1) Diabetes is a growing problem in Malaysia, with prevalence increasing from 11.6% in 2006 to 15.2% currently, straining the healthcare system. 2) The Ministry of Health of Malaysia has implemented a National Strategic Plan for Non-Communicable Diseases from 2010-2014 to strengthen prevention, clinical management, and control of diabetes and obesity at both the national and community levels. 3) However, challenges remain in providing quality care for increasing diabetes patients, addressing undiagnosed cases, empowering patients, and coordinating multi-sectoral policies and regulations across government ministries.

1. Ministry of Health
Malaysia
Management of Diabetes in
Malaysia:
Issues & Challenges
Hilmi Yahaya
Deputy Minister of Health, Malaysia
International Diabetes Leadership Forum
15 November 2013
Istanbul, Turkey]

2. Population of Malaysia
• 2000: 23.3 mil
• 2010: 28.3 mil
• Life expectancy:
• Total pop : 70.83 (2000), 73.79 (2011).
• Male: 71.05
• Female: 76.73
• Average annual population growth
• 1996 to 2000: 2.65%
• 2000 to2010: 2.0%
• Fertility rate :
• 2000: 3%
• 2010: 2.6%
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3. Burden of Diabetes in Malaysia: Trends &
Projections by 2020 (Adults age 18 years and above)
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Sources: NHMS I (1986), NHMS II (1996), NHMS III (2006) and NHMS 2011

4. Seven Strategies:
1.
2.
3.
4.
National Strategic Plan for
Non-Communicable Diseases
(NSP-NCD) 2010-2014
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•
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•
Prevention and Promotion
Clinical Management
Increasing Patient Compliance
Action with NGOs, Professional
Bodies & Other Stakeholders
5. Monitoring, Research and
Surveillance
6. Capacity Building
7. Policy and Regulatory
interventions
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”.
Diabetes & obesity are used as the entry points.
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5. Strengthening Chronic Disease
Management at the primary care
level
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6. MANAGEMENT OF NCD (Including Diabetes):
7 BASIC PRINCIPLES TO BE INTRODUCED AT
THE COMMUNITY LEVELS (KOSPEN with
KEMAS)
1.
2.
3.
4.
5.
6.
7.
SCREENING
REGISTER
CLINICAL MANAGEMENT
COMPLICATIONS
REHABILITATION
DEFAULTER TRACING
SELFCARE – Patient’s empowerment
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7. Initiatives to Improve Clinical Outcome:
• The formation of Diabetes Team which consists of Diabetic Educator, Medical Officer,
Family Medicine Specialist (FMS), Nutritionist and Pharmacist in every clinic as
appropriate to their burden of diabetes patients.
• FMS or senior Medical Officer in the clinic to do regular audits on green book.
• Intensify and more frequent supervision especially by FMS of clinical staff to ensure
compliance to CPGs and related guidelines.
• Regular training and CMEs on diabetes care for all clinic staffs, and the state office to
monitor the numbers of training sessions conducted.
• Availability of module for health education for patients and a set of pre- and post-test
for patients, as published by Disease Control Division, MOH.
• The usage of the Diabetes Conversation Map.
• Further development of a Peer Support Group.
• Personalized care by Medical Officer in clinics with low to moderate burden of loads,
as appropriate in the individual clinic settings.
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8. National Diabetes
Registry
• Web-based application.
• Went live on 1 January 2011.
• Supports the implementation of the
annual “Diabetes Clinical Audit” and the
“Diabetes Quality Assurance Programme”
amongst Type 2 Diabetes patients in MOH
Health Clinics.
• First report, “NDR Report, Volume 1, 20092012” was published in August 2013,
available at the MOH website http://
www.moh.gov.my/v/NCDs.
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9. Challenges:
1. The prevalence of diabetes has increased 31.0% in 5 years,
from 11.6% in 2006 to the current 15.2%.
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Mostly contributed by increase of “undiagnosed”.
Increase in prevalence occurring across all age-groups.
2. Increasing challenge in providing satisfactory quality of care to
patients with diabetes.
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•
•
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.
Need to address “patient-related factors” i.e. patient
empowerment.
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10. Challenges for Malaysia
3. 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
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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.
For Malaysia, the establishment of the Cabinet Committee was
an important initial step to achieve the “whole-of-government
approach”.
The health sector needs to play a strong advocacy role.
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11. Thank you
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