Preventive care for diabetes

About this guide

Well-controlled diabetes does most of its damage quietly, over years, without you feeling it. By the time complications produce symptoms, some of that damage is irreversible. That’s why scheduled screening — even when you feel completely fine — is not optional. It’s the single most effective thing you can do after lifestyle and medication.

The good news: almost every major complication of diabetes is detectable early and treatable early — if someone is looking for it.

This is the final guide in the five-part series:

1. What is diabetes and pre-diabetes?
2. Diet and lifestyle
3. Oral medications (and supplements)
4. Injectables — insulin and GLP-1 medications
5. Preventive care for diabetes (you are here)

Your diabetes check-list

The routine checks we aim to do for every patient with diabetes, grouped by how often they’re scheduled:

Every visit

Every 3 to 6 months

Every 6 months (or more often if clinically indicated)

Spacing these at 6-month intervals, rather than annually, helps catch changes sooner and has a practical advantage — it’s easier to remember when they overlap with your chronic disease review visits.

Annually

Retinal photography and foot assessment are usually organised together as an annual diabetes review.

Every 6 to 12 months

We track all of this at Kenneth Tan Medical Clinic — so if you can’t remember when you last had a particular check, we can.

Eyes — retinal photography

Diabetic retinopathy is the leading cause of blindness in working-age adults in Singapore. It usually gives no early symptoms — by the time you notice blurred vision or floaters, significant damage may already have occurred.

Retinal photography is a simple screening test: you sit at a machine, the operator dilates your pupils (if needed), and digital photographs of the back of your eye are taken. The whole thing takes 10 to 15 minutes. The images are graded by trained readers — in Singapore, the national DRP (Diabetic Retinopathy Screening Programme) handles this for most patients.

How often?

• Every year for all patients with diabetes, usually scheduled together with your annual foot assessment
• More often (every 6 months, or urgently) if retinopathy has been picked up, if your HbA1c has changed significantly, or if you develop new visual symptoms

If retinopathy is found, you will be referred to an ophthalmologist for further management — which may include injections, laser treatment, or simply closer monitoring depending on severity.

A few things worth noting:

• Don’t drive home after retinal photography if your pupils have been dilated — your vision will be blurred and light-sensitive for several hours. Bring a companion or use public transport.
• Cataracts, glaucoma, and refractive errors are separate conditions that are NOT checked by retinal photography — you should still see an optometrist for eye-glasses reviews and a general eye health check every 1 to 2 years.

Feet — annual screening + daily self-check

Foot complications are one of the most preventable — and most devastating — problems in diabetes. In Singapore, over 4 lower-limb amputations are performed every day, most of them in people with diabetes. Almost all of them start as a small problem that wasn’t noticed early.

What we check once a year

At an annual foot check, we look at:

• Circulation — checking pulses in your feet, skin colour and temperature
• Sensation — using a 10 g monofilament (a thin plastic fibre) at several points on each foot, plus a tuning fork for vibration sense. Patients who cannot feel the monofilament at all are at high risk and need more frequent review
• Skin and nails — looking for cracks, calluses, fungal infection, ingrown nails
• Deformities — high-pressure areas, bunions, hammer toes, previous amputations
• Footwear — whether your shoes are likely to rub or cause injury

Based on this, you’ll be classed as low, moderate, or high risk — and that sets how often we re-check.

What you check every day

Most diabetic foot damage starts with something you didn’t feel. That’s why we ask you to check your feet every day — ideally at a set time (before bed, after a shower) so it becomes automatic.

Look for:

• Cuts, blisters, or scrapes — even tiny ones
• Redness or swelling, particularly around nails or pressure points
• Colour changes — pale, blue, or very red
• Warm or hot spots — can signal infection
• Hard skin (calluses) and cracks in the heels
• Ingrown nails
• Fungal infection between toes (itch, maceration, peeling skin)

If you can’t see the soles easily, use a mirror — or ask a family member to check for you. If you notice something that wasn’t there yesterday, come and see us the same day. Minor wounds in diabetes don’t always stay minor.

A few practical things

• Don’t walk barefoot, even indoors — step on something sharp without feeling it, and you may not notice the wound for days.
• Wear well-fitting shoes — avoid tight new shoes; break them in gradually.
• Moisturise dry heels and feet daily — but NOT between the toes (that encourages fungal infection).
• Cut toenails straight across, not curved into the corners.
• See a podiatrist if you have deformities, hard calluses, or need help with nail cutting. We can refer.

