Symposium paper presented at the Malaysian Society of Interventional Radiology 2013 Conference. Kuala Lumpur, Malaysia.

1. Ministry of Health
Malaysia
Diabetes Epidemic in
Malaysia
Feisul Idzw an Mustapha MBBS, MPH, AM(M)
Public Health Specialist
Disease Control Division, MOH
MYSIR 2013
Prince Hotel, Kuala Lumpur
27 September 2013
dr.feisul@moh.gov.my

2. National Health and Morbidity
Surveys (NHMS)
Ministry of Health
Malaysia
• 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

3. NHMS 2011
(Volume II, NCD risk factors)
Ministry of Health
Malaysia
• 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-nihscientific-meeting.
3

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

5. Prevalence of Diabetes, ≥30 years
(1996, 2006 & 2011)
Ministry of Health
Malaysia
25
20.8
20
Prevalence (%)
14.9
15
10.7
10
5
9.5
8.3
6.5
4.3
1.8
10.1
5.4
5.3
Total diabetes
Known
Undiagnosed
IFG
4.7
0
NHMS II
(1996)
NHMS III
(2006)
NHMS 2011
5

6. Prevalence of Diabetes, ≥18 years,
by age groups (2011)
Ministry of Health
Malaysia
40.0
36.2
36.6
35.0
31.9
31.6
30.3
30.0
Prevalence (%)
26.7
25.5
25.0
23.1
20.6
20.0
20.3
19.4
17.9
17.6
15.1
13.7
15.0
10.9
9.4
10.0
5.0
4.1
4.9
4.1
3.5
5.3
4.5
4.4
0.8
7.5
5.5
10.0
13.1
11.6
12.5
11.0
9.1
10.1
7.6
6.2
6.1
5.7
0.8
2.6
2.1
0.0
6.8
5.2
11.4
Known
Undiagnosed
Total diabetes
IFG
4.6
3.4
5.1
4.3
4.7
5.1
0.0
Age groups
6

7. Prevalence of Diabetes, ≥18 years, Ministry of Health
by age groups (1996, 2006 & 2011) Malaysia
40.0
36.2
36.6
35.0
31.6
30.3
30.0
Prevalence (%)
26.7
26.1
22.8
20.6
20.0
20.8
18.2
17.6
16.1
15.0
15.0
13.1
10.9
10.3
6.4
4.9
5.0 2.1
2.0
5.3
4.9
3.1
2.9
15.3
NHMS II (1996)
NHMS III (2006)
NHMS 2011
6.4
9.4
10.0
0.0
24.5
24.4
25.0
9.8
10.7
4.1
2.0
Age groups
7

8. Prevalence of Diabetes, ≥18 years,
Ministry of Health
by States (2011)
Malaysia
30.0
25.0
22.5
Prevalence (%)
20.0
Total
24.8
Known
22.0
19.7
Undiagnosed
17.1
16.7
15.0
16.2
16.5
IFG
15.0 13.4
12.3
11.6
10.0
9.0
11.3
8.8
5.0
0.0
8

9. Usual Place of Treatment (2011)
60
Ministry of Health
Malaysia
56.0
50
Percentage
40
30
24.6
20
15.0
10
2.5
1.6
0.2
0
9

10. Ministry of Health
Malaysia
How do we compare to our
neighbouring countries?
10

11. Overweight in adults, ASEAN
region, 2010
Ministry of Health
Malaysia
50.0
45.0
40.0
Prevalence %
35.0
30.0
25.0
20.0
15.0
Male
Female
10.0
5.0
0.0
11

12. Obesity in adults, ASEAN
region, 2010
Ministry of Health
Malaysia
18.0
16.0
14.0
Prevalence %
12.0
10.0
8.0
6.0
Male
Female
4.0
2.0
0.0
12

13. High blood sugars in
adults, ASEAN region, 2010
Ministry of Health
Malaysia
12.0
10.0
Prevalence %
8.0
6.0
Male
4.0
Female
2.0
0.0
13

14. Burden of Diabetes in Malaysia:
Trends & Projections by 2020
Ministry of Health
Malaysia
(Adults age 18 years and above)
25
5,000,000
Current
projection
4,500,000
4,000,000
Prevalence (%)
3,500,000
15
3,000,000
2,500,000
10
2,000,000
1,500,000
5
Estimated population
20
1,000,000
500,000
0
0
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Year
Est. population, 2006
Prevalence projection, 2006
Est. population, 2011
Prevalence projection, 2011
14

15. National Diabetes
Registry
Ministry of Health
Malaysia
• 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, 20092012” was published in August
2013, available at the MOH website
http://www.moh.gov.my/v/NCDs.
15

16. Number of Active Registered
Patients; as of 31 July 2013
Negeri
Johor
Kedah
Kelantan
Melaka
N.Sembilan
Pahang
Perak
Perlis
P.Pinang
Sabah
Sarawak
Selangor
Terengganu
WPKL
WP Labuan
WP Putrajaya
Malaysia
Bilangan pesakit aktif
90,615
41,808
26,345
35,331
42,079
38,503
67,414
12,714
38,387
11,340
51,327
93,591
18,550
28,385
717
2,141
599,247
Ministry of Health
Malaysia
16

17. Glycaemic Control: Percentage of
T2DM Patients with HbA1c <6.5%,
2009 to 2012
2009
Johor
Kedah
Kelantan
Melaka
Negeri Sembilan
Pahang
Perak
Perlis
Pulau Pinang
Sabah
Sarawak
Selangor
Terengganu
WP Kuala Lumpur
WP Labuan
WP Putrajaya
Malaysia
2010
14.0
8.5
8.7
18.4
13.9
13.4
14.5
30.6
12.3
22.6
7.8
15.8
19.9
12.6
n.a.
15.6
13.3
18.3
12.8
9.2
15.3
19.6
19.9
16.3
24.3
18.5
19.6
3.6
25.2
20.5
27.9
30.8
26.2
17.2
2011
14.4
12.3
12.5
16.9
17.8
13.4
13.9
26.1
19.3
25.9
6.4
15.1
17.9
17.9
23.1
15.1
15.6
Ministry of Health
Malaysia
2012
17.5
15.8
11.3
21.7
19.7
15.1
18.1
27.9
16.5
28.5
7.0
18.4
16.2
24.3
53.5
29.6
18.1
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18. Diabetes Clinical Audit (2012)
Variable
Targets
HbA1c
< 6.5 %
BP : Systolic
Total no. of
tests
Meeting
target (%)
Ministry of Health
Malaysia
Mean
95% CI
99,823
23.7
8.1
8.1 - 8.1
< 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
HDL
LDL
≤ 1.7 mmol/l
≥ 1.1 mmol/l
≤ 2.6 mmol/l
101,008
76,214
75,734
60.6
65.5
37.8
1.8
1.3
3.1
1.8 - 1.8
1.3 - 1.3
3.1 - 3.1
BMI
< 23 kg/m2
108,559
16.6
27.4
27.3 - 27.4
35,520
55,493
33.6
14.4
94.0
90.7
93.9 - 94.1
90.6 - 90.8
< 90 cm (Male)
Waist
circumference
< 80 cm (Female)
Total: 130,340 Patients
18

19. Diabetes Clinical Audit
(2009-2012)
Anti-Diabetics
Ministry of Health
Malaysia
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%
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20. Summary
Ministry of Health
Malaysia
• 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. Ministry of Health
Malaysia
Thank you
dr.feisul@moh.gov.my
Facebook: Feisul Mustapha
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