Prevalence and risk factors of depression and anxiety in primary care.

Introduction: Anxiety and depressive disorders are highly prevalent mental health conditions worldwide. However, little is known about their specific prevalence in primary care settings. This study aimed to determine the prevalence of depression and anxiety in the primary care population and identify associated patient characteristics. Method: We conducted a cross-sectional study using stratified sampling by age with a self-administered questionnaire survey in Singapore's National Health-care Group Polyclinics from December 2021 to April 2022. A total score of Patient Health Questionnaire-9 (PHQ-9) ≥10 represents clinical depression, and a total score of Generalised Anxiety Disorder-7 (GAD-7) ≥10 indicates clinical anxiety. Multivariable logistic regression was used to identify the factors associated with depression and anxiety. Results: A total of 5694 patients were approached and 3505 consented to the study (response rate=61.6%). There was a higher prevalence of coexisting clinical depression and anxiety (DA) (prevalence=5.4%) compared to clinical depression only (3.3%) and clinical anxiety only (1.9%). The odds of having DA were higher among those aged 21-39 years (odds ratio [OR] 13.49; 95% confidence interval [CI] 5.41-33.64) and 40-64 years (OR 2.28; 95% CI 1.03-5.03) compared to those ≥65 years. Women had higher odds of having DA (OR 2.33; 95% CI 1.54-3.50) compared to men. Respondents with diabetes had higher odds of having DA (OR 1.78; 95% CI 1.07-2.94) compared to those without diabetes. Conclusion: Coexisting clinical depression and anxiety are significantly present in the primary care setting, especially among younger individuals, patients with diabetes and women. Mental health screening programmes should include screening for both depression and anxiety, and target these at-risk groups.

Experiences of living with overweight/obesity and early type 2 diabetes in Singapore-a qualitative interview study.

OBJECTIVES: To understand the lived experience of adults with overweight/obesity and early type 2 diabetes in a modern urban environment, and the interrelations among the various aspects of these experiences and participants' attitudes to weight management. DESIGN: Qualitative inductive approach to analysing data thematically from semistructured interviews and interpreted from a socioecological perspective. SETTING: Primary care clinics located in northern and central Singapore. PARTICIPANTS: 21 patients between 29 and 59 years old who are living with overweight/obese (Body Mass Index of 25.3-44.0kg/m2) and type 2 diabetes for 6 years or less. RESULTS: The main themes - everyday life, people around me and within me - pointed to a combination of barriers to weight and health management for participants. These included environmental factors such as easy physical and digital access to unhealthy food, and high-stress work environments; social factors such as ambiguous family support and dietary practices of peers; and individual factors such as challenges with self-regulation, prioritising work, dealing with co-existing medical conditions and the emotional significance of food. While lack of motivation and cultural dietary practices are hard to change, a problem-solving attitude, and presence of role models, may enable behaviour change. CONCLUSION: An exploration of the lifeworld of patients with overweight/obese and early type 2 diabetes revealed that work demands, dietary practices in the workplace and at home, and the easy availability of calorie-dense foods afforded by a technology-infused environment hindered the individual's efforts at maintaining a healthy weight and lifestyle. Policy and initiatives promoting work-life balance as well as individualised interventions can support participants' stress management, and problem-solving capability for behaviour change. These barriers stemmed from the various domains of the environmental, interpersonal and intrapersonal but were interrelated. They underscored the need for an integrated approach to weight and diabetes management.

Challenges of care coordination for complex patients among family medicine residents in a community ambulatory clinic: a qualitative study.

BACKGROUND: Care coordination has been identified as one of five focuses of HealthierSG. Family medicine residents are expected to collaborate with other healthcare professionals for complex patients by the end of residency. However, many residents felt that it was challenging to coordinate care effectively among healthcare stakeholders. However, to date, no qualitative studies have explored these challenges. Therefore, this study aimed to understand the challenges encountered by family medicine residents when coordinating care for complex patients. METHODS: This was a qualitative descriptive study in which semi structured in-depth interviews were conducted and guided by a topic guide. Total population sampling of 15 third-year family medicine residents in the National Healthcare Group Polyclinics was performed. The interviews were performed over Zoom and were transcribed. Thematic analysis was subsequently performed to analyse the transcripts. Coding was performed iteratively by two independent researchers. Disagreements were adjudicated by a third coder. A coding framework was agreed upon. Potential themes were then independently developed based on the coding framework. RESULTS: Six themes emerged from the data, namely, interprofessional communications, accessibility, personal knowledge, time constraints, patient factors and caregiver dissent. CONCLUSION: Challenges faced by family medicine residents are multifaceted. While a few are systemic and pertain to the broader healthcare framework, others, such as issues of unfamiliarity with institutional workflows, community resources, and confidentiality, pertain to the microcosm of residency itself. These are reversible areas for improvement. These challenges can be addressed during planning of residency curricula to better equip family medicine residents with coordinating care for complex patients in the future.

