Current Burden of Diabetes in Malaysia Feisul Idzwan Mustapha MBBS, MPH, AM(M) Public Health Physician, NCD Section, Disease Control Division Ministry of Health, Malaysia National Oral Health Research Conference 2014 11 November 2014 Kuala Lumpur [email protected]Ministry of Health Malaysia
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Current Burden of Diabetes in Malaysia
Feisul Idzwan Mustapha MBBS, MPH, AM(M)
Public Health Physician, NCD Section, Disease Control DivisionMinistry of Health, Malaysia
National Oral Health Research Conference 201411 November 2014
Proportional mortality, Malaysia (% of total deaths, all ages, both sexes)
2
Premature mortality due to NCDs, Malaysia
3
The probability of dying between ages 30 and 70 years from the 4 main NCDs is 20%
DALYs attributable to risk factors
4
10.8%
10.7%
9.0%
8.3%
5.2%
4.3%
3.1%
0.7%
0.1%
10.8%
0.7%
11.4%
12.1%
5.1%
0.9%
4.3%
0.7%
0.1%
15.0% 10.0% 5.0% 0.0% 5.0% 10.0% 15.0%
High BP
Tobacco
Diabetes Mellitus
High BMI
High Cholesterol
Alcohol
Physical Inactivity
Underweight
Poor Water & Sanitation
Male Female
Burden of Disease Study Malaysia, slide courtesy of Dr Mohd. Azahadi Omar, Institute for Public Health
19.4%
15.7%
8.5%
7.3%
7.0%
5.0%
2.3%
0.2%
0.1%
22.8%
1.2%
9.1%
8.1%
8.2%
7.1%
0.3%
0.2%
0.1%
25% 20% 15% 10% 5% 0% 5% 10% 15% 20% 25%
High BP
Tobacco
Diabetes Mellitus
High Cholesterol
High BMI
Physical Inactivity
Alcohol
Underweight
Poor Water & Sanitation
Male Female
Deaths attributable to risk factors
Burden of Disease Study Malaysia, slide courtesy of Dr Mohd. Azahadi Omar, Institute for Public Health
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NHMS 2011 (Volume II, NCD risk factors)
• Full report published in January 2012.
• Pdf copy available from the Institute for Public Health (IKU).
• Fact sheet available at MOH website http://www.moh.gov.my/index.php/pages/view/115
• Results were presented at the 15th NIH Scientific Meeting 2012.
• Powerpoints available at the Institute for Health Management (IHM) website http://www.ihm.moh.gov.my/index.php/en/power-point-presentation-15th-nih-scientific-meeting. 6
Prevalence of Diabetes, ≥18 years, by age groups (2011)
Known
Undiagnosed
Total diabetes
IFG
9
2.94.1
6.4
9.810.7
13.1
18.2
16.115.3
2.0
2.03.1
4.96.4
10.3
15.0
20.8
24.4
26.124.5
22.8
2.1
4.9 5.3
9.410.9
17.6
20.6
26.7
31.6
36.2 36.6
30.3
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
Pre
vale
nce
(%
)
Age groups
Prevalence of Diabetes, ≥18 years, by age groups (1996, 2006 & 2011)
NHMS II (1996)
NHMS III (2006)
NHMS 2011
10
56.0
24.6
15.0
2.5 1.6 0.20
10
20
30
40
50
60
Pe
rce
nta
ge
Usual Place of Treatment (2011)
11
0.0
2.0
4.0
6.0
8.0
10.0
12.0
Pre
vale
nce
%
Male
Female
High blood sugars in adults, ASEAN region, 2010
National Diabetes Registry
• Web-based application.
• Went live on 1 January 2011.
• Supports the implementation of the annual “Diabetes Clinical Audit” amongst Type 2 Diabetes patients in MOH Health Clinics.
• First report, “NDR Report, Volume 1, 2009-2012” was published in August 2013, available at the MOH website http://www.moh.gov.my/index.php/pages/view/115.
Number of Active Registered Patients; as of 28 Feb 2014
State Number of active patients
Johor 117,363
Kedah 52,271
Kelantan 35,556
Melaka 54,725
N.Sembilan 67,950
Pahang 52,196
Perak 90,512
Perlis 16,384
P.Pinang 45,852
Sabah 15,643
Sarawak 70,642
Selangor 130,148
Terengganu 28,292
WPKL 42,287
WP Labuan 1,534
WP Putrajaya 2,983
Malaysia 824,338
Glycaemic Control: Percentage of T2DM Patients with HbA1c <6.5%, 2009 to 2013
• People diagnosed with diabetes have access to diabetes care and treatment in Malaysia.
• Diabetes costs are estimated to account for 16% of the national Malaysian healthcare budget.
• placing Malaysia among the top 10 countries in the world in terms of percentage of healthcare budget spent on diabetes.
• In 2010, an estimated RM 2.4 billion was spent on diabetes-related healthcare.
17
Zhang P. et al. Global healthcare expenditure on
diabetes for 2010 and 2030. Diabetes research
and clinical practice. 2010; 87: 293– 301.
Cost of Diabetes in Malaysia
• Cost of managing diabetes in Malaysia: ~RM19,000.00 per patient per year
• Conservative estimate from a study we did in 2007
• Not ideal treatment
• Data from NHMS 2011 estimates about 1.1 million patients are on follow up at MOH hospitals and clinics
• 1.1 M x RM 19k = RM 20.9 billion!!
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Complications drive costs!
• While there are no studies in Malaysia that outline the breakdown of diabetes costs, a study (CODE II) shows that up to 73% of diabetes-related healthcare costs result from hospitalisation and ambulatory care, as a result of complications due to poor blood sugar control.
• Only 7% of the total diabetes-related healthcare cost is spent on anti-diabetic drugs.
19Jonsson B. Revealing the costs of type 2 diabetes
in the EU and findings from 8 EU countries.
Diabetologia 2002;45:S5–S12.
Summary
• The prevalence of diabetes has increased 31.0% in 5 years, from 11.6% in 2006 to the current 15.2%.
• Mostly contributed by increase of “undiagnosed”.
• Increase in prevalence occurring across all age-groups.
• Increasing challenge in providing satisfactory quality of care to patients with diabetes.
• Number of patients in MOH health clinics will continue to increase.
• Referrals for specialists management will also continue to increase due to late diagnosis and sub-optimal control.
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Sub-analysis of NHMS 2011 data
• At least 15% (18 years and above) already with known NCD risk factors (diabetes, hypertension or hypercholesterolemia).
• Undiagnosed high blood sugar, high blood pressure or high cholesterol: 42.1% (18 years and above).
• Or, if include obesity: 48.3% (18 years and above).
• Therefore our high risk and at risk population: 63.3% (18 years and above)
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We are a SICK population!
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Source of icons: World Heart Federation Champion Advocates Programme