The development of innovative treatments, technologies, and renewed emphasis on lifestyle interventions over the last five years brings hope to millions of Malaysians suffering from Type 2 diabetes mellitus (T2DM); and for healthcare professionals as well to effectively manage this serious chronic disease and its life-threatening complications. All these advances have been incorporated into the recommendations contained in the 6th edition of the Clinical Practice Guidelines (CPG) for the Management of Type 2 Diabetes Mellitus.
The CPG was jointly produced by a team of 69 experts under the auspices of the Malaysian Endocrine and Metabolic Society (MEMS), Ministry of Health, Academy of Medicine Malaysia, Diabetes Malaysia, and the Family Medicine Specialists’ Association of Malaysia. The publication was launched recently by YBhg Tan Sri Dato’ Seri Dr Noor Hisham Abdullah, Director-General of Health Malaysia, in a virtual ceremony themed, A United Front against Diabetes: Delivering Care in the New Era and Beyond!
In his keynote address, Tan Sri Dr Noor Hisham said: “Diabetes negatively impacts quality of life and healthcare cost. It also increases the economic burden on individuals, families and communities, and affects national productivity.
“Therefore, it is vital to control diabetes and limit its complications with a holistic approach and active patient participation, supported by appropriate diabetes education and lifestyle modification as well as pharmacological treatment.”
The Director-General of Health lauded the CPG as a valuable resource for healthcare professionals to deliver the best possible care for patients from disease prevention to treatment of complications. He reaffirmed the need for a multi-disciplinary approach and said: “Placing the patient at the very centre of integrated care services will improve his or her motivation throughout the journey of living with diabetes.”
He added that medical professionals should embrace technology and innovation, and noted the potential of use mobile apps, other technological advances, and telemedicine to improve diabetes self-management.
Professor Dr Chan Siew Pheng, President of the Malaysian Endocrine and Metabolic Society (MEMS) and Chairperson of the CPG Development Committee, highlighted what the new CPG brings to diabetes care.
She said that recent research has shown that losing 7-10% of body weight with diet and lifestyle can prevent pre-diabetic people from becoming diabetic. In addition, people diagnosed with T2DM in less than 3 years can reverse their diabetes by losing 15% of their body weight and keeping it off. Such weight loss can be facilitated with the help of meal replacement products, very low calorie diets or bariatric surgery, and regular exercise.”
The consultant endocrinologist added that the weight reduction would also benefit the liver by improving non-alcoholic liver disease (NAFLD) which, if left untreated, may lead to liver scarring and cancer.
Professor Dr Chan went on to reveal that new classes of diabetes medications not only lower high glucose levels, some are also capable of protecting the heart and kidneys from diabetes-related damage, too.
She explained: “Diabetes was known to shorten lifespans by 5-12 years. In 2016, diabetes was the 2nd most common cause of heart attack admissions (45% of all admissions) to coronary care units. However, according to several recent Cardiovascular Outcome Trials (CVOTs), heart attacks, strokes and death from heart disease may be reduced within 1-2 years of being on those new medications.”
Diabetic kidney disease (DKD) is the largest contributor of new patients requiring dialysis in Malaysia. Fortunately, as Professor Dr Chan pointed out, a 2nd class of medication has been shown to directly reduce worsening of DKD while preventing the progression to end-stage renal failure.
Professor Dr Chan mentioned that the CPG also provided guidance on managing acute illness or infection, quipping that diabetes does not take a holiday even during a pandemic. She remarked: “People with diabetes tend to experience more severe COVID-19 infection and have a higher risk of death than non-diabetics. If other chronic diseases are also present, the risk of severity of COVID-19 infection has been found to increase by 2-3 times.
“This is why the best course of action is to closely manage their glucose, blood pressure, and cholesterol while taking every precaution to avoid catching COVID-19!
Healthcare professionals may download a copy of the 6th CPG for the Management of Type 2 Diabetes Mellitus from the following sites: