Ranking fifth in the Western Pacific region for the highest rate of diabetes, Malaysia spends more than RM9.6 billion on diabetes management per year. In its category of non-communicable diseases (NCDs), Diabetes consumed the highest annual healthcare spending at 45.4%, nearly tripling the allocation for Cancer and Cardiovascular disease.
This figure places diabetes as a prevalent concern in the country. As it is the leading disease among NCDs, great efforts will be needed to address the severity of diabetes.
Sweetest Nation in Asia
According to the International Diabetes Federation (IDF) Malaysia, a staggering 4.4 million adults out of 22 million adults in the country are living with diabetes. In other words, one out of five adults in the country has diabetes.
According to the National Health and Morbidity Survey 2019 (NHMS 2019):
In a study focusing on the prevalence of type-2 diabetes and pre-diabetes among Malaysians, the prevalence of diabetes differed slightly by gender – 13.8% for males and a higher prevalence of 14.5% for females. Furthermore, for each ethnic subpopulation, Indians had the highest prevalence of diabetes at 25%, followed by Malays at 15%. Chinese at 12%, Bumiputeras at 8%, and others at 6%.
The same study showed that adults in the 20–29 year old age group have a noticeably low diabetes prevalence of 3.1%. Senior citizens at 60 years and older, unsurprisingly, had a significantly higher prevalence at 33.4%.
Malaysia is expected to be an aged nation by 2030, where people of the age of 65 will comprise over 14% of the population. This demographic change means that the health and economic burden of NCDs may increase. – Tan Sri Dr Noor Hisham Abdullah, Health Ministry director-general
However, according to IDF Malaysia, the total adult population (20–29 yrs) in Malaysia with diabetic records amounted to a total of 22 million in 2022 and is expected to reach 25 million in 2030. While the total children and adolescent population (0–19 yrs) was recorded at 10 million.
These figures suggest that diabetes is a problem that affects everyone, regardless of age. The elderly, young adults, teenagers and even children! No one is safe from this illness. .
Debunking Traditional Beliefs
A Malaysian Diabetes Index (MDI) Survey conducted to measure Malaysians’ awareness of diabetes found that half of their respondents (52%) do not know that diabetes is incurable, and one in three respondents (37%) do not know what abnormal blood sugar level readings are.
Respondents believe diabetes to be caused by a high-calorie diet, family history, obesity, and lack of physical activity, and over 53% of respondents think that they are at risk of developing it later in life. This indicates that many of them believe that diabetes is only a concern for older people, ‘an ageing disease’.
Diabetes is becoming a growing concern among young people in Malaysia. Between 2008 and 2019, the number of children under 18 diagnosed with diabetes more than doubled from 408 to 977, according to the Diabetes in Children and Adolescents Registry. On average, this equates to 57 new cases of diabetes in children each year.
Indeed, the National Health and Morbidity Survey (NMHS) 2022 found that one in three Malaysian teenagers aged 13-17 is overweight or obese, and overweight or obese children are about four times more likely to develop type-2 diabetes compared to those with normal weights.
Many people also believe sugar can only be found in sweet foods. In actuality one of the more common sources of hidden sugar is carbohydrate-heavy foods. Not only do Malaysians love to eat carb-heavy meals such as fried rice, roti canai and mee goreng for breakfast, lunch or dinner, but such foodstuffs are commonly donated to or purchased by low-income households in the Bottom 40% (B40).
A high-carbohydrate diet that consists of rice, noodles, bread, roti canai, etc, whereby the carbohydrate is broken down into sugar in our blood can also cause an increase in the risk of diabetes. – Prof Dr Chan Siew Pheng, senior consultant endocrinologist
Astonishingly, one in three Malaysians believe that cutting down on sugar is good enough to reduce their chances of getting diabetes. While cutting sugar out of your diet can help, high sugar consumption is not the only cause of diabetes as the disease occurs when there is a lack of insulin action in the body due to defective insulin release, as a result of a combination of genetic and lifestyle factors.
