Ministry of Health and Local Experts Rally to Call Malaysians to “Check, Confirm, Consult and Change”

WORDS LIM TECK CHOON

On 24 April 2024, YB Dato’ Lukanisman Awang Sauni, the Deputy Minister of Health Malaysia, launched the public health promotion campaign, Stand Against Prediabetes; Don’t Sugarcoat It (SAPd), in Putrajaya.

WHAT IS PREDIABETES?

Prediabetes is a condition where blood sugar levels are higher than normal, but not high enough to be diagnosed as type 2 diabetes.

Nonetheless, this higher-than-normal blood sugar levels will put one at an increased risk of developing type 2 diabetes, heart disease, and stroke in the future, if preventive measures are not taken to control their blood sugar levels.

YOU MAY HAVE PREDIABETES IF YOU HAVE:
  • HbA1c 5.7%-6.2% (39 to 44 mmol/mol).
  • Fasting plasma glucose of 6.1 to 6.9 mmol/L.
  • Oral glucose tolerance test shows that your blood glucose levels are 7.8 to 11.0 mmol/L.
WHY IS THERE A NEED FOR A PREDIABETES CAMPAIGN?
  1. An estimated 3.5 million Malaysians may have prediabetes.
  2. Because prediabetes has no symptoms, many may not be aware that they have it unless they go for a medical check-up.
  3. 1 in 10 people with prediabetes are likely to develop full-blown diabetes within a year, while up to 7 out of these 10 people may face the same outcome in 10 years.
  4. These individuals are already at risk of developing cardiovascular disease, vision loss, nerve damage, and chronic kidney disease even before diabetes sets in!
MORE ABOUT SAPd
FEATURED EXPERT
DR NURAIN MOHD NOOR
President of the Malaysian Endocrine and Metabolic Society (MEMS)

Dr Nurain Mohd Noor said during the launch: “MEMS initiated SAPd and invited the collaboration of seven other medical and allied health societies, as well as the involvement of Ministry of Health Malaysia.”

These societies include Malaysian Diabetes Educators Society (MDES), Malaysian Dietitians’ Association (MDA), Malaysian Family Medicine Specialists’ Association (FMSA), Malaysian Medical Association (MMA), Malaysian Pharmacists Society (MPS), National Heart Association Malaysia (NHAM), and The Chapter of Chemical Pathology & Metabolic Medicine, College of Pathologists, Academy of Medicine Malaysia (CPath AMM).

The SAPd programme is supported by Merck Malaysia.

Dr Nurain further remarked that SAPd managed to attain several important achievements over the last 2 years:

  • Successfully promoted the adoption of standardized prediabetes blood glucose test values in over 200 private chain, independent and hospital laboratories, as well as over 2,000 government clinics and 100 government hospitals.
  • Trained more than 2,000 healthcare professionals including doctors, nurses, pharmacists, and dietitians to enhance their effectiveness in the management of prediabetes.
  • Published a clinical guide for the reference of healthcare professionals, as well an educational website, booklet, and pamphlet for the public.
THE 4Cs OF SAPd
FEATURED EXPERT
PROFESSOR EMERITA DR CHAN SIEW PHENG
Consultant Endocrinologist and Chairperson of the SAPd Programme

Professor Emerita Dr Chan Siew Pheng provided further elaboration into the key message of campaign: the 4Cs or Check, Confirm, Consult, and Change.

CHECK Your Prediabetes Risk

  1. Take the online risk checker at the SAPd website (link opens in a new tab).
  2. If the results show that you are at risk, ask for a simple finger prick blood glucose test at your community pharmacy, private GP clinic, or government health clinic.

SAPd aids to enlist 700 community pharmacies nationwide to provide complimentary finger prick blood glucose tests by mid-May of this year.

CONFIRM the Presence of Prediabetes

If your finger prick blood glucose test results show a higher-than-normal blood glucose level, you will need to get a proper blood test from a laboratory, clinic or hospital.

CONSULT Your Healthcare Professional

The guidance and support of a healthcare professional is important to determine the best approach for you to manage prediabetes with lifestyle intervention and medication, if required.

By attending follow-up visits, your healthcare professional will be able to monitor your progress and keep motivating you to achieve the results you desire.

CHANGE to Reclaim Your Health

The five pillars of prediabetes management are:

  1. Lose excess body weight and maintain healthy weight.
  2. Increase physical activity and exercise.
  3. Adopt healthy lifestyle habits (getting enough good quality sleep, managing stress, and quitting smoking, vaping, alcohol and other substance abuse).
  4. Take your medications as prescribed.
  5. Team up with healthcare professionals.
Visit the SAPd website for more information and free educational downloads (link opens in a new tab). The website is available in English and Bahasa Melayu.

Get the Flu Shot to Prevent a Heartbreaking Holiday Season!

In Malaysia, flu can occur year-round. Older persons, especially those with chronic diseases such as diabetes and high blood pressure, are advised to make flu vaccination an annual priority, especially during the holiday seasons when mingling and traveling are often inevitable. It’s important to strike a balance between staying safe and creating beautiful memories!

DO YOU KNOW THAT YOU COULD END UP WITH A HEART ATTACK OR STROKE WHEN YOU GET THE FLU?

Recent studies have cautioned that influenza increases the risk of heart attack by more than 10 times in the first 7 days after contracting the flu.

This is especially so if you are 65 and over, regardless of whether you have a history of heart disease or are living with chronic illnesses such as heart disease, diabetes, lung disease and kidney disease. In industrialized countries, most deaths associated with flu occur among older persons aged 65 years and above!

