From diagnosis to daily life: a qualitative investigation into patients' lived experiences of pre-diabetes diagnosis and care in a primary care setting in Singapore.

introductionThe prevalence of pre-diabetes mellitus (pre-diabetes, pre-DM) is increasing globally, with 5%-10% of adults with pre-DM progressing to type 2 DM (T2DM) annually. Despite the availability of national screening programmes and lifestyle interventions, uptake remains suboptimal and the lived experiences of individuals navigating pre-DM diagnosis and care in Singapore remain poorly understood. Understanding these experiences is critical, as patient perspectives can reveal gaps in care delivery, particularly in a multiethnic population where cultural, social and systemic factors intersect in complex ways. The current study explores the barriers and facilitators in detecting and managing pre-DM in Singapore's multiethnic population.

methodsThis qualitative study employed purposive sampling and a phenomenological approach to capture the experiences of those living with pre-DM (n=13). Participants were recruited from National Healthcare Group polyclinics through clinician referrals and through self-referrals. Eligible participants were aged 21 and above, Singapore citizens or permanent residents, diagnosed with pre-DM and conversant in at least one local language, while those with T2DM or type 1 DM were excluded. One-to-one in-depth interviews were conducted between August 2023 and February 2024, which were audio-recorded, transcribed verbatim and analysed through reflexive thematic analysis.

resultsSix overarching themes were identified: a) pathways to pre-DM diagnosis (detection during management of chronic conditions, self-initiated detection through health screening (HS)), b) dealing with diagnosis: navigating shock, acceptance and worry about the future, c) life before diagnosis: living in comfort and the absence of consequences (dietary habits and lifestyle choices before diagnosis, when not knowing felt safer: the reasons for not doing HS), d) life after diagnosis: reconfiguring daily life (lifestyle changes: renegotiating diet and exercise habits, alternative therapies: integrating traditional approaches), e) pre-DM care (challenges and enablers of pre-DM management) and f) reimagining care: suggestions for improving pre-DM care. The main barriers were i) personal factors: the struggle to sustain behavioural changes (such as lack of awareness, difficulty with dietary and physical activity changes, lack of self-discipline), ii) navigating social and environmental barriers to lifestyle change, iii) the financial burden of lifestyle changes, iv) work-related factors: competing priorities and time constraints,v) feeling unheard: the healthcare team-related barriers to care and vi) gaps in the systems: structural barriers to care (such as long waiting times, clinician rotation, short consultations). Enablers included i) fear to action: personal drivers of pre-DM self-management (such as personal factors including fear of developing T2DM), ii) family, peers and domestic help as daily support, iii) feeling heard and cared for: healthcare team-related factors, iv) seamless care through operational excellence and v) knowledge about pre-DM: sources and information seeking.

conclusionsOur findings suggest the need for multilevel collaboration to promote effective strategies to manage pre-DM in the community. This requires interventions to promote early screening, healthcare reforms to reduce waiting times and clinician rotation, and sustaining lifestyle modifications. Interventions should leverage the enablers identified in the study while addressing the barriers to ensure healthcare reforms. The insights derived from this study can directly inform locally contextualised interventions and policy reforms to strengthen pre-DM care delivery within a multiethnic healthcare setting.