabetic patients have Type 1 diabetes, an autoimmune condition in which the body can’t produce insulin. It’s likely to be genetic. People who develop this type of diabetes tend to be young (under 30) and lean.
Type 2 diabetes (adult onset)
The overwhelming majority of diabetics in Singapore fall under this category. Type 2 diabetes happens when your once-functional body starts producing less and less insulin.
Type 2 diabetes sets in later in life (often after age 40) and is usually associated with lifestyle e.g. unhealthy diet, lack of exercise. Obesity (high body weight) can also greatly increase the risk of developing Type 2 diabetes.
Gestational diabetes (during pregnancy)
This type of diabetes is temporary and happens only during pregnancy, which brings on lots of hormonal changes which can lead to higher levels of blood sugar. Up to 10% of pregnant women develop this.
Though it goes away once the baby is born, some women who have gestational diabetes go on to develop Type 2 diabetes, about 10 to 20 years down the road.
Cost of screening for diabetes in Singapore
In its early stages, diabetes is almost symptomless. So the best way to detect the disease is through a blood test.
Singaporeans can get $5 subsidised health screenings (for selected conditions only) under the Screen for Life programme. This can be done at polyclinics, hospitals and CHAS-participating clinics, and includes a consultation if any of the tests prove positive.
Here’s how much the screening would cost:
|Age group / demographic||Subsidised price|
|Singaporeans aged 18 to 35 (only if at risk based on Diabetes Risk Assessment test)||$5|
|Singaporeans aged 40 and above||$5|
|CHAS (Community Health Assist Scheme) card holders||$2|
|Pioneer Generation (aged 65 and above in 2014)||Free|
For those who don’t fall under these categories, you can go for a basic health screening at private or public hospitals or private clinics. Prices start at about $50 (at a clinic) or $80 (at a hospital); see our break down of health screening costs for more info.
If you’re pregnant and at risk of developing gestational diabetes, you request an oral glucose test at your clinic between Week 26 and 28 of your pregnancy. The test can be repeated 6 weeks after delivery to check if the diabetes persists. It costs about $20 to $50.
Medical treatment for diabetes in Singapore
If you do test positive for diabetes, your course of treatment depends on whether you have Type 1 or Type 2 diabetes.
Type 1 diabetes treatment (insulin)
Type 1 diabetes is treated with insulin injections (usually 1 to 3 times a day).
You’d have to buy the insulin itself, plus whatever equipment your injection method requires. The price range is massive – the insulin can cost anywhere from $7.69 to $120 per cartridge, and equipment can cost from $3.85 for a syringe to $6,000 for a pump.
Every 3 months, you would also go for a consultation and blood test to check your blood sugar levels. A reading of less than 7% shows good diabetes control.
Type 2 diabetes treatment (pills)
Unlike the injections involved in treating Type 1 diabetes, Type 2 diabetes is managed using oral medication i.e. pills (usually taken 1 to 3 times a day). These fall in one of three broad types:
|Type of diabetes medication||Common brand names||What it does|
|Sulfonylureas||Tolbutamide, Glibenclamide (Daonil), Glipizide (Minidiab), Gliclazide (Diamicron)||Make pancreas release insulin to lower blood sugar|
|Biguanides||Metformin (Glucophage)||Reduce insulin resistance in cells|
|Alpha-glucosidase inhibitors||Acarbose (Glucobay)||Slow sugar absorption in the intestine and prevent sudden increase in blood sugar after eating|
Again, you’d have to go for periodic check-ups to check your blood sugar levels and ensure that the medication works. For those who have had Type 2 diabetes for several years, insulin injections may be prescribed instead.
Type 2 diabetes medicine costs anywhere from $0.06 to $6 per pill. The Pharmaceutical Society of Singapore has a list of diabetes related drugs and their prices.
Monitoring blood sugar levels at home
Regardless of whether you have Type 1 or Type 2 diabetes, it’s important to supplement your doctor’s visits with regular blood sugar level monitoring at home.
You can do this with a glycemic monitor, also known as a blood glucose monitoring kit. You’d have to extract a tiny amount of blood by pricking your skin with a lancet (which looks like a large needle) and dropping it on a test strip before feeding it into the monitor.
