diabetes epidemic in malaysia, mysir 2013, final

Diabetes Epidemic in Malaysia

Feisul Idzwan Mustapha MBBS, MPH, AM(M)

Publ ic Heal th Special istDisease Control Divis ion, MOH

MYSIR 2013Prince Hotel, Kuala Lumpur27 September 2013

[email protected]

Ministry of Health Malaysia


National Health and Morbidity Surveys (NHMS)

• 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)

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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/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-nih-scientific-meeting.

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http://www.moh.gov.my/v/NCDs



http://www.ihm.moh.gov.my/index.php/en/power-point-presentation-15th-nih-scientific-meeting






4

NHMS III (2006) NHMS 20110

2

4

6

8

10

12

14

16

11.6

15.2

7 7.2

4.5

8.0

4.24.9

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

Total diabetesKnownUndiagnosedIFG

Pre

vale

nce

(%

)


5

NHMS II (1996)

NHMS III (2006)

NHMS 20110

5

10

15

20

25

8.3

14.9

20.8

6.5

9.510.7

1.8

5.4

10.1

4.3

4.7

5.3

Prevalence of Diabetes, ≥30 years (1996, 2006 & 2011)

Total diabetesKnownUndiagnosedIFG

Pre

vale

nce

(%

)


6

18-1

920

-24

25-2

930

-34

35-3

940

-44

45-4

950

-54

55-5

960

-64

65-6

970

-74

75+

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

0.00.8 0.8

2.6 3.4

7.69.1

15.1

17.9

23.1

25.5

20.319.4

2.14.1 4.5

6.8 7.5

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 5.5

4.66.2 6.1

5.14.3

5.74.7 5.1

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

KnownUndiagnosedTotal diabetesIFG

Age groups

Pre

vale

nce

(%

)


7

18 -

19

20 -

24

25 -

29

30 -

34

35 -

39

40 -

44

45 -

49

50 -

54

55 -

59

60 -

64

65 -

69

70 -

740.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

2.94.1

6.4

9.810.7

13.1

18.2

16.1 15.3

2.0

2.03.1

4.96.4

10.3

15.0

20.8

24.426.1

24.522.8

2.14.9 5.3

9.410.9

17.6

20.6

26.7

31.6

36.2 36.6

30.3

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

NHMS II (1996)NHMS III (2006)NHMS 2011

Age groups

Pre

vale

nce

(%

)


8

Joho

r

Kedah

Kelan

tan

Mel

aka

Neger

i Sem

bila

n

Pahan

g

Penan

g

Perak

Perlis

Selan

gor

Teren

ggan

u

Sabah

& W

P Lab

uan

Saraw

ak

WP K

uala

Lum

pur

WP P

utra

jaya

0.0

5.0

10.0

15.0

20.0

25.0

30.0

13.4

22.5

19.7

17.1

22.0

16.715.0

16.2

24.8

16.5

11.6

9.0

12.311.3

8.8

Prevalence of Diabetes, ≥18 years, by States (2011)

Total

Known

Undiagnosed

IFG

Pre

vale

nce

(%

)


9

MOH h

ealth

clin

ics

MOH h

ospi

tals

Privat

e cli

nics

Privat

e ho

spita

ls

Self-m

edica

teTCM

0

10

20

30

40

50

60 56

24.6

15

2.5 1.6 0.2

Usual Place of Treatment (2011)

Per

cen

tag

e


How do we compare to our neighbouring countries?

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11

Overweight in adults, ASEAN region, 2010

Viet N

am

Cambo

dia

Lao

Mya

nmar

Indo

nesia

Philip

pine

s

Thaila

nd

Singa

pore

Mal

aysia

Japa

n0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

50.0

MaleFemale

Pre

vale

nce

%


12

Obesity in adults, ASEAN region, 2010

Viet N

am

Cambo

dia

Lao

Mya

nmar

Indo

nesia

Philip

pine

s

Thaila

nd

Singa

pore

Mal

aysia

Japa

n0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

MaleFemale

Pre

vale

nce

%


13Cam

bodia

Myanmar

Philippines

Indonesia

Thail

and

Singa

pore

Viet N

am

Malaysi

aJap

an0.0

2.0

4.0

6.0

8.0

10.0

12.0

MaleFemale

Prev

alen

ce %

High blood sugars in adults, ASEAN region, 2010


Burden of Diabetes in Malaysia: Trends & Projections by 2020 (Adults age 18 years and above)

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 20200

5

10

15

20

25

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

3,500,000

4,000,000

4,500,000

5,000,000

Est. population, 2006 Est. population, 2011Prevalence projection, 2006 Prevalence projection, 2011

Year

Pre

vale

nce

(%

)

Est

imat

ed p

op

ula

tio

n

Current projection

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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/v/NCDs.

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Number of Active Registered Patients; as of 31 July 2013

Negeri Bilangan pesakit aktifJohor 90,615Kedah 41,808Kelantan 26,345Melaka 35,331N.Sembilan 42,079Pahang 38,503Perak 67,414Perlis 12,714P.Pinang 38,387Sabah 11,340Sarawak 51,327Selangor 93,591Terengganu 18,550WPKL 28,385WP Labuan 717WP Putrajaya 2,141Malaysia 599,247

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Glycaemic Control: Percentage of T2DM Patients with HbA1c <6.5%, 2009 to 2012

2009 2010 2011 2012Johor 14.0 18.3 14.4 17.5Kedah 8.5 12.8 12.3 15.8Kelantan 8.7 9.2 12.5 11.3Melaka 18.4 15.3 16.9 21.7Negeri Sembilan 13.9 19.6 17.8 19.7Pahang 13.4 19.9 13.4 15.1Perak 14.5 16.3 13.9 18.1Perlis 30.6 24.3 26.1 27.9Pulau Pinang 12.3 18.5 19.3 16.5Sabah 22.6 19.6 25.9 28.5Sarawak 7.8 3.6 6.4 7.0Selangor 15.8 25.2 15.1 18.4Terengganu 19.9 20.5 17.9 16.2WP Kuala Lumpur 12.6 27.9 17.9 24.3WP Labuan n.a. 30.8 23.1 53.5WP Putrajaya 15.6 26.2 15.1 29.6Malaysia 13.3 17.2 15.6 18.1

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Ministry of Health MalaysiaDiabetes Clinical Audit (2012)

Variable Targets Total no. of tests

Meeting target (%) Mean 95% CI

HbA1c < 6.5 % 99,823 23.7 8.1 8.1 - 8.1

BP : Systolic < 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 ≤ 1.7 mmol/l 101,008 60.6 1.8 1.8 - 1.8HDL ≥ 1.1 mmol/l 76,214 65.5 1.3 1.3 - 1.3LDL ≤ 2.6 mmol/l 75,734 37.8 3.1 3.1 - 3.1

BMI < 23 kg/m2 108,559 16.6 27.4 27.3 - 27.4

Waist circumference

< 90 cm (Male) 35,520 33.6 94.0 93.9 - 94.1< 80 cm (Female) 55,493 14.4 90.7 90.6 - 90.8

Total: 130,340 Patients

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Anti-Diabetics 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%

Diabetes Clinical Audit(2009-2012)

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Ministry of Health MalaysiaSummary

• 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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Thank you

[email protected]

Facebook: Feisul Mustapha

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diabetes epidemic in malaysia, mysir 2013, final

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