Malaysia is a developing country that is actively and rapidly growing in terms of technology, human

resources, health and education systems. . Malaysia by now is moving towards becoming a mordern

country by 2020. A lot of efforts and plans have been executed by the Malaysian Government to make

this vision a reality. Among the plans is the ETP which has been introduces in 2010 (Ministry of

Prime Minister 2013). There are few productivity aspects in the programme and one of them is the

health care. There are several areas of success in the program, among them is the health care.

Talking about health issue, among the challenges are to mantain the health level of Malaysians and to

produce healthy Malaysians by 2020. As one of the developing countries, a lot of challenges need to

be taken care by the government. One of them is the increasing number of diabetics. Diabetes

Mellitus describes a group of matabolic disease ( Nancy Haley et.al 2014). It is a major global public

health, the fastest growing public health problems in both developing and developed countries. In

Malaysia, more developed state like Selangor and Penang are recorded with the highest diabetes

patients by Malaysian Diabetes Association (2007). Based on the audit conducted by the Ministry of

Health Malaysia in 2009 (Diabetes Registry Malaysia, 2009), a total of 70 889 patients with diabetes

mellitus type two (T2DM) has been registered in the Diabetes Registry Malaysia (DRM). And based

on the upward trend, it is expected that incidence of diabetes in Malaysia will continue to increase

each year. What is diabetes? Diabetes is also known as a disease of the endocrine system. According

to Hu and Toumehlito (2007), diabetes is the disease growing among developed countries. Mariana.K

and Maria Kanakari ( 2012) also assumed that diabetes mellitus is an enormous public health

problem globally and also mentioned that this disease associated with morbidity and mortality. Nancy

Haley et.al (2014) reported that by now, almost 171 milions world populations have been diagnosed

with diabetes and the number will probably become double by 2030. Nancy Haley et.al (2014) also

found out that 25.8 milion of American population have been diagnosed with the same threat. Harati

et. al (2010) found that the majority of developing countries, particularly in Asia is expected to face

an increasing risk of them suffering from diabetes. Demographically through studying done by

Alberti et.al (2007) found that each population surveyed are suffering from diabetes type two. The

study also identified that there is evidence in the event that if there are no preventive measures, the

potential increase in global diabetes will increase. According to Nancy Haley et.al (2014) diabetes

mellitus decribes a group of metabolic disease characterized by elevated blood glucose or

hyperglicemia.

What are the factors that contribute to the increament of diabetes patients in Malaysia? And what are

the actions taken by the government to overcome the situation ? Among the factors contributing to

the increament of diabetic cases that I have identified are their diet, lifestyle, outer and inner factor

and also hereditary and age. My opinion is supported by the DiabetesMellitus-information.com

(2012), through the website I identified a few key factors that have contributed to the increase in

diabetes. Among the key factor, five factors are lifestyle, eating habits or diet, environmental factors

and external factors age and heredity. Among the five factors, the main factor identified is the

lifestyle. Unhealthy lifestyle such as lack of exercise and consumption of food that contains high level

of carbohidrate are the highest contributers to diabetes. Hu and Tuomehlito (2007) and Cockram (200)

also agree that lifestyle factors are one of the leading causes of diabetes, especially diabetes mellitus

type two. A sudden change of lifestyle can lead to a continuous increase in the incidence of diabetes

in line with the socio-economic development by Ramachandran et al (2012) . For example in the

when people are living in urban area, they are too busy with their daily activity . There is no time to

prepare food when they are back at home, that leads to fast food or instant food as the last choice that

is well known as food that contain high carbohydrates that cause incresing sugar level if taken

overload. Ministry of Malaysia Statistic ( 2014 ) had assumes in HIS report 2012 that household

income in Malaysia was increased from RM 4024 in 2009 to RM 5000 in 2012. In other words, this is

another factor why people in Malaysia have changes in lifestyles. Based on pervious studies, poor

diet gave a major impact on the risk of developing Type 2 diabetes. For those who work in the office,

usually only the premises have rest rooms, most workers are not keen to relax in a place like that for

lunch. They prefer to eat outside the office as fast food restaurants provide the convenient. The

situation is greatly influenced by their ability to spend. This is supported by household spending

report issued by the department of statistics of 2009/10 (Ministry of Statistic Malaysia, 2009/10). In

the report, majority of consumers in Malaysia spent an average of 13 per cent or RM 444 to RM 393

in the year 1993/1994.

According to Malaysian Diabetes Association report in 2007, risk of suffering from diabetes also

occurs among those who are old age hence the prevalence of diabetes. In the age of ever-increasing,

particularly for those aged, some of them have difficulty in physical activity. Reduced of activity and

consumption on more than usual can lead to diabetes in old age. This is because the reduction in

physical activity will result in less carbohydrate metabolism activity. This in turn became one of the

contributors to the incidence of diabetes in the elderly. Peter Schwandt ( 2012) found that survey done

in china in 1974, less than one in 150 Chinese citizens had develop diabetes and recent survey

indicate more than 10-fold increase resulting in 1 in 10 Chinese citizens and 1 in 5 among those aged

60 and older. One factor that cause to inactivity in old age is because of their health condition. Old

age people suffer from musculoskeletal disease such like arthritis and osteoperosis . This condition

has influenced on their physical activity, it is very difficult for them to do regular exercise .

