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THE HEALTH | JANUARY-FEBRUARY , 2023
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morbidities . It affects their capacity to earn or look after their families , and the treatment they need is an additional expenditure for the country .”
He added : “ Many government clinics have dedicated clinics for diabetes . These should be made available in more government outpatient departments ( OPDs ) and be staffed by dedicated nurses whose role should include educating these patients on diet , weight control , exercise , etc .”
HEALTH LITERACY AND AWARENESS ARE KEY
Inadequate health literacy hinders people from understanding their health , seeking help , and protecting themselves from risk factors and illness .
“ Lack of awareness from individuals and society for behaviour change to reduce risk of diabetes is also an important factor ,” said Dr Norhayati . “ Data from our National Health and Morbidity Survey ( NHMS ) in 2019 showed that in general , 35.1 per cent of adults have low health literacy ; 28 per cent have low health literacy in managing medical issues , 32.3 per cent have low health literacy related to disease prevention activities , while 27 per cent have low health literacy in health promotion and healthy lifestyle practices .
“ Patients and caretakers need to understand and be knowledgeable about their condition and accept responsibility for self-care . We need a whole-of-society , and whole-ofgovernment approach as health is
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Datuk Dr Balwant Singh Gendeh , President , Association of Specialists in Private Medical Practice in Malaysia |
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Dr Shalini Sree Dharan , Consultant Physician and Endocrinologist |
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SOURCE : NHMS 2019
the MoH ’ s and everyone ’ s responsibility .”
Meanwhile , Dr Jeyakumar suggested creating more awareness in the general public via drama series with a diabetic person as one of the key characters , which he believes would be much better and more effective than dry and boring lectures by doctors .
The Association of Specialists in Private Medical Practice in Malaysia ( ASPMP ) organises diabetes workshops and health screening camps annually to update doctors and the public about the early detection of diabetes and its early intervention .
Its President Datuk Dr Balwant Singh Gendeh , said this was done through its Physicians /
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Endocrinologists in collaboration with the Malaysian Medical Association ( MMA ).
So what can be done to persuade Malaysians to reduce their high intake of high sugar content products ?
Said Marimuthu , ” To change consumer behaviour we need to change both the consumer ’ s environment and his behaviour . Environmental change , he explained , would include implementing taxes on sugary food and drinks , which would increase the price of these items , making them less appealing to consumers .
“ Eliminating sugar subsidies and adding a sugar tax would reduce sugar consumption . Due to the extremely high level of diabetes in Malaysia , this may be painful but a necessary step in Malaysia .
“ The government can also encourage the food industry to reduce sugar in their products and offer subsidies or other incentives to promote businesses to provide healthier food options , such as fruits and vegetables .
“ Restricting advertising and marketing of sugary products to children . This can help prevent children from developing a taste for sugary food at a young age .”
He said : “ Governments must also improve access to healthy food in low-income communities and make it more affordable .”
He also emphasised starting early and educating children on healthy diets and lifestyles . “ Ensure affordable healthy foods at school canteens and collaborate with schools to promote healthy eating .” – The Health
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Prevention is key
DIABETES is a silent disease , and many only seek treatment after developing complications from it .
Diabetes can lead to complications in many body parts and increase the risk of dying prematurely . Possible complications include heart attack , stroke , kidney failure , leg amputation , vision loss and nerve damage . In pregnancy , poorly controlled diabetes increases the risk of fetal death and other complications .
“ A population-level increase in the prevalence of diabetes may be attributable to a wide range of potential factors . Obesity is often seen as the main contributor to an increasing prevalence of diabetes ,” said Deputy Director of Health ( Public Health ) Datuk Dr Norhayati Rusli .
“ Obesity rate has increased steadily in Malaysia , from 15.1 per cent in 2011 to 19.7 per cent in 2019 . Besides , ageing has also been associated with non-communicable diseases , including diabetes and Malaysia is expected to become an aged nation by 2030 .”
The rate of obesity gives rise to insulin resistance which is the cause of diabetes , explained Consultant Physician and Endocrinologist , Dr Shalini Shree Dharan .
“ Our environment promotes disease . Food is prevalent everywhere and every corner . The fast pace of life makes fast food an easy option for energy sources rather than preparing a healthy balanced diet .”
The reliance on fast foods and food delivery services leads to an obesogenic environment . Easy access to unhealthy foods that consist of high calories , highly-processed foods and refined starches or sugary beverages , in addition to a sedentary lifestyle , majorly contributed to being overweight and obese , subsequently increasing the risk of developing diabetes .
Dr Norhayati adds : “ Other factors such as lifestyle ( including physical inactivity and energy-dense diet ), socioeconomic status , education , and urbanisation have also been identified as potentially important factors . These affect how people experience the world and the choices they make . When these conditions challenge people , they become health and wellness risk factors .”
EARLY DETECTION AND PREVENTION
“ Typical signs of uncontrolled diabetes include increased tiredness , increased urination and feeling thirsty ,” explained National Diabetes Institute ( NADI ) Chairman , Emeritus Prof Datuk Dr Mustaffa Embong .
“ But most people with diabetes do not have symptoms , and they claim to be healthy . The best way to know if a person has diabetes is to do blood tests .”
The 2019 National Health and Morbidity Survey ( NHMS ), shared Dr Norhayati , shows that 50 per cent of people with diabetes are undiagnosed .
“ It is therefore vital to do a regular health screening , especially for those with risk factors . Clinical monitoring for early signs of complications is also crucial so that early intervention can be initiated .
“ For known diabetic patients , it is crucial to comply with follow-up schedules , prescribed medication and lifestyle modification advice .”
People with Type 1 diabetes need to take a diabetes medicine called insulin to control their blood sugar . Some people with Type 2 diabetes can control their blood sugar with healthy food choices and physical activity .
According to Dr Shalini , a person should be put on insulin at diagnosis for Type 1 diabetes or individuals with very high glucose levels having failed a combination of oral glucose-lowering medication .
“ Newer medication such as GLP1 receptor agonist is as potent as insulin in bringing down glucose level , but is usually less affordable .
“ Usually , individuals in a pre-diabetes state do not need insulin . They need lifestyle modification , including diets that are lower in calories and sugar , regular exercise , weight reduction , and medications that can improve their insulin sensitivity or weight .”
President of the Malaysian Pharmacists Society ( MPS ), Prof Amrahi Buang said : “ Insulin is no doubt an important treatment for diabetes used to lower glucose in diabetic emergencies .”
There are many insulin shots , such as rapid-acting insulin analogues and longlasting insulin , some even individualised for particular patients . Therefore , patients must be aware of and adhere to the correct insulin type , dosage and administration protocol .
MOVING AWAY FROM “ SICK CARE .”
Dr Norhayati stated : “ Coming out of the pandemic , we know and recognise that the public healthcare system is chronically underfunded against the increasing demands of NCDs , an ageing population and the emergence of new communicable diseases .
“ Like many other countries , the health and social systems are struggling to meet the current health needs of the people . Therefore , health system reformation is vital and should be the utmost priority .
“ The Healthcare System Transformation Plan through the Health White Paper put forth by the Ministry of Health ( MoH ) will need to address the imbalance in resource allocation , organisation and policy focus between primary health care and hospital care .
“ Serving the people ’ s needs in the health continuum , from health promotion to disease prevention to treatment , rehabilitation , and palliative care , should be initiated as early as possible , where relevant , and should be delivered as much as possible within the community .
“ All too often , we focus on treating and ensuring chronically sick people become healthy again . It is time to move from “ sick care ” to healthcare and wellness . Our ultimate goal should be to ensure that all Malaysians can live long and healthy lives no matter who they are or how old they are .”