Treatment of diabetes in adults or children in Malaysia

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Organizational Change: treatment of diabetes in adults or children in Malaysia

Identify a research or evidence-based article that focuses comprehensively on a specific intervention or new diagnostic tool for the treatment of diabetes in adults or children.

Malaysia is located in Southeast Asia and comprises of 3 federal territories and 13 states with a total area of 127,350 square miles (329,847 square kilometers). Malaysia is divided by the South China Sea forming East Malaysia and Peninsular Malaysia. Malaysia is in the equatorial area, depicting a tropical rainforest climate throughout the year. Kuala Lumpur is the capital city, and the seat of the federal government is Putrajaya.

With estimated rise in the incidence of diabetes across the world, health systems keep on focusing on optimizing and improving diabetes care by changing patient behavior and progressing efficiency of care. Mafauzy, Hussein, and Chan. (2011) diabetes is a fundamental public health issue in Malaysia, and the predominance of 2 diabetes (T2D) type has gone high to 20.8% in adults exceeding the age of 30, affecting 2.8 million people. The problem of managing diabetes falls under primary and tertiary health care givers operating in several settings.

This study focuses on the present diabetes status in Malaysia, comprising lifestyle, epidemiology, pharmacologic treatments and complications, in addition to the employment of technologies in its administration and the implementation of the World Health Organization chronic care model in primary care hospitals.

The predominance of diabetes differs in the key ethnic sets in Malaysia, with Asian Indians possessing the greatest prevalence of T2D, and then Malays and finally by Chinese. The rise of the prevalence of obesity and overweight has supplemented the rise in T2D. Tertiary and primary care clinics have a multidisciplinary care which consist integrated pharmacotherapy, lifestyle and diet changes.

Epidemiology

Diabetes is a key public health affair in Malaysia that is intimately related to growth of macro- and micro vascular problems, in addition to preventable and premature mortality. According to Mafauzy, Hussein and Chan. (2011) in the earlier decade, an increase of prevalence of 2 diabetes (T2D) type has been recorded among adults with an age of ≥ 30 years in Malaysia. The fourth Malaysian National Health and Morbidity Survey (NHMS IV) in 2011, conveyed that the predominance of T2D grew to 20.8%, hurting 2.8 million people, likened to the third National Health and Morbidity Survey (NHMS III), which stated a predominance of 14.9% in the year 2006. Amongst the main ethnic sets in Malaysia, Indians had the greatest prevalence of T2D (19.9% in 2006 and 24.9% in 2011), Malays being next in line (11.9% in 2006 and 16.9% in 2011), and finally Chinese (11.4% in 2006 and 13.8% in 2011). Glycemic control amongst Malaysians with T2D deteriorated further, with the average hemoglobin A1c (A1C) growing to 8.66% in 2008, contrasted with 8.0% in 2003. In addition, only 22% of individuals with T2D gained A1C target < 7%, the least rate since 1998.

Disease complications

Great micro vascular problem rate probably as a result of better rates of problem screening with urinalysis, retinal assessment and foot examination carried in more than 90% of sick people; cardiovascular problems were lower, with the exclusion of cerebrovascular events.

Diabetes Management

Feisul (2012) states that an approximated 1.1 million got treatment at public health care clinics. Of the patients getting public-based health care, an approximated 70% went to primary care clinics, while the rest got follow-up and treatment at public clinics. Medical physicians and officers widely give public hospital–based diabetes care lengthily in common medicine outpatient settings. Consultations are concentrated on optimizing glycemic control with ant hyperglycemic therapies (in single or in mixture) and strengthening lifestyle interference while exactly tackling cardiovascular risk decrease.

Lifestyle Management

Management of diet is well-thought-out to be one of the fundamentals of diabetes care. This includes effective diabetes management outcomes from appropriate integration of physical activity, healthy eating and pharmacotherapy. Improper adherence to lifestyle suggestions was greatly prevalent amongst Malaysian sick people with T2D. For example, only 16.4% people with diabetes observe the dietary routine given by dietitians.

Medical nutrition therapy (MNT) that gives personal nutrition suggestions, considering individual and culturally sensitive lifestyle favorites to attain the set treatment goals, has been applied for management of T2D in Malaysia. The success of MNT on glycemic regulation in diabetes individuals has been well recorded.

According to Letchuman, Nazaimoon, Mohamad, et al. (2010) various researches have been carried out in a sub group of the Malaysian diabetes populace. In a research carried among individuals with T2D in the Cheras health facility, 47% recorded an average level of physical activity, 33.3% recording a low level of physical activity, and 20% reporting a high level of physical activity . Furthermore, it was again recorded that 54% of Malaysian diabetes adults were physically inactive.

Pharmacologic Management

Presently there are 7 differing groups of oral anti-hyperglycemic therapies accessible in Malaysia: sulfonylureas, biguanides, dipeptidyl peptidase IV (DPPIV) inhibitors, meglitinides, thiazolidinediones, alpha-glucosidase inhibitors, and, lately, the sodium glucose transporter 2 (SGLT-2) inhibitors.

Use of Technologies

Insulin pump therapy was introduced in Malaysia in 2005, mainly amongst adolescent diabetic persons with T1D with low regulation on multiple-dose insulin vaccinations. Letchuman, Nazaimoon, Mohamad, et al. (2010) said the Medtronic brand of insulin pumps are the only accessible choice, and presently there are an estimated 170 local diabetic people consuming insulin pump therapy, with an approximate 70% having T1D and the rest having T2D.

Chronic care model

The advancement of a chronic care model (CCM) in the mid-1990s altered the viewpoint of Malaysian health care givers in handling non communicable chronic illnesses. Over the time, the model has been improved and enlarged more to address various dimensions and particular issues in chronic disease handling. This enhances practical implementation, particularly in low and middle income countries.

References

G.R. Letchuman, W.M. Wan Nazaimoon, W.B. Wan Mohamad, et al. (2010). Prevalence of diabetes in the Malaysian National Health Morbidity Survey III 2006. Med J Malaysia, 65, 180-186

Feisul (2012). Current burden of diabetes in Malaysia. Proceedings of the 1st National Institutes of Health (NIH) Scientific Meeting. Selangor, Malaysia: National Institute of Health
Mafauzy, Z. Hussein, S.P. Chan. (2011).The status of diabetes control in Malaysia: results of DiabCare 2008. Med J Malaysia, 66, 175-181

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