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It's one of the most major public health concerns in the country, but how much do you actually know about it? We take a closer look at the insidious disease plaguing millions of Malaysians and its links to other complications and risks, including premature death

One of the greatest health crises facing our nation, aside from coronary heart disease, stroke, and cancer, is the quieter and often overlooked chronic non-communicable disease (NCD) known as diabetes. Malaysians are generally aware of what the disease entails i.e. higher than normal blood sugar/glucose levels, but how many are actually affected by the condition? The statistics are sobering.

In fact, one in five adults or about 3.9 million people over the age of 18 in Malaysia have been diagnosed with diabetes. According to the latest National Health and Morbidity Survey (NHMS) by the Ministry of Health (MoH), the prevalence rate of diabetes among adults aged 18 years and above had increased to 18.3 per cent in 2019, versus 13.4 per cent in 2015.

To say that it is a silent killer would be a sore understatement, especially when the number of people being diagnosed continues to rise. What is even more staggering is that 49 per cent of people with diabetes had never been examined or diagnosed with chronic disease. This means that for each one diagnosed, many more in Malaysia go undiagnosed.

While facts and figures may not spur an urgency, perhaps a closer look at the disease and its host of critical complications that can impair a person’s quality of life if left uncontrolled will.

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Understanding the basics

Diabetes is not caused just by eating too much sugar, and there are two types of diabetes: Type 1 and Type 2.

Type 1 diabetes is a complex genetic disorder linked to family history while Type 2 diabetes, the most common form of diabetes, is largely caused by both genetic and lifestyle factors such as being overweight, obesity, and physical inactivity. Type 2 diabetes develops when the body becomes resistant to insulin or when the pancreas is unable to produce enough insulin, causing blood glucose levels to rise.

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Diabetes, undiagnosed and untreated

A person who is suffering from diabetes is more likely to develop critical complications such as cardiovascular diseases.

Elevated blood glucose levels predispose to plaque build-ups that will damage and can block blood vessels including those supplying the heart and brain which can lead to heart attacks and strokes. Statistics show that cardiovascular diseases are responsible for up to 80 per cent of deaths among Malaysian patients.

Other complications from diabetes include kidney failure, lower-limb amputations, and ultimately, premature death.

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The moving parts to diabetes

Getting an early diagnosis is only a small component to combating the disease. An unmanaged condition would increase the risk in a patient developing serious eye conditions such as diabetic retinopathy, which over time can lead to permanent blindness. Nerves in the body can also become damaged, causing pain, burning, tingling, and loss of feeling, and a patient’s feet and skin can develop agonising sores and infections.

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So, is Type 2 diabetes preventable? Absolutely! In fact, an astounding 90 per cent of Type 2 diabetes can be prevented through lifestyle changes, coupled with proper diagnosis and treatment.

In speaking about diabetes treatment and medication, Subang Jaya Medical Center Consultant Endocrinologist Dr Chan Siew Pheng assured that there are emerging tools and medications aimed at strengthening diabetes management. “Diabetes management has progressed to meet the rising burden of the disease, the treatment of diabetes has also continued to evolve, ranging from multiple-daily to once-weekly medications. There are also newer treatment innovations available in the market such as GLP-1 RA class of injectable medicines that are not only able to reduce blood glucose levels, but also help manage other diabetes-related complications like cardiovascular disease and obesity,” Chan said.

“GLP-1 works differently from insulin to help control and maintain optimal sugar levels in the body. GLP-1 decreases blood sugar levels by enhancing the production of insulin naturally, whereas insulin is used to take the place of insulin that is normally produced by the body. Clinical trials have shown that GLP-1 reduced body weight more effectively than insulin. The proportion of patients experiencing hypoglycaemic episodes was 34 per cent lower with GLP-1, with a similar trend for severe hypoglycemia,” Prince Court Medical Centre Consultant Endocrinologist Dr Shamin Ramasamy told Tatler Malaysia.

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“GLP-1 are available in either twice daily, once daily, or once-weekly formulations. It is also available in multi-use or single-use, disposable pen devices. On the other hand, insulin regimens currently range from the once-daily injection to multiple daily injections. The less frequent injection schedule and ease of use of GLP-1 may offer the advantage of better adherence to treatment,” Ramasamy explained.

“Approximately two-thirds of individuals with diabetes die of cardiovascular disease, including coronary heart disease (CHD), stroke, and peripheral vascular disease. Having said that, my advice is to never wait for the symptoms to show because even during the pre-diabetic stage, you're already at an increased risk of developing not only Type 2 diabetes but also heart disease and stroke,” Gleneagles Hospital Kuala Lumpur Consultant Cardiologist Dr Azani Mohamed Daud, a pre-diabetic thriver himself, cautioned.

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“It’s not just about your sugar intake, it’s also about what you eat. Excessive carbohydrates and even certain fruits can contribute to your sugar levels so be sure to control your portions and intervene by adopting a healthy lifestyle in terms of both a healthy, balanced, and nutritious diet as well as adequate and sustained exercise to reduce the risk of developing the incidence of Type 2 diabetes, heart attacks, and strokes," Azani said.

So buckle up and pull the brakes on diabetes by living a healthier lifestyle: work out regularly, monitor your blood glucose levels, make healthy food choices, manage your weight, and adhere to prescribed medication where appropriate.