Diabetes is a chronic disease that affects many people globally. In Malaysia, the number of diabetes cases has doubled over the past decade due to risk factors like obesity, lack of exercise, and diets high in sugar and processed foods. Similarly, Sri Lanka faces a growing diabetes problem, with over 1 million adults affected. Both countries aim to curb diabetes rates through education campaigns, screening programs, and initiatives to promote healthier lifestyles.

2. Definition
 a chronic disease caused by inherited and/or acquired deficiency
in production of insulin by the pancreas, or by the ineffectiveness
of the insulin produced.
deficiency results in increased concentrations of glucose in the
blood, which in turn damage many of the body's systems, in
particular the blood vessels and nerves.

3. FACTS :
 The number of people with diabetes has risen from 108 million in 1980 to 422 million in 2014
 The global prevalence of diabetes* among adults over 18 years of age has risen from 4.7%
in 1980 to 8.5% in 2014 (1).
 Diabetes prevalence has been rising more rapidly in middle- and low-income countries.
 Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb
amputation.
 In 2015, an estimated 1.6 million deaths were directly caused by diabetes. Another 2.2 million
deaths were attributable to high blood glucose in 2012**.
 Almost half of all deaths attributable to high blood glucose occur before the age of 70
years. WHO projects that diabetes will be the seventh leading cause of death in 2030

11. Causes Type 1 diabetes :
caused by the immune system destroying the cells in the pancreas that make insulin. This causes diabetes by leaving the body
without enough insulin to function normally. This is called an autoimmune reaction, or autoimmune cause, because the body
is attacking itself.
 There is no specific diabetes causes, but the following triggers may be involved:
a)Viral or bacterial infection
b)Chemical toxins within food
c)Unidentified component causing autoimmune reaction
d)Underlying genetic disposition may also be a type 1 diabetes cause.
 Type 2 diabetes:
causes are usually multifactorial - more than one diabetes cause is involved. Often, the most overwhelming factor is a family
history of type 2 diabetes.
 There are a variety of risk factors for type 2 diabetes such as :
a)Obesity
b)Living a sedentary lifestyle
c)Increasing age
d)Bad diet
e)Other type 2 diabetes causes such as pregnancy or illness can be type 2 diabetes risk factors.

12.  Gestational diabetes :
causes of diabetes in pregnancy also known as gestational diabetes remain unknown.
 However, there are a number of risk factors that increase the chances of developing this condition:
a)Family history of gestational diabetes
b)Overweight or obese
c)Suffer from polycystic ovary syndrome
d)Have had a large baby weighing over 9lb
e) ethnicity - some ethnic groups have a higher risk of gestational diabetes.
 Other diabetes causes such as:
a)Pancreatitis or pancreatectomy as a cause of diabetes. Pancreatitis is known to increase the risk of developing diabetes, as is a
pancreatectomy.
b)Polycystic Ovary Syndrome (PCOS). One of the root causes of PCOS is obesity-linked insulin resistance, which may also increase
the risk of pre-diabetes and type 2 diabetes.
c)Cushing’s syndrome. This syndrome increases production of the cortisol hormone, which serves to increased blood glucose
levels. An over-abundance of cortisol can cause diabetes.
d)Glucagonoma. Patients with glucagonoma may experience diabetes because of a lack of equilibrium between levels of insulin
production and glucagon production.

13. • Polydipsia
arises as a consequence of dehydration resulting from loss of fluid, salt and other electrolytes in the urine. The acute thirst of
type 1 diabetes may be almost unquenchable. Some attempt to slake their thirst with sugar-containing fluids such as Coca-
Cola, thus creating a spiral of hyperglycaemia, dehydration and increased craving for fluids.
• Polyuria
develops when the rate at which glucose enters the proximal tubules of the kidney exceeds the capacity of the tubules to
pump glucose back into the circulation. This is achieved by an active transport system which (in most people) can extract
almost all glucose below a concentration of ~10 mmol/l (180 mg/dl). Above this point, known as the renal threshold for
glucose, glucose spills over into the urine. This exerts an osmotic effect, causing loss of water, salt and other electrolytes from
the body, and resulting in dehydration and thirst.
• Weight loss
a consequence of calories lost as glucose in the urine, amounting to hundreds of grams of glucose per day in severely
uncontrolled diabetes. This is aggravated by insulin deficiency, which accelerates glucose production by the liver while
promoting breakdown of fat and protein; the glucose loss and metabolic inefficiency of uncontrolled diabetes thus produces a
state of accelerated catabolism.

14. • Tiredness and lack of energy but not at all specific for diabetes.
• Changing glucose levels can produce osmotic changes in the lens of the eye, causing changes in visual
accommodation resulting in visual blurring, and many freshly diagnosed patients have a new pair of glasses
which (unfortunately) will no longer be right for them once the glucose abnormality has been corrected!
• Pruritus vulvae (genital itching) in women or balanitis (inflammation of the prepuce) in men. This is due to
Candida albicans, a fungal infection which grows more readily in the presence of glucose.