Environment factors and external factors is also the factor can cause diabetes mellitus. According to

DiabetesMellitus-information.com (2012) have found for those who take steroids for treatment and

additional supplements, may experience a disruption in the production of hormones, including insulin

which helps in controlling blood sugar. In addition, factors hormonal changes can also cause diabetes.

Nancy et.al (2014) found in his research trend of increasing diabetes now occur among teenagers. For

example, in the 1980s, the disease is rare in teenagers, but by 3600 cases detected between 2002 and

2005, which is associated with hormonal changes. Heredity is another factor that can not be avoided

in diabetes. For example, if in a family, if the parent has been diagnosed with diabetes, according to a

study that was done previously found the opportunity for their children to have diabetes is very high

especially mellitus type two diabetes. This statement is proven by website DiabetesMellitus-

information.com (2012) which stated that diabetes linked with hereditary is vey high .

Diabetes is a chronic disease that involved every aspect of health (Jackson and Barber, 2010) . As we

all know, diabetes is a chronic disease of the growing threat to human life. Indirectly, this will have a

significant impact on those diagnosed with the disease. For those with diabetes, they are faced with

two possibilities of short-term complications and long-term. Complications of diabetic ketoacidosis

and hypoglycaemia usually occur in short team while long term complications of diabetes mellitus are

arteriosclerosis, stroke ,diabetic retinopathy, heart disease and other complications. Diabetes is also

associated with complications failure of various organs such as the eyes, kidneys and nerves.

According to the American Diabetes Association (2004) found that diabetes complications are a major

cause of morbidity and mortality in the United States.

Common long-term complications of diabetes and the leading cause of blindness is diabetic

retinopathy. In diabetic retinopathy, the small blood vessels that supply blood in the retina are

damaged which can cause bleeding in the retina. Jackson and Barber (2010) also noted in his study

that showed the leading causes of blindness in people with diabetes is diabetic retinopathy. And

according to a survey conducted by the Malaysian Diabetes Association in 2007, concluded that the

findings of a survey conducted showed that 50.6% among peaskit diabetes have vision problems.

Review Pompei (2006) also found the leading cause of blindness cases among adults aged 20 to 74

years are due to complications from diabetes.

In addition, coronary heart disease is another complication that often happens to diabetics. American

Diabetes Association (2004 ) through a survey that was conducted , showing that individuals with

type 2 diabetes have a higher risk of coronary heart disease. Alberti et al (2007) also supports

previous research and stating that about 75-80 % of people with diabetes die of cardiovascular

disease. His study also found that those diagnosed with diabetes at risk of developing type two

termasukklah complications of cardiovascular disease.

In addition, kidney function is also affected by factors of diabetes. The statement also called diabetes

nefropati.Berdasarkan Pompei (2006 ) states that the main organs of the human body , namely the

kidneys are also commonly affected by diabetes. In diabetic nephropathy , kidney breakdown will

cause the protein from the blood into the urine . Malaysian Diabetes Association ( 2007 ) indicates

that it is estimated that about 10 % of cases of diabetes will get kidney disease.

According to the American Diabetes Association (2004) cited that around the world, diabetes is one

of the most expensive chronic diseases and the burden is increasing in epidemic proportions. Diabetes

is now not only will affect not only the increased cost to the patient but also to the nation. Financial

resources are not only used for the purpose of prevention and health promotion, but also used for the

purchase of medicines and management of complications of diabetes. Schwandt P (2012) also

support by found that thirteen percent of China’s health expenditure it about US $25 Bilion to be

attributable to diabetes. Ng et al (2001) revealed that in 1997 it is estimated that diabetes accounted

for USD 27 billion in direct medical costs and USD 32 billion in indirect or lost-productivity costs.

From this we know that diabetes mellitus really cost a lot to the government. Based on a study

conducted by Hernan et.al (2003), generally costs associated with diabetes are divided into two

categories: direct and indirect costs kos. For the direct costs, they are paid by the operator of the

health system. This indirectly caused the government to bear the burden of high diabetes to treat

patients. According to a report released by the Ministry of Health Malaysia (Health Fact, 2013), found

that an amount of RM 19,277,189 million has been allocated to the Ministry for operating expenses

and development.

Diabetes mellitus is growing worldwide, but it is stilll an underestimed health threat comprising about

366 million people worldwide. According to Schwandt P (2012), by 2030 this number is estimated to

reach 552 miilion in both develop and devlopin country. Due to the increasing number of patient

suffer from diabetes mellitus in Malaysia, the Ministry of Health Malaysia by units under its

management should strive to identify strategies to control the rise in cases of diabetes in Malaysia.

Through a survey by Fox (2010) found an increased incidence of diabetes in Canada has led body

responsible for regulating health care system is there to implement various plans and strategies. As in

Canada, in Malaysia, for example, through the Ministry of Health Malaysia under the agency of the

Malaysian Diabetes Association is the body that are directly involved in the programs of prevention

and control of diabetes. To control growing incidence of diabetes mellitus, lifestyle modification and

medication are the two major approaches that can be used. In addition, to ensure that relevant

information is always updating diabetes, Diabetes Registry Malaysia was established by the ministry

of health malaysia to ensure that the information and the latest statistics of diabetes in Malaysia.

In spite of the variety of activities and programs undertaken by governments in an attempt to reduce

the rate of increase in diabetes cases in Malaysia, but the number of people with diabetes in Malaysia

continues to grow. Based on the audit report carried out by the ministry of health malaysia (Diabetes

Registry Malaysia, 2009), a total of 72 742 patients were enrolled in Peninsular Malaysia. These

statistics do not include people with diabetes registered in Sabah and Sarawak. Therefore, evaluation

of programs that have been implemented previously to evaluate and identify the existing weaknesses.

The assessment should be made to ensure that the incidence of diabetes in Malaysia continues to

grow. The introduction of new programs should involve all parties, including the public so that people

are aware of the dangers of diabetes and its effects. Of the factors we have discussed previously,

changes in lifestyle factors are encouraging factors of diabetes in Malaysia. Therefore programs

should be emphasis on the introduction of a healthy lifestyle. Through Harati et al (2010) and the

American Diabetes Association (2004, p.50) also states that in order to reduce the incidence of

diabetes, lifestyle changes to be implemented. This includes doing a variety of healthy activities like

exercise and aerobics.

Lifestyle changes are associated with an increased diabetes. These factors associated with physical

activity. For those who do a lot of physical activities such as exercise and so on, it will indirectly

affect their BMI. Based on a study by Jason MR et.al (2008) found that those who are obese with a

BMI over 35 are at risk of suffering from diabetes compared to those with BMI less than 23.

Consequently, the activity of doing physical exercise and aerobics are much in control activities and

diabetes prevention. For those suffering from diabetes, the activity of exercise should be done

regularly. This statement is also supported by Jason MR (2008) which states that physical activity can

control diabetes, particularly type 2 or TD2M. For people with diabetes, changing your lifestyle

available to a more healthy is a challenge that must be faced in order to ensure their health are always

in a good situation. At the same time for those who are healthy and free of diabetes, practicing a

healthy lifestyle should be continued, both should make sure to perform the intake of healthy and

balanced. This is because one practice a healthy lifestyle is taking a well-balanced meal. According to

a study by Alberti et.al (2007), unbalanced food intake causes obesity and as we know obesity is one

of the causative factors of diabetes in the world.

Other aspect that is useful in prevention and control of diabetes mellitus is health education.

Mariana.K and Maria Kanakari(2012) also express that education is very related with diabetes. With

the education, it can improved the knowledge on diabetes among the patient also among the public.

Health promotion unit is one of the init under the ministry of health that play a role in creating

awareness and health education to the public. However, the cooperation of other government agencies

eg schools and centers of higher education are also able to assist in such efforts. This is important to

ensure understanding of diabetes can be started earlier. This opinion is supported by studies Nancy

et.al (2014) also argues that early education about diabetes should be implemented earlier. As a result

of health education programs are implemented, the understanding of diabetes among patients and the

public will continue to grow. This opinion is also supported by Pompei (2006, p. 43) cited that

‘patients should improved their understanding of disease including treatment and management.

Schwarz P et.al ( 2007) cited educated patients can positively affect the outcome of disease like

diabetes. At the same time, to ensure that the planning of diabetes prevention and control program is

successful, the Ministry should ensure that all staff involved have the skills and in-depth

understanding of the proceedings of diabetes and related matters. For those involved, intensive

courses or short term also can improve their knowledge. Pompei (2006 ) mentioned that healthcare

providers should remain up to date with latest information or issue in management of chronic

disease).

In a nutshell, instant health campaign and health promotion done for contolling of diabetes mellitus,

cooperation between health care providers with patients and awareness among people is the important

element to be successful in prevention of diabetes mellitus in worldwide. With the cooperation of the

various stakeholders in the success of activities related to the control and prevention of diabetes, the

incidence of diabetes in Malaysia can reduce. At the same time the government, through the Ministry

of Health to reassess its effectiveness programs undertaken previously and also to introduce new

programs that suit the current situation. Moreover, by creating many recreation centers as a

recreational area that can be used for exercise and aerobics activities and sports should be increased.

The move to create the facility will be able to encourage people to do sports and recreational activities

and so as a first step in controlling the increase in cases of diabetes in Malaysia. When the number of

cases of diabetes can be reduced indirectly will reduce government spending in dealing with cases of

diabetes in Malaysia. Financial resources of the program we can use to perform other activities for

diabetes prevention program. To keep people healthy, more study should be carried out to find out a

better way to reduce diabetes prevalence and to prevent diabetes in the future. This study can be

implemented by the ministry of health through clinical research center (CRC) in any information or

data obtained can be used to improve diabetes prevention and control activities in Malaysia and

throughout the world in general.