Malaysians aware of diabetes risk factors, but don't care

There is still a gap between knowledge and action when it come to Malaysians and the prevention of diabetes. — FOO CHERN HWAN/The Star

Malaysians display a casual attitude when it comes to many illnesses.

Take diabetes, for instance.

We know it is related to obesity or being overweight, eating too much (and not just too much sugar!), being sedentary and having a family history of the disease.

Despite having this awareness, we are not doing anything to prevent ourselves from getting diabetes.

Basically, we don’t translate our knowledge into action.

This was the finding of the first Malaysian Diabetes Index survey carried out online from April 12 to May 9 (2021), involving 2,539 respondents, mainly from the central Peninsula region.

The survey was conceived to measure the level of awareness and understanding of diabetes in Malaysia under the Beyond Sugar campaign – a community initiative supported by pharmaceutical company AstraZeneca, in partnership with the Malaysian Endocrine & Metabolic Society (MEMS).

More than half (52%) of the respondents revealed that they did not know diabetes cannot be cured, while 51% think diabetes is not difficult to manage.

What’s more startling is that over one in three respondents (37%) with diabetes do not even know what abnormal blood sugar readings are!

“Year after year, we see more diabetes cases emerge, but the sense of urgency seems to be tepid.

“We did the survey to find out what our local population thinks and where some of the gaps are.

“Everybody knew what was not good. They knew diabetes is a problem related to high glucose and insulin.

“And yet, half the respondents said they were not doing anything to improve their circumstances so that they will not develop diabetes,” says senior consultant endocrinologist and MEMS president Professor Dr Chan Siew Pheng.

When it comes to diabetes complications, 95% were aware that amputation can happen to someone with diabetes.

They also knew of other complications, such as eye damage (93%), kidney damage (90%) and nerve damage (84%).

The survey reveals that only one in four diabetics are monitoring their blood glucose levels, which is crucial to managing their disease. — AFP

The fatal heart

Interestingly, while heart complications are actually the deadliest of all the diabetic complications, they happen to be the least known (75%).

For Prof Chan, it is worrying that half the respondent do not know diabetes cannot be cured.

They think by cutting down sugar and carbohydrates, they will be all right.

The fact is, while high sugar consumption does contribute to the development of diabetes, it is not the only cause.

Optimal management of diabetes goes way beyond reduction in sugar consumption.

When diabetes is diagnosed, there is already the presence of defective insulin release from the pancreas, on top of insulin resistance, where the effectiveness of insulin has significantly decreased.

“If you are overweight or obese before becoming diabetic and have had only a short duration of diabetes, if you lose about 15% of that weight, then you might go into ‘remission’, i.e. your sugar level is well-controlled without the need for medication.

“In general, less than 1% will lose weight, so really, diabetes cannot be cured in the majority of our patients,” she says.

She adds: “Seven out of 10 are able to link heart disease to diabetes and that is quite a big gap in the knowledge, that the deadliest complication causing diabetic individuals to die prematurely is the least recognised.

“The one that is going to kill the person with diabetes is not the toe that has been amputated and not the kidney that is having problems because there is dialysis to keep the body functioning (only 2% of diabetics actually die of kidney failure).

“The data from the United States and around the world shows that 66% of diabetics are likely to perish early due to a cardiovascular event.”

In addition, a third of respondents think cutting down sugar alone is enough, but only 25% are monitoring their blood glucose levels.

“If they don’t know what causes the damage and what to aim for, how can they work with doctors to improve their lives?

“These need to be addressed as they are barriers as to why we cannot work together with the patient for better diabetes control – diabetes is just not taken seriously!” she says.

With food delivery easily available, even in enhanced MCO areas, many diabetics are gaining weight despite Covid-19 restrictions. — FAIHAN GHANI/The Star

Ignorant and at risk

Unsurprisingly, the survey sheds light on why our diabetes statistics continue to increase steadily over the decades despite a multitude of awareness campaigns and screenings nationwide.

Based on the 2019 National Health and Morbidity Survey (NHMS), there are approximately 3.9 million Malaysian adults living with diabetes, i.e. one in every five adults, giving us the title of “Sweetest Nation in Asia”.

