Diabetes epidemic in malaysia, mysir 2013, final

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

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Diabetes epidemic in malaysia, mysir 2013, final

  1. 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. 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. 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. 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. 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. 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. 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. 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. 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. 10. Ministry of Health Malaysia How do we compare to our neighbouring countries? 10
  11. 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. 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. 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. 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. 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. 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. 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 17
  18. 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. 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% 19
  20. 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. 20
  21. 21. Ministry of Health Malaysia Thank you dr.feisul@moh.gov.my Facebook: Feisul Mustapha 21

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