Diabetes Epidemic in Malaysia
Feisul Idzwan Mustapha MBBS, MPH, AM(M)
Publ ic Heal th Special istDisease Control Divis ion, MOH
MYSIR 2013Prince Hotel, Kuala Lumpur27 September 2013
Ministry of Health Malaysia
Ministry of Health Malaysia
National Health and Morbidity Surveys (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
• National Household Sampling Frame made up of Enumeration Blocks (EBs) derived from the Population and Housing Census, Malaysia (2010)
• Multistage Random Sampling (28 strata)
2
Ministry of Health Malaysia
NHMS 2011 (Volume II, NCD risk factors)
• Full report published in January 2012.
• Pdf copy available from the Institute for Public Health (IKU).
• Fact sheet available at MOH website http://www.moh.gov.my/v/NCDs.
• Results were presented at the 15th NIH Scientific Meeting 2012.
• Powerpoints available at the Institute for Health Management (IHM) website http://www.ihm.moh.gov.my/index.php/en/power-point-presentation-15th-nih-scientific-meeting.
3
Ministry of Health Malaysia
4
NHMS III (2006) NHMS 20110
2
4
6
8
10
12
14
16
11.6
15.2
7 7.2
4.5
8.0
4.24.9
Prevalence of Diabetes, ≥18 years (2006 & 2011)
Total diabetesKnownUndiagnosedIFG
Pre
vale
nce
(%
)
Ministry of Health Malaysia
5
NHMS II (1996)
NHMS III (2006)
NHMS 20110
5
10
15
20
25
8.3
14.9
20.8
6.5
9.510.7
1.8
5.4
10.1
4.3
4.7
5.3
Prevalence of Diabetes, ≥30 years (1996, 2006 & 2011)
Total diabetesKnownUndiagnosedIFG
Pre
vale
nce
(%
)
Ministry of Health Malaysia
6
18-1
920
-24
25-2
930
-34
35-3
940
-44
45-4
950
-54
55-5
960
-64
65-6
970
-74
75+
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
0.00.8 0.8
2.6 3.4
7.69.1
15.1
17.9
23.1
25.5
20.319.4
2.14.1 4.5
6.8 7.5
10.011.4 11.6
13.7 13.1
11.010.1
12.5
2.1
4.9 5.3
9.410.9
17.6
20.6
26.7
31.6
36.2 36.6
30.331.9
4.1 3.54.4 5.2 5.5
4.66.2 6.1
5.14.3
5.74.7 5.1
Prevalence of Diabetes, ≥18 years, by age groups (2011)
KnownUndiagnosedTotal diabetesIFG
Age groups
Pre
vale
nce
(%
)
Ministry of Health Malaysia
7
18 -
19
20 -
24
25 -
29
30 -
34
35 -
39
40 -
44
45 -
49
50 -
54
55 -
59
60 -
64
65 -
69
70 -
740.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
2.94.1
6.4
9.810.7
13.1
18.2
16.1 15.3
2.0
2.03.1
4.96.4
10.3
15.0
20.8
24.426.1
24.522.8
2.14.9 5.3
9.410.9
17.6
20.6
26.7
31.6
36.2 36.6
30.3
Prevalence of Diabetes, ≥18 years, by age groups (1996, 2006 & 2011)
NHMS II (1996)NHMS III (2006)NHMS 2011
Age groups
Pre
vale
nce
(%
)
Ministry of Health Malaysia
8
Joho
r
Kedah
Kelan
tan
Mel
aka
Neger
i Sem
bila
n
Pahan
g
Penan
g
Perak
Perlis
Selan
gor
Teren
ggan
u
Sabah
& W
P Lab
uan
Saraw
ak
WP K
uala
Lum
pur
WP P
utra
jaya
0.0
5.0
10.0
15.0
20.0
25.0
30.0
13.4
22.5
19.7
17.1
22.0
16.715.0
16.2
24.8
16.5
11.6
9.0
12.311.3
8.8
Prevalence of Diabetes, ≥18 years, by States (2011)
Total
Known
Undiagnosed
IFG
Pre
vale
nce
(%
)
Ministry of Health Malaysia
9
MOH h
ealth
clin
ics
MOH h
ospi
tals
Privat
e cli
nics
Privat
e ho
spita
ls
Self-m
edica
teTCM
0
10
20
30
40
50
60 56
24.6
15
2.5 1.6 0.2
Usual Place of Treatment (2011)
Per
cen
tag
e
Ministry of Health Malaysia
How do we compare to our neighbouring countries?
