Preventive care for diabetes

In brief

• Almost every diabetes complication can be caught and treated early, so scheduled checks matter even when you feel well.
• Check HbA1c every 3 to 6 months, cholesterol every 6 months, kidney tests at least yearly, and eyes, feet and mood every year.
• Most people aim for blood pressure below 130/80 mmHg, and a statin is recommended for most adults with diabetes over 40.
• Keep vaccines up to date, including yearly flu, and see a dentist every 6 to 12 months.
• Check your feet daily, and see us the same day if you find anything new.

We arrange these checks at our Punggol clinic, with eye and foot screening through our Primary Care Network. See our chronic disease care.

Diabetes series: 1. What is diabetes · 2. Diet and lifestyle · 3. Oral medications · 4. Injectables · 5. Preventive care

Your diabetes check-list

Diabetes complications develop quietly, and by the time they cause symptoms some damage cannot be reversed. Almost every major complication can be caught and treated early, so scheduled checks matter even when you feel completely well.

We aim to do these checks for every patient with diabetes:

We may test more often if needed. Checking some tests six-monthly rather than yearly catches changes sooner and fits in with your chronic disease reviews. We keep track, so if you can’t remember your last check, we can.

Eyes — retinal photography

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

Retinal photography is a simple screening test. Your pupils are dilated if needed, and a machine takes digital photographs of the back of your eye. It takes 10 to 15 minutes. Trained readers grade the images; in Singapore, the national SiDRP (Singapore Integrated Diabetic Retinopathy Programme) does this for most patients.

How often:

• Every year for everyone with diabetes, usually together with your foot assessment as an annual diabetes review
• More often (every 6 months, or urgently) if retinopathy has been found, your HbA1c has changed significantly, or you develop new eye symptoms

If retinopathy is found, we refer you to an ophthalmologist for injections, laser or closer monitoring, depending on severity.

• Don’t drive home if your pupils were dilated. Your vision will be blurred and light-sensitive for several hours. Bring a companion or use public transport.
• Retinal photography does not check for cataracts, glaucoma or refractive errors. See an optometrist every 1 to 2 years for a glasses review and general eye check.

Feet — annual screening + daily self-check

Foot complications are among the most preventable and most devastating problems in diabetes. In Singapore, over 4 lower-limb amputations are performed every day, mostly in people with diabetes. Almost all start as a small problem not noticed early.

What we check once a year

• Circulation: pulses in your feet, skin colour and temperature
• Sensation: a 10 g monofilament (a thin plastic fibre) at several points on each foot, plus a tuning fork for vibration sense. If you cannot feel the monofilament at all, you are at high risk and need more frequent review.
• Skin and nails: 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

We then class your risk as low, moderate or high, which sets how often we re-check.

What you check every day

Most diabetic foot damage starts with something you didn’t feel. Check your feet every day at a set time, such as before bed or 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, which can signal infection
• Hard skin (calluses) and cracked heels
• Ingrown nails
• Fungal infection between the toes (itch, soggy or peeling skin)

Use a mirror to see your soles, or ask a family member. If you notice something that wasn’t there yesterday, see us the same day. Minor wounds in diabetes don’t always stay minor.

Practical foot care

• Don’t walk barefoot, even indoors. You might step on something sharp and not notice the wound for days.
• Wear well-fitting shoes. Avoid tight new shoes and break them in gradually.
• Moisturise dry heels and feet daily, but not between the toes, as that encourages fungal infection.
• Cut toenails straight across, not curved into the corners.
• See a podiatrist if you have deformities or hard calluses, or need help cutting your nails. We can refer you.

Kidneys — routine monitoring

Diabetes is the leading cause of chronic kidney disease (CKD) and kidney failure in Singapore. Early kidney damage is silent, but a simple blood and urine test can detect it. Several medications are now proven to slow its progression.

At least once a year (more often if results are abnormal), you should have:

• Blood creatinine, used to calculate eGFR (estimated glomerular filtration rate), which shows how well your kidneys filter
• Urine albumin : creatinine ratio (UACR), which detects tiny protein leaks, the earliest sign of kidney involvement in diabetes

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

• Repeat the test to confirm, as UACR can fluctuate
• Check your blood pressure control, which is the biggest lever
• Add or adjust medications: SGLT2 inhibitors and ACE inhibitors or ARBs both have proven kidney-protective effects
• Share your care with a kidney specialist (nephrologist), usually if eGFR is below 45 mL/min, falling rapidly, or a lot of protein is leaking into the urine

Heart and blood vessels

People with diabetes have roughly double the risk of heart attack and stroke of people without, even at the same blood sugar levels. Managing cholesterol and blood pressure matters as much as managing glucose.