A kit, complete with test strips and lancets, can cost anywhere from $20 upwards, with the more established brands costing closer to $100. You can buy strip refills and lancets separately.
There are two kinds of home blood tests – fasting (i.e., done before breakfast) and post-prandial (i.e., done 2 hours after a meal). Both measure how well your body breaks down carbohydrates and produces insulin. A diabetic should maintain an FPG of under 130mg/dl and a PPG of under 180mg/dl.
Diabetic diet & lifestyle changes for Type 2 diabetes
For Type 2 diabetes and gestational diabetes, a healthy balanced diet and exercise are important components of treatment.
A controlled diet helps to control blood sugar levels and maintain a desirable weight. Opt for wholegrain carbs like brown rice instead of white, as these break down into simple sugars slower, and balance it out with plenty of unprocessed/lean proteins, fresh veggies and whole fruit (not fruit juice).
The diabetic diet need not be THAT austere. You can buy occasional diabetes-friendly treats from places like Redmart’s The Diabetic Shop and baked goods from Delcie’s Desserts and Cakes. But of course, they’ll cost a bit more than regular treats.
Regular exercise (at least 3 times a week for 30 minutes each) also helps. Brisk walking, jogging, cycling and swimming are recommended.
Apart from managing your weight, exercise promotes proper insulin function and lowers blood sugar levels naturally.
Financial assistance for diabetes treatment
In an article published in 2018 in the Journal of Diabetes, the estimated lifetime medical cost of treatment for diabetes was $132,506 for someone diagnosed at the age of 40.
That’s… a lot. Let’s find out what subsidies you might be able to make use of.
You can use Medisave for diabetes treatment if you are diagnosed with chronic diabetes. You have to go to one of the 700 participating clinics and co-pay 15% of your bill in cash for each claim, though.
As of June 2018, Medisave can now be used to pay for lancets and test strips in your blood sugar monitoring kit.
Those who are pre-diabetic can pay for medical consultations with their Medisave from June as well.
Apart from your own Medisave account, you can tap on your immediate family members’. The limit is $400 per Medisave account per year, up to 10 accounts.
You can claim under MediShield life only if you are hospitalised in public hospitals for your diabetes condition.
You can claim up to $350 a day for admission into a community hospital (which means you typically need to co-pay about 3% to 10% of the bill). There’s a claim limit of $70,000 to $100,000 per year but no limit to the amount you can claim in your lifetime.
CHAS – Community Health Assist Scheme
For lower income households and the pioneer generation, there is CHAS. Under this scheme, you pay subsidised rates at CHAS GP and dental clinics for common illnesses and some chronic conditions like diabetes.
|Factor||CHAS Blue||CHAS Orange|
|Average household income||Max. $1,000 per person||$1,001 to $1,800 per person|
|Annual value of home (for households with no income)||Max. $13,000||$13,001 to $21,000|
|Subsidy per visit||$80||$50|
|Annual subsidy cap||$320||$200|
Low income patients can use MediFund to offset their medical bills. Simply approach the medical social workers at public hospitals.
The MediFund Committee in these institutions will then decide how much help to give based on your financial and social circumstances and that of your family as well as the size of the medical bill.
Drug subsidies & schemes
MOH has a list of subsidised drugs in Singapore, including insulin and diabetes medication. Some are priced at no more than $1.40 for a week’s supply. You can request for the drugs on this list to manage your treatment costs.
Here’s the perfect illustration of why getting health insurance while you’re still young and healthy is important. It’s pretty challenging to get insured once you get diagnosed with diabetes.
However, if you need an insurance policy after diagnosis, there’s AIA Diabetes Care which covers pre-diabetes, Type 2 and gestational diabetes as well as several diabetes-related complications.
While premiums are naturally expensive, they remain the same throughout the policy up to age 80. You can also get premium discounts and another incentives through AIA’s healthy living programme (which is after all, part of managing diabetes).
Is there anything else about the cost of diabetes treatment that we left out? Let us know in the comments.
The post Diabetes in Singapore 2018 - Guide to Cost of Screening, Treatment & Medication appeared first on the MoneySmart blog.
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