Current Burden of Diabetes in Malaysia

Feisul Idzwan Mustapha MBBS, MPH, AM(M)

Public Health Physician, NCD Section, Disease Control DivisionMinistry of Health, Malaysia

National Oral Health Research Conference 201411 November 2014

Kuala Lumpur

dr.feisul@moh.gov.my

Ministry of Health

Malaysia

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

2

Premature mortality due to NCDs, Malaysia

3

The probability of dying between ages 30 and 70 years from the 4 main NCDs is 20%

DALYs attributable to risk factors

4

10.8%

10.7%

9.0%

8.3%

5.2%

4.3%

3.1%

0.7%

0.1%

10.8%

0.7%

11.4%

12.1%

5.1%

0.9%

4.3%

0.7%

0.1%

15.0% 10.0% 5.0% 0.0% 5.0% 10.0% 15.0%

High BP

Tobacco

Diabetes Mellitus

High BMI

High Cholesterol

Alcohol

Physical Inactivity

Underweight

Poor Water & Sanitation

Male Female

Burden of Disease Study Malaysia, slide courtesy of Dr Mohd. Azahadi Omar, Institute for Public Health

19.4%

15.7%

8.5%

7.3%

7.0%

5.0%

2.3%

0.2%

0.1%

22.8%

1.2%

9.1%

8.1%

8.2%

7.1%

0.3%

0.2%

0.1%

25% 20% 15% 10% 5% 0% 5% 10% 15% 20% 25%

High BP

Tobacco

Diabetes Mellitus

High Cholesterol

High BMI

Physical Inactivity

Alcohol

Underweight

Poor Water & Sanitation

Male Female

Deaths attributable to risk factors

Burden of Disease Study Malaysia, slide courtesy of Dr Mohd. Azahadi Omar, Institute for Public Health

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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/power-point-presentation-15th-nih-scientific-meeting. 6

7

11.6

15.2

7.0 7.24.5

8.0

4.24.9

0

2

4

6

8

10

12

14

16

NHMS III (2006) NHMS 2011

Pre

vale

nce

(%

)

Prevalence of Diabetes, ≥18 years (2006 & 2011)

Total diabetes

Known

Undiagnosed

IFG

8

0.00.8 0.8

2.63.4

7.69.1

15.1

17.9

23.1

25.5

20.319.4

2.1

4.1 4.5

6.87.5

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 5.54.6

6.2 6.15.1

4.35.7

4.7 5.1

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

Pre

vale

nce

(%

)

Age groups

Prevalence of Diabetes, ≥18 years, by age groups (2011)

Known

Undiagnosed

Total diabetes

IFG

9

2.94.1

6.4

9.810.7

13.1

18.2

16.115.3

2.0

2.03.1

4.96.4

10.3

15.0

20.8

24.4

26.124.5

22.8

2.1

4.9 5.3

9.410.9

17.6

20.6

26.7

31.6

36.2 36.6

30.3

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

Pre

vale

nce

(%

)

Age groups

Prevalence of Diabetes, ≥18 years, by age groups (1996, 2006 & 2011)

NHMS II (1996)

NHMS III (2006)

NHMS 2011

10

56.0

24.6

15.0

2.5 1.6 0.20

10

20

30

40

50

60

Pe

rce

nta

ge

Usual Place of Treatment (2011)

11

0.0

2.0

4.0

6.0

8.0

10.0

12.0

Pre

vale

nce

%

Male

Female

High blood sugars in adults, ASEAN region, 2010

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.

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

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

Diabetes Clinical Audit (2013)

Variable TargetsTotal 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 (Female)

50,008 14.4 90.7 90.6 - 90.8

Total 115,254 Patients

Diabetes Clinical Audit (2013)

ComplicationsPresent Absent Not known

n % n % n %

Retinopathy 8,640 7.50% 89,118 77.32% 17,488 15.17%

Ischaemic Heart Disease

6,133 5.32% 94,448 81.95% 14,665 12.72%

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%

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.

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Zhang P. et al. Global healthcare expenditure on

diabetes for 2010 and 2030. Diabetes research

and clinical practice. 2010; 87: 293– 301.

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!!

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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.

19Jonsson B. Revealing the costs of type 2 diabetes

in the EU and findings from 8 EU countries.

Diabetologia 2002;45:S5–S12.

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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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)

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We are a SICK population!

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Source of icons: World Heart Federation Champion Advocates Programme

Global NCD

Targets

Thank you

dr.feisul@moh.gov.my

Facebook: Feisul Mustapha

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