25 February 2011

Increasing numbers of younger Malaysians afflicted by type 2 diabetes.

THE Metabolic Syndrome Study of Malaysia (MSSM) that was conducted in 2008, had uncovered startling facts: 22% of those surveyed above the age of 18 are suffering from type 2 diabetes mellitus (T2DM).

Even more alarming is the fact that half of these people were unaware that they even have the condition.

The rise in the occurrence of T2DM has been linked to the increase in obesity amongst the population. With the mean age of T2DM sufferers gradually lowering, a greater number of the Malaysian public are at risk from this condition, which can lead to diseases involving multiple organ systems, including coronary artery disease, stroke, blindness, and renal failure.

Prof Wan Mohamad Wan Bebakar, chairperson of the Clinical Practice Guidelines for Management of T2DM, reiterated the recommendation of the committee that every Malaysian above the age of 30 should be screened for diabetes in a bid to arrest the spread of the condition.

“The escalation of diabetes over the last 20 years is fairly shocking, with over 50% of Malaysians currently grappling with a weight management problem.

“The socio-economic burden of the disease to the Government and population will become overwhelming unless we get a handle on diabetes management, now,” said Prof Wan, who was speaking at a media workshop organised by Invida.

Malaysians are also rather recalcitrant when it comes to managing diabetes, with over 80% of patients demonstrating poor glycaemic (or blood glucose level) control and low treatment compliance.

Hyperglycaemia is caused by two main conditions: insulin deficiency and/or insulin resistance. Insulin deficiency is a condition where the body does not produce enough insulin.

Insulin resistance prevents the body from converting glucose into glycogen (a starch-like source of energy stored mostly in the liver), which in turn makes it difficult or impossible to remove excess glucose from the blood. To further compound the issue, a 2006 study found that 92% of type 2 diabetes patients are insulin resistant.

Diet and exercise remains the first line remedial measures to reduce glucose levels. If these measures fail, pharmacological intervention is the next logical approach.

Studies undertaken have shown conclusively that effective control of blood glucose, to keep blood sugar levels as close to normal as possible, is beneficial in preventing and delaying the progression of complications of diabetes.

The results showed that good control of blood sugar and blood pressure led to massive reductions in the development of complications due to diabetes.

The number of drugs options for diabetes is increasing rapidly. “Before the year 2000, there only were five classes of anti-diabetic medications, but in the next year alone, this figure grew to 13,” explained Prof Nor Azmi Kamaruddin, president of the Malaysian Endocrine and Metabolic Society, who also presented during the workshop.

Unfortunately, this increase in treatment options does not do anything to increase the proportion of patients with good diabetic control. In fact, it is getting worse!

A recent issue linking a particular drug rosiglitazone with an increased risk of heart attacks, has caused some concern and confusion amongst patients.

It is important to note however, that the issue does not affect all medicines within the class (TZD). While drugs may be in the same class and have the same indication, they may also have different effects due to their unique chemical structures.

Although rosiglitazone has been severely restricted by the US Food and Drug Administration and European Medical Authority, there still is a viable treatment option within the thiazolidinediones class of medicine, which is pioglitazone.

Finally, Prof Nor Azmi summed up the session with the following:

1. At the present rate, half of our children will have a weight problem and a third will have diabetes!

2. Two-thirds of patients with diabetes will die due to cardiovascular diseases.

3. Obesity-related cancers will double in 40 years time.

4. If all of us were to do something about our lifestyle, the current rate of diabetes and obesity will only come down in 20 years time!

5. The implications on the economy when a greater portion of our national income will be spent on diseases brought about by obesity and diabetes (treating heart diseases and cancers are not cheap).

This article was published in www.thestar.com.my on 16 January 2011.