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.

Mealtime Strategies to Transform the Lives of People with Type 2 Diabetes

WORDS LIYANA TAN ABDULLAH, DR HARVINDER KAUR GILCHARAN SINGH & DR KANIMOLLI ARASU

FEATURED EXPERTS

LIYANA TAN ABDULLAH
BSc Applied Chemistry UM
Student of Master Clinical Nutrition
Universiti Kebangsaan Malaysia
DR HARVINDER KAUR GILCHARAN SINGH
Senior Lecturer
Centre for Community Health Studies (ReaCH) Faculty of Health Sciences
Universiti Kebangsaan Malaysia (UKM)
DR KANIMOLLI ARASU
Dietitian and Senior Lecturer
IMU Division of Nutrition & Dietetics
International Medical University (IMU)

Type 2 diabetes mellitus (T2DM) poses a significant public health challenge in Malaysia, mirroring a global trend of increasing prevalence.

According to the International Diabetes Federation (IDF), there are almost 463 million people suffering from T2DM worldwide. In Malaysia, this chronic condition is on the rise, with approximately 1 in 5 adults living with diabetes according to 2019 National Health and Morbidity Survey.

THE COST OF TREATING T2DM IN MALAYSIA IS INCREASING DAY BY DAY

Globally, total annual cost for treating diabetes in 2022 was estimated to be USD412.9 billion, which include USD306.6 billion for direct medical costs and $106.3 billion for indirect costs attributable to diabetes.

T2DM has a huge socioeconomic implication with an estimated cost of RM 4.38 billion in 2017 to treat T2DM and its complications, according to a report published by the Malaysian Ministry of Health (MOH) and the World Health Organization (WHO).

Additionally, people with T2DM suffer from complications such as heart disease, chronic kidney disease, nerve damage, vision and/or hearing problems, and mental health issues when the disease is poorly managed. Consequently, it leads to poor quality of life among Malaysians living with T2DM.

There is a need for public awareness and caution when managing T2DM. This article aims to provide comprehensive insights of the risk factors associated with T2DM and lifestyle strategies for effective diabetes management.

WHAT IS TYPE 2 DIABETES?

T2DM is a chronic health condition characterized by increased sugar (glucose) levels in the blood.


An overview of T2DM. Click on the image for a larger and clearer version.


Following a meal, our body processes the ingested food, generating sugar, specifically glucose molecules. Glucose molecules are then released into the blood stream.

Concurrently, the pancreas secretes insulin hormone to control and maintain our blood glucose level. Insulin helps our cells to utilize sugars as a source of energy for the body.

In people with T2DM, their body cannot produce sufficient insulin or there is a problem in the effective utilization of insulin. Thus, blood glucose level remains high, causing multiple complications.

RISK FACTORS OF T2DM

Various risk factors, including overweight and obesity, have been identified in association with T2DM.

Overweight and obesity

The mechanisms that link obesity with insulin resistance are still uncertain. However, some studies suggest that people with obesity have fewer insulin receptors, especially in the skeletal muscle, liver and adipose tissue, than lean people.

Excessive weight gain is posited as a potential factor contributing to the impairment of insulin function, possibly linked to the detrimental effects of fat accumulation in tissues such as the muscles and liver.

Other risk factors

Besides obesity, other risk factors for T2DM includes combination of environmental and genetic risk factors. Even though strong correlation between genetic risk factors and T2DM are found in many studies, environmental risk factors remain as crucial in the development of T2DM.

Therefore, specific strategies such as promotion of physical activity, healthy lifestyle and healthy dietary patterns combined with interventions to reduce the rate of obesity could reduce increasing number of T2DM incidences in near future.

MEALTIME STRATEGIES FOR PEOPLE WITH T2DM

Here are some important strategies recommended by Ministry of Health Malaysia.

Portion control is crucial.

People with T2DM are recommended to have:

  • 2 servings of carbohydrates for breakfast.
  • 2 to 3 servings for lunch and dinner, respectively.
  • 1 to 2 servings of snack.

You can use your hand as a visual guide to determine portion sizes of your foods.

NUTRIENTS EXAMPLES SIZE OF 1 PORTION
Carbohydrates Rice The size of your fist.
Protein Tenggiri fish The size of your palm.
Fats Butter The size of the tip of your thumb.
Dietary fibre Green vegetables 2 hands full.

