Paper based mainly on NHMS 2011 and the NDR

1. Ministry of Health
Malaysia
Current Burden of Diabetes
in Malaysia
Feisul Idzwan Mustapha MBBS, MPH, AM(M)
Public Health Physician, NCD Section, Disease Control Division
Ministry of Health, Malaysia
National Oral Health Research Conference 2014
11 November 2014
Kuala Lumpur
dr.feisul@moh.gov.my

2. Proportional mortality, Malaysia
(% of total deaths, all ages, both sexes)
2

3. Premature mortality due to NCDs,
Malaysia
3
The probability of dying between ages 30 and 70 years
from the 4 main NCDs is 20%

4. DALYs attributable to risk factors
4
Poor Water & Sanitation
Underweight
Physical Inactivity
Alcohol
High Cholesterol
High BMI
Diabetes Mellitus
10.7%
10.8%
8.3%
9.0%
3.1%
4.3%
5.2%
0.1%
0.7%
12.1%
10.8%
0.1%
0.7%
11.4%
5.1%
0.9%
4.3%
0.7%
Tobacco
High BP
15.0% 10.0% 5.0% 0.0% 5.0% 10.0% 15.0%
Male Female
Burden of Disease Study Malaysia, slide courtesy of Dr Mohd. Azahadi Omar, Institute for Public Health

5. Deaths attributable to risk factors
Poor Water & Sanitation
Underweight
Alcohol
Physical Inactivity
High BMI
High Cholesterol
Diabetes Mellitus
19.4%
15.7%
7.0%
7.3%
8.5%
5.0%
2.3%
0.1%
0.2%
22.8%
0.1%
0.2%
1.2%
7.1%
8.2%
8.1%
9.1%
0.3%
Tobacco
High BP
25% 20% 15% 10% 5% 0% 5% 10% 15% 20% 25%
Male Female
Burden of Disease Study Malaysia, slide courtesy of Dr Mohd. Azahadi Omar, Institute for Public Health
5

6. 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/index.php/pages/view/
115
• 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/pow
er-point-presentation-15th-nih-scientific-meeting.
6

7. 7
11.6
15.2
8.0
7.0 7.2
4.5
4.2
4.9
16
14
12
10
8
6
4
2
0
NHMS III (2006) NHMS 2011
Prevalence (%)
Prevalence of Diabetes, ≥18 years
(2006 & 2011)
Total diabetes
Known
Undiagnosed
IFG

8. 8
0.0
Prevalence of Diabetes, ≥18 years,
0.8 0.8
2.6
by age groups (2011)
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
4.9 5.3
9.4
10.9
17.6
20.6
26.7
31.6
36.2 36.6
30.3
31.9
4.1 3.5
4.4
5.2 5.5
4.6
6.2 6.1
5.1
4.3
5.7
4.7 5.1
40.0
35.0
30.0
25.0
20.0
15.0
10.0
5.0
0.0
Prevalence (%)
Age groups
Known
Undiagnosed
Total diabetes
IFG

9. 9
Prevalence of Diabetes, ≥18 years,
by age groups (1996, 2006 & 2011)
2.9
4.1
6.4
9.8
10.7
13.1
18.2
16.1
15.3
2.0
2.0
3.1
4.9
6.4
10.3
15.0
20.8
24.4
26.1
24.5
22.8
2.1
4.9 5.3
9.4
10.9
17.6
20.6
26.7
31.6
36.2 36.6
30.3
40.0
35.0
30.0
25.0
20.0
15.0
10.0
5.0
0.0
Prevalence (%)
Age groups
NHMS II (1996)
NHMS III (2006)
NHMS 2011

10. 10
56.0
24.6
15.0
2.5 1.6 0.2
60
50
40
30
20
10
0
Percentage
Usual Place of Treatment (2011)

11. 11
12.0
10.0
8.0
6.0
4.0
2.0
0.0
Prevalence %
Male
Female
High blood sugars in adults, ASEAN
region, 2010

12. 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/index.php/pages/view/115.

13. Number of Active Registered
Patients; as of 28 Feb 2014
State Number of active patients
Johor 117,363
Kedah 52,271
Kelantan 35,556
Melaka 54,725
N.Sembilan 67,950
Pahang 52,196
Perak 90,512
Perlis 16,384
P.Pinang 45,852
Sabah 15,643
Sarawak 70,642
Selangor 130,148
Terengganu 28,292
WPKL 42,287
WP Labuan 1,534
WP Putrajaya 2,983
Malaysia 824,338

