Medically reviewed by Dr Todd On, Associate Consultant, Family Physician, MBBS, GDFM, MMED (FM), MCFP (S)
Key takeaways
- The path leading to type 2 diabetes begins years earlier, when the body becomes insulin resistant and works harder to keep blood sugar normal.
- A routine glucose result can look normal while that process is well under way, so “my sugar is fine” is not the same as “my risk is low”.
- Asians tend to develop type 2 diabetes at a lower body weight and with more fat around the organs, so the bathroom scale is an unreliable guide.
Every 14 November, World Diabetes Day asks the world to look at a disease that now affects more than half a billion people. The theme for 2026 to 2027 is “Early action on diabetes”. It is a timely prompt, because early action is usually understood as early diagnosis. This article argues for something earlier still: acting before blood sugar ever crosses the diagnostic line.
Why do we wait for a number before we act?
Diabetes is diagnosed by thresholds. A fasting glucose or a glucose tolerance test crosses a line, and a person goes from “normal” to “diabetic” overnight. Biology does not work like that.
Type 2 diabetes develops gradually and often causes few or no noticeable symptoms, which is why the World Health Organization notes that more than 40% of people living with diabetes are undiagnosed. According to the International Diabetes Federation, up to 50% of people with type 2 diabetes already have complications at the time of diagnosis.
In other words, for many people the diagnosis is not the beginning of the story. It is the point at which the story becomes visible.
What happens in the years before blood sugar rises?
There is evidence from the Whitehall II study, which followed 6,538 British civil servants who did not have diabetes at the start. Researchers found that insulin sensitivity was already falling about five years before diagnosis, which means insulin resistance is rising. The pancreas responded by producing more insulin, and this compensation held blood sugar steady until roughly three to four years before diagnosis, after which the pancreas’ beta-cell function declined rapidly, indicating that the body can no longer compensate for the increased insulin resistance.
To simplify this, imagine a door lock that gradually becomes stiffer. The body makes more keys (= more insulin) each time, and for years the door still opens with more keys (insulin). During this period, glucose stays in the normal range. Only when the pancreas (key making factory) can no longer keep up making sufficient keys (insulin), does blood sugar climb.
Because standard screening measures glucose rather than insulin, the compensation phase can go unnoticed.
A test called HOMA-IR can be used to determine how sensitive your tissues are to insulin, using the levels of both insulin and glucose in your blood. NOVI Longevity Core measures HOMA-IR along with 100+ essential biomarkers.
Why does this matter more for Asians?
Research shows that type 2 diabetes develops in East Asians at a lower average body mass index than in people of European descent. At any given BMI, East Asians carry more body fat and a greater tendency towards visceral fat, the fat stored deep in the abdomen. Diabetes also tends to appear at a younger age and is characterized by early beta-cell dysfunction alongside insulin resistance. Meanwhile, studies of Asian populations estimate body fat to be roughly 3% to 5% higher than in Caucasians at the same BMI.
The practical message is that a “normal” weight does not rule out risk.
This is the reason Singapore’s clinical guidance for prediabetes sets a weight loss BMI target below 23 kg/m² for those of Asian ethnicity who are overweight or obese, and why waist measurement and family history deserve as much attention as the number on the scale.
Recommended reading: Everything you need to know about prediabetes. Take a look at the causes, risks and the symptoms.
Where does Singapore stand?
- Prevalence of Diabetes in Singapore is stable, but the problem is not solved. The National Population Health Survey (NPHS) 2021-2022 found diabetes in 8.5% of residents aged 18 to 74, down from 9.5% in 2019-2020. The NPHS 2024 reported that prevalence of both diabetes and hypertension remained stable.
- However, the prevalence of obesity is climbing. Obesity prevalence rose from 8.6% in 2013 to 11.6% in 2021-2022, and the NPHS 2024 flagged a further significant increase in its prevalence. Since obesity is a major driver of insulin resistance, the pressure on diabetes numbers has not gone away.
- Many people do not know their status. A 2024 survey by the NUS Institute for Pandemic and Urban Resilience (IPUR) with Diabetes Singapore found nearly 40% of respondents had prediabetes, and nearly 70% of those with prediabetes believed they did not have diabetes.
- Progression is common, but preventable. Early diagnosis and lifestyle interventions that include proper nutrition, movement and weight management, can slow or even reverse the progression of prediabetes to diabetes.
What does “early action” look like in practice?
- Get tested earlier than you think you need to. Adults of any age with risk factors, such as a family history, obesity or high blood pressure, should discuss testing with their doctor. Monitor your blood glucose regularly, and discuss with your doctor a periodic hemoglobin A1c test to determine your average blood sugar levels.
- Treat risk, not just readings. Singapore’s clinical guidance recommends a healthy plate, less fat, avoiding sugary drinks and food, reducing alcohol, stopping smoking and reducing sedentary time, and keeping your BMI below 23 kg/m² if you are of Asian ethnicity, and 25 kg/m2 and below if you’re non-Asian.
- Sustainable lifestyle changes. Lifestyle change delays and reduces risk, but it needs to be sustained. Early action is a long-term habit, not a one-year project.
You may want to learn more about NOVI Weight Care, a holistic medical treatment for sustainable weight loss which includes: weight loss medication with home delivery, doctor consultation (virtual or in-clinic), a dedicated dietitian, diet, fitness & lifestyle guidance and NOVI app with daily check-in.
Early action also means less stigma
The 2026 campaign explicitly calls for reducing diabetes stigma, which WHO describes as “widespread, harmful and preventable”. A prevention message framed around individual blame will backfire. The honest framing is that risk is shaped by biology, age, family history and environment, and that screening and early support are tools for everyone, not a verdict on anyone.
If you have prediabetes, then now is your chance to prevent yourself from developing diabetes. If your lifestyle stays the same, then there’s a very good chance that you’ll end up with diabetes in the future.
NOVI Health has a care team of experienced dietitians, specialist doctors and professional fitness instructors who all specialize in glucose management to help you get into the best health possible.
Frequently asked questions
Can you have diabetes risk with a normal blood sugar result?
Yes. Insulin resistance can develop years before glucose rises, because the pancreas compensates by producing more insulin.
Can a slim person get type 2 diabetes?
Yes. Asians in particular develop type 2 diabetes at lower BMIs and tend to carry more visceral fat at the same weight.
When should I get tested?
From age 40, or earlier with risk factors.
About Dr. Todd On
Dr. Todd On, an Associate Consultant and Family Physician with 16 years of experience in tertiary and community care, specializes in person-centered treatment for acute and chronic conditions. He has led quality initiatives in smoking cessation and diabetic care and is an award-winning clinical tutor at the College of Family Physicians Singapore.