About 3.9 million Malaysians over the age of 18 currently live with diabetes. That’s roughly one in five adults who have the chronic disease.
MALAYSIANS are no stranger to diabetes. And for good reason too.
The National Health and Morbidity Survey 2019 (NHMS) estimates that millions in our country have this chronic non-communicable disease, with recent statistics showing that about one in five adult Malaysians over the age of 18 live with diabetes.
And this trend is expected to increase in the coming years, with the number expected to grow to about one in three by 2025.
Endocrinologist Emeritus Professor Dr Chan Siew Pheng says these alarming numbers are largely due to the poor lifestyle and diet choices of Malaysians, which only add to the prevalence of the disease in our country.
“Many Malaysians spend most of their time sitting in the office and hardly go out to do any form of exercise. When you multiply this with the genetic background risk, you have a ‘timebomb’ for an explosion of diabetes. It’s a recipe for disaster,” says Prof Dr Chan, who is consultant endocrinologist.
A majority of people with diabetes in Malaysia have Type 2 diabetes, which is the most common form of the disease. Type 2 diabetes occurs when the insulin does not function as it should (insulin resistance), resulting in high blood glucose.
Prof Dr Chan shares that 50% of people with diabetes do not have the classical symptoms of thirst, passing more urine or poor wound healing. This means that many Malaysians are walking around completely unaware that they have the disease – until it's too late, when complications have occurred.
Prof Dr Chan says that the prevalence of diabetes is mainly down to our poor lifestyle.
She says that diabetes is a disease that results from multiple key risk factors, such as an inherited genetic risk of a family member with Type 2 diabetes (either a parent or sibling), being overweight or obese, living a sedentary lifestyle and even increasing age.
Most people who have Type 2 diabetes also have a higher risk of developing other non-communicable disorders such as high blood pressure (hypertension) and high cholesterol, which Prof Dr Chan calls the tiga sekawan as diabetes and these chronic disorders often occur together in the same individual and contribute to the increased risk of complications, such as heart disease, stroke and impairment of kidney function.
Based on the NHMS 2019, 1.7 million Malaysians currently live with diabetes, hypertension and high cholesterol, while 3.4 million live with at least two of these health issues.
But there is hope on the horizon when it comes to treating these complications with the introduction of new innovative medications such as GLP-1 RA and SGLT2-i, which Prof Dr Chan says provides the vital target organ protection that people with Type 2 diabetes need.
GLP-1 RAs reduces glucose and weight by increasing glucose-dependent insulin secretion and decreasing glucagon secretion, which delays gastric emptying and increases satiety; while SGLT2-inhibitors result in glucose excretion in the urine and also reduces glucose and body weight.
Prof Dr Chan says these are “exciting times” for clinicians, as breakthroughs such as GLP-1 RA were previously given by injection, but a newer version of a GLP1-RA in tablet form may change the way patients with diabetes are managed and treated.
The new generation of medications have been shown to reduce risk of developing further diabetes complications, such as cardiovascular and kidney problems.
“I have spent my entire career looking after people with endocrine disorders, so I’m excited about the new data from recent landmark trials that we can do something to reduce the very serious complications that people with diabetes can suffer from.
The traditional management remains important, which is that blood glucose, blood pressure and cholesterol need to be controlled – to prevent complications. However, these new innovative medications have transformed the way in which diabetes is being managed.
“Now, I can say that I have medicines that can try and give you that extra quality of life and potentially increase life expectancy, because you are less likely to develop complications. I’m not saying it is 100%, but it is certainly better than before.”
Diabetes and the heart
One thing many people do not realise is that the moment an individual is diagnosed with diabetes, they are immediately more likely to develop conditions that raise the risk of cardiovascular complications.
Cardiovascular diseases, such as coronary heart disease and stroke, are also the leading causes of death in Malaysia.
Interventional cardiologist Datuk Seri Dr Azhari Rosman, who is a senior consultant cardiologist at the National Heart Institute (IJN), shares that more people need to be aware that diabetes acts as a risk multiplier for heart diseases.
Dr Azhari explains that the new generation of medications can help to reduce cardiovascular complications.
“This means that whatever risk you have – like high cholesterol and hypertension – diabetes actually multiplies the risk of having an event like a heart attack or dying,” says Dr Azhari.
“This is because people actually develop the disease very early on and by the time of the diagnosis, the blood vessels are already damaged, because the changes in the vessels have actually started five to eight years before that.”
This is due to the abnormally high insulin production levels which promote inflammation in the lining of the vessels. This causes the blood to become thicker and promotes the inflammatory chemicals to be produced in the vessels as well – thereby damaging it further.
Dr Azhari explains that due to this phenomenon, new blood vessels also grow where they shouldn’t, like behind the eyes in the retina for example. These newly-formed vessels are also weak-walled, meaning that they rupture easily.
He adds that the new generation of medications – like GLP-1 RA – can help to reduce cardiovascular related complications.
“By mimicking your own physiological GLP (glucagon-like-peptide) it improves the utilisation of sugar and minimises the episodes of hypoglycemia by reducing the fluctuations and the rise of insulin in response to diet.
“It plays a role by normalising the function in your body which works to prevent cardiovascular disease and strokes. That is why such medical innovations are very important to help us manage these conditions better in the medium and long term, as diabetes is a life-long disease.”
Diabetes and the kidneys
Diabetes also plays a major role in the deterioration of the kidneys, with more than 80% of kidney disease caused by diabetes and hypertension.
Consultant nephrologist and head of renal division at University Malaya Medical Centre, Prof Dr Lim Soo Kun, says that the management of diabetes and hypertension is crucial to kidney disease prevention and care.
Prof Lim says that kidney disease is on a steady rise in our country.
He says that obesity is also a contributing factor of kidney disease and that roughly 30% of people with diabetes are obese or overweight.
Medications such as GLP-1 RA and SGLT2 inhibitors can help patients manage their diabetes and at the same time protect their kidneys, as they also help in weight loss in patients. This in turn helps to stop the vicious cycle of patients gaining weight as a side effect of taking some medication such as insulin.
“This is why drugs like the GLP-1 RA are now being used in treating diabetes, as we know it is very effective in lowering the sugar level and reducing a patient’s weight.
“It also helps the kidneys as well because it reduces the amount of protein leaking in the urine, which is a telltale sign of kidney disease or complications.”
Prof Dr Lim says, however, that more data is needed to see if GLP-1 RAs can benefit the kidneys in the long run, although early data have shown to be very promising.
He is also hopeful that more “new generation” medications will be available in the coming years as nephropathy (kidney disease) is still on the rise in our country.
“The main aim is to delay the progression of the disease. If you have diabetes or hypertension which is not well controlled, the rate of deterioration can be very fast, up to 1% per month. In contrast, patients with well-managed diabetes may only progress at 2 to 3% per year.
“But, with new treatment innovations, we can potentially slow it down. Even though we can’t stop it, it’s still a success as you will have more time before you reach the end stage and need to embark on dialysis.”
Prof Dr Lim cautions that patients living with diabetes and kidney disease cannot solely depend on medications to manage the disease and they should make significant strides to alter their lifestyle as well.