Senior consultant endocrinologist Prof Dr Chan Siew Pheng says that while high sugar consumption does not directly cause diabetes, high sugar intake leading to weight gain can increase the risk of contracting Type 2 diabetes.
Many other factors including your overall diet with excess food intake that results in weight gain, lifestyle and genetics also impact your risk of developing diabetes. This is a common misunderstanding Malaysians have towards sugar and diabetes. – Prof Dr Chan Siew Pheng, senior consultant endocrinologist
She further highlighted the role genetics plays in getting diabetes. According to her, family history and age may contribute to one’s risk of developing diabetes. “Your risk of developing diabetes increases if a parent or sibling has diabetes,” she says.
If you have been diagnosed with diabetes, there is a good chance that someone in your family has diabetes as well. Several gene mutations have been linked to the development of Type 2 diabetes, which can interact with the environment to further increase your risk of diabetes. – Dr Chan Siew Pheng, senior consultant endocrinologist
Debilitating Health Complications
Diabetes can affect many organs in the body, and lead to serious health complications over time. These complications are classified into two categories, Microvascular and Macrovascular.
Microvascular refers to damage in the nervous system, renal or urinary system, and eyes. More commonly, these come in the form of eyesight loss, kidney problems leading to urinary dysfunction, as well as nerve damage that affects sensory abilities.
On the other hand, Macrovascular refers to damage in any large blood vessels, such as cardiovascular disease, stroke, and peripheral vascular disease (PVD, a circulation disorder). PVD may lead to injuries that do not heal, gangrene, and ultimately, amputation.
With these complications, it’s no wonder that patients with diabetes spend RM500 to RM1000 a month on direct and indirect medical costs.
Impact on a Social and National Scale
With over 4 million diabetic cases in Malaysia and the escalating costs of treatment, the government’s expenditure on managing diabetes exceeded RM9.6 billion in 2022. Additionally, a joint report by the Ministry of Health (MOH) Malaysia and the World Health Organization (WHO) highlighted that non-communicable diseases (NCDs) impose a heavy economic burden, costing the Malaysian economy RM8.9 billion, equivalent to 0.65% of the nation’s GDP. This cost encompasses productivity losses resulting from workplace absenteeism and the premature deaths of the working-age population.
As a sobering fact, Malaysia is on track to achieve aged nation status by 2030, which further raises the risk of NCDs like diabetes, adding to the urgency of addressing this health crisis.
On an individual basis, diabetes can have a toll on one’s financial situation, stress, and mental health.
The treatment was very expensive. At that time, it was already very expensive. Whatever savings he had was spent on the treatment for those few last days. But by then, we already knew, the doctor told us he didn’t have very much time. It was very bad by then. – Yeoh Phek Chin, a Malaysian diagnosed with diabetes, whose father was diabetic
Over the past 12 years since Yeoh Phek Chin was diagnosed as a diabetic patient, she has spent nearly RM30,000 on medications and diabetes-related treatments, including glucometer purchases and upgrades, metre strips, and lancets – a cutting instrument with a double-edged blade and a pointed end for making small incisions or drainage punctures.
How is it possible that diabetes could affect my vision? I was never aware of it and was devastated because I wasn’t born blind. It just felt so unfair at the time. – Sivalila Balakrishnan, a 41-year-old diabetic patient
At 35 years old, Sivalila lost the vision in her right eye to diabetic retinopathy. Three years later, she was diagnosed with Charcot foot, a disease that attacks the bones, joints and soft tissues in the feet as a result of diabetes. She was told to amputate her leg or face the potential prospects of dying.
Diabetes doesn’t make you feel sick. You don’t feel like you’re going to die, you know? You don’t feel like you need medical help until something drastic happens. – Yeoh
This all the more highlights the need to be aware and proactive on diabetes to maintain our health and prevent further complications.
