Four in 10 deaths from Covid-19 are diabetics

IT’S a “sugary” problem with bitter consequences if we don’t control it, especially in this pandemic.

Those with diabetes are at higher risk of dying from Covid-19, or suffering more severe conditions if infected, compared with those without it.

Out of every 10 people who died from Covid-19 in Malaysia this year, about four of them had diabetes, the Health Ministry tells Sunday Star.

In fact, most of the coronavirus deaths in Malaysia have underlying comorbidities, with diabetes and hypertension topping the list.

As of Oct 28 this year, 37.3% of Covid-19 fatalities had a background of diabetes.

“It’s a slight reduction from last year, when 38.8% of patients who died from Covid-19 were diabetic,” says the ministry’s disease control division deputy director (non-communicable disease section) Dr Feisul Idzwan Mustapha.

Nevertheless, Malaysia must be on guard against the “sweet” disease, with its growing prevalence in our society, including among younger people.

It’s also a timely reminder for the public to monitor their blood sugar levels, with today being World Diabetes Day, carrying the theme “Access to Diabetes Care: If Not Now, When?”

The event is marked every year on Nov 14 as it’s the birthday of Canadian physician Sir Frederick Banting who co-discovered insulin with American physiologist Charles Best in 1922.

In Malaysia, one in five people live with diabetes – that works out to about 3.9 million people aged 18 and above.

The National Health and Morbidity Survey (NHMS) 2019 found that 18.3% among Malaysian adults in this age group have the disease. Worryingly, the percentage has been rising, from 11.2% in 2011 and 13.4% in 2015.

Today, with Covid-19 still in our community, those with noncommunicable diseases (NCDs) like diabetes and high blood pressure are at higher risk of more serious infections.

“This is especially more so if their condition is poorly controlled,” says Dr Feisul, who is a consultant public health physician.

The American Diabetes Association also says that the risk of getting very sick from Covid-19 is likely to be lower if diabetes is well-managed. Its website says that viral infections can also increase inflammation, or internal swelling, in people with diabetes, which could contribute to more severe complications.

As such, diabetics face a double whammy during the pandemic, says Diabetes Malaysia vice-president Jong Koi Chong.

Such patients already have to control their blood sugar levels, but they also have to be extra cautious about Covid-19 to prevent severe illness if infected with the coronavirus.

“If infected, their mortality risk is 2.5 times more than those without diabetes. Also, they are 2.4 times more likely to suffer from a severe Covid-19 infection,” says Jong.

However, he adds that diabetes patients with good control of their glycated haemoglobin A1C (blood sugar control over two to three months) have better outcomes if infected with Covid-19.

Young diabetics on the rise

A higher number of younger people are getting diabetes, with the number of patients aged between 18 and 40 doubling over the past 15 years, says Jong.

“The rising 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,” adds Jong, who is also the president of the Malaysian Council for the Prevention of Obesity.

He says the rising number of young diabetics shows that there needs to be improved awareness and recognition of risk factors.

“Many clinical trials have demonstrated how healthy lifestyle choices can prevent diabetes effectively, particularly good nutrition and plenty of exercise.

“Being overweight and obese are key drivers of the younger diabetes population in Malaysia,” Jong says.

Those with diabetes have high levels of glucose or sugar in their blood. It’s a disease that is caused by the body not producing enough of the hormone insulin to control the amount of blood sugar. It can also be caused when the body doesn’t use insulin efficiently, also known as insulin resistance.

Factors that drive this process include obesity, unhealthy eating habits, sedentary lifestyles and genetics.

So it doesn’t help that the recent NHMS found that one in two adults in Malaysia is overweight or obese.

“In Malaysia, current statistics from the ministry’s National Diabetes Registry (NDR)show that 84% of patients with diabetes are overweight, and among them are young Malaysians aged 18 to 40,” says Jong.

Dr Feisul agrees that there are more patients in younger age groups, in line with the increasing trend of diabetes over the years.

“However, data from our NDR has not shown much difference in the mean age of patients – from 52.8 in 2011 to 53.1 in 2020,” he adds.

And while more younger people are getting diabetes, the highest prevalence is seen among those aged 65 to 69, with an estimated 349,000 individuals in this age group having the disease.

Giving support

With the growing number of diabetics, the Health Ministry is boosting its support for patients, including providing them with psychosocial support.

“Diabetes care is not just about treatment and medications. We acknowledge the importance of a supportive living environment to help in caring for people living with diabetes,” Dr Feisul says.

The ministry is currently looking into an initiative known as the Sama-Sama programme, which aims to empower family members and caregivers to provide support for people living with diabetes to improve control and outcomes of the disease.

“Under the programme, the ministry is joining forces with the private sector to train healthcare providers and later, caregivers.

“By exploring such family caregiver- based interventions to improve the quality of life of patients, we can create an enabling living environment for families to better manage their conditions at home,” he says.

The initiative is currently in the pilot phase and being evaluated.

“This will be beneficial, as psychosocial support plays an important role in caring for patients living with chronic diseases including diabetes,” Dr Feisul adds.

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