LifeCare Diagnostic

November 1, 2020

Diabetes mellitus, commonly known as diabetes, remains one of the major non-communicable diseases in Malaysia, affecting up to 3.6 million of the Malaysian population with a prevalence of 16.8%. 

Seven million Malaysian adults aged 18 years and older are estimated to develop diabetes by 2025, a major health public concern that will see a higher diabetes prevalence of 31.3%.

Introduction to Diabetes

Diabetes is a chronic, metabolic disease characterized by elevated levels of blood glucose (or blood sugar), which can lead to serious complications to the heart, blood vessels, eyes, kidneys, and nerves if it is poorly controlled.

Insulin, produced by the beta cells in the pancreas, is a naturally occurring hormone in your body which helps to regulate and maintain your blood sugar level. However, with diabetes, your body either does not make enough insulin as seen in Type 1 diabetes (insulin deficiency), or cannot effectively use the insulin that your body does make as seen in Type 2 diabetes (insulin resistance). 

Type 1 diabetes affects 10% of diabetic patients under 30 years old, and type 2 occurs most commonly in adults over 40 years old although they can be presented in earlier age groups if there is the presence of other risk factors.

Risk Factors for Diabetes

  • First-degree relative with diabetes
  • History of cardiovascular (heart) disease (CVD)
  • Hypertension (BP ≥140/90 mm Hg or on therapy for hypertension)
  • Impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) on previous testing
  • High density lipoprotein (HDL) cholesterol <0.9 mmol/L or triglycerides (TG) >2.8 mmol/L
  • Other clinical conditions associated with insulin resistance (e.g. severe obesity and acanthosis nigricans)
  • Women who delivered a baby weighing ≥4 kg or were diagnosed with gestational diabetes mellitus (GDM)
  • Women with polycystic ovarian syndrome (PCOS)
  • Physical inactivity
  • Special populations (those who are receiving antiretroviral therapy 5 (Level II-1) or atypical antipsychotic drugs

Symptoms of Diabetes

Majority of diabetics are asymptomatic, but common symptoms include:

  • Increased thirst
  • Polydipsia
  • Polyuria
  • Lethargy
  • Weight loss
  • Blurring of vision
  • Increased risk of infection

Symptoms of Diabetes

Majority of diabetics are asymptomatic, but common symptoms include:

  • Increased thirst
  • Polydipsia
  • Polyuria
  • Lethargy
  • Weight loss
  • Blurring of vision
  • Increased risk of infection

Who Should Be Screened? 

  1. Any individuals with symptoms suggestive of diabetes.
  2. Individuals with no symptoms but are overweight or obese (BMI ≥23kg/m2 or have a waist circumference of ≥80cm in women and ≥90cm for men) AND one of the above risk factors.
  3. In those without risk factors, testing should begin at the age of 30 years. If tests are normal, screening should be done annually.

Complications of Diabetes

Over time, diabetes can damage the heart, blood vessels, eyes, kidneys, and nerves.

  • Adults with diabetes have a two- to three-fold increased risk of heart attacks and strokes.
  • Combined with reduced blood flow, neuropathy (nerve damage) in the feet increases the chance of foot ulcers, infection, and eventual need for limb amputation.
  • Diabetic retinopathy (eye damage) is an important cause of blindness and occurs as a result of long-term accumulated damage to the small blood vessels in the retina. 2.6% of global blindness can be attributed to diabetes.
  • Kidney failure 

How to Prevent and Manage Diabetes? 

1. Prevention

Simple lifestyle modifications have been shown to be an effective means of preventing or delaying the onset of type 2 diabetes. To help prevent type 2 diabetes and its complications, people should:

  • Achieve and maintain healthy body weight (BMI 18-23kg/m2);
  • Be physically active – at least 30 minutes of regular, moderate-intensity activity on most days. More activity is required for weight control;
  • Eat a healthy diet, avoiding sugar and saturated fats intake; and
  • Avoid tobacco use – smoking increases the risk of diabetes and cardiovascular diseases.

2. Diagnosis and treatment

Early diagnosis can be accomplished through relatively inexpensive testing of blood sugar, either by fasting blood glucose or HbA1c which reflects the average blood sugar readings in the past 3 months.

Treatment of diabetes involves diet and physical activity along with lowering blood glucose and the levels of other known risk factors that damage blood vessels. Tobacco use cessation is also important to avoid complications.

KKLIU 1600/2021