PETALING JAYA: Malaysia is not only the country with the highest prevalence of diabetes in South-East Asia, there are also close to five million people living with pre-diabetes.
Pre-diabetes is a condition where a person’s glucose levels do not meet the criteria for diabetes but are too high to be considered normal.
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In view of the gravity of the situation, health experts have urged adults to get screening for pre-diabetes.
Dr Alexander Tan Tong Boon, an endocrinology and diabetes specialist, said a mixture of genetics and lifestyle factors is at play when it comes to pre-diabetes.
“When I look at our food, I think every adult Malaysian should get tested,” he said, adding that this is especially the case for those who are overweight or obese, have a family history of diabetes, gestational diabetes, high blood pressure, or high cholesterol.
He said pre-diabetes is diagnosed with the same blood tests as diabetes, but with lower cut-offs.
The two common tests are the oral glucose tolerance test and HbA1c, which are used to diagnose abnormal glucose.
“For an oral glucose tolerance test, pre-diabetes is if the fasting glucose is between 6.1 and 6.9 mmol/L (millimoles per litre). Seven mmol/L and above is diabetes.
“Two hours after drinking the glucose drink, pre-diabetes is diagnosed if the glucose rises to between 7.8 and 11.0 mmol/L. Above 11.0 mmol/L is diabetes,” he added.
(Millimoles per litre measures the concentration of a chemical species).
“For HbA1c, pre-diabetes is diagnosed if the HbA1c is between 5.7% and 6.2%. Readings of 6.3% and above is diabetes,” said Dr Tan.
While pre-diabetes is reversible, it takes a lot of discipline and effort, he added.
“The key to reversing it is to lose weight through diet and exercise. There are also medications that can be used. If left untreated, it will unfortunately ultimately lead to diabetes.
“There are also medications that have been proven to prevent the development of diabetes from pre-diabetes,” he said.
On the ideal level of sugar intake, Dr Tan said it depends on the person and how active they are.
“In general, it is recommended that adult males can take in up to 150 calories per day and adult females 100 calories per day.
“To put this into perspective, a can of soft drink contain about 140 calories,” he said, adding that carbohydrate intake is even more complex as there are many different types.
“Carbohydrates are an important energy source, and in general should form between 50% and 70% of our total energy intake. Carb intake should be individualised and discussed with your doctor,” he said.
Prof Dr Sharifa Ezat Wan Puteh, a health economics and public health specialist with Universiti Kebangsaan Malaysia’s Faculty of Medicine, said darkened skin which looks velvety, or skin tags on the neck, armpits and groin, are signs to look out for.
“According to the American Diabetes Association, for people aged 45 years old and above who are living with pre-diabetes, the risk of developing Type 2 diabetes in 10 years is 9% to 14%.
“The good news is that it’s possible to reverse pre-diabetes with healthy diet and lifestyle changes.
“People with pre-diabetes should regularly eat healthy low-sugar food, and get regular exercise that can help return their blood sugar to healthy levels and prevent or delay Type 2 diabetes,” she added.
Assoc Prof Dr Geeta Appannah, a senior lecturer at the Department of Nutrition, Faculty of Medicine and Health Sciences of Universiti Putra Malaysia, said an ideal diet for the prevention of diabetes and pre-diabetes should be nutrient-dense, have low-glycaemic index (low GI), and include unprocessed foods that enhance glycaemic control and insulin sensitivity.
“High-fibre foods such as whole grains, legumes, non-starchy vegetables, and low GI fruits (such as guava, papaya, apples) for slow glucose absorption, improve postprandial (after meal) blood glucose levels.
“Incorporating lean protein sources such as fish, poultry, and plant-based proteins promotes satiety without significantly affecting blood glucose. Unsaturated fats from sources like vegetable oils, nuts and seeds enhance lipid profiles and reduce insulin resistance,” she said.
Limiting refined carbohydrates, added sugars, and processed foods, which rapidly elevate blood glucose and contribute to hyperinsulinemia (elevated levels of insulin) is crucial.
“A focus on balanced macronutrient intake, portion control, and hydration optimises metabolic health and mitigates the progression toward Type 2 diabetes,” added Geeta, who is also president of the Malaysian Association for the Study of Obesity.
Beyond dietary factors, she said maintaining a healthy weight and engaging in regular physical activity are equally important as these can significantly reduce the risk of developing diabetes.
In April, Deputy Health Minister Datuk Lukanisman Awang Sauni said that nearly five million Malaysians are pre-diabetic and at risk of becoming diabetic.
Diabetes treatments, he said, cost almost RM4bil, which is close to half of the ministry’s annual treatment allocation.