Additionally, you can also adhere to their specific recommended portions by following the Malaysian healthy plate such as the quarter, quarter half concept.


  1. Pick a dinner plate of 9-inch or 23-cm diameter.
  2. Fill half the plate with non-starchy vegetables, such as salad, green beans, broccoli, cauliflower, cabbage, or carrot.
  3. Fill one quarter with a lean protein, such as chicken, fish, turkey, beans, tempeh, tofu, or eggs.
  4. Fill the remaining quarter with carbohydrate-rich foods such as rice, pasta, noodles, corn, or other wholegrains. Note that a cup of milk counts as carbohydrate.
  5. Choose water or a low-calorie drink such as unsweetened fruit juice or tea to go with your meal.
  6. You can also add 2 serving of fruits per day as part of your diet.

Consume high-fibre food such as fresh fruits and vegetables.

Foods containing high amounts of soluble fibres such as apples, citrus fruits, barley, and beans help to prevent sugar spikes as they slow down the digestion process.

However, these foods also contain carbohydrates and thus, you need to watch the portion sizes.

Choose wholegrains instead of simple carbohydrates.
EXAMPLES OF SIMPLE CARBS EXAMPLES OF COMPLEX CARBS
  • White bread
  • White pasta
  • White rice
  • Cakes
  • Cookies
  • Candy
  • Ice cream
  • Non-diet sodas
  • Sugar cereals
  • Sweetened drinks
  • Whole wheat bread
  • Brown rice
  • Starchy vegetables
  • Fruit
  • Beans
  • Lentils
  • Quinoa
  • Oats
  • Sweet potatoes
  • Chia seeds
Avoid or limit intake of foods high in sodium as these foods may lead to high blood pressure.

Examples of high sodium foods include salty snacks, fast food, pickles, and gravies.

Low sodium foods include whole foods such as fresh fruits and vegetables, unsalted foods or snacks, herbs and spices.

Consume healthy fats such as foods rich in unsaturated fatty acids.

Examples of fgood sources of unsaturated fatty acids include fish, nuts and seeds.

Avoid or limit intake foods high in saturated fats such as processed meat, cheese, and fatty meat.

Avoid or limit sugar sweetened beverages such as canned drinks or carbonated drinks.

These beverages add to your total calorie intake and lead to increased blood glucose levels.

People with T2DM can opt for unsweetened coffee or tea.

Avoid or limit alcohol drinks and cigarettes smoking.
Lead an active lifestyle by doing exercises.

Perform moderate-intensity exercises such as cycling less than 20km/hour, water aerobics, mowing the lawn, actively playing with children for 150 minutes per week.

Perform for at least 90 minutes per week vigorous exercise such as race walking, hiking uphill, aerobics, swimming, and cycling uphill.

Additionally, aim for at least 2 sessions per week of muscle strengthening exercises such as push-ups, squats and abdominal crunches.

Consult a healthcare professional on the appropriate types and frequency of exercise. as some individuals may need personalized exercise regime—especially the older adults, elderly and those with chronic conditions.

It is also recommended to check blood glucose levels before engaging in vigorous exercise regimes.

Consume adequate fluids to maintain good hydration status during exercise.

OTHER USEFUL TIPS
Monitoring carbohydrates intake is essential.

A dietitian can provide guidance on estimating carbohydrates intake through techniques such as carbohydrates counting or maintaining a food diary. These approaches enable people with T2DM to understand how different foods impact their blood sugar levels. It is important to pair carbohydrates counting with the blood glucose levels and medication intake.

Always monitor at home the blood sugar level for those who are at risk of hypo- or hyperglycaemia, using a blood glucose meter.

Self-monitoring of blood glucose level is important to ensure blood glucose stays within the recommended levels and it helps to prevent hypo- or hypoglycemia.

It can be done in a fasting state before and/or 2 hours after a meal.

People with T2DM should adhere to anti-diabetic medications dosage intake and insulin injection regimen to help improve blood glucose control.

Always seek guidance from healthcare professionals to manage your diabetes effectively.

Keeping a close watch on overall carbohydrates and sugar consumption remains a fundamental strategy for achieving optimal blood sugar control in people with T2DM.

Besides, people with T2DM should possess awareness and understanding of all the recommendations and guidelines provided by their healthcare professionals.


References:

  1. CPG Secretariat, Health Technology Assessment Section. (2020). Clinical practice guidelines: Management of type 2 diabetes mellitus (6th ed.). Ministry of Health Malaysia. https://www2.moh.gov.my/moh/resources/Penerbitan/CPG/Endocrine/CPG_T2DM_6th_Edition_2020_13042021.pdf
  2. Nasir, B.M., Abd. Aziz A., Abdullah, M.R., & Mohd Noor, N. (2012). Waist height ratio compared to body mass index and waist circumference in relation to glycemic control in Malay type 2 diabetes mellitus patients, Hospital Universiti Sains Malaysia. International journal of collaborative research on internal medicine & public health (IJCRIMPH), 4, 406. https://www.researchgate.net/publication/281629114_Waist_height_ratio_compared_to_body_mass_index_and_waist_circumference_in_relation_to_glycemic_control_in_Malay_type_2_diabetes_mellitus_patients_Hospital_Universiti_Sains_Malaysia
  3. Bener, A., Zirie, M., & Al-Rikabi, A. (2005). Genetics, obesity, and environmental risk factors associated with type 2 diabetes. Croatian medical journal, 46(2), 302–307.
  4. Ganasegeran, K., Hor, C. P., Jamil, M. F. A., Loh, H. C., Noor, J. M., Hamid, N. A., Suppiah, P. D., Abdul Manaf, M. R., Ch’ng, A. S. H., & Looi, I. (2020). A systematic review of the economic burden of type 2 diabetes in Malaysia. International journal of environmental research and public health, 17(16), 5723. https://doi.org/10.3390/ijerph17165723
  5. Gardner, C. D., Trepanowski, J. F., Del Gobbo, L. C., Hauser, M. E., Rigdon, J., Ioannidis, J. P. A., Desai, M., & King, A. C. (2018). Effect of low-fat vs low-carbohydrate diet on 12-month weight loss in overweight adults and the association with genotype pattern or insulin secretion: The DIETFITS randomized clinical trial. JAMA, 319(7), 667–679. https://doi.org/10.1001/jama.2018.0245
  6. Kojta, I., Chacińska, M., & Błachnio-Zabielska, A. (2020). Obesity, bioactive lipids, and adipose tissue inflammation in insulin resistance. Nutrients, 12(5), 1305. https://doi.org/10.3390/nu12051305
  7. Feisul, I. M., Azmi, S., Mohd Rizal, A. M., Zanariah, H., Nik Mahir, N. J., Fatanah, I., Aizuddin, A. N., & Goh, A. (2017). What are the direct medical costs of managing type 2 diabetes mellitus in Malaysia?. The medical journal of Malaysia, 72(5), 271–277.
  8. Shafie, A., & Ng, C.H. (2020). Estimating the costs of managing complications of type 2 diabetes mellitus in Malaysia. Malaysian journal of pharmaceutical sciences, 18, 15-32. 10.21315/mjps2020.18.2.2
  9. Goossens G. H. (2008). The role of adipose tissue dysfunction in the pathogenesis of obesity-related insulin resistance. Physiology & behavior, 94(2), 206–218. https://doi.org/10.1016/j.physbeh.2007.10.010
  10. Parker, E. D., Lin, J., Mahoney, T., Ume, N., Yang, G., Gabbay, R. A., ElSayed, N. A., & Bannuru, R. R. (2024). Economic costs of diabetes in the U.S. in 2022. Diabetes care, 47(1), 26–43. https://doi.org/10.2337/dci23-0085

A Dermatologist Shares Essential Skincare Tips for People with Diabetes

WORDS DR GAN TECK SHENG

FEATURED EXPERT
DR GAN TECK SHENG
Consultant Dermatologist
Tung Shin Hospital

The stakes are high when it comes to diabetes management.

High blood sugar is not just a number; it affects various bodily components, including your skin.

For many, a skin problem serves as an early warning sign of diabetes. Those elevated glucose levels are often the culprits behind the dry, itchy skin.

But here is the lifestyle twist–many individuals living with diabetes are not aware of the vital role that proper skin care plays. It is not just about administering insulin and watching your diet; it is about a comprehensive approach to well-being that includes your skin.