17. Diabetes Screening and Diagnosis
FPG ≥126 mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for at least 8 h.*
OR
2-h PG ≥200 mg/dL (11.1 mmol/L) during an OGTT. The test should be performed as described by the WHO, using a glucose load
containing the equivalent of 75 g anhydrous glucose dissolved in water.*
OR
A1C ≥6.5% (48 mmol/mol). The test should be performed in a laboratory using a method that is NGSP certified and standardized
to the DCCT assay.*
OR
In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose ≥200 mg/dL (11.1
mmol/L).

24. IN MALAYSIA

25. Diabetes in Malaysia
• Malaysia has a population of 30 331 000 people.
• We are from a upper middle class income group.
• Globally there is a rising trend in the prevalence of diabetes
due to many factors.
• Malaysians consume about 26 teaspoons of sugar daily. We are
the eighth highest sugar users in the world.

26. Causes of Diabetes in Malaysia
• Population growth, aging, urbanization and increasing prevalence of obesity
and physical inactivity are some of the causes.
• Doctors found that the young diabetics were usually obese, and their
condition could be traced to eating too much unhealthy food and having a
sedentary lifestyle.
• There is growing evidence that High Fructose Corn Syrup (HFCS), a cheap
substitute for sugar used in processed food and drinks that may facilitate
insulin resistance, and eventually lead to Type 2 diabetes. HFCS is widely used
in a wide range of foods such as jams breads spreads, chocolate, baking and
cooking ingredients, packed fruit juices soft drinks, beverages, energy drinks,
bread, breakfast cereals, sauces, snacks and soups.
• Beverages and processed foods made with HFCS are high in calories and low
in nutritional value.

28. Prevalance and Trend of Diabetes in Malaysia
• According to the Second National Health and Morbidity survey it is estimated that 3.4
million Malaysians are diabetes sufferers in 2010.
• Results of the two latest National Health and Morbidity Surveys showed a dramatic
increase in the prevalence of diabetes from 8.3% in 1996 to 14.9% in 2006 for Malaysian
adults aged 30 years and above - an increase of 80% over a period of just 10 years.
• More worryingly, about a third (or 36%) of the diabetic population are undiagnosed.
• The prevalance of diabetes in males is 10.2% and and 9.5% in females according to a
survey done by the World Health Organization (WHO) in 2016.
• The prevalence of diabetes varies among the major ethnic groups in Malaysia, with
Asian Indians having the highest prevalence of Type 2 Diabetes Mellitus, followed by
Malays and Chinese. The increase prevalence of overweight and obesity has
accompanied the rise in T ype 2 Diabetes Mellitus.

30. Prevalance of Diabetes in Malaysia by age group,
2006

35. Almost 1 in 5 Malaysian Adults Have Diabetes

36. Complications Related to Diabetes
• The disease can affect the patient’s vital organs like the heart, kidneys, nerves and eyes.
High blood glucose levels over a period of time, coupled with the features of metabolic
syndrome, cause damage to the blood vessels, which in turn, result in damage to many
organs such as kidney failure or blindness.
• The complications of the foot that take the greatest toll. Of all lower extremity amputations,
40-70% is related to diabetes.
• In most studies, the incidence of lower leg amputation is estimated to be 5-25/100,000
inhabitants/year: among people with diabetes, the figure is 6-8/1,000.Diabetes and end
stage renal failure is a big health problem in Malaysia.
• It is estimated that there are 13,000 kidney patients undergoing dialysis and every year
2,500 people join the ranks of end-stage renal failure patients.
• Another major health concern is that 4 out of 5 people with diabetes will die of heart
disease (the number 1 killer in the country). Six new cases of stroke occur every hour in
Malaysia.

38. Measurements To Fight Diabetes Mellitus
• Diabetes prevalence rate in Malaysia has risen much faster than expected, almost doubling
in magnitude over the last decade. Diabetes has not only taken a toll on the resources, as it
is a costly disease for the nation but also on the limbs and eyesight of its sufferers.
• Diabetes care is available at most public hospitals at state level. Patients are referred for
consultations with dietitians, diabetes nurse educators, and pharmacists, mostly on an
individual basis.
• There are established Diabetes Resource Centers in most hospitals where trained diabetes
nurse educators deliver patient-centered diabetes education to inpatients and outpatients.
• Group-based diabetes education is not yet well established in the public hospital setting. In
recent years, group-based diabetes education using the Diabetes Conversation Maps
endorsed by the International Diabetes Federation has been popularized ever since the
complete set was translated into Bahasa Melayu, the national language.