Kidneys — routine monitoring

Diabetes is the leading cause of chronic kidney disease (CKD) and kidney failure in Singapore. The good news: early kidney damage is silent but detectable with a simple blood and urine test — and there are now several medications proven to slow or reverse that early damage.

Every 6 months (or more often if clinically indicated) you should have:

• Blood creatinine → calculated as eGFR (estimated glomerular filtration rate), which tells us how well your kidneys are filtering
• Urine albumin : creatinine ratio (UACR) → detects very small amounts of protein leak, which is the earliest sign of kidney involvement in diabetes

If the UACR is raised, or eGFR is low, we may:

• Repeat to confirm (UACR can fluctuate)
• Check your blood pressure control — it’s the biggest lever
• Add or adjust medications — SGLT2 inhibitors and ACE inhibitors / ARBs both have proven kidney-protective effects
• Refer to a nephrologist if eGFR is low (generally below 45 mL/min) or progressing rapidly

Heart and blood vessels

People with diabetes have roughly double the risk of heart attack and stroke compared to those without, even at the same blood sugar levels. Managing cholesterol and blood pressure alongside diabetes is just as important as managing the glucose itself.

Blood pressure

• Target for most: below 130/80 mmHg — lower than the general population target
• Treatment usually starts with an ACE inhibitor or ARB (these also protect the kidneys), often combined with a calcium-channel blocker, a thiazide-like diuretic, or both
• Home BP monitoring is very useful — we can review your log at each visit

Cholesterol / LDL

• A statin (e.g. atorvastatin, rosuvastatin) is recommended for most adults with diabetes who are over 40, or younger with additional cardiovascular risk factors
• LDL target depends on your overall risk profile — generally below 2.6 mmol/L for moderate risk, below 1.8 mmol/L for high risk, and below 1.4 mmol/L for very high risk (established cardiovascular disease)
• Ezetimibe or PCSK9 inhibitors may be added if a statin alone doesn’t reach target
• Muscle aches on a statin are common but usually not serious — don’t stop without checking with us. Often a dose reduction or a switch to a different statin solves it

Cardiovascular risk assessment

We typically use the Singapore-modified Framingham Risk Score 2023 (SG-FRS-2023) — a locally recalibrated 10-year cardiovascular risk calculator — to guide how aggressive cholesterol and blood pressure targets should be. The tool is available at cvd.clinicaltools.mohtgroup.com. We reassess periodically, typically at least every few years or whenever your treatment or risk factors change.

Mood — screening with PHQ-2 and PHQ-9

Depression is about twice as common in people with diabetes as in the general population — and it often goes unrecognised. Untreated depression makes diabetes harder to control (adherence drops, motivation drops, appetite and sleep patterns change) and poorly-controlled diabetes worsens mood, so the two feed off each other.

We screen for mood at least once a year using two short, validated questionnaires:

PHQ-2 — a 2-question first-pass

Over the last 2 weeks, how often have you been bothered by:

1. Little interest or pleasure in doing things?
2. Feeling down, depressed, or hopeless?

If you answer “more than half the days” or “nearly every day” to one or both, we move on to the PHQ-9.

PHQ-9 — the fuller 9-item version

The PHQ-9 adds seven more questions — about sleep, energy, appetite, concentration, self-worth, physical restlessness, and thoughts of self-harm. It takes about 3 minutes. The total score helps us gauge severity and guide treatment.

What happens if the screen is positive

• Mild depression — lifestyle changes, brief counselling, exercise prescription, follow-up in 2 to 4 weeks
• Moderate to severe depression — we discuss options: talking therapy, antidepressant medication, or both
• Any thoughts of self-harm or suicide — we address this immediately. You will not be rushed or dismissed. We may refer you for urgent mental health assessment or arrange closer follow-up, depending on severity.

Mood is a legitimate medical issue, not a personal weakness. It is treatable. Please don’t brush it off.

Nurse-led counselling

Under Healthier SG and through our Primary Care Network, nurse-led counselling sessions are available for patients with diabetes — covering lifestyle, diet, smoking cessation, self-monitoring, and self-management skills. These are often more in-depth than a standard consultation and can be booked separately — ask our reception.

