28 October 2013
If you think diabetes isn’t a big deal, think again. The most recent National Health and Morbidity Survey (NHMS 2011) has this alarming statistic: 1-in-5 Malaysians over the age of 30 is diabetic.
Dr Zanariah Hussein, a Consultant Endocrinologist at Putrajaya Hospital, warns: “In fact, there is strong likelihood that the actual prevalence is higher”. In the study, a fasting finger-prick blood test was used to diagnose those who were unaware of their diabetes. “But this method may miss a proportion of patients with normal fasting glucose, but elevated glucose following an oral glucose challenge test, which is the standard method of diagnosing diabetes,” she says.
Also of concern is the number of individuals who were unaware of their diabetic state. “This number has risen to comprise almost half of total diabetics, compared to about a third as reported in the previous NHMS results in 2006 says Dr Zanariah. “This is most apparent in younger adults (below 30), where about three-quarters were undiagnosed.”
Not an old person’s disease
The prevalence of diabetes among younger individuals (between 18-40) has increased by a whopping two to three times in the past 15 years, says Dr Zanariah. This increasing number of diabetics means an increased burden of the disease and its complications: heart disease, stroke, blindness, chronic kidney disease and lower limb amputation, among others. “All these result in greatly increased healthcare costs – both direct and indirect – as well as higher mortality rates.”
The rising number of young diabetics implies that “there needs to be improved awareness and recognition of risk factors among younger adults so that they will be screened earlier”.
The awareness issue
Dr Zanariah believes that the majority of Malaysians are aware of the growing presence of diabetes, as well as the nature of the disease, its related complications and the key risk factors. “The Ministry of Health (MOH), diabetes related non-government organisations like the National Diabetes Institute (NADI) and the Malaysian Diabetes Association (PDM), as well as the media, have continuously imparted strong messages to the public regarding diabetes prevention. “
However, the knowledge and awareness that the public has gained have not necessarily resulted in a positive change in attitude or behaviour in most individuals, she adds. “The main challenge is to translate the knowledge and awareness into action which changes attitudes and behaviour towards healthier lifestyle practices, especially with regards to food choices as the Malaysian diet is typically very high in carbohydrates and fat.
Preventing diabetes
Dr Zanariah says many clinical trials have demonstrated how healthy lifestyle choices can prevent diabetes effectively, particularly good nutrition and plenty of exercise. “Overweight and obesity are key drivers of the diabetes epidemic. The recent NHMS found that 44.5% of the population studied are overweight or obese by WHO standards, where it is defined as a body mass index (8MI) of 25 kglm2 or higher.”
In fact, in Malaysia, a 8MI of 23kglm2 or higher is considered overweight. “Current statistics from the MOH’s National Diabetes Registry show that 84% of patients with diabetes are overweight, with a 8MI above 23kglm2.”
Individuals who are deemed pre-diabetic where blood sugar is higher than normal, but not yet in the diabetes range – can still take measures to prevent the onset of the disease, says Dr Zanariah. These include healthy lifestyle choices and regular screenings, as well as management of co-existing conditions.
Medication can also be considered, particularly for those with a high risk of cardiovascular disease. “There is evidence that medication can prevent diabetes in those with milder blood glucose elevations or pre-diabetes,” she says. “Diabetes drugs such as metformin, acarbose and thiazolidinediones, as well as obesity medications such as orlistat, have been shown to reduce the risk of diabetes by 30-70%.” HT
Screening for diabetes
Dr Zanariah recommends that diabetes screening be done annually for adults at risk of the condition, as well as those aged 30 or older. Women who develop gestational diabetes (a form of diabetes that occurs during pregnancy) are at higher risk of developing full-blown diabetes in the future, and should be screened annually.
In addition, children and adolescents who are overweight and have risk factors such as a family history of diabetes or signs of insulin resistance should also be screened for pre-diabetes and diabetes. “In this group, screening should be done every two years, starting at the age of 10 or at the onset of puberty if puberty occurs at a younger age.”
This article was first published in www.bernama.com.