ACE Clinical Guidances (ACGs)

[also known as Appropriate Care Guides]

ACGs provide concise, evidence-based recommendations to inform specific areas of clinical practice and serve as a common starting point nationally for clinical decision-making. ACGs are underpinned by a wide array of considerations contextualised to Singapore, based on best available evidence at the time of development. Each ACG is developed in collaboration with a multidisciplinary group of local experts representing relevant specialties and practice settings. ACGs are not exhaustive of the subject matter and do not replace clinical judgement.

Published on 03 Jul 2017
Last Updated on 27 Jul 2021
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This Appropriate Care Guide (ACG) covers diagnosis and management of pre-diabetes, with a focus on lifestyle intervention (including diet and physical activity) and pharmacotherapy.  

First published in 2017, this ACG has been updated in 2021 to incorporate the latest evidence where relevant.

Download the PDF below to access the ACG.

Key Messages
1. Pre-diabetes is asymptomatic but puts a person at high risk of developing type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD).
2. Early diagnosis, appropriate management and follow-up help to prevent or delay T2DM in persons with pre-diabetes.
3. Recommend lifestyle intervention to all persons with pre-diabetes.
4. Tailor lifestyle intervention to individual needs for sustained behavioural changes.
5. Consider metformin for persons with pre-diabetes when
  • glycaemic status does not improve despite lifestyle intervention OR
  • they are unable to adopt lifestyle intervention,
especially if the persons outlined in the two points above have a body mass index (BMI) of ≥ 23 kg/m2, are younger than 60 years of age, or are women with a history of gestational diabetes.

Managing Pre-diabetes (Updated on 27 Jul 2021) Pre-diabetes Management References (Jul 2021)