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The Future of Diabetes
in Malaysia
Dato Sri Dr Hasan Abdul Rahman
Director General of Health, Malaysia Keynote Address Malaysian
Diabetes Educators Society Seminar 2012 Subang Jaya, Selangor 20
April 2012 [email protected]
Ministry of Health
Malaysia
Ministry of Health
Malaysia
National Health and
Morbidity Surveys
Also known as NHMS
Population-based survey conducted by MOH
NHMS I (1986), NHMS II (1996) & NHMS III (2006)
Latest NHMS 2011
For NCD risk factors, now conducted every 4 years
Based on WHO STEPwise Methodology
Sampling Frame:
National Household Sampling Frame made up of Enumeration Blocks
(EBs) derived from the Population and
Housing Census, Malaysia (2010)
Sampling Design:
Multistage Random Sampling (28 strata)
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Ministry of Health
Malaysia NHMS 2011: Diabetes
3
11.6
15.2
7.0 7.2
4.5
8.0
4.2
4.9
0
2
4
6
8
10
12
14
16
NHMS III (2006) NHMS 2011
Pre
vale
nce (
%)
Prevalence of Diabetes, 18 years
Total diabetes
Known
Undiagnosed
IFG
Ministry of Health
Malaysia NHMS 2011: Diabetes
4
0.0 0.8 0.8
2.6 3.4
7.6 9.1
15.1
17.9
23.1
25.5
20.3 19.4
2.1
4.1 4.5
6.8 7.5
10.0 11.4 11.6
13.7 13.1
11.0 10.1
12.5
2.1
4.9 5.3
9.4 10.9
17.6
20.6
26.7
31.6
36.2 36.6
30.3 31.9
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
Pre
vale
nce (
%)
Age groups
Prevalence of Diabetes, 18 years, by age groups
Known
Undiagnosed
Total diabetes
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Ministry of Health
Malaysia
Burden of Diabetes in Malaysia:
Trends & Projections by 2020
(Adults age 18 years and above)
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
3,500,000
4,000,000
4,500,000
5,000,000
0
5
10
15
20
25
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
2019 2020
Esti
mate
d p
op
ula
tio
n
Pre
vale
nce (
%)
Year
Est. population, 2006 Est. population, 2011 Prevalence
projection, 2006 Prevalence projection, 2011
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Ministry of Health
Malaysia
Deaths in MOH Hospitals due to
Circulatory Diseases & Cancer:
Projections by 2020
y = 605.97x + 8657.9 R = 0.9027
y = 305.31x + 3776.1 R = 0.9542
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
20,000
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
2018 2019 2020
Circulatory diseases Malignant neoplasms Projected, Circulatory
diseases Projected, Cancer
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Ministry of Health
Malaysia
Primary Renal Diseases:
Projections by 2020
y = 314.5x + 1735.7 R = 0.9634
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
New dialysis patients
New dialysis patients Projected new dialysis patients
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Ministry of Health
Malaysia National Diabetes Registry
Web-based application
Went live on 1 January 2011
Supports the implementation of the annual Diabetes Clinical
Audit amongst Type 2 Diabetes patients in MOH Health Clinics
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Ministry of Health
Malaysia
NDR Patients registered (Active patients; as of 18 April
2012)
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States Returns
Coverage of registration (Active patients)
NDR % Coverage
Johor 81,013 77,351 95.5
Kedah 77,931 30,093 38.6
Kelantan 24,774 22,459 90.7
Melaka 31,427 34,433 109.6
Negeri Sembilan 39,393 44,056 111.8
Pahang 43,871 36,505 83.2
Perak 68,372 60,101 87.9
Perlis 10,338 9,082 87.9
Pulau Pinang 31,895 39,260 123.1
Sabah 9,205 10,162 110.4
Sarawak 64,848 40,510 62.5
Selangor 104,137 90,953 87.3
Terengganu 16,944 18,701 110.4
WP Kuala Lumpur 23,728 29,773 125.5
WP Labuan 535 594 111.0
Malaysia 628,411 544,033 86.6
Ministry of Health
Malaysia Diabetes Clinical Audit (2011)
Variable Targets Total no. of
tests Meeting
target (%) Mean 95% CI
HbA1c < 6.5 % 53,149 22.5 8.2 8.2 - 8.2
BP : Systolic < 130 mmHg 70,356 49.0 135.4 135.3 - 135.5
BP: Diastolic < 80 mmHg 70,344 66.5 78.9 78.9 - 79.0
Blood pressure < 130 / 80 mmHg 70,328 42.0
Total cholesterol < 4.5 mmol/l 55,591 26.4 5.2 5.2 - 5.2
TG 1.7 mmol/l 55,140 58.8 1.9 1.9 - 1.9
HDL 1.1 mmol/l 38,348 65.9 1.3 1.3 - 1.3
LDL 2.6 mmol/l 37,707 34.6 3.2 3.1 - 3.2
BMI < 23 kg/m2 61,544 16.3 27.4 27.4 - 27.5
Waist
circumference < 90 cm (Male) 19,761 35.0 93.7 93.5 - 93.8
< 80 cm (Female) 32,131 15.2 90.4 90.3 - 90.5
Total: 75,411 Patients
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Ministry of Health
Malaysia
Anti-Diabetics 2009 2010 2011
Metformin 81.7% 85.7% 82.3%
Sulphonylureas 65.2% 62.9% 59.5%
Alpha-glucosidase
inhibitors 4.7% 5.9% 6.5%
Insulin 12.0% 11.9% 17.1%
Monotherapy (OHA) 33.6% 34.1% 27.8%
>= 2 OHA 51.1% 51.7% 48.7%
OHA + insulin 8.8% 8.9% 13.2%
Diet only 3.4% 2.3% 6.4%
Diabetes Clinical Audit
(2009-2011)
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Ministry of Health
Malaysia Main Issues for Malaysia
Increasing prevalence of
diabetes
Unsatisfactory quality of care
High numbers of
undiagnosed
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Ministry of Health
Malaysia
Response at the Global level
UN Resolution A/66/L.1: Political Declaration of the
High-level
Meeting of the General Assembly on the Prevention and
Control of Non-Communicable Disease
19 September 2011, New York
Malaysia is signatory to
this declaration
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Ministry of Health
Malaysia
UN
P
olitical D
eclaration:
Com
mitm
ent of governm
ents
Commitment of government
National leadership & ownership Early
diagnosis & treatment
Prevention
Health system
strengthening
Research & development
Resourcing
Global development
agenda
Collaborative partnerships with NGOs
Monitoring &
evaluation
Follow-up
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Ministry of Health
Malaysia
National Strategic Plan for Non-Communicable Diseases (NSP-NCD)
2010-2014
Presented and approved by the Cabinet on 17
December 2010
Provides the framework for strengthening NCD
prevention & control program in Malaysia
Adopts the whole-of-government and whole-
of-society approach
Seven Strategies: 1. Prevention and Promotion
2. Clinical Management
3. Increasing Patient
Compliance
4. Action with NGOs,
Professional Bodies & Other
Stakeholders
5. Monitoring, Research and
Surveillance
6. Capacity Building
7. Policy and Regulatory
interventions
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Ministry of Health
Malaysia
Cabinet Committee for A Health
Promoting Environment
To support the implementation of NSP-NCD, the Cabinet on 17
December
2010 approved the establishment of a Cabinet-level committee,
chaired by
the Right Honourable Deputy Prime Minister, and comprises of 10
members
1. Minister of Health 2. Minister of Education
3. Minister of Information, Communications, Arts & Culture
4. Minister of Rural & Regional Development
5. Minister of Agriculture and Agro-based Industry 6. Minister
of Youth & Sports
7. Minister of Human Resource 8. Minister of Domestic Trade,
Co-operatives and Consumerism
9. Minister of Housing and Local Governments
10. Minister of Women, Family and Social Affairs
Main TOR: To determine policies that creates a living
environment which supports positive behavioural changes of the
population towards healthy eating and active living
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Ministry of Health
Malaysia
Policy & Regulatory
Interventions
Guideline on Marketing of food and beverages to children
Involvement of industries
Healthy eating environment in schools
New guideline on school canteen food & beverages Banning of
sale of food & beverages by mobile vendors
outside of school perimeters
Commitment of industries
Decrease the salt , sugar and fat content in food and
beverages
Improvement of food labels
17 Continued..
Ministry of Health
Malaysia
Policy & Regulatory
Interventions
Health-promoting workplaces in the public sector
Healthy menus during meetings Healthy vending machines
Anti-obesity Law, year 2020
Looking at Japan as an example
Salt reduction Strategy for Malaysia
Formalising and strengthening current efforts in Malaysia
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Ministry of Health
Malaysia
Multi-disciplinary care team (in health
clinics)
Post-basic training for paramedics
Clinical practice guidelines
Quality improvement
programs
Clinical information
systems
Patient resource centres
1Malaysia clinics
Strengthening Chronic Disease
Management at the primary
care level
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Ministry of Health
Malaysia
Recognising & Addressing the
Complexities of Diabetes
Management
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Diabetes Patients
Glycaemic targets
Other Metabolic
targets
Newer & better
medications
Improved glucose testing
equipment
Interactions with Mental
Health
Greater complexity of
nutrition
Still human & susceptible
to usual non-
diabetic
conditions
such as flu or
cancers
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Ministry of Health
Malaysia Diabetes Educators
Healthcare professionals who focus on helping people with
diabetes achieve behavioural change goals
Highly skilled professional, integral to the multi-disciplinary
diabetes care teams
Possess the skills and competencies to provide education about
diabetes self-management to other health care providers
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Ministry of Health
Malaysia
Empowering patients for
more than good self-care
Empowerment is an important approach to diabetes self
management.
But we should also help them speak out about important issues
that could
affect the health of others.
It has worked for the HIV community before.
The voice of the people can influence policy-makers particularly
those
outside of the health sector and
politicians.
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People with diabetes and
their families have a right
to speak out, not only for
their own health, but for
that of their community.
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Ministry of Health
Malaysia
Accepting and Embracing
Globalisation
Globalisation is inevitable especially for a developing country
such as
Malaysia.
Unfortunately, with globalisation, we are also importing the
unhealthy NCD risk factors from the western developed
countries unhealthy foods, physically inactive lifestyles.
We are part of an ever-shrinking world.
We need to think about more than our own workplace, city, state
or even
country
There is much we can learn from other countries regarding
approaches to
diabetes prevention and control.
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Ministry of Health
Malaysia Challenges
The main challenge in policy and regulatory interventions remain
that they are mostly under the responsibilities of
ministries and departments other than Ministry of Health
Ministry of Health needs to take leadership role.
Need to find a win-win solution mutuality of interest.
Economic and political consideration remains paramount and needs
to be acknowledged.
We have taken the initial small steps to achieve the
whole-of-government approach; but much still needs to be done.
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Ministry of Health
Malaysia
Thank you
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