39. • The Ministry of Health has conducted training courses for diabetes nurse educators since 2004, and
an estimated 900 diabetes nurse educators have been trained and practice in both primary care and
hospital-based diabetes care.
• The role of hospital pharmacists in the Malaysian comprehensive care model for diabetes deserves
further discussion. Diabetes education incorporating the hospital pharmacist facilitates a focus on
medication use, which, in effect, promotes better awareness and improved medication adherence.
This strategy was initiated in 2006 in the Ministry of Health with the formation of Diabetes Mellitus
Treatment Adherence Clinics, which are coordinated and operated by pharmacists. Currently, all
major public hospitals have this facility, which has been recently extended to primary care clinics as
well.
• The government also educates the children in school by putting up posters around the school as well
as campaigns are held.
• In 1981, a group of doctors and individuals wanted to set up an organisation with the aim of providing
social services to diabetics and establish a centre for dissemination of information on diabetes. This
group of people founded Persatuan Diabetes Malaysia (“PDM”), which was registered as a social
association with the Registrar of Societies on 16. June 1983. PDM is now known officially as Diabetes
Malaysia. (currently known as DM : Diabetes Malaysia).
• International Diabetes Federation (IDF) was founded in 1950 and helps in promoting, prevention, and
cure worldwide.
• Diet management also has to be taken in consideration

40. IN
SRI LANKA

42. • The Diabetes Association of Sri Lanka (DASL) statistics reveals that there are almost one-fifth of the world’s
people with diabetes live in South-East Asia Region.
• According to recent statistics by the International Diabetes Federation (IDF), the prevalence of diabetes among
adults in Sri Lanka is 8.5%.
• At present, one in 12 adults in the country suffers from diabetes, which totals to 1.16 million.
• Over the past five years, approximately 1 – 1.4% of total diabetes patients have lost their lives due to the disease.
• In 2011, 71.4 million people (8.3%) in South East Asia were affected by diabetes and 23.8 million people (2.8%)
were affected by Impaired Glucose Tolerance (IGT). Numbers are expected to rise to 120.9 million (10.2%) for
diabetes and 38.6 million (3.2%) for IGT by 2030, according to the DASL.
• According to the World Health Organization (WHO) about 347 million people worldwide had diabetes and it was
predicted to become the 7th leading cause of death in the world by the year 2030. In 2012 diabetes was the direct
cause of 1.5 million deaths.
• One in five adults has either diabetes or pre-diabetes and one-third of those with diabetes are undiagnosed, reveals
one of the first nation-wide studies to be conducted in Sri Lanka.

47. Causes of Diabetes
• With the pace in globalization and urbanization, people’s dietary patterns have changed, both quantitatively and
qualitatively.
• People tend to consume high energy dense food (food with minimal water content, and rich in saturated fats,
trans-fats, free sugar or salt), instead of low energy dense food (food rich in water, and fiber content, and little
fat).
• Socio- economic status (aging, education, income, working environment, living conditions, social life, etc.)
and heredity factors are also positively associated with diabetes prevalence.
• Sugar is an important contributing factor to diabetes. While it is an essential ingredient for energy, its excessive
intake has negative effects. To prevent and control negative health effects of sugar among adults and
children, WHO recommends reducing daily sugar intake to less than 10% of total energy intake (optional
recommendation is to reduce below 5%).
• For Sri Lanka, the recommended sugar consumption is about 25 grams/6 teaspoons of sugar per non-diabetic
person per day. However, an average Sri Lankan consumes 36 grams of sugar a day.

48. Why diabetes is a problem to a developing country
like Sri Lanka?
• Increasing number of patients put forward an unnecessary
burden to the free health system in Sri Lanka.
• Diabetes is incurable so life long treatment should be given.
• Due to the high amount of complications such as amputations
and cataracts, the government should have to treat them
additional to diabetes.

53. Prevalence of DM in SEA 2010

54. Deaths attributable to diabetes (DM), 2010-SEA

56. #1every6seconds – An awareness campaign to raise diabetes onto the
global political agenda
#1every6seconds was launched on World Diabetes Day 2014 to
highlight that Diabetes kills as many as Tobacco. A video was released
on electronic, printed and social media on WDD. This DASL thought
concept was presented to the President of the IDF in 2014 and 2015
where it has evolved into the present IDF Frame Work on Action for
Sugar presented at the WHA in May 2015 as a side show and
incorporated into the WDD theme of healthy eating.
“Life is sweeter with less sugar” – Awareness at national level
In January 2014, DASL signed a 10 year agreement with Watawala Tea
Ceylon Ltd where a specially designed logo indicating that “Life is sweeter
with less sugar” is displayed on all their tea packages in 3 languages i.e.
Sinhala, Tamil and English. This campaign has a substantial impact and
reach as the company has a 40% market share in the country.

59. WDD 2011 – Fork Spoon
The campaign to reduce sugar consumption in Sri Lanka was initiated by us in 2011 on World Diabetes Day [WDD] with the
creation of the Fork Spoon. This was a simple innovative idea to introduce a serrated teaspoon in all sugar bowls in cafes, hotels
and restaurants which reduces the quantum of sugar added into a cup of tea or coffee.

60. PREVENTION OF

80. diabetes.org.my