Not so sweet: Tackling the diabetes epidemic in Malaysia

In Southeast Asia, particularly Malaysia, diabetes isn’t just a health condition, but an epidemic. According to recent findings, its prevalence has been climbing steadily.

Malaysia, in particular, reports one of the highest rates of diabetes in Asia and Western Pacific regions, with approximately one in five adults affected. It was also alarming to note more than 11% of Malaysians have prediabetes, a condition characterised by an elevated blood glucose level.

The growing prevalence of the disease has made it a critical public health issue, one that threatens the quality of life and burdens healthcare systems.

The economic burden of diabetes on Malaysian healthcare is substantial. Patients often suffer from comorbidities, such as cardiovascular diseases and kidney complications, which require extensive and costly treatments.

Beyond the immediate healthcare costs, diabetes also impacts workforce productivity, particularly as it increasingly affects younger populations.

The recently-concluded SEACO-CH20 study underscores these concerns, revealing metabolic risk factors such as high blood pressure and elevated fasting blood glucose are prevalent among Malaysian adolescents and young adults, setting the stage for lifetime risk of type 2 diabetes​.

Key risk factors driving diabetes in Malaysia

The escalation of prediabetes and diabetes prevalence in Malaysia can be attributed to hereditary predispositions and lifestyle factors, including poor diet and physical inactivity.

Dietary habits have evolved significantly in recent years, with processed foods and sugary drinks increasingly popular among Malaysian youth.

The SEACO-CH20 study, for instance, observed high consumption of energy-dense processed foods and sugary beverages in a semi-rural community. Nearly 35% of children and adolescents in the study were found to have abdominal obesity, a key risk factor for metabolic syndrome and type 2 diabetes.

Further, the study highlighted a low adherence to dietary guidelines, particularly in food groups such as fruits, vegetables and dairy, which are essential for balanced nutrition​.

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With rapid urbanisation, sedentary lifestyles have become more common in Malaysia. Limited access to safe and accessible exercise spaces, coupled with an increase in screen time, has contributed to physical inactivity among Malaysians of all ages.

According to the recently-released National Health and Morbidity Survey (NHMS) 2023, one in three adults in Malaysia was not physically active.

The implications of these findings for diabetes are significant. Physical inactivity is a key risk factor for obesity and insulin resistance, both of which are linked to type 2 diabetes. Without adequate physical activity, the body's ability to regulate blood glucose is compromised, leading to elevated blood sugar levels.

For those already at risk, physical inactivity exacerbates insulin resistance, setting a trajectory toward diabetes.

Challenges in managing diabetes in Malaysia

Managing diabetes in Malaysia involves overcoming several obstacles, including low adherence to dietary recommendations, limited healthcare access in rural areas, and socio-cultural barriers to adopting healthier lifestyles.

Despite government efforts to promote balanced diets, many Malaysians struggle to meet recommended dietary guidelines, and have poor diet quality.

High-calorie, low-nutrient foods are often cheaper and more readily available than healthier options, particularly in low-income areas. For adolescents in particular, dietary patterns established early in life tend to persist into adulthood, heightening the risk of later obesity and type 2 diabetes.

Cultural factors often play a role in lifestyle choices related to diet and exercise. Traditional dietary practices often involve high carbohydrate intake, which may not align with modern dietary recommendations.

Additionally, there may be a lack of awareness or motivation to make lifestyle changes that could reduce diabetes risk.

Specific communities, such as the urban poor and rural communities, may face additional barriers, from limited healthcare facilities to a lack of specialised care for non-communicable diseases, including diabetes.

The way forward

Malaysia faces distinct challenges in combating diabetes, driven by urbanisation, evolving dietary habits, and lifestyle shifts.

Effective diabetes prevention and management will require a multifaceted approach, integrating community engagement initiatives, digital health tools, and targeted public health interventions.

These strategies can help ensure efforts are inclusive and accessible to all segments of the population, reaching individuals across diverse socio-economic and geographic backgrounds.

Peer-led interventions, for example, have shown considerable promise in managing chronic diseases such as diabetes. These programs utilise trained community members to provide guidance, motivation and support, making it easier for participants to adopt and maintain healthy lifestyle changes.

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Studies have shown peer support can effectively address barriers to behaviour change, providing emotional and social support healthcare providers alone may not offer.

Our recent systematic review of peer-led programs highlights the positive impact of such initiatives on cardiovascular health, which is closely linked to diabetes management.

Also, as technology use grows, social media becomes vital for health interventions. Our scoping review found that social media platforms such as WhatsApp and WeChat have effectively delivered lifestyle interventions for diabetes prevention.

These platforms provide an accessible medium for health education, enabling real-time communication with healthcare providers and fostering peer support, which is crucial for behaviour change.

Interventions conducted on these platforms have shown significant reductions in glycosylated haemoglobin (HbA1c) levels, a critical indicator of blood glucose control. Such outcomes underscore the potential of social media as a low-cost, scalable solution for diabetes management in a region where smartphone use is widespread.

A multi-pronged approach

The fight against diabetes in Malaysia and Southeast Asia requires a multifaceted approach that addresses dietary habits, physical activity, and socio-economic factors.

Early interventions and scalable solutions, such as peer-led programs and digital health tools, are essential to prevent and manage diabetes effectively.

By fostering collaborations among policymakers, healthcare providers and communities, we can create sustainable strategies to reduce diabetes prevalence and improve the quality of life for those affected by the disease.

As we observe World Diabetes Day, it’s an opportune moment to reflect on the progress made and the road ahead, reaffirming our commitment to tackling this pressing health challenge in Southeast Asia.