Incidence and variation in progression to Type 2 Diabetes Mellitus among Singaporeans with prediabetesa retro
Applied/Translational Research
Care Continuum
Singapore Health Biomedical Congress
National Healthcare Group
2 March 2026
The primary aim of this study is to evaluate if there are ethnic differences in the risk and rate of progression from newly. Clinical and demographic variables appear to influence progression from IFG to T2DM among Singaporeans.
Year Submitted: 2025
Published Date: 02 March 2026
Tags: Primary Care, Care Continuum, Applied/Translational Research, Quantitative Research, Population Health
About this Content
Aims
The primary aim of this study is to evaluate if there are ethnic differences in the risk and rate of progression from newly confirmed impaired fasting glycaemia (IFG) to Type 2 Diabetes Mellitus (T2DM) among Singaporean adults seen in primary care. Our hypothesis is that Indian and Malay Singaporeans have an increased risk of progression from IFG to T2DM compared to their Chinese counterparts.
Background
Asians have a greater risk of progression from intermediate hyperglycaemia to T2DM. A prospective study in Singapore on a multi-ethnic cohort without prediabetes found that different ethnicities had unique biological risk factor profiles related to T2DM development. However, recent data on the risk of progression among those newly confirmed to have IFG is lacking.
Methods
In this retrospective cohort study, 2,350 Chinese, Malay and Indian adults newly diagnosed with IFG between September 2011 and August 2014 at five primary care polyclinics in Singapore were followed until August 2023. We calculated T2DM incidence per 1,000 person-years and compared progression hazards using Cox regression, adjusting for variables including age, sex, smoking, Aspartate Aminotransferase/Alanine Aminotransferase (AST/ALT) ratio, and percent weight change.
Results
Over a median 95-month follow-up (IQR 53 - 138), 50.3% (1,182/2,350) developed T2DM (incidence 81.6 per 1,000 person-years). After multivariable adjustment, Malays had significantly higher odds of progression than Chinese (OR 1.36 [95% CI 1.00 - 1.85] p = 0.048), though progression rates were similar across ethnicities (HR 1.14 [95% CI 0.94 - 1.37] p = 0.156). Female sex, smoking, lower AST/ALT ratio and percentage weight gain independently increased progression risk and accelerated rate.
Conclusion
Clinical and demographic variables appear to influence progression from IFG to T2DM among Singaporeans. Tailored preventive strategies targeting high-risk groups particularly Malays, smokers, women and those with weight gaincould optimise resource allocation and reduce T2DM burden.
Lessons Learnt
The findings highlight the heterogeneous nature of diabetes risk in a population with IFG. Not all individuals progress uniformly; certain subgroups - particularly Malays, women, smokers, those with metabolic liver markers, and those with weight gain - are at higher risk. This supports a personalised approach to prediabetes management, including closer monitoring and early intervention for high-risk individuals.
Additional Information
Merit award, SHBC 2025
Keywords
Impaired fasting glycemia, Diabetes Mellitus, Disease progression, Ethnic differences, Singapore, Primary Care
Innovators' Details
Innovators' Details
Healthcare Cluster(s) | National Healthcare Group |
Organization(s) Involved | National Healthcare Group Polyclinics, SIngapore |
Platform(s) | Singapore Health Biomedical Congress |
Healthcare Professional Group(s) | Medical |
Applicable Specialty or Discipline | General Practice, Endocrinology, Clinical Research |
Project Lead(s) | Rufus Daniel |
Project Member(s) | Tang Wern Ee |
Connect with this contributor!
Rufus Daniel - rufusdnlsg@gmail.com