Primary Care Networks — team-based diabetes care

Kenneth Tan Medical Clinic is part of the Class Primary Care Network (Class PCN) — one of several PCNs across Singapore that organise private GP clinics into teams with nurses and care coordinators to deliver comprehensive chronic disease care.

Because of this, we can offer many of the ancillary services you’d otherwise have to travel separately for — at our clinic or at a nearby PCN session:

• Diabetic retinal photography organised as dedicated sessions
• Diabetic foot screening with monofilament and full documentation, by a trained nurse
• Nurse-led counselling for lifestyle, diet, smoking, and self-management (as above)
• Chronic disease registry tracking of your key indicators (HbA1c, BP, LDL, UACR, eGFR) so nothing gets missed over the years

These services are subsidised for eligible patients (CHAS, Pioneer Generation, Merdeka Generation, and Healthier SG enrollees). Ask our reception what you’re eligible for and how to book.

Vaccinations

People with diabetes have a higher risk of infection, and infections like pneumonia and influenza tend to be more severe. Routine vaccinations are a simple, high-value preventive measure:

We review your vaccination status at every visit to avoid gaps in protection — not just once a year. Many of these vaccines are subsidised under the National Adult Immunisation Schedule (NAIS) for eligible Singaporeans and PRs. Ask us about what you’re due at your next visit.

Dental

Gum disease (periodontitis) is more common and more severe in people with diabetes. Active periodontitis also makes blood sugars harder to control. We recommend:

• A dental check and clean every 6 to 12 months
• Brush twice a day with a fluoride toothpaste
• Floss or use interdental brushes daily
• Tell your dentist you have diabetes — they may want to time procedures around when your sugars are well controlled, and they’ll know to watch for specific issues

When to see us between scheduled checks

Come back sooner than your next review if you notice:

• New or worsening symptoms of uncontrolled diabetes (thirst, frequent urination, unexplained weight loss, tiredness, blurred vision, slow-healing wounds)
• Low blood sugar episodes — particularly if you’ve had more than one in a week, or if you’ve lost warning symptoms
• A new foot wound, blister, or area of concern
• Significant mood change — low mood, loss of interest, disturbed sleep
• Side effects from any medication — stomach upset, unusual tiredness, muscle aches, dizziness
• An upcoming surgery, dental procedure, or long trip — many medications need to be temporarily adjusted or held
• An upcoming pregnancy — diabetes care differs substantially in pregnancy

The long view

Diabetes is a long-term condition, but the story doesn’t have to be one of slow decline. We have seen many patients stay well-controlled and complication-free for decades — and a few who have been able to step back down from insulin to oral medication, or come off medication altogether after substantial lifestyle change.

What seems to separate those who do well:

• A steady daily routine that they don’t have to re-invent every month
• A team they trust — both at home and in the clinic
• Regular preventive care, not waiting for symptoms
• Early action when something changes — a new symptom, a side effect, a rising HbA1c — rather than hoping it will pass

We are here for the long term too.

Get in touch

Joo Chiat — 172 Joo Chiat Road, #01-01, Singapore 427443 · Tel 6920 1952

Punggol — 658 Punggol East, #01-04, Singapore 820658 · Tel 6312 4589

Email — admin@ktmc.sg

References

• Agency for Care Effectiveness (ACE). Foot assessment in patients with diabetes mellitus. Updated August 2024. ace-hta.gov.sg
• Agency for Care Effectiveness (ACE). Lipid management — focus on cardiovascular risk. December 2023.
• Agency for Care Effectiveness (ACE). Chronic kidney disease management. October 2023.
• Agency for Care Effectiveness (ACE). Hypertension. December 2023.
• Agency for Care Effectiveness (ACE). Major depressive disorder — achieving and sustaining remission. March 2025.
• Health Promotion Board Singapore. National Adult Immunisation Schedule (NAIS). healthhub.sg
• SingHealth / SNEC — Diabetic Retinopathy Screening Programme (DRP).
• American Diabetes Association. Standards of Care in Diabetes — 2026.

This information is for general education only and is not a substitute for medical advice. Preventive care must be individualised — please speak with our team about what’s right for you. v1.0 · April 2026 · Review due April 2028.