A projection of progression of normal and impaired glucose

tolerance to Type 2 Diabetes Mellitus in Singapore using

Markov Modelling
Yee Gary ANG, Ruijie LI, Bee Hoon HENG
Health Services and Outcomes Research, National Healthcare Grou, Sin!aore
OB"E#$I%E

$ye & 'ia(etes )ellitus *')+ is a !ro,in! ro(lem in

Sin!aore-

.e sou!ht to roject ro!ression o/ normal and imaired

!lucose tolerance to $&') in Sin!aore usin! )ar0ov
)odellin!
)E$HO'S

A three state 1Normal Glucose $olerance *NG$+, Imaired

Glucose $olerance *IG$+ and ')2 )ar0ov model ,as (uilt
usin! $reeA!e 3ro &445 *Re/er to 6i!- 7 and &+

'ata /rom the Sin!aore Imaired Glucose $olerance

6ollo,89 Study *7::&8&444+ ,as used to assi!n transition
ro(a(ilities *Re/er to $a(le 7+-

A total o/ &;5 su(jects ,ith NG$ and &:7 su(jects ,ith IG$
,ere /ollo,ed u /or 5 years *7 cycle+-

As the mean a!e o/ the su(jects ,ere <=-; > 4-; /or the NG$
!rou and <=-5 > 4-; /or the IG$ !rou, < cycles *=& years+
,ere used to aro?imate their li/etime ro!ression-

It ,as assumed that there ,ere no deaths and the

ro!ression rate is similar throu!hout the < cycles-
6IN'INGS

A/ter < cycles *=& years+, &5-@A o/ NG$ su(jects ,ould

develo '), 7&-=A o/ NG$ su(jects ,ould develo IG$
,hile B:-7A su(jects ,ould remain as NG$-

6or IG$ su(jects, BB-BA ,ould develo '), ;-;A ,ould

remain as IG$ and =@-5A ,ould revert (ac0 to NG$-

9sin! data /rom the oulation census &474, assumin!

residents a!ed <48<: *@=&,:44+ are all NG$, 757,444 ,ill
develo ') in their li/etime *=& years+ (ased on the
simulation o/ NG$ su(jects-

$his ,ould (e a conservative rojected disease (urden o/

') i/ no intervention is !iven to those a!ed <48<: to revent
')-
#ON#L9SION

$he )ar0ov )odel can (e used to roject the ro!ression

/rom NG$ and IG$ to ')- $his o//ers a ,ay to evaluate the
imact o/ reventive ro!rammes ,ithout the use o/
rosective /ollo, u studies ,hich can (e costly-
$a(le 7- #han!e in !lucose tolerance /or
su(jects ,ith NG$ and IG$ /rom 7::& to
&444, the Sin!aore Imaired Glucose
$olerance /ollo,8u study
Glucose tolerance state in &444
NG$ IG$ ')
NG$ in
7::&
*nC&;5+
&&;
*57-;A+
=:
*7<-4A+
7&
*<-=A+
IG$ in
7::&
*nC&:7+
7&&
*<7-:A+
@;
*&=-4A+
74&
*=B-7A+
6i!ure 7- NG$ )ar0ov )odel
IG$
NG$
')
4-57;
4-7<4
4-4<=
NG$ IG$
4-<7:
4-&=4
4-=B7
6i!ure &- IG$ )ar0ov )odel
NG$
IG$
')
4-&=4
4-<7:
4-=B7
IG$ NG$
4-7<4
4-57;
4-4<=
#ORRES3ON'EN#E
Yee Gary ANG, )BBS )3H
Re!istrar
@ #ommon,ealth Lane, D4<84&
G)$I Buildin!, Sin!aore 7<:B<;
EmailE GaryFANGGnh!-com-s!