Solutions to the Nation’s Diabetes
With the prevalence of diabetes in Malaysia, there are several programs initiated by organisations to address the issue and provide a solution for the nation.
- The PRIME (Pre-diabetes Intervention, Management and Evaluation) program, created by Monash University School of Pharmacy in partnership with Caring Pharmacy and Bionime Malaysia, aims to educate people with pre-diabetes about their condition and how to prevent it from getting worse . It’s designed to connect pre-diabetic individuals with appropriate services, tackle the underuse of community pharmacies for disease management, and promote the use of digital health technology for better patient monitoring. The program began a pilot study in January 2022 and is scheduled for full implementation by December 2023.
- The Brighter Health Blood Glucose Screening Programme, organised by Sun Life Malaysia, took place from July to October 2023. Its purpose is to assist Malaysians in identifying potential symptoms and risks related to diabetes. This marks the fourth edition of the program, with the primary goal of raising awareness about diabetes prevention. Since its inception in 2019, the program has positively impacted over 21,000 Malaysians, equipping them with knowledge about early detection and prevention of diabetes.
- Lifestyle Medicine by the Malaysian Society of Lifestyle Medicine (MSLM) is an initiative providing a solution to increasing NCD cases in the country. It is an intervention providing health risk assessment, health behaviour coaching, and lifestyle modification, aiming to prevent, treat, and reverse chronic illnesses by addressing the underlying causes.
The benefits are plentiful. From not knowing anything, to being able to change our way of life. Now I feel healthier, lighter and have a lot more energy. Sometimes I do not feel like I’m 50 years old. – Nurzela, a participant in the Lifestyle Medicine program
How to Stay Diabetes-Free?
Knowing the significance of diabetes in Malaysia, we now understand the factors affecting diabetes and the importance of staying vigilant in our health—no matter our age. Here are some ways to stay proactive on our health:
#1: Consciously Nourish Your Body
Making conscious dietary choices that stem from sustainable and conservative farming not only reduces the ecological impact of our food choices but also contains less toxic metabolites such as heavy metals, synthetic fertilisers, and antibiotic-resistant bacteria.
Eating a balanced diet prioritising whole grains, lean proteins, and healthy fats is key to warding off the progression of pre-diabetes. Furthermore, limiting sugar intake between 5% and 10% of one’s total energy intake, depending on respective conditions, is recommended by the WHO.
#2: Be Aware Of Your Lifestyle Choices
Are you constantly at your desk, studying or working? Do you find yourself tired and worn out by the end of the day, both mentally and physically, despite not engaging in any physical activity?
KPJ Johor Specialist Hospital endocrinologist and internal medicine specialist Dr Kiran Nair, says, “urbanisation and modern lifestyles, where everything has gone virtual, is fueling sedentary habits and obesity, which in turn lead to alarming rates of diabetes, emphasising the critical need for preventive measures.”
Finding time to exercise can be challenging because of work and other commitments. However, considering the substantial benefits of exercise for our health, it’s vital to prioritize it. You can make time for exercise by incorporating short, intense workouts like High-Intensity Interval Training (HIIT), walking, or biking. Also, using public transport for commutes can encourage more physical activity. Utilising short breaks for stretching and movement is another effective way to stay active.
Dealing with the lack of motivation and fatigue when it comes to exercise can be addressed by ensuring your food and drinks provide nutritional value instead of empty calories. Adequate sleep at night is essential, and engaging in enjoyable activities like dancing, boxing, or pilates can make exercise more appealing.
#3: Frequent Visits To The Doctor
Regular checkups and screenings are crucial for managing diabetes, especially if there’s a family history of the condition. The suggested screening frequency depends on individual factors like age, weight, activity level, and other health conditions. In general, it’s recommended to get screened every six months for those at higher risk. However, it’s essential to consult a doctor for personalised guidance on diabetes management.
Early detection and management are keys to preventing or effectively managing diabetes and its complications.
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