When will diabetes be taken seriously?


  • Letters
  • Friday, 24 Jan 2020

IN 2019, the Health Ministry estimated that RM3.2bil was spent on managing diabetes and hypertension in its outpatient facilities. This is more than 10% of its annual budget.

Given that hospital admissions and treatment of complications (heart disease, stroke, renal failure) were not included in this amount, the ministry is justifiably concerned about the budgetary impact of diabetes on its services.

With each national health survey (conducted every couple of years), the projected number of Malaysians on track to get Type 2 diabetes is rising. The latest estimate is 31.3% or nearly one in three of us by 2025.

Early life, the environment and health-related behaviours as we grow up have been shown to play crucial roles in whether we develop diabetes or not. The Diabetes Prevention Programme for high-risk individuals in the United States found that intensive lifestyle intervention reduced the risk of diabetes by 58% over three years and 34% after a follow-up of 10 years.

Most of the money being spent on healthcare in Malaysia is for curative care (68%), with only 6% spent on public health and prevention in 2018.

Health services have become the battleground to treat diseases and complications rather than to help people become healthier. But this is only part of the solution.

Diabetes prevention programmes involve adopting a low-calorie, low-saturated fat, high-fibre diet and doing moderate intensity physical activity for at least 150 minutes per week. This would bring about a weight loss of 5% from the initial body weight.

If nutrition and exercise are key to filling the prescription for diabetes prevention, some important lessons can be gleaned here for Malaysians.

The balanced plate model of “suku suku separuh” delivers a simple message: Fill half of your plate with sources of fibre, a quarter with protein and a quarter with carbohydrates.

For many Malaysians, satiety is gained through simple carbohydrates, hence the idea of filling half of the plate with sources of fibre is culturally alien. When eating out, it is often necessary to request for the rice portion to be reduced, or paying extra to get more vegetables. Finding legumes and whole grains at the average Malaysian eatery is even trickier, and most drinks are sweetened.

Hence, if we’re talking about the general population, adopting the “suku suku separuh” model would require extreme willpower and effort.

Marketing and advertising would have you believe that our children and teenagers grow up active and fit. But in general, only one in five teenagers actually achieve the minimum standard for physical activity.

For adults, more than half of those surveyed reach the recommended standard.

Women were also found to be engaged in lower total physical activity and at less intensity. Notably, the prevalence of diabetes in Malaysia was higher in women (18.3%) than men (16.7%) in 2015.

Without adequate investment in prevention, healthcare spending for curative care will continue to rise, to the detriment of household savings, government revenue and other opportunities.

WINNIE ONG

Galen Centre for Health & Social Policy

Kuala Lumpur


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