14. Glycaemic Control: Percentage of T2DM
Patients with HbA1c <6.5%, 2009 to 2013
2009 2010 2011 2012 2013
Johor 14.0 18.3 14.4 17.5 16.3
Kedah 8.5 12.8 12.3 15.8 17.0
Kelantan 8.7 9.2 12.5 11.3 16.2
Melaka 18.4 15.3 16.9 21.7 23.9
Negeri Sembilan 13.9 19.6 17.8 19.7 20.0
Pahang 13.4 19.9 13.4 15.1 16.4
Perak 14.5 16.3 13.9 18.1 21.6
Perlis 30.6 24.3 26.1 27.9 25.6
Pulau Pinang 12.3 18.5 19.3 16.5 18.7
Sabah 22.6 19.6 25.9 28.5 34.5
Sarawak 7.8 3.6 6.4 7.0 7.4
Selangor 15.8 25.2 15.1 18.4 21.3
Terengganu 19.9 20.5 17.9 16.2 17.1
WP Kuala Lumpur 12.6 27.9 17.9 24.3 30.0
WP Labuan n.a. 30.8 23.1 53.5 41.4
WP Putrajaya 15.6 26.2 15.1 29.6 32.4
Malaysia 13.3 17.2 15.6 18.1 19.8

15. Diabetes Clinical Audit (2013)
Variable Targets
Total no. of
tests (n)
Meeting
Target (%)
Mean 95% CI
HbA1c < 6.5 % 91,944 25.6 8.1 8.1 - 8.1
BP: Systolic < 130 mmHg 106,842 47.6 135.1 135.0 - 135.2
BP: Diastolic < 80 mmHg 106,828 69.2 77.7 77.6 - 77.8
Blood Pressure
< 130 / 80
mmHg
106,809 41.2
Total cholesterol < 4.5 mmol/l 91,214 29.0 5.2 5.1 - 5.2
TG ≤ 1.7 mmol/l 90,593 61.8 1.8 1.8 - 1.8
HDL ≥ 1.1 mmol/l 67,354 66.6 1.3 1.3 - 1.3
LDL ≤ 2.6 mmol/l 67,090 37.3 3.1 3.1 - 3.1
BMI < 23 kg/m2 96,954 16.4 27.4 27.4 - 27.4
Waist
circumference
< 90 cm (Male) 31,790 33.7 94.0 93.9 - 94.1
< 80 cm
50,008 14.4 90.7 90.6 - 90.8
(Female)
Total 115,254 Patients

16. Diabetes Clinical Audit (2013)
Complications
Present Absent Not known
n % n % n %
Retinopathy 8,640 7.50% 89,118 77.32% 17,488 15.17%
Ischaemic Heart
6,133 5.32% 94,448 81.95% 14,665 12.72%
Disease
Cerebrovascular
Disease
1,519 1.32% 99,490 86.32% 14,237 12.35%
Nephropathy 10,476 9.09% 90,693 78.69% 14,077 12.21%
Diabetic Foot
Ulcer
1,470 1.28% 101,211 87.82% 12,565 10.90%
Amputation 726 0.63% 102,034 88.53% 12,486 10.83%
Concomitant Co-
Morbidity
Yes No Not known
n % n % n %
Hypertension 83,765 72.68% 25,898 22.47% 5,583 4.84%
Dyslipidaemia 69,157 60.00% 38,145 33.10% 7,944 6.89%

17. Cost of Diabetes in Malaysia
• People diagnosed with diabetes have access to diabetes care
and treatment in Malaysia.
• Diabetes costs are estimated to account for 16% of the
national Malaysian healthcare budget.
• placing Malaysia among the top 10 countries in the world in
terms of percentage of healthcare budget spent on diabetes.
• In 2010, an estimated RM 2.4 billion was spent on diabetes-related
healthcare.
17
Zhang P. et al. Global healthcare expenditure on
diabetes for 2010 and 2030. Diabetes research
and clinical practice. 2010; 87: 293– 301.

18. Cost of Diabetes in Malaysia
• Cost of managing diabetes in Malaysia: ~RM19,000.00 per
patient per year
• Conservative estimate from a study we did in 2007
• Not ideal treatment
• Data from NHMS 2011 estimates about 1.1 million patients
are on follow up at MOH hospitals and clinics
• 1.1 M x RM 19k = RM 20.9 billion!!
18

19. Complications drive costs!
• While there are no studies in Malaysia that outline the breakdown
of diabetes costs, a study (CODE II) shows that up to 73% of
diabetes-related healthcare costs result from hospitalisation and
ambulatory care, as a result of complications due to poor blood
sugar control.
• Only 7% of the total
diabetes-related
healthcare cost is spent
on anti-diabetic drugs.
19 Jonsson B. Revealing the costs of type 2 diabetes
in the EU and findings from 8 EU countries.
Diabetologia 2002;45:S5–S12.

20. Summary
• 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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21. Sub-analysis of NHMS 2011 data
• At least 15% (18 years and above) already with known NCD
risk factors (diabetes, hypertension or hypercholesterolemia).
• Undiagnosed high blood sugar, high blood pressure or high
cholesterol: 42.1% (18 years and above).
• Or, if include obesity: 48.3% (18 years and above).
• Therefore our high risk and at risk population: 63.3% (18
years and above)
21
We are a SICK population!

22. 22

23. 23
Global NCD
Targets
Source of icons: World Heart Federation Champion Advocates Programme

24. Thank you
dr.feisul@moh.gov.my
Facebook: Feisul Mustapha
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