10
Ministry of Health Malaysia
11
Overweight in adults, ASEAN region, 2010
Viet N
am
Cambo
dia
Lao
Mya
nmar
Indo
nesia
Philip
pine
s
Thaila
nd
Singa
pore
Mal
aysia
Japa
n0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
50.0
MaleFemale
Pre
vale
nce
%
Ministry of Health Malaysia
12
Obesity in adults, ASEAN region, 2010
Viet N
am
Cambo
dia
Lao
Mya
nmar
Indo
nesia
Philip
pine
s
Thaila
nd
Singa
pore
Mal
aysia
Japa
n0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
MaleFemale
Pre
vale
nce
%
Ministry of Health Malaysia
13Cam
bodia
Myanmar
Philippines
Indonesia
Thail
and
Singa
pore
Viet N
am
Malaysi
aJap
an0.0
2.0
4.0
6.0
8.0
10.0
12.0
MaleFemale
Prev
alen
ce %
High blood sugars in adults, ASEAN region, 2010
Ministry of Health Malaysia
Burden of Diabetes in Malaysia: Trends & Projections by 2020 (Adults age 18 years and above)
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 20200
5
10
15
20
25
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
Est. population, 2006 Est. population, 2011Prevalence projection, 2006 Prevalence projection, 2011
Year
Pre
vale
nce
(%
)
Est
imat
ed p
op
ula
tio
n
Current projection
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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.
• First report, “NDR Report, Volume 1, 2009-2012” was published in August 2013, available at the MOH website http://www.moh.gov.my/v/NCDs.
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Ministry of Health Malaysia
Number of Active Registered Patients; as of 31 July 2013
Negeri Bilangan pesakit aktifJohor 90,615Kedah 41,808Kelantan 26,345Melaka 35,331N.Sembilan 42,079Pahang 38,503Perak 67,414Perlis 12,714P.Pinang 38,387Sabah 11,340Sarawak 51,327Selangor 93,591Terengganu 18,550WPKL 28,385WP Labuan 717WP Putrajaya 2,141Malaysia 599,247
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Ministry of Health Malaysia
Glycaemic Control: Percentage of T2DM Patients with HbA1c <6.5%, 2009 to 2012
2009 2010 2011 2012Johor 14.0 18.3 14.4 17.5Kedah 8.5 12.8 12.3 15.8Kelantan 8.7 9.2 12.5 11.3Melaka 18.4 15.3 16.9 21.7Negeri Sembilan 13.9 19.6 17.8 19.7Pahang 13.4 19.9 13.4 15.1Perak 14.5 16.3 13.9 18.1Perlis 30.6 24.3 26.1 27.9Pulau Pinang 12.3 18.5 19.3 16.5Sabah 22.6 19.6 25.9 28.5Sarawak 7.8 3.6 6.4 7.0Selangor 15.8 25.2 15.1 18.4Terengganu 19.9 20.5 17.9 16.2WP Kuala Lumpur 12.6 27.9 17.9 24.3WP Labuan n.a. 30.8 23.1 53.5WP Putrajaya 15.6 26.2 15.1 29.6Malaysia 13.3 17.2 15.6 18.1
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Ministry of Health MalaysiaDiabetes Clinical Audit (2012)
Variable Targets Total no. of tests
Meeting target (%) Mean 95% CI
HbA1c < 6.5 % 99,823 23.7 8.1 8.1 - 8.1
BP : Systolic < 130 mmHg 121,751 47.6 135.5 135.4 - 135.6
BP: Diastolic < 80 mmHg 121,726 67.2 78.4 78.3 - 78.4
Blood pressure < 130 / 80 mmHg 121,698 40.9
Total cholesterol < 4.5 mmol/l 101,286 28.5 5.2 5.2 - 5.2
TG ≤ 1.7 mmol/l 101,008 60.6 1.8 1.8 - 1.8HDL ≥ 1.1 mmol/l 76,214 65.5 1.3 1.3 - 1.3LDL ≤ 2.6 mmol/l 75,734 37.8 3.1 3.1 - 3.1
BMI < 23 kg/m2 108,559 16.6 27.4 27.3 - 27.4
Waist circumference
< 90 cm (Male) 35,520 33.6 94.0 93.9 - 94.1< 80 cm (Female) 55,493 14.4 90.7 90.6 - 90.8
Total: 130,340 Patients
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Ministry of Health Malaysia
Anti-Diabetics 2009 2010 2011 2012
Metformin 81.7% 85.7% 82.3% 82.2%
Sulphonylureas 65.2% 62.9% 59.5% 56.6%
Alpha-glucosidase inhibitors
4.7% 5.9% 6.5% 4.8%
Insulin 12.0% 11.9% 17.1% 21.3%
Monotherapy (OHA) 33.6% 34.1% 27.8% 27.3%
>= 2 OHA 51.1% 51.7% 48.7% 45.5%
OHA + insulin 8.8% 8.9% 13.2% 16.2%
Diet only 3.4% 2.3% 6.4% 5.9%
Diabetes Clinical Audit(2009-2012)
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Ministry of Health MalaysiaSummary
• The prevalence of diabetes has increased 31.0% in 5 years, from 11.6% in 2006 to the current 15.2%.
• Mostly contributed by increase of “undiagnosed”.• Increase in prevalence occurring across all age-groups.
• Increasing challenge in providing satisfactory quality of care to patients with diabetes.
• Number of patients in MOH health clinics will continue to increase.
• Referrals for specialists management will also continue to increase due to late diagnosis and sub-optimal control.
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Ministry of Health Malaysia
Thank you
Facebook: Feisul Mustapha
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