Foot self-care behaviour in primary care patients with diabetic foot ulcers: Structural equation modelling of psychological predictors.

Diabetic foot ulcers (DFUs) are one of the most prevalent and costly diabetes complications, associated with diminished quality of life and poor prognosis. Management of DFUs relies heavily on patients' foot self-care behaviour. This study aims to explore psychological determinants of this important behaviour among primary care patients. A total of 186 patients with active DFUs self-reported their illness perception, diabetes distress, self-efficacy, and foot self-care behaviour. Structural equation modelling was performed to examine interrelationships among measured variables. The final model demonstrated satisfactory fit, CFI = 0.933, TLI = 0.913, RMSEA = 0.050, SRMR = 0.073, χ2(95) = 132.256 (p = 0.004), and explained 51.1% of the variance of foot self-care. Illness threat perceptions (i.e., consequence, timeline, identity, concern, and emotion) had a direct positive effect on foot self-care behaviours, but also indirectly decreased foot self-care through increasing diabetes distress. Control perceptions (i.e., personal control, treatment control, and coherence) were not directly associated with foot self-care behaviours, but indirectly improved foot self-care by reducing diabetes distress and increasing foot care confidence. These findings suggest illness perceptions, diabetes distress, and self-care confidence as modifiable predictors to be targeted in self-management interventions for patients with DFUs.

How family physicians in Singapore recognise complexity during consultations: a qualitative study.

BACKGROUND: The prevalence of persons with complex needs in Singapore is rising. Poor understanding of what constitutes complexity impedes the identification of care gaps and development of interventions to improve care for these individuals. We aim to identify the characteristics contributing to complexity in primary care, from the Family Physicians' (FP) perspectives. METHODS: Focus group discussions (FGDs) were conducted from January to September 2021 with experienced FPs across 14 study sites, employing a qualitative descriptive approach based on a complexity framework. Data were coded independently and categorised using thematic analysis by two independent investigators. RESULTS: Five FGDs were conducted with 18 FPs aged 32 to 57 years old working in different primary care settings, with a mean of 13.5 years of primary care experience. Participants emphasised the need for a unified definition of complexity. Complexity is characterised by the presence of issues spanning across two or more domains (medical, psychological, social or behavioural) that adversely impact medical care and outcomes. Persons with complex needs contrast with persons with medically difficult issues. Medical domain issues include the number of active medical problems, poor chronic disease control, treatment interactions, ill-defined symptoms, management of end-of-life conditions and functional impairment. Psychological domain issues include the presence of mental health conditions or cognitive impairment. Social domain issues include the lack of social support, competing social responsibilities and financial issues, while behavioural domain issues include a lack of trust in healthcare workers, fixed health beliefs and poor health literacy. CONCLUSION: Recognising the medical, psychological, social and behavioural factors that contribute to complexity aids in discerning the diverse needs of individuals with complex needs. This underscores the need for additional support in these pertinent areas.

Primary Technology Enhanced Care Home HbA1c Testing (PTEC HAT) programme: a feasibility pilot study in Singapore.

