7 April 2016 

Launching of the Newly Revised Clinical Practice Guidelines for the Management of Type 2 Diabetes Mellitus by the Honourable Minister of Health Datuk Seri Dr. S Subramaniam in conjunction with the World Health Day Celebration 2016 at the Dewan Serbaguna, Taman Sri Keramat AU2, Kuala Lumpur on the 7th of April 2016.

This press statement is released in conjunction with the World Health Day Celebration 2016 and the Launching of the Newly Revised Clinical Practice Guidelines for the Management of Type 2 Diabetes Mellitus by the Honourable Minister of Health Datuk Seri Dr. S Subramaniam.

Over the last decade there has been a marked increase in the incidence of diabetes mellitus in this country. The percentage of adults above the age of 18 years with diabetes has gone up from 11.6% in 2006 to 17.5% in 2015. That represents an increase of 50% over the 9-year period. By 2020, when Malaysia attained a developed nation status it is predicted that 22 % (more than 1 in 5) of adults above the age of 18 years will have the disease. Based on the recently released National Health & Morbidity Survey (NHMS) 2015, 53% of these adults are not aware that they have the disease. The percentage is highest among those between the ages of 18 and 30 years old where up to 88% of them are unaware that they have the disease.

The above issue is confounded by findings that showed only 13% of patients with diabetes in tertiary hospitals and 24% in health clinics have their diabetes under control. Among countries in the South East Asia region, Malaysia fared the worst in terms of having good diabetes control. As a result, majority of our patients are subjecting themselves to unnecessary risk of heart diseases, strokes, kidney failures and blindness by having poorly controlled diabetes. One of the major factors that has lead to the escalation of heart diseases in this country is diabetes as more than 40% of patients admitted with coronary artery disease into hospitals in this country have diabetes.

In light of the above, the Ministry of Health, Academy of Medicine, Diabetes Malaysia (Persatuan Diabetes Malaysia) and the Malaysian Endocrine & Metabolic Society (MEMS) have commissioned a group of medical specialists and experts in the field of diabetes management to revise the Clinical Practice Guidelines (CPG) for the Management of Type 2 Diabetes Mellitus. The purpose of the CPG is to improve patient management and health care outcomes by recommending evidenced based medicine to healthcare professionals. It is revised every 5 years to incorporate recent advances in knowledge and clinical practice.

There are several main improvements to this edition of the CPG for the Management of Type 2 Diabetes.

The most important of them is the introduction of a blood test named A1c to diagnose diabetes mellitus. Prior to this, diabetes can only be diagnosed by performing a blood glucose test following an 8-hour fast (fasting blood glucose) which may be supplemented by the ingestion of a 75-gram glucose drink followed 2 hours later by a second blood glucose test (oral glucose tolerance test). Both fasting blood glucose and glucose tolerance tests are cumbersome to patients since they have to fast overnight, consume a very sweet drink and wait a further 2 hours for a repeat blood test. With the A1c test, patients can come unprepared or even immediately after a meal. By being one of the first few countries in Asia to introduce A1c as a diagnostic test for diabetes, we hope to bring down the number of undiagnosed diabetes among our adult population.

The second most important improvement is the decision to lower the cut-off level of A1c for the diagnosis of diabetes down to 6.3% instead of 6.5% like the rest of the World. It has long been known that diabetes occurs at a lower body weight, body mass index (weight in kgs divide by height in cm2, essentially a measure of obesity) and waist circumference (abdominal obesity) in South East Asian population. Based on a locally conducted study of 4,400 subjects, an A1c level of 6.3% correlated well with results of fasting blood glucose and glucose tolerance tests which were in the diabetes range.

The third notable improvement is the number of oral anti-diabetic drugs permitted to patients with diabetes before they are started on insulin injections. Most of the diabetes guidelines in the world only allow a maximum of 3 oral diabetes drugs to control patient’s blood glucose, failing which insulin injection is promptly instituted. In view of the multitude of pathologies that contribute to the high blood glucose of diabetes ( as illustrated on the front cover of the CPG) together with the availability of numerous drugs to handle these different pathologies, the committee of the CPG advocates up to 4 oral diabetes drugs prior to starting insulin therapy. This is offered primarily to capitalise on the abilities of these different drugs to overcome to a certain extent the various pathologies that constitute the diabetes conundrum.

In order to help the busy clinicians manage the blood glucose levels of their patients, the CPG has come up with a novel algorithm that deals with specific patient profiles. We believe this to be the first in the world for a diabetes guideline. Patients are profiled based on the following characteristics: normal body weight, overweight, obese, tendency to develop low blood glucose (hypoglycaemia) or the existence of chronic kidney diseases. Based on the individual patient profiles, different diabetes drugs are recommended at different stages of the patient management. The sequence of these drugs is matched for each patient profile and they are based on the following pre-determined priorities: safety (risk of hypo), convenience (aid in patient’s compliance), cardiovascular risk reduction (effect on weight etc) and cost effectiveness of the drugs.

Other noteworthy improvement of the CPG is the recommendation for universal screening for gestational diabetes (GDM) for all pregnant women regardless of their risk factors for GDM. Those with risk factors are screened at booking when they turned up for their first antenatal clinic visits. If the results are normal they are repeated 4 to 6 weeks later. While those without risk factors are screened between week 24 to week 28 of their pregnancy. Such a recommendation is deemed necessary in view of the high prevalence of diagnosed and undiagnosed diabetes in this country.

Eleven new sections have been added to this edition of the CPG including a first for any diabetes guideline; a write-up on female sexual dysfunction. The management of 3 important diabetes emergencies; hypoglycaemia, ketoacidosis and hyperosmolar syndrome feature prominently along with the treatment algorithm for follow-up patients.

It is our hope that this new edition of the CPG will serve our doctors well in their fight against diabetes.

Endocrinology or endocrine is a field of medicine which deals with the diagnosis and treatment of diseases related to hormones; the most important among these diseases is diabetes mellitus. Other organs that produce hormones include the pituitary, thyroid, parathyroids, adrenals and the reproductive system.

The Malaysian Endocrine & Metabolic Society (MEMS) is a professional non-governmental organisation consisting of medical specialists and scientists whose objective is to advance and promote the education, training and research in the field of diabetes and endocrinology.

Prof. Dr. Nor Azmi Kamaruddin
Chairperson, Development Committee, CPG for the Management of Type 2 Diabetes Mellitus.
President, Malaysian Endocrine & Metabolic Society (MEMS).
Executive Committee, International Society of Endocrinology (ISE).

Dated 7th of April 2016.

Please download the Press Release in English and BM below…

Press Release World Health Day 2016.pdf (English – pdf – 165 Kb)

Press Release World Health Day 2016 BM.pdf (English – pdf – 164 Kb)