Blood pressure

• Target for most: below 130/80 mmHg, lower than the general population target
• Treatment usually starts with an ACE inhibitor or ARB, which also protect the kidneys. A calcium-channel blocker, a thiazide-like diuretic or both are often added.
• Home blood pressure 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 over 40, and for younger adults with other cardiovascular risk factors.
• Your LDL target depends on your overall risk: 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; a lower dose or a different statin often solves it.

Cardiovascular risk assessment

We usually use the Singapore-modified Framingham Risk Score 2023 (SG-FRS-2023), a locally recalibrated 10-year cardiovascular risk calculator, to set how aggressive your cholesterol and blood pressure targets should be. The tool is at cvd.clinicaltools.mohtgroup.com. We reassess 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 often goes unrecognised. The two feed each other. Untreated depression makes diabetes harder to control, as motivation, adherence, appetite and sleep change. Poorly controlled diabetes worsens mood.

We screen for mood at least once a year with 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 questions on 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, an exercise prescription and follow-up in 2 to 4 weeks
• Moderate to severe depression: we discuss talking therapy, antidepressant medication or both
• Any thoughts of self-harm or suicide: we address this immediately, and you will not be rushed or dismissed. Depending on severity, we may refer you for urgent mental health assessment or arrange closer follow-up.

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

Nurse-led counselling

Under Healthier SG and through our Primary Care Network, you can book nurse-led counselling on lifestyle, diet, smoking cessation, self-monitoring and self-management. Sessions often go deeper than a standard consultation. Ask our reception to book.

Primary Care Networks — team-based diabetes care

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

So we can offer these services at our clinic or a nearby PCN session, saving you separate trips:

• Diabetic retinal photography in dedicated sessions
• Diabetic foot screening by a trained nurse, with monofilament testing and full documentation
• Nurse-led counselling (see above)
• Chronic disease registry tracking of your key results (HbA1c, BP, LDL, UACR, eGFR), so nothing is 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 are eligible for and how to book.

Vaccinations

People with diabetes have a higher risk of infection, and pneumonia and influenza tend to be more severe. Routine vaccination is simple and high-value:

We review your vaccinations at every visit to avoid gaps. Many are subsidised under the National Adult Immunisation Schedule (NAIS) for eligible Singaporeans and PRs.

Dental

Gum disease (periodontitis) is more common and more severe in people with diabetes, and active gum disease makes blood sugar harder to control. We recommend:

• A dental check and clean every 6 to 12 months
• Brushing twice a day with a fluoride toothpaste
• Flossing or using interdental brushes daily
• Telling your dentist you have diabetes. They may time procedures for when your sugars are well controlled, and will watch for specific problems.

When to see us between scheduled checks

Come in before 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 more than one in a week, or if you have lost your warning symptoms
• A new foot wound, blister or area of concern
• A significant mood change, such as low mood, loss of interest or disturbed sleep
• Side effects from any medication, such as stomach upset, unusual tiredness, muscle aches or dizziness
• An upcoming surgery, dental procedure or long trip, as many medications need temporary changes
• An upcoming pregnancy, as diabetes care differs substantially in pregnancy

The long view

Diabetes is long-term, but it need not mean slow decline. Many people stay well controlled and complication-free for decades. A few step back down from insulin to tablets, or come off medication altogether after substantial lifestyle change.

People who do well tend to have:

• A steady daily routine they don’t have to reinvent every month
• A team they trust, at home and in the clinic
• Regular preventive care, rather than waiting for symptoms
• Early action when something changes, such as a new symptom, a side effect or a rising HbA1c

We are here for the long term too.

Get in touch

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

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

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.
• Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney International 2024;105(4S):S117–S314. kdigo.org
• Singapore National Eye Centre (SingHealth). Singapore Integrated Diabetic Retinopathy Programme (SiDRP). healthxchange.sg

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. v1.1 · October 2026 (v1.0 April 2026) · Review due April 2028.