BACKGROUND: Considering time-consuming, cost-related limitations of laboratory-based HbA1c testing and follow-up clinic visits for diabetes management, it is important to explore alternative care models which incorporate point-of-care testing for HbA1c to monitor glycaemic control and related management. METHODS: Therefore, we adopted an implementation perspective to conduct one group pre- and post-intervention feasibility pilot assessing feasibility, acceptability and satisfaction with conducting home HbA1c test by patients with type 2 diabetes coupled with telemonitoring and teleconsultations (i.e., the Primary Technology Enhanced Care (PTEC) Home HbA1c Testing (HAT) Programme) in Singaporean primary care setting. The secondary objective was to compare the HbA1c, blood pressure and primary care visits at the end or during intervention, vs. 6 months before. Adult patients with type 2 diabetes with HbA1c ≤ 8% without any diabetes complications and having phone compatibility were recruited. Data was collected via patient self-reports and electronic medical records extraction. While summary statistics and paired t-test were computed for quantitative data, open-ended feedback was analysed using content analysis. RESULTS: A total of 33 participants completed the intervention out of 37 (33/37 = 89%) recruited from 73 eligible (37/73 = 51%). Most were either 51 to 60 years old (46.9%) or more than 60 years (37.5%), with more males (53.1%) and majority Chinese (93.8%). Majority (81.3%) felt that home HbA1c testing was beneficial with most commonly reported benefit of not having a clinic visit. A key finding was the average of diabetes-related visits being significantly lower post-intervention with comparable HbA1c values pre- and post-intervention. The most commonly reported challenge was using Bluetooth to transmit the reading (43.7%), followed by having too many steps to remember (28.1%). While participants reported being overall satisfied with the intervention, only 22% were willing to pay for it. CONCLUSION: Our findings support home HbA1c testing by patients coupled with telemonitoring and teleconsultations. Following are practical recommendations for the implementation scaling phase: offering PTEC HAT Programme to suitable patients who are self-motivated and have adequate digital literacy, provision of adequate educational and training support, sending reminders and exploring enabling manual submission of HbA1c readings considering Bluetooth-related challenges.

Pharmacist-led medication reconciliation service for patients after discharge from tertiary hospitals to primary care in Singapore: a qualitative study.

BACKGROUND: Medication discrepancies commonly occur when patients are transferred between care settings. Despite the presence of medication reconciliation services (MRS), medication discrepancies are still prevalent, which has clinical costs and implications. This study aimed to explore the perspectives of various stakeholders on how the MRS can be optimized in Singapore. METHODS: This is a descriptive qualitative study. Semi-structured interviews with 30 participants from the National Healthcare Group, including family physicians (N = 10), pharmacists (N = 10), patients recently discharged from restructured hospitals (N = 7) and their caregivers (N = 3) were conducted. All transcribed interviews were coded independently by three coders and inductive thematic analysis approach was used. RESULTS: Five core themes were identified. (1) The MRS enhanced healthcare services in various aspects including efficiency and health literacy; (2) There were several challenges in delivering the MRS covering processes, technology and training; (3) Issues with suitable patient selection and follow-up; (4) Barriers to scaling up of MRS that involve various stakeholders, cross-sector integration and environmental restrictions; and finally (5) Role definition of the pharmacist to all the stakeholders. CONCLUSION: This study identified the role of MRS in enhancing healthcare services and explored the challenges encountered in the provision of MRS from family physicians, pharmacists, patients and their caregivers. These findings supported the need for a shift of MRS towards a more comprehensive medication review model. Future improvement work to the MRS can be conducted based on the findings.

Public awareness of war on diabetes campaign and its association with behavioural outcomes.

The War on Diabetes campaign was launched in 2016, encouraging Singapore residents to engage in regular exercise, adopt healthy dietary habits and screen for early detection of diabetes. This study aims to examine campaign awareness and its associations with sedentary behaviour, dietary habits and identifying diabetes. Data were obtained from the nationwide Knowledge, Attitudes and Practices study on diabetes in Singapore. A total of 2895 participants responded to a single question assessing campaign awareness. The Dietary Approaches to Stop Hypertension (DASH) diet screener assessed dietary habits, and the Global Physical Activity Questionnaire (GPAQ) measured sedentary behaviour. Recognition of diabetes was established using a vignette depicting a person with diabetes mellitus. Logistic and linear regression models were used to measure the associations. Most participants were 18- to 34-years old (29.9%) and females (51.6%). About 57.4% identified the campaign. Campaign awareness exhibited positive associations with identifying diabetes based on the vignette [odds ratio (OR): 1.5; 95% confidence interval (CI): 1.1-2.2; P = 0.022], lower odds of sedentary behaviour ≥7 h/day (OR: 0.7; CI: 0.5-0.9; P = 0.018) and higher DASH scores (ß = 1.3; P < 0.001). The study recognized early significant associations between the behavioural outcomes and the campaign, emphasizing the need for ongoing campaign sustainability and evaluation of its long-term impact on population health.

Cross-sectional study assessing health outcome priorities of older adults with multimorbidity at a primary care setting in Singapore.

