Stop the Storm of Diabetes

The body’s blood sugar is controlled by insulin, a hormone produced by the pancreas in the abdomen. Insulin acts on food in the bloodstream to move glucose into cells, where it is broken down to produce energy.

Diabetes is a chronic condition in which cells are unable to break down glucose into energy. This is due to insufficient production of insulin or the insulin produced does not function properly. The former, which is much more common, is called type 2 diabetes and the latter, type 1 diabetes.
During pregnancy, it is possible for blood glucose levels to reach levels that the insulin produced is insufficient for all of it to be moved into cells (gestational diabetes).

Many people have raised blood glucose levels which are not high enough for a diagnosis of diabetes (prediabetes), which is a wake-up call that the person is enroute to diabetes.

Data from National Health and Morbidity Surveys
The prevalence of diabetes in Malaysia’s National Health and Morbidity Survey in 1986 was 6.3%. This increased to 8.2% in the National Health and Morbidity Survey in 1996 and 17.5% in the National Health and Morbidity Survey in 2015.

At the current rate of increase, about one in five Malaysians will be diabetic in 2020. The findings from NHMS 2015 of the overall prevalence of diabetes were:

• There was an increase in overall prevalence with age, with an increasing trend from 5.15% in the 18-19 years age group to a peak of 39.1% in the 70-74 years age group
• The overall prevalence in females was 18.3% and 16.7% in males
• Indians had the highest overall prevalence at 22.1%, followed by Malays at 14.6%, Chinese at 12.0% and Other Bumiputras at 10.7%.
Of the known diabetics, the findings included:
• The prevalence of known diabetes was 8.3% with an increasing trend from 0.7% in the 20-24 years age group reaching a peak of 27.9% in the 70-74 years age group
• The prevalence of known diabetics in the urban areas was 8.7% and 7.2% in the rural areas
• The prevalence in females was 9.1% and 7.6% in males
• Indians had a prevalence of known diabetes at 16.0%, followed by the Malays at 9.0%, Chinese at 7.7% and Other Bumiputras at 6.8%
• 25.1% claimed that they were on insulin therapy and 79.1% on oral anti-diabetic medicines within the past two weeks
• 82.3% had received diabetes diet advice from healthcare personnel
• 69.6% had been advised to lose weight
• 76.8% had been advised to be more physically active or start exercising
• 79.3% sought treatment at Health Ministry facilities (59.3% at clinics and 20.0% at hospitals) and 18.7% at private facilities (15.1% at clinics and 3.6% at hospitals);
• About 1.5% self-medicated by purchasing medicines directly from pharmacies; and 0.5% were on traditional and complementary medicine.
Of the undiagnosed diabetics, the findings included:
• The prevalence of undiagnosed diabetes was 9.2%, with an increasing trend from 5.5% in the 18-19 years age group reaching a peak of 13.6% in the 65-69 years age group
• The prevalence was 9.2% in females and 9.1% in males;
• Indians had a prevalence of undiagnosed diabetes at 11.9%, followed by the Malays at 9.8%, Others at 8.6%, Other Bumiputras at 8.1% and Chinese at 7.7%.
Of the pre-diabetics (the term used in NHMS 2015 was impaired fasting glucose), the findings included:
• The prevalence was 4.7%;
• There were no statistical differences by age groups, gender and between urban and rural areas;
• Indians had a prevalence of pre-diabetes at 7.7%, followed by Malays at 5.2%, Others at 4.3% and Chinese at 3.8%.
Going forward

Medical attention should be sought whenever there are symptoms of increased thirst and frequent passing of urine, especially at night, feeling very tired, weight loss, loss of muscle bulk, itching in the penis or opening to the vagina (vulva), frequent fungal infections (thrush), slow or poor healing of wounds and blurring of vision.

Type 1 diabetes can develop over weeks or even days.

Type 2 diabetes is often associated with overweight, obesity and inactivity. The overweight comprises 37.3% of the Malaysian population and the obese 12.9%. It is estimated that 51.6% of the population are physically inactive. Many people with type 2 diabetes are unaware they have the condition because the early symptoms are often non-specific.

The complications of diabetes are multitude and include an increased risk of heart disease and stroke; damage to nerves; damage to the retina in the eyes; kidney disease and failure; foot ulcer; erectile dysfunction; sexual hypo function in women; miscarriage and stillbirth.

Due to delayed detection, diabetics are more likely to present for the first time with complications. The increase in the number of diabetics seeking treatment will increase the country’s health expenditure substantially. This will be increased further by diabetic complications.

With about 80% of diabetes patients currently seeking treatment at Health Ministry facilities, the burden to the country will be substantial.
The medical profession recently received directives from the Health Ministry on Ebola virus disease management. This is important for preparedness, although there is no reported case of Ebola infection in Malaysia, as the mortality from Ebola infection is around 50%.

According to the World Health Organization, Malaysia has no operational policy/strategy/action plan for diabetes and reduction of physical inactivity.
This incongruence is difficult to understand particularly when the diabetes epidemic in the country continues unabated.

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