The Low-down on Diabetes
Gleneagles Hospital Kuala Lumpur consultant endocrinologist Dr Saiful Kassim shares why advancements in tailored treatment approaches are a game-changer when tackling this chronic disease in Malaysia
In Malaysia, one in every five adults above 18 has diabetes, a staggering statistic experts predict will increase yearly. What’s more insidious about this disease is that one in every two Malaysian adults with diabetes is undiagnosed—at risk of developing conditions such as kidney failure, heart disease, blindness and more if the disease remains untreated. Nearly 80 per cent of adults with type 2 diabetes in Malaysia are overweight, with obesity being a main driver of diabetes. “A lot of people tend to associate diabetes with high blood sugar levels, but it’s so much bigger than that,” says Gleneagles Hospital Kuala Lumpur consultant endocrinologist Dr Saiful Kassim, who completed his specialist training in Endocrinology and Diabetes at the Regional Centre of Excellence in Belfast, United Kingdom. “Diabetes has been redefined as a state of what I call premature cardiovascular death, or premature death from heart disease, which is associated with high blood sugar.”
“What worries me most about this disease is not just the obesity of approximately 84 per cent of type 2 diabetes patients; but you have 80 per cent who are hypertensive, more than 75 per cent who have hypercholesterolemia,” Dr Saiful shares. “Around 60 per cent of diabetes patients are above the age of 50, and 40 per cent are below the age of 50. I see a lot more patients now who are in their 20s. I’ve had patients in their teens and even one patient as young as eight years old with type 2 diabetes and very obese. Our whole dynamic of diabetes is changing, and it won’t abate until we actually treat the underlying problem of obesity.”
Fortunately, medical advances in diabetes management and care have dramatically improved patients’ health and quality of life, shifting from the sole glucose-centric approach of reducing blood sugar levels to reducing the risk of heart attack, kidney failure, obesity progression and more complications associated with type 2 diabetes. “In terms of the modernity of treatments, there are new therapies, what we call glucagon-like peptide-1 (GLP-1) receptor agonists and SGLT2 inhibitors—these are multiple groups of treatments in the world of diabetes. Nowadays, we’re trying to combine these treatments in different mechanistic ways to achieve the target of lowering sugar but also protecting the heart, the kidney and other organs,” Dr Saiful says. When they first come to see him, many of Dr Saiful’s type 2 diabetes patients fear the
prospect of needing life-long insulin injections to manage their high blood sugar problem. The reality is that doctors generally take patients off insulin jabs and maintain on oral glucose-lowering therapies once their sugar levels are under control. Additionally, those who are soured by the thought of regular injections benefit greatly from oral glucose lowering tablets that tackle the underlying issues of diabetes, from obesity to cholesterol and fatty liver issues.
“The newer drugs like GLP-1 receptor agonist are injectable therapies which are now available in the oral form as well,” Dr Saiful explains. “Data on GLP-1 receptor agonist shows a 26 per cent reduction in risk of cardiovascular events along with a reduction in risk of protein leaks in the urine. I get a lot of patients asking, ‘What can these medications do for my weight, doctor?’ As an endocrinologist, I only aim for 5 to 10 per cent weight loss, which to me equates to improvements in blood pressure, sugar reduction, cholesterol reduction, fatty liver improvements and more. With multiple therapies, a lot of my patients are able to achieve 15 to 20 or even 25 per cent weight loss; which is equitable to gastric balloon or bariatric surgery such as sleeve gastrectomy. That’s not just with the therapies themselves but with the patients being involved, empowered by their partners and families, and adhering to diet regimen.”
From cholesterol and high blood pressure to stress and lack of sleep, no patient with diabetes experiences the same conditions. Therefore, treatment and management of this chronic disease is most effective when it is tailored to the patient’s individual needs and lifestyles. “To pigeonhole someone into one single box doesn’t work,” Dr Saiful remarks. “There’s no one-size-fitsall solution. A lot of my patients who have diabetes and obesity have issues with body-shaming and stress at work—and stress causes high-blood sugar and lack of sleep, which also leads to obesity. So there are so many other factors involved, and it takes a lot of time and effort to work through these chronic issues with every single patient.” To people diagnosed with type 2 diabetes or to those with loved ones who have this condition, Dr Saiful shares this message of encouragement: “Diabetes is a legacy disease. If you look after yourself now, you will live longer. If you can control your sugars now, ergo reducing your risk of a heart attack and stroke, you will live with less complications. The legacy effect, what we do now at Year Zero, will have an impact 10 years, 20 years, and 30 years on. Diabetes can disappear, but it depends on you. If you’re good, it will remain in remission for the rest of your life. In addition to the medication, it’s also about having a healthy lifestyle.”
Dr Saiful leaves this final advice on kickstarting the journey to taking back your health—it’s what he calls the ‘Rule of 8’s. Encouraging families to achieve these goals together, he tells patients to hit a goal of 8,000 steps a day, whether it be walking to the MRT stations or taking a walk in the evenings after work. Next is ensuring a solid eight hours of sleep, reiterating the weight-loss benefits of a good night’s rest. Finally, drinking eight glasses of water a day is helpful to expand the stomach so that you feel like eating less in a day.
Seek medical help if you have anyone in your family who already has diabetes or you yourself fear you may have it. While it helps to do your own research about the latest therapies and medications available to control diabetes, speak to your doctor about what works best for your needs.
“A lot of my patients worry that the medical therapies we give them will cause kidney disease because of something they read on Google. I respond by saying that any therapy that we give is intertwined with improving outcomes. In other words, the treatment we start you on will not just improve your sugars but will improve your heart, your kidneys, your weight, and other organ complications, like fatty liver, obstructive sleep apnea, and so on. We’re not talking about one single target but multiple targets in multiple ways so that in the end, the patient has a better quality of life and a remission of diabetes.”
This is a disease awareness and educational message brought to you by Novo Nordisk Pharma Malaysia.