OBJECTIVES: Managing older adults with multimorbidity may be challenging due to the conflicting benefits and harms of multiple treatments. Thus, it is important to identify patients' health outcome priorities to align treatment goals with their health preferences. This study aimed to use the Outcome Prioritisation Tool (OPT) to describe the health outcome priorities of older adults with multimorbidity and determine the factors associated with these priorities. Additionally, it aimed to assess the ease of completing the OPT in Singapore's primary care population. DESIGN: Cross-sectional study conducted from January to March 2022. SETTING: A public primary care centre in Singapore. PARTICIPANTS: 65 years and older with multimorbidity. OUTCOME MEASURES: Primary outcome measure was the most important health outcome priorities on the OPT. Secondary outcome measures were factors affecting these priorities and ease of completing the OPT. RESULTS: We enrolled 180 participants (mean age: 73.2±6.1 years). Slightly more than half (54.4%) prioritised 'staying alive', while the remainder (45.6%) prioritised 'maintaining independence' (25.6%), 'relieving pain' (10.6%) and 'relieving other symptoms' (9.4%). Participants with six or more chronic conditions were three times (OR 3.03 (95% CI1.09 to 8.42)) more likely to prioritise 'staying alive' compared with participants with three conditions. Most participants (69.4%) agreed that the OPT was easy to complete, and the mean time taken to complete the OPT was 3.8±1.6 minutes. CONCLUSION: 'Staying alive' was the most important health outcome priority, especially for older adults with six or more chronic conditions. The OPT was easily completed among older adults with multimorbidity in primary care. Further qualitative studies can be conducted to understand the factors influencing patients' priorities and explore the relevance of the OPT in guiding treatment decisions.

How do older adults with multimorbidity navigate healthcare?: a qualitative study in Singapore.

BACKGROUND: Patients living with multimorbidity may require frequent visits to multiple healthcare institutions and to follow diverse medical regimens and advice. Older adults with multimorbidity could face additional challenges because of declining cognitive capability, frailty, increased complexity of diseases, as well as limited social and economic resources. Research on how this population navigates the healthcare system in Singapore also remains unknown. This study investigates the challenges older adults with multimorbidity face in navigating healthcare in Singapore. METHODS: Twenty older adults with multimorbidity from a public primary care setting were purposively sampled. Interviews conducted inquired into their experiences of navigating the healthcare system with multiple conditions. Inductive thematic analysis was performed by independent coders who resolved differences through discussion. RESULTS: Older adults with multimorbidity form a population with specific characteristics and challenges. Their ability to navigate the healthcare system well was influenced by these themes including patient-related factors (autonomy and physical mobility, literacy and technological literacy, social support network), healthcare system-related factors (communication and personal rapport, fragmented system, healthcare staff as advocate) and strategies for navigation (fitting in, asking for help, negotiating to achieve goals, managing the logistics of multimorbidity). DISCUSSION: Older adults with multimorbidity should not be treated as a homogenous group but can be stratified according to those with less serious or disruptive conditions (less burden of illness and burden of treatment) and those with more severe conditions (more burden of illness and burden of treatment). Among the latter, some became navigational experts while others struggled to obtain the resources needed. The variations of navigational experiences of the healthcare system show the need for further study of the differential needs of older adults with multimorbidity. To be truly patient-centred, healthcare providers should consider factors such as the existence of family support networks, literacy, technological literacy and the age-related challenges older adults face as they interact with the healthcare system, as well as finding ways to improve healthcare systems through personal rapport and strategies for reducing unnecessary burden of treatment for patients with multimorbidity.

Variant-specific IgA protects against Omicron infection.

BACKGROUND: The emergence of rapidly evolving SARS-CoV-2 variants, coupled with waning vaccine-induced immunity, has contributed to the rise of vaccine breakthrough infections. It is crucial to understand how vaccine-induced protection is mediated. METHODS: We examined two prospective cohorts of mRNA-vaccinated-and-boosted individuals during the Omicron wave of infection in Singapore. RESULTS: We found that, individuals, who remain uninfected over the follow-up period, had a higher variant-specific IgA, but not IgG, antibody response at 1-month post booster vaccination, compared with individuals who became infected. CONCLUSIONS: We conclude that IgA may have a potential contributory role in protection against Omicron infection.

Validation of the 12-item World Health Organization Disability Assessment Schedule 2.0 in individuals with schizophrenia, depression, anxiety, and diabetes in Singapore.

BACKGROUND: There is limited evidence on the reliability and validity of the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) in an Asian patient population with mental and physical disorders. The current study aimed to examine the psychometric properties of the WHODAS 2.0 among patients with schizophrenia, depression, anxiety, and diabetes. METHODS: A total of 1076 patients (M = 40.9 years, SD = 14.7) were recruited from the outpatient clinics of a tertiary psychiatric hospital and a primary care clinic. Internal consistency and test-retest reliability, structural validity, convergent validity, agreement, and floor and ceiling effects were examined. RESULTS: Our confirmatory factor analysis (CFA) showed that the 1-factor model fits our data. Multigroup CFA demonstrated metric and scalar invariance, indicating the scores can be compared across the four conditions. The WHODAS 2.0 scale had excellent reliability in the overall sample and good to excellent reliability across conditions. The test-retest reliability and agreement between self-administered and interviewer-administered modes were good. The WHODAS 2.0 scores had moderate to strong correlations with the Social and Occupational Functioning Scale and the Sheehan Disability Scale scores in the overall sample and across four conditions. CONCLUSION: Findings suggest that the WHODAS 2.0 is a valid tool to measure functioning and disability in those with schizophrenia, anxiety, depression, and diabetes in an Asian patient population.

A descriptive study of percutaneous injuries in National Healthcare Group POLYCLINICS dental clinics in Singapore from 2014 to 2020.

INTRODUCTION: All dental staff face risk of percutaneous injuries (PCI)s. Blood-borne diseases may be transmitted to staff via contaminated sharp instruments. Hence there are significant impacts on staff when PCIs occur. Though a PCI is an occupational hazard, it is preventable. AIM: This study aims to identify factors associated with PCIs among dental staff by evaluating the circumstances and staff designations involved. METHODS: PCIs were reported through an electronic incident reporting system from 2014 to 2020. Reports involved their nature and extent. Statistical analysis was carried out to find associations between factors such as injury site, type of instrument and staff designation. RESULTS: A total of 63 PCIs were included in this study. The type of instrument was found to be significantly associated with staff designation (p = 0.04, p < 0.05) with significantly more dental burs causing injury in dentists and more injuries caused by 'other instruments' in health attendants (p = 0.0083). Majority of PCIs occurred in dentists, then dental assistants and health attendants. Staff designation was significantly associated with the instance where PCIs occurred (p < 0.001). Dentists and dental assistants were more likely to sustain injuries during a dental procedure than before procedure and after procedure (p = 0.0167). The mean incidence of PCIs among our dentists was 15.6/100. CONCLUSIONS: All dental staff are at risk of PCIs however dentists sustain the highest number of PCIs. Needles, dental burs and metal matrices are the top three instruments. Targeted interventions might help prevent/reduce PCIs.

A scoping review on the factors associated with the lost to follow-up (LTFU) amongst patients with chronic disease in ambulatory care of high-income countries (HIC).

BACKGROUND: Despite the importance of long term follow-up care for patients with chronic disease, many patients fail to adhere to their follow-ups, which increase their risk of further health complications. Therefore, the purpose of this scoping review was to find out the factors associated with lost to follow-up (LTFU) amongst patients with chronic disease in the ambulatory care setting of high-income countries (HICs) to gain insights for better quality of care. Understanding the definition of LTFU is imperative in informing patients, health professionals and researchers for clinical and research purposes. This review also provided an overview of the terms and definitions used to describe LTFU. METHODS: The following databases: CINAHL, EMBASE, Medline, PsycINFO and Web of Science were searched for studies investigating the factors associated to LTFU from the date of inception until 07 January 2022. RESULTS: Five thousand one hundred and seven records were obtained across the databases and 3,416 articles were screened after removing the duplicates. 25 articles met the inclusion criteria, of which 17 were cohort studies, five were cross-sectional studies and three were case-control studies. A total of 32 factors were found to be associated with LTFU and they were categorised into patient factors, clinical factors and healthcare provider factors. CONCLUSION: Overall, the factors associated with LTFU were generally inconsistent across studies. However, some factors such as financial factors (i.e., no insurance coverage) and low accessibility of care were consistently associated with LTFU for both mental and physical chronic conditions. The operational definitions of LTFU also varied greatly across studies. Given the mixed findings, future research using qualitative aproaches would be pivotal in understanding LTFU for specific chronic diseases and the development of targeted interventions. Additionally, there is a need to standardise the operational definition of LTFU for research as well as clinical practice purposes.

Investigating causal relationships between obesity and skin barrier function in a multi-ethnic Asian general population cohort.

