Diabetes no longer a disease of the old in Malaysia as experts call for new solutions
According to Malaysia’s National Health and Morbidity Survey (NHMS) – conducted every four years – the prevalence of diabetes increased from 11.2 per cent in 2011 to 13.4 percent in 2015 and to 18.3 per cent in 2019.

A restaurant worker preparing 'teh tarik' that contains sweetened milk and sugar. Health experts are worried about the rising prevalence diabetes in the country because of unhealthy diets and sedimentary lifestyles. (Photo: CNA/Fadza Ishak)
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KUALA LUMPUR: When R. Kumaran, 70, was diagnosed with diabetes about 35 years ago, he just shrugged it off.
He didn’t care much about his health and continued to indulge in several bad habits, including the consumption of aerated drinks such as Coca-Cola.
It was only in 2010 when a stent was inserted in his heart that he started to take his condition more seriously.
“I was young and adamant. I didn’t want to accept it. I ignored what the doctors told me and didn’t take care of myself,” he told CNA at his home in Kuala Lumpur.
By then, it was already late. Just three years later, he had to amputate his right leg after health complications.
These days, Mr Kumaran, who used to work in the insurance industry, prefers drinking warm water. He also measures the level of his blood sugar much more diligently as well as taking his two daily insulin jabs.
Mr Kumaran who uses a wheelchair is just one of the estimated 3.9 million people in Malaysia who are living with the disease.
This number does not include those who are believed to be suffering from the disease but have yet to be diagnosed.
According to Malaysia’s National Health and Morbidity Survey (NHMS) – conducted every four years – the prevalence of diabetes increased from 11.2 per cent in 2011 to 13.4 percent in 2015 and to 18.3 per cent in 2019. There are no newer numbers available publicly.
This means nearly one in every five adult Malaysians are diabetic.
According to the International Diabetes Federation, the prevalence of diabetes among adults in Singapore is 14.9 per cent in while Thailand has a prevalence rate of 11.6 per cent.
The increasing number of diabetics in the country is one reason the Health Ministry recently launched a campaign in Putrajaya to reduce sugar intake, one of several similar drives organised over the years, going back to the 1990s.
During the latest campaign launch on Sunday (Oct 29), Health Minister Dr Zaliha Mustafa said many studies have proven the connection between the overconsumption of sugar and the occurrence of various types of diseases including diabetes.
She added that the cost of treating diabetes alone was RM4.38 billion (US$920 million) a year in 2017, compared to RM2.04 billion in 2011.
“The increase in the number of patients will place a huge burden on the country’s economy and finances. This directly affects the level of productivity of the national workforce,” she said.
Several health experts told CNA that they foresee the prevalence of diabetes increasing in the future especially among the young, posing a major public health risk that could put more strain on the healthcare system of the country.
They said that there needs to be more focus on education and awareness campaigns about the disease as well as steps to deter consumption of sugary drinks, like Singapore’s move in requiring pre-packaged drinks to display labels showing their sugar content levels.

CAUSES AND EFFECTS OF DIABETES IN MALAYSIA
Diabetes occurs when the pancreas cannot produce insulin or when the body cannot use the insulin that is produced, resulting in an excess of blood glucose.
There are two types of diabetes – type one and type two.
In type one diabetes - also known as juvenile diabetes - the body can’t produce enough insulin it needs.
In type two diabetes, the excess blood glucose is usually a result of the inability of the body to respond fully to insulin or “insulin resistance”.
Dr Ikram Ismail, president of Diabetes Malaysia, said that of all the diabetes cases in Malaysia, about 95 per cent are type two diabetes, which is genetically determined but also dependent heavily on lifestyle factors such as diet and physical inactivity.
“People were more active before. They worked the fields, and they didn’t use the car so often. They were more active, and their diet was healthier,” he added.
“They didn’t eat so much fast food and because of that the diabetes appeared much later. We had people getting diabetes only when they are 60 while some might not even develop it during their lifetime.”
Dr Ikram, whose outfit aims to assist people with diabetes to lead healthy and productive lives, said symptoms of diabetes include frequent urination, blurred vision, slow-healing wounds, and unexplained weight loss.
Ants appearing in the toilet bowl are another sign of diabetes, but Dr Ikram said that at this stage, it might be too late.
He added that diabetes can result in major complications such as kidney and heart disease, stroke, blindness, and nerve damage, among others.
Severe cases of diabetes can result in amputations of legs or lead to patients requiring dialysis.
“Unfortunately, diabetes is very common in Malaysia these days. It’s increasing well beyond what we expected,” Dr Ikram told CNA.
The CEO of the National Kidney Foundation (NKF) Khor Xin Yun told CNA that diabetes is the biggest contributor to kidney failure in Malaysia.
She said that of the new patients that required dialysis in Malaysia last year, 52 per cent was due to diabetes.
“This has been the overall trend over the last 10 years,” she said, adding that dialysis treatment in a private setting can cost patients up to RM50,000 yearly.
She said that the number of new people requiring dialysis also has gone up from 6,700 people in 2012 to 9,600 people last year.