GENERAL SKIN CARE
Use gentle cleanser when bathing or showering.
  • Avoid bar soaps as they strip away natural oils and disrupt skin barrier function.
  • Also avoid cleansers that contain perfumes and harsh detergents as they may cause irritation and redness to the skin. Instead, use gentle cleansers to help maintain hydration and prevent skin dryness.
Bathe or shower the right way.
  • Use lukewarm water as hot water strips away natural oils and damages the skin.
  • Keep your baths or showers short, ideally no longer than 10 minutes.
Dry your skin carefully.
  • After a bath or shower, dry your skin with gentle pats.
  • Remember to dry the skin between your toes, armpits and other skin folds. Intertrigo—rashes and inflammation caused by skin-to-skin friction—occurs more easily in warm moist environments.
Apply moisturizer every day.
  • Keep your skin moisturized and prevent cracks that lead to infection.
  • Pick a hypoallergenic, fragrance-free moisturizing cream or ointment.
  • Apply after bathing or when your skin is dry or itchy.
FOOT CARE
Check your feet daily.
  • First, dry your feet carefully.
  • Make sure to check between your toes and your feet for rashes, cuts, sores, or any other changes to the skin.
  • Use a mirror if you cannot see your soles.
Wear shoes that fit well.
  • Always wear shoes and socks to avoid injury.
  • Wear closed, well-fitting shoes with cushioned sole.
  • Check if there is any object or pebble inside your shoes before putting them on.
Treat dry, cracked heels.
  • Apply urea cream on dry, cracked hills every day before getting into bed. This will help in preventing the development of non-healing sores and serious skin infections.
Take care of your toenails.
  • Keep your toenails short and trim them straight across.
  • Gently smooth any sharp edges with a nail file.
  • Do not let the sides of your toenails grow into the skin.
See a doctor for treatment of corns and calluses on your feet.
  • Do not remove corns or calluses with sharp objects. Any skin injury on the feet may increase the risk of ulcers and infection, especially patients with diabetic neuropathy.
  • Be cautious when using over-the-counter products, as these products may irritate your skin.
Treat all wounds immediately.
  • Wash wounds with antiseptic and water.
  • Only apply antibiotic cream if recommended by your doctor.
  • Cover the wound with an adhesive bandage.
  • Perform daily dressing to help your skin heal.
SEE A DOCTOR IF YOU EXPERIENCE ANY OF THE FOLLOWING
  • Reddish and swollen skin.
  • Pain or tenderness.
  • Honey-coloured crusts.
  • Change in the colour and temperature of your feet.
  • Wound that is weeping or leaking pus.
  • Thickened or discoloured nails.

First Large-Scale Diabetes Cohort Study Launched in Malaysia

WORDS LIM TECK CHOON

On 10 July 2023, the Seremban Diabetes (SeDia) Cohort Study, was officially launched by Duli Yang Maha Mulia Yang Di Pertuan Besar Negeri Sembilan, Tuanku Muhriz ibni Almarhum Tuanku Munawir in Seremban.

PURPOSE OF THE SeDia COHORT STUDY

This study was launched to holistically explore all the factors involved in the development of diabetes as well as the complications experienced by people with diabetes in this country.

THE HISTORY OF THE STUDY

The genesis of the SeDia Cohort Story began on 17 May 2022 when the Ministry of Health Malaysia and the International Medical University signed a memorandum of understanding for the establishment of this study.

The research protocol of the study received the approval of the Medical Research and Ethics Committee (MREC) on 17 March 2023.

OVER 12,000 PARTICIPANTS SIGNED UP TO AID INVESTIGATION

This SeDia Cohort Study will cover a period of 12 years.

The first important step now is to obtain data that is socio-culturally relevant to the local community. So far, over 5,000 patients and over 7,000 of their family members have voluntarily registered as part of the Diabetes Registry of Klinik Kesihatan Seremban.

The investigators will use digital systems and data infrastructure to collect these participants’ personal and medical information.

Blood samples will also be obtained from these participants for genetic profiling, to study individual predisposition to diabetes and, for people with diabetes, their predisposition to complications and response to medications as well as physical and dietary interventions.

These participants will be followed regularly, with the process of data collection conducted every 3 years over the next 12 years.

Additionally, details of the participants’ life events, such as hospital admission and deaths, will be collected and updated every year.

STUDY HOPES TO IMPROVE DIABETES PREVENTION & MANAGEMENT IN MALAYSIA

Using the data obtained from these participants, the investigators will study and analyze the complex web of factors that contribute to the development of diabetes and its complications.

These factors include genetics and family history of diabetes to lifestyle and environmental factors, dietary regimes, physical activity, socio-economic levels, and healthcare delivery.