BACKGROUND: Skin diseases impact significantly on the quality of life and psychology of patients. Obesity has been observed as a risk factor for skin diseases. Skin epidermal barrier dysfunctions are typical manifestations across several dermatological disturbances. OBJECTIVES: We aim to establish the association between obesity and skin physiology measurements and investigate whether obesity may play a possible causal role on skin barrier dysfunction. METHODS: We investigated the relationship of obesity with skin physiology measurements, namely transepidermal water loss (TEWL), skin surface moisture and skin pH in an Asian population cohort (n = 9990). To assess for a possible causal association between body mass index (BMI) and skin physiology measurements, we performed Mendelian Randomization (MR), along with subsequent additional analyses to assess the potential causal impact of known socioeconomic and comorbidities of obesity on TEWL. RESULTS: Every 1 kg/m2 increase in BMI was associated with a 0.221% (95%CI: 0.144-0.298) increase in TEWL (P = 2.82E-08), a 0.336% (95%CI: 0.148-0.524) decrease in skin moisture (P = 4.66E-04) and a 0.184% (95%CI: 0.144-0.224) decrease in pH (P = 1.36E-19), adjusting for age, gender, and ethnicity. Relationships for both TEWL and pH with BMI remained strong (Beta 0.354; 95%CI: 0.189-0.520 and Beta -0.170; 95%CI: -0.253 to -0.087, respectively) even after adjusting for known confounders, with MR experiments further supporting BMI's possible causal relationship with TEWL. Based on additional MR performed, none of the socioeconomic and comorbidities of obesity investigated are likely to have possible causal relationships with TEWL. CONCLUSION: We establish strong association of BMI with TEWL and skin pH, with MR results suggestive of a possible causal relationship of obesity with TEWL. It emphasizes the potential impact of obesity on skin barrier function and therefore opportunity for primary prevention.

A five-safes approach to a secure and scalable genomics data repository.

Genomic researchers increasingly utilize commercial cloud service providers (CSPs) to manage data and analytics needs. CSPs allow researchers to grow Information Technology (IT) infrastructure on demand to overcome bottlenecks when combining large datasets. However, without adequate security controls, the risk of unauthorized access may be higher for data stored on the cloud. Additionally, regulators are mandating data access patterns and specific security protocols for the storage and use of genomic data. While CSP provides tools for security and regulatory compliance, building the necessary controls required for cloud solutions is not trivial. Research Assets Provisioning and Tracking Online Repository (RAPTOR) by the Genome Institute of Singapore is a cloud-native genomics data repository and analytics platform that implements a "five-safes" framework to provide security and governance controls to data contributors and users, leveraging CSP for sharing and analysis of genomic datasets without the risk of security breaches or running afoul of regulations.

Evaluation of the clinical effectiveness of telephone consultation compared to face-to-face consultation in terms of glycaemic control among patients with suboptimally controlled type 2 diabetes: a retrospective cohort study.

OBJECTIVE: With the COVID-19 pandemic, telemedicine has been increasingly deployed in lieu of face-to-face consultations for management of diabetes in primary care. There was a need to evaluate clinical effectiveness of telephone consultations for diabetes management and this study aimed to show whether one-off telephone consultation was inferior or not to face-to-face consultation in terms of glycaemic control among patients with suboptimally controlled type 2 diabetes. DESIGN: Retrospective cohort study. Data of all patients with type 2 diabetes who had a chronic disease consultation during the period 9 April 2020-18 September 2020, and met the study's inclusion and exclusion criteria was obtained from the electronic medical records. SETTING: A primary care clinic in the north-eastern region of Singapore. The clinic's patient population was representative of Singapore's population in terms of gender and age. PARTICIPANTS: 644 patients with type 2 diabetes and glycated haemoglobin (HbA1c) 7.0% and above, aged 21-80 years old. INTERVENTIONS: Participants either underwent telephone or face-to-face consultation for diabetes management. OUTCOME MEASURE: Mean HbA1c change (∆HbA1c) between preintervention and postintervention. RESULTS: Over 4 months, the mean ∆HbA1c was -0.16 percentage points (p.p.) (95% CI -0.26 to -0.07) and -0.11 p.p. (95% CI -0.20 to -0.02) for face-to-face and telephone consultation groups, respectively. The difference in mean ∆HbA1c between the two groups was +0.05 p.p. (95% CI -∞ to 0.16), with the upper limit of the one-sided 95% CI less than the prespecified non-inferiority margin of 0.5 p.p. (p<0.05). In those with HbA1c≥9%, the difference in mean ∆HbA1c was +0.31 p.p. (95% CI -∞ to 0.79), which exceeded the non-inferiority margin. CONCLUSION: For patients with suboptimally controlled type 2 diabetes, one-time telephone consultation was non-inferior to face-to-face consultation in terms of glycaemic control in the short term. However, more studies are required to investigate the long-term effects of telephone consultations and for those with HbA1c≥9%.