Among older persons, influenza can present as a relatively mild respiratory illness; it may also present without any symptoms (no fever and/or no cough). It can also lead to fatigue and confusion, potentially setting off a sequence of catastrophic events.

Professor Datuk Dr Zulkifli Ismail, Technical Committee Chairman of the Immunise4Life Programme, explains: “It is not just a fever, runny nose, cough and body aches, it could seriously harm your heart.”

HOW THE FLU AFFECTS YOUR HEART

When the flu virus enters your system, your immune system strings into action.

Just like fights in real life, collateral damage may result; when an infection triggers a strong response from your immune system, the immune cells can also damage your own healthy tissues and organs.

One example is COVID-19, which can trigger very high activation of the immune system, resulting in the uncontrolled release of cytokines, small molecules that aid cell-to-cell communication in immune responses and stimulate the movement of cells towards sites of infection.

This uncontrolled release (“cytokine storm”) may lead in failure and death of many organs in the body.

 

An illustration of cytokine storm, sometimes called hypercytokinemia, and how it affects both healthy and infected cells. Click on the image for a larger version.

Studies suggest that the same inflammatory response described above can trigger effects that can damage the heart (cardiovascular events) when you have an influenza infection.

Dr Alan Fong, the President of the National Heart Association Malaysia (NHAM) and a consultant cardiologist, shares that your body’s immune response, when present along the direct effects of flu on the inner lining of your blood vessels or atherosclerotic plaques, may cause rupture of such plaques or blockage in the arteries–effects that can lead to a heart attack or stroke.

OLDER PERSONS ARE ESPECIALLY AT RISK WHEN THEY CATCH THE FLU

In older persons, there are changes that occur in the immune system that leads to a decline in the ability of the body to fight off infections such as the flu; this is known as immunosenescence.

Professor Dr Tan Maw Pin, a consultant geriatrician that chairs the Flu & Older Persons Sub-Committee of the Malaysian Influenza Working Group (MIWG), tells us: “In addition to this, ageing contributes to chronic, non-infectious, low-grade inflammation—known as inflammaging—which plays a key role in the cause and progression of chronic conditions such as cardiovascular diseases.”

She further adds that ageing also promotes the development and progression of atherosclerosis, the most common cause of acute coronary syndrome. This syndrome gives rise to situations in which the blood supplied to the heart is suddenly blocked.”

“Hence, when an older person gets the flu, all these factors put them at higher risk of developing a heart attack and stroke,” Prof Tan reiterates.

FLU VACCINATION CAN PROTECT YOUR HEART

Studies have found that the flu vaccination was associated with a 34% lower risk of major adverse cardiovascular events, and those that have recent acute coronary syndrome had a 45% lower risk.

There is also an 18% reduced risk of death reported in patients with heart failure.

For people with type 2 diabetes mellitus, studies have shown that the flu vaccination reduces the risk of heart failure by 22%, stroke by 30%, heart attack by 19% and pneumonia by 15%.

Flu vaccination does not require behaviour change or a daily intervention, yet it prevents cardiovascular events as well as as other evidence-based approaches such as statin therapy, antihypertensive therapy, and smoking cessation.

This article is contributed by Immunise4Life (IFL), a collaboration of the Ministry of Health Malaysia with the Malaysian Paediatric Association (MPA) and the Malaysian Society of Infectious Diseases & Chemotherapy (MSIDC).

The article has been edited by HealthToday for publication on this website.

For more information on flu, you can visit IFL’s website Act of Love (link opens in a new tab).

References:

  1. Warren-Gash, C., Blackburn, R., Whitaker, H., McMenamin, J., & Hayward, A. C. (2018). Laboratory-confirmed respiratory infections as triggers for acute myocardial infarction and stroke: a self-controlled case series analysis of national linked datasets from Scotland. The European respiratory journal, 51(3), 1701794. https://doi.org/10.1183/13993003.01794-2017
  2. Michos, E. D., & Udell, J. A. (2021). Am I getting the influenza shot too?: Influenza vaccination as post-myocardial infarction care for the prevention of cardiovascular events and death. Circulation, 144(18), 1485–1488. https://doi.org/10.1161/CIRCULATIONAHA.121.057534
  3. Modin, D., Jørgensen, M. E., Gislason, G., Jensen, J. S., Køber, L., Claggett, B., Hegde, S. M., Solomon, S. D., Torp-Pedersen, C., & Biering-Sørensen, T. (2019). Influenza vaccine in heart failure. Circulation, 139(5), 575–586. https://doi.org/10.1161/CIRCULATIONAHA.118.036788
  4. Vamos, E. P., Pape, U. J., Curcin, V., Harris, M. J., Valabhji, J., Majeed, A., & Millett, C. (2016). Effectiveness of the influenza vaccine in preventing admission to hospital and death in people with type 2 diabetes. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 188(14), E342–E351. https://doi.org/10.1503/cmaj.151059
  5. King, S. C., Fiebelkorn, A. P., & Sperling, L. S. (2020, November 2). Influenza vaccination: Proven and effective cardiovascular disease prevention. American College of Cardiology. https://www.acc.org/latest-in-cardiology/articles/2020/11/02/14/42/influenza-vaccination-proven-and-effective-cvd-prevention
  6. Vetrano, D. L., Triolo, F., Maggi, S., Malley, R., Jackson, T. A., Poscia, A., Bernabei, R., Ferrucci, L., & Fratiglioni, L. (2021). Fostering healthy aging: The interdependency of infections, immunity and frailty. Ageing research reviews, 69, 101351. https://doi.org/10.1016/j.arr.2021.101351