MORE DIABETIC YOUTH TAXING HEALTHCARE SYSTEM
Part-time property agent Siti Nazmalinda, 38, only realised she had diabetes three years ago when she fell sick and sought treatment from the clinic.
The mother of three children from age nine to 13 was diagnosed with the disease and her blood glucose reading was recorded at 27mmol/L.
A blood glucose level above 15mmol/L is considered to be too high while a normal non-fasting blood sugar level goes up to 7.8 mmol/L.
“The doctor told me that I was lucky to be able to walk into the clinic. He told me that most people with that reading would be unconscious,” she told CNA.
Worried about her condition especially as her children are still young, Mrs Siti has taken steps of controlling her food intake and exercising intensively.
Besides her insulin shots, she fasts intermittently and tries to walk at least 10,000 steps every day. Her weight had decreased from 90kg three years ago to about 73kg now.
Her blood glucose levels are still high at times, but at a much more manageable level now.
Besides social media groups where she shares her diabetes journey, Mrs Siti also gets motivation from her family and friends.
“Even my nine-year-old will ask me if I have achieved 10,000 steps a day. It helps when you have people supporting you on your journey,” she said.

While there are no exact numbers, health experts say they are seeing anecdotally more young diabetic patients like Ms Siti.
NKF’s CEO Madam Khor also noted how there has been an increase in those below age 45 requiring dialysis, making up 21.3 per cent of patients last year, up from 19 per cent in 2012.
She said that early detection and compliance to medication was important so that the disease could be managed, and to prevent the onset of kidney disease.
Public health expert Prof Dr Sharifa Ezat Wan Puteh of Universiti Kebangsaan Malaysia told CNA that diabetes was expected to be more of a burden to the healthcare system in the future.
Like the other health experts, she said that there were more youngsters who were diagnosed with non-communicable diseases (NCD) such as diabetes and cardiovascular diseases (CVD).
“Before, the recommended health screening was for those aged 40. But there might be a need to move this to the age of 30 because people are getting diabetic and hypertension at a much younger age,” she said.
Dr Sharifa said that the amount spent on treating diabetes – about 13 per cent of the Health Ministry’s budget - could have been better spent on other things.
“This figure is also just for diabetes and doesn’t include the other complications caused by diabetes such as kidney failure, CVD, and stroke. The effect of diabetes is manyfold, and all this cost is a burden to the government,” she said.
An Aug 2022 report on the direct health-care cost of NCDs by the Ministry of Health and the World Health Organisation (WHO) said the health and economic burden of NCDs can be expected to worsen over time.
“NCDs will continue to consume an increasing share of national health expenditure,” read the report which found that the total direct health-care costs of three selected NCD categories –diabetes, cardiovascular disease, and cancer - were estimated at RM 9.65 billion in 2017.
This is why early diagnosis and treatment are important, said Dr Ikram, adding that high blood sugar levels can cause serious damage to the organs, which is even more taxing on the young.
“With people getting diabetes at a much younger age – during their late teens and early 20s - it means they must live with the disease for a much longer period of their life, resulting in more complications and a lower quality of life,” he added.
Dr S. Inthirani, chairman of Diabetes Malaysia Kuala Lumpur told CNA that for every diagnosed case of diabetes, another goes undiagnosed.
She added that there are many misconceptions about diabetes such as that it only affects older people, and that one would not get it if one didn’t consume much sugar.
“People must realise that it is beyond just sugar but the amount of carbs one consumes.
“Many youngsters are more exposed because many eat out late after midnight while watching football matches in 24-hour Mamak shops. They come back and then sleep. That is an issue,” said Dr Inthinrani, a former clinician at a government clinic.
As for testing, Dr Inthirani who has set up a peer support group for patients of the disease said that one should not just rely on a fasting blood glucose test to find out if they have diabetes.
“You cannot just do a fasting blood sugar test and be happy about it. You should also measure yourself after eating to get a more accurate result,” she said, adding that the HbA1c and oral glucose tolerance tests are also useful to test for the disease.
HOW TO SLOW DOWN DIABETES
During the tabling of the 2024 budget on Oct 13, Prime Minister Anwar Ibrahim announced an increase in the excise duty on sugary premix drinks from 40 cents per litre to 50 cents per litre.
The excise duty had been introduced back in 2019.
“The revenue from this tax will be used to treat diabetes and support dialysis centres," Mr Anwar said.
But the Consumers Association of Penang (CAP) which has been organising “reduce sugar campaigns” among the public for decades told CNA that the 10-cent increase wasn’t enough and that it had hoped for a larger quantum increase.
“People will not feel the pinch with a 10 cent increase and they will just keep on paying for these drinks. The duty could have been increased by at least 50 cents,” said CAP president Mohideen Abdul Kadeer.
Mr Mohideen also told CNA that there was a need to remove the ceiling price of sugar sold domestically, which at a capped price of RM2.85 is one of the cheapest in the region.
“There are many factors that cause diabetes but sugar plays a main role,” he said.

Mr Mohideen also hoped that Malaysia would follow in the steps of Singapore that has mandated nutrition labels on sugary drinks.
In December last year, Singapore’s Ministry of Health announced that pre-packaged drinks such as soft drinks, juice and milk will be graded based on the sugar and saturated fat content in beverages.
The labels are colour-coded according to four categories, with category for instance D being the category with the highest sugar and fat thresholds.
The ministry also announced in August this year that food-and-beverage outlets will be required by end-2023 to include nutrition labels on their menus indicating drinks that contain higher levels of sugar and saturated fat.
These include freshly brewed drinks from coffee shops, freshly squeezed juices and bubble tea.
Dr Sharifa, the public health expert, also believed that the increased tax for sugary drinks was minimal and might not deter people from buying these drinks.
She pointed out that there was an influx of sweetened beverages in the market these days unlike before, and this also contributed to the onset of diabetes.
Dr Sharifa believed that the government needed to increase awareness of good eating habits and the importance of exercise among youngsters in schools.
Mr Kumaran agrees with Dr Sharifa and hopes that the Health Ministry and Education Ministry would work together to spread the message about healthy living.
“There must be awareness about this in schools. It is best to start them from a young age,” he said.