Can Malaysia meet its goals when it comes to diabetes? It could be challenging


The Prime Minister’s Office in Putrajaya lit up with blue in conjunction with World Diabetes Day in 2020. Events such as this help support and promote the awareness of diabetes. — Filepic

Non-communicable diseases (NCDs) are major causes of death and disability in Malaysia.

About one in five adult Malaysians are living with diabetes, one in three are living with hypertension (high blood pressure), two in five are living with high cholesterol, and nearly half are overweight or obese.

All these are major risk factors for cardiovascular (heart) disease with an estimated 1.7 million Malaysians having three major risk factors, and 3.4 million, two major risk factors, according to the 2019 National Health and Morbidity Survey (NHMS).

The Health Ministry (MOH) and World Health Organization (WHO) 2022 report titled Direct Health-care Cost of Noncommunicable Diseases in Malaysia, revealed that hospitalisations, medical tests, medications and primary care consultations of NCDs – particularly cardiovascular diseases, diabetes and cancer – costs the Malaysian economy over RM9.65 billion annually.

The annual costs from diabetes alone totalled about RM4.4bil, which is about 11% higher than the cost of cardiovascular disease at RM3.9bil.

Meanwhile, the costs of cancer were around RM1.3bil.

However, the lack of accessible data means that the costs involved are likely to be underestimated.

A previous MOH and WHO 2020 report titled The Impact of Noncommunicable Diseases and Their Risk Factors on Malaysia’s Gross Domestic Product estimated the productivity loss in 2017 due to absenteeism, presenteeism in the workplace (present at work, but not working at full capacity) and premature death in persons of working age exceeded RM8.91-12.88bil.

Further, the cost of disability and loss of healthy life years was estimated to be RM100.79-302.37bil.

Diabetes is common

The 2019 NHMS reported that the prevalence of known diabetes was 9.4%, while the prevalence of unknown diabetes was 8.9%.

This gives an overall diabetes prevalence in 2019 of 18.3%, with about 3.9 million Malaysians living with diabetes and giving Malaysia the title of the “Sweetest Nation in Asia”.

The prevalence rate had increased from 11.2% in 2011 and 13.4% in 2015.

There were no large differences noted between sexes or urban and rural localities.

More than 80% of those with raised blood glucose, but whose diabetes status was unknown, were aged 60 years and below.

The International Diabetes Federation (IDF) estimated that there were 4.431 million Malaysians with diabetes in 2021, of which 2.175 million were undiagnosed.

The IDF predicted that there will be 5.024 and 6.465 million Malaysian diabetics in 2030 and 2045 respectively.

Details of monitored diabetics’ profiles were found in the 2020 National Diabetes Registry (NDR), with 1,698,683 patients enrolled in the registry and 902,991 active diabetics at the end of 2020.

A total of 99.33% of patients had type 2 diabetes.

Most of these were between 55 to 59 years of age (16.59%), female (57.02%) and of Malay ethnicity (59.35%).

Eighty percent of patients in the NDR also had hypertension, while 75.72% had dyslipidaemia (abnormal fat levels).

The complications were nephropathy (kidney disease, 14.38%), retinopathy (eye disease, 11.52%), and ischaemic heart disease (5.64%)

Only 30.7% in the NDR achieved the HbA1c target of less than or equal to 6.5% (a measure of good control).

However, this was an increase from 27.64% in 2019.

World Diabetes Day

World Diabetes Day, which was commemorated on Nov 14, was established in 1991 by the IDF with support from the WHO.

It was established in response to increasing concerns about the health and economic threat due to diabetes.

Nov 14 is the birthday of Frederick Banting, who discovered insulin with Charles Best.

World Diabetes Day was officially recognised by the United Nations (UN) in 2006.

The theme for this year’s Day is “Education to protect tomorrow”.

The IDF’s recommendations to support the call and increase awareness of diabetes education are:

  • Take and share IDF’s free education courses and training.
  • Support IDF’s call to action to policymakers by sending a letter to your national health minister or other policymaker.
  • Support IDF’s survey on access to diabetes education among healthcare professionals and people living with diabetes.
  • Download and display our posters, infographics and banners in your community.
  • Organise an event, e.g. walk in blue for diabetes, light up a local landmark or arrange a local diabetes fair, and submit your activities and images online.
  • Take a photo with the diabetes blue circle and share your diabetes story online.

Meeting WHO targets

The WHO adopted targets at the 75th World Health Assembly (WHA) in May to strengthen and monitor member countries’ diabetes responses.

The aim of the targets is to reduce the risk of diabetes and move towards a world where everyone diagnosed with diabetes has access to equitable, comprehensive, affordable and quality treatment and care.

The coverage targets by 2030 are

  • 80% of people living with diabetes are diagnosed.
  • 80% of people with diagnosed diabetes have good control of glycaemia.
  • 80% of people with diagnosed diabetes have good control of blood pressure.
  • 60% of people with diabetes of 40 years or older receive statins.
  • 100% of people with type 1 diabetes have access to affordable insulin and blood glucose self-monitoring.

The WHO targets were agreed to at the WHA when Malaysia’s Health Minister became a vice-president of WHO.

The prevalence of undiagnosed diabetics and poor control in the diagnosed diabetics are very high in Malaysia.

As such, the effort needed to achieve the WHO targets is challenging, to say the least.

Action is urgently needed by the MOH and civil society to reduce the risks of diabetes.

Only time will tell whether the WHO targets for our country will be met.

Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email starhealth@thestar.com.my. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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