Diabetes update

New local guidelines on managing diabetes are now available, including on how to reverse type 2 diabetes mellitus in certain cases.

WHEN it comes to diabetes, the first thought that comes to mind is sugar.

Yes, sugar does play an important part in this disease, but there is a lot more to this chronic condition.

Diabetes is a metabolic disorder and has to do with how the body breaks down food to create energy through the use of insulin, a hormone produced by the pancreas.

With diabetes, your body either doesn’t make enough insulin or can’t effectively use the insulin it makes.

Uncontrolled diabetes can lead to many other ailments, and even death.

However, over the last five years, the development of innovative treatments, technologies and lifestyle interventions has brought new hope of effectively managing this disease and its life-threatening complications.

All these advances have been incorporated into the recommendations contained in the recently launched 6th edition of the Clinical Practice Guidelines (CPG) for the Management of Type 2 Diabetes (T2DM) Mellitus in Malaysia.

For example, several new classes of diabetes medications not only lower high glucose levels, but also offer cardiovascular (heart) and renal (kidney) protection from diabetes-related damage.

Says consultant endocrinologist and Malaysian Endocrine and Metabolic Society (MEMS) president Professor Dr Chan Siew Pheng: “Diabetes was known to shorten lifespan by five to 12 years.

“In 2016, diabetes was the second most common cause of heart attack admissions (45% of all admissions) to coronary care units in Malaysia.

“However, according to several recent Cardiovascular Outcome Trials, heart attacks, strokes and death from heart disease may be reduced within one to two years of being on these new medications.”

Reversing diabetes

While these are exciting discoveries, the prevalence, or frequency, of diabetes in Malaysia is sobering.

The 2019 National Health and Morbidity Survey (NHMS) shows a prevalence of 18.3% for adults above 18 years, which is a 4% increase from 2015.

Nearly half (48.6%) had not been diagnosed prior to the survey.

Breaking it down further, roughly 5% of young Malaysians between 18-29 years are diabetic, which is worrying.

T2DM is not a stand-alone disease, but reaches across a spectrum of other non-communicable diseases.

Diabetic kidney disease (DKD) is the largest contributor of new patients requiring dialysis in Malaysia.

Fortunately, Prof Chan points out that a second class of medication for this condition has been shown to directly reduce the worsening of DKD, while also preventing progression to end-stage renal failure.