JANUARY-FEBRUARY , 2023 | THE HEALTH

management of diabetic patients , help to identify issues and improve further ,” she added .

Type 1 diabetes ( T1D ) is an autoimmune condition where the body ’ s immune system mistakenly attacks and destroys cells in the pancreas that produce insulin , resulting in diabetes . This type of diabetes is more common in children and requires life-long insulin replacement to survive .

Type 2 diabetes ( T2D ) is caused by insulin resistance , where insulin is produced normally , but its function is impaired by excess body fat . In Malaysia , the prevalence of overall diabetes increased with age , from 5.4 per cent in the 20-24 age group , reaching a peak of 43.4 per cent ( 95 per cent CI : 37.37 , 49.65 ) among the 65-69 years old as reported by NHMS 2019 .

“ Unfortunately , T2D is no longer a condition that only affects older people , although the likelihood does increase with age . It is now increasingly seen among adolescents with the rise of childhood obesity ,” shared Dr Norhayati .

According to Duopharma Biotech Berhad CEO ( Commercial ), Wan Amir-Jeffery Wan Abdul Majid , there may be periodic price increases on drugs and medication due to input and supply chain costs .

“ And in the last three years , it is evident that the costs in the supply chain , raw material , packaging and even logistics have increased significantly .”

Echoing Wan Amir-Jeffery , Malaysian Pharmacists Society ( MPS ) President Prof Amrahi Buang stated that the pandemic had contributed to price hikes due to border control , active pharmaceutical ingredient ( API ) supply disruption , and packaging material disruptions .

“ The pandemic resulted in concerns of medicine security and an immense increase in the cost of drugs .”

SCALING UP FACILITIES AND BRINGING DOWN COSTS

In response to how to cope with the increase in diabetes-related cases , National Diabetes Institute ( NADI ) Chairman , Emeritus Prof Datuk Dr Mustaffa Embong , said : “ There is a need to put in place adequate capacity in health services like more health clinics with adequate staffing including nurses and doctors . “ We should also create a dedicated body to monitor cardiometabolic diseases and provide advice on reversing the worsening trends .”

Meanwhile , Consultant Physician and Endocrinologist Dr Shalini Sree Dharan said : “ We can create more diabetes onestop centres that can support our patients with the help they need at a cheaper cost as insulin needles , glucometers and strips which are more affordable .

“ Medications which have been proven effective in reducing diabetes-related complications should be reduced in price to make it more affordable to the majority .”

Parti Sosialis Malaysia ( PSM ) Chairman Dr Michael Jeyakumar agreed on the importance of scaling up the capacity of the nation ’ s healthcare system to deliver diabetes early intervention and comprehensive treatment .

“ The government must put more funds into healthcare by raising it to four per cent of GDP from the current 2.3 per cent .

“ Early interventions are important to save patients from suffering complications , which are often only partially reversible and lead to many

SOURCE : NHMS 2019

INSULIN is a critical drug that diabetic patients require continuous daily dosing .

The total insulin market is over RM200 million with about around four per cent compound annual growth rate ( CAGR ). Human insulin makes up about 56 per cent of that total , followed by insulin aspart and glargine .

Duopharma Biotech Berhad CEO ( Commercial ) Wan Amir-Jeffery Wan Abdul Majid shared : “ The human insulin market in Malaysia is primarily a government market and is supplied mainly by two players , Duopharma Biotech / Biocon and Novo Nordisk .

“ Duopharma is the exclusive marketing and distribution partner in the tripartite agreement signed with the MoH and Biocon , a manufacturer of insulins locally . After the expiry of the off-take agreement with the MoH in 2022 , we have managed to secure a new contract for another three years to supply to the MoH until 2025 .” Regarding the high cost of insulin , Wan Amir-Jeffery explained : " Innovator medications in particular , are generally more costly than generic or biosimilar options .

“ This is because innovator medications undergo rigorous research and development ( R & D ), clinical trials , marketing , education and knowledge sharing , etc ., on the products . These cost a lot of money . The innovator brands will charge a premium price during the patent protection period , which is about 20 to 25 years .

“ But , after the patent expires , other generic and biosimilar manufacturers , such as Duopharma Biotech and Biocon , can come into markets with their strengths and advantages .”

Biosimilars relate to a biopharmaceutical drug designed to have active properties similar to a previously licensed drug . Biosimilar drugs have established their bio-similarity and noninferiority to the reference biologic drug . Meanwhile , generic drugs contain identical medicinal ingredients to their reference products . They comprise small molecules that are chemically synthesised .

Generics and biosimilars help keep costs down to a certain degree . “ They are more affordable than innovator brand insulins .

President of the Malaysian Pharmacists Society ( MPS ), Prof Amrahi Buang , shared his support for cost-effective and safe alternatives .

“ Biosimilar alternatives allow more patients to use insulin in diabetes treatment . So , we should support biosimilars .”

He also emphasised the safety and efficacy of biosimilar insulins in the market .

According to Amrahi , the National Pharmaceutical Regulatory Agency ( NPRA ) safeguards the nation ’ s health by ensuring all medicinal products ’ quality , safety and efficacy . Therefore , registered biosimilar insulins are guaranteed to be safe and effective .