The investigators believe that the understanding of these complex factors and the connection between them would enable us to uncover optimal strategies for diabetes prevention and treatment.

Such strategies would enable implementation of evidence-based policies and programmes to address the escalating burden of diabetes in Malaysia.

ACCESS WILL BE GRANTED TO LOCAL & INTERNATIONAL RESEARCHERS

To establish the SeDia Cohort as a study of national significance, local and international researchers will be granted access to SeDia Cohort to conduct further analysis and studies, subject to approval of the MREC.

FUNDING INFORMATION

The SeDia Cohort study will be funded through public funds, which includes contributions from corporations and individuals.

“Don’t Let Diabetes Ruin Your Eyesight!” Warns Expert

WORDS LIM TECK CHOON

FEATURED EXPERT
DR PEH KHAIK KEE
Consultant Ophthalmologist and Vitreoretinal Surgeon
Sunway Medical Centre
DIABETES IS THE MOST COMMON CAUSE OF BLINDNESS AMONG WORKING-AGE ADULTS

“1 in 5 Malaysians is diabetic, which equals to an estimated 4.6 million Malaysians, and diabetic eye disease affects 1 in 3 diabetics. That means about 500,000 of these people will experience vision-threatening eye disease,” says Dr Peh Khaik Kee.

DIABETIC RETINOPATHY IS A DIABETES-LINKED EYE DISEASE THAT CAN LEAD TO VISION LOSS

According to Dr Peh, diabetes affects the eye in several ways:

  • It causes changes to the lens, leading to blurry vision.
  • Increased pressure in the eye can lead to glaucoma.
  • Damages the nerves that control the eye muscles, giving rise double vision.
  • Damages the blood vessels in the retina, leading to diabetic retinopathy.
Overview of diabetic retinopathy. Click on the image for a larger, clearer version.

Dr Peh shares: “Diabetic retinopathy has become of epidemic proportions. A large part of this issue is due to poor awareness. Many people with diabetes do not undergo regular eye exams to check for signs of the condition.”

REGULAR EYE EXAMS ARE IMPORTANT BECAUSE EARLY STAGE DIABETIC RETINOPATHY DOES NOT SHOW ANY SYMPTOMS

Vision loss occurs at late-stage diabetic retinopathy—this is when most people affected by this disease seeks medical help.

Dark spots floating around in the person’s vision (floaters) are a possible symptom of diabetic retinopathy.

Unfortunately, the vision loss is permanent, and at that stage, there is little to be done to improve the person’s eyesight.

On the other hand, should diabetic retinopathy be detected at its early stages, treatment can be prescribed to help slow down or stop the vision loss over time.

“That is where the importance of screening comes in,” Dr Peh said.

EYE SCREENING FOR DIABETIC RETINOPATHY IS MORE COMFORTABLE THESE DAYS

In the past, such screening can involve staring at a bright light for up to 5 minutes for each eye, which can be very uncomfortable for some people.

Dr Peh shares that the eye screening process has improved since. “These days we have ultra-widefield fundus cameras that can capture a single, 150-degree field view of the retina; 3 times more field view than a standard camera.”

He adds that the camera captures images in under 1 minute, with up to 98% accuracy in detecting and grading retina disease when combined with targeted slit-lamp examination.

Thus, the screening process is faster and hence the person undergoing screening will have a more comfortable experience, while at the same time offering a high accuracy rate in detecting diabetic retinopathy.

EYE SCREENING MAKES A DIFFERENCE

“Diabetic eye screening was formally initiated in the UK in 2009, and by 2014, diabetes is no longer the commonest cause of blindness in working adults in the UK. That is the difference that screening makes,” says Dr Peh.

WHO SHOULD GO FOR EYE SCREENING?

Dr Peh encourages those with a family history of diabetes to have their blood sugar screened, and those diagnosed with diabetes should see an ophthalmologist to have their retina examined.

If You Have Diabetes, Here’s What You Need to Know About Muscle Loss

WORDS DR NIZAR ABDUL MAJEED KUTTY

FEATURED EXPERT
DR NIZAR ABDUL MAJEED KUTTY
Senior Lecturer
Department of Physiotherapy
Universiti Tunku Abdul Rahman (UTAR)

People with diabetes are living longer now, which is incredibly exciting. Still, they are vulnerable to accelerated muscle loss or sarcