Effects of Uncontrolled Diabetes

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Diabetes mellitus is a major global public health problem. The rise in global prevalence is expected to reach 5.4% or 300 million worldwide by 2025, with developed countries carrying a larger burden (1). Malaysia is not spared from this phenomena, with an alarming rise in prevalence of Type 2 diabetes mellitus (T2DM) over the past fifteen years, from 8.3% (NHMS 1, 1996) to 20.8% (NHMS IV, 2011) (2). What is most worrying is the figure for undiagnosed diabetics, which recorded almost a ten-fold increase (from 1.8% to 10.1%) within the same period. The national economic burden for provision of ambulatory or outpatient care for diabetes patients alone was estimated to cost the Ministry of Health RM 836 million, which took up 2.2% of the nation’s total health expenditure for 2009 (3). The average provider cost per outpatient visit for diabetes treatment at primary care was RM393.24, compared to RM 2707.44 at Specialist diabetic clinics. Treatment at primary care health centres was also highly cost effective compared to Specialist diabetic clinics (4). Due to the chronic nature of the disease, its many related complications and the progress in medical expertise, the costs to provide health care for the this group can only be expected to escalate in years to come. Strategies to effectively treat the chronic diseases (i.e. NCDs and T2DM) have been in place since the 1990s, however, the National Strategic Planning for Non-Communicable Diseases, (NSPNCD)(5) recommends that efforts should be channeled towards primary prevention, early NCD risk factor identification and NCD risk factor intervention or “clinical preventive services”. The clinical preventive services however, need to be emphasised, as early preventive measures can reduce long-term complications and morbidity related to diabetes. The risk factors which should trigger clinicians to provide clinical preventive measures include: obesity, sedentary lifestyles, dietary indiscretions, elderly (for late onset diabetes, pancreas insufficiency), family history of diabetes (risk in offspring of one diabetic parent: 30%, both parents: 60%). The 10th Malaysian Plan : Country Health Plan aims to restructure the national healthcare financing and healthcare delivery system to ensure universal health coverage of healthcare services to be provided at minimal cost using the existing infrastructure in delivering continuity of care across programmes, across healthcare settings and across healthcare providers (6). To reduce the fragmentation of care which commonly occurs in most NCD programmes, there is a need to involve healthcare providers within the healthcare service to be orientated in their roles and contribution in providing a seamless long-term care programme. It is hoped that this effort will benefit not only the patients but also provide relevant feedback on quality of healthcare service provision by the stakeholders. The current public health centre set up which combines Outpatient Primary Care

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Effects of Uncontrolled Diabetes

1. Photo by brianjmatis

2. Photo by trustypics

3. Photo by Yeshe

4. Photo by BasiliskSam

5. Photo by Jenn and Tony Bot

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10. Photo by jennifertomaloff

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