Experts call for improvement in diabetes, cardiovascular care

The recent National Health and Morbidity Survey (NHMS) 2019 revealed diabetes is on the uptrend, with about 18.3 percent of persons above the age of 18 being diagnosed with type 2 diabetes. This amounts to about 3.9 million persons living with diabetes in the country.

In comparison the diabetes rate was only 13.4 percent in 2015. This increase is worrying as earlier projections by the International Diabetes Federation indicated a diabetes prevalence of 18.7 percent in 2045. “We have achieved the IDF projections for diabetes prevalence 25 years in advance. This is nothing to be proud of,” said Dr Chan Siew Pheng, a consultant endocrinologist.

Amongst the contributing factors to this increase is that many Malaysian adults are either overweight or obese. Chan said the NHMS 2019 revealed that half of Malaysians have central obesity. Looking closer at this figure, the biggest contributors to this demographic are women (64.8 percent have central obesity) of which 68.3 percent are of Indian ethnicity. [Available at http://www.iku.gov.my/nhms/ Accessed on 5 October] The rise in obesity and noncommunicable disease can be attributed to unhealthy lifestyle such as having a poor diet, being physically inactive, and lack of preventive action.

It is well established that diabetes can also lead to a host of critical complications that can impair a person’s quality of life. These include microvascular (retinopathy, kidney disease) and macrovascular (cardiovascular disease and lower limb amputation) complications.

Diabetes and heart disease are closely linked—patients with poorly controlled blood glucose levels will develop plaque build-ups that leads to atherosclerosis of the coronary vessels with the end result being heart attack and possible death. Dato’ Sri Dr Azhari Rosman, senior consultant cardiologist, National Heart Institute (IJN), said: “A person who is suffering from diabetes, is more likely to develop cardiovascular disease early if not managed well. It is important for the patient to seek help as statistics show that cardiovascular diseases are responsible for up to 80 percent of deaths among Malaysian patients. This is becoming a serious issue as we are now seeing more patients being diagnosed with diabetes and cardiovascular disease at a younger age.”

Thus, the answer to reducing diabetes-linked heart disease lies in prevention as it is a key aspect to reducing the disease burden. Chan noted that these diabetes-related complications can be prevented with proper management by improving glucose, blood pressure and lipid control; by living a healthier lifestyle, exercising regularly, monitoring blood glucose levels, and taking prescribed medication where appropriate.

“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,” said Chan. 

Chan noted that just 5 years ago, the main goal of treatment was to ensure a patient had good glycaemic control. However, with the therapeutic options available to her, she can now ensure that a patient’s glucose levels are brought down safely, with consideration for target organ protection (heart and kidneys).

Both Azhari and Chan were speaking at a diabetes and cardiovascular awareness workshop organized by Novo Nordisk in Kuala Lumpur recently. Also present was Richard Abela, vice president and general manager (Malaysia, Singapore and Brunei), Novo Nordisk Pharma (M) Sdn Bhd.