Roughly 11.7% are between the ages of 30 and 39, although only 3.2% of this age group were diagnosed – 8.5% were unaware they had the disease at the time of the survey.

“We have a very skewed idea of what diabetes does to us and we need to adjust this concept and bridge the gaps.

“Some will also say ‘I’ve done everything possible – eaten right, exercised, watched my weight, etc, and yet, I still got diabetes’ – this is a genetic risk they have inherited.

“Having first degree family members with diabetes means you are already predisposed, so that recognition is a big influence for you to do something about it,” says Prof Chan.

Adds consultant endocrinologist Dr Foo Siew Hui: “Somehow, Indians are more predisposed to getting diabetes, even though they have a lower average body mass index (BMI).

“Studies show that they have a higher body fat percentage in the central area and this is partly genetic.”

Both the specialists were speaking at the Beyond Sugar & Malaysian Diabetes Index webinar held in June (2021).

The survey respondents comprised a mix of diabetics and non-diabetics, and disappointingly, Dr Foo says the diabetics did not have better knowledge than the non-diabetics.

In the survey, the youth (millennials and Gen Z) fell short in terms of general diabetes awareness, compared to their older counterparts, with 19% of Gen Z (those below 24 years) not knowing that the two main types of diabetes are type 1 and type 2.

She says: “There has been no improvement over the years, and despite awareness campaigns by so many parties, the young are not getting diagnosed.

“People who are responding are not all diabetics, but are from the older age group; the younger ones run away from the campaigns, so they don’t get screened.

“We have also introduced point-of-care HBa1C testing at clinics because if we tell patients to do a fasting blood sugar test, they will not come back.

“It really boils down to human behaviour.”

Diabetes is a risk with ageing, but here, it is shocking that so many young people in their 20s to 40s are being affected.

“Even before retirement, they will end up with premature complications, deteriorating health and loss of some working capacity, which would result in negative social economic impact to the country,” Dr Foo says.

People are also in denial and don’t want to face the fact that they have a problem unless it becomes symptomatic, then only will they seek treatment.

“The priority is not there; they have a wait-and-see attitude,” she laments.

“It could be due to socioeconomic reasons, but then again, people without economic issues are also not motivated to go and get tested.”

Judging from the trend, Prof Chan advises young adults in the high-risk category to check their blood glucose levels.

“If you are under the age of 30, but have very strong risk factors like family history, being sedentary and gaining weight, then you should screen for diabetes, as per our Malaysian guidelines.

“Overseas, it is an older age for testing blood glucose levels as they develop diabetes later, but we have a younger age cut-off,” she says.

If you’re a diabetic and a durian lover, Prof Chan suggests having no more than two durian seeds at one time as the fruit is extremely high in calories. — Filepic

Pandemic impact

Prof Chan also highlights that the Covid-19 restrictions have been disastrous for diabetics, even though it was promising in the early stages last year (2020).

She recalls: “During the three months of the first movement control order, 80% of my diabetic patients got better.

“That got me thinking... but hey, they couldn’t possibly have exercised and lost weight while staying at home.

“Then I realised that they could not access food easily!

“Thus, a lot of them lost weight and had better glucose controls.

“But after the food delivery services came into the picture, everything went out the window!

“The glucose controls were lost and many gained weight.”

On whether diabetics should eat durians (as it is currently in season), Prof Chan says there is no reason to refrain if they can practise self-discipline.

“Durians as a whole have a bad reputation, but the key point about diabetes is consuming too much calories. I tell my patients they can eat two ulas if they’re diabetic.

“But if they cannot stop at two, then don’t start because durians are extremely high in calories.”

As its name implies, the Beyond Sugar campaign aims to educate the public that diabetes is not just about sugar alone and that managing blood sugar levels solely will not prevent other related health complications.

“We no longer just want to support patients when they already have diabetes; it is time for more meaningful and calculated efforts to mitigate this health crisis.

“It is time for us to get educated and take action.

“If you are not diabetic, but someone in your family is, watch out because you could be next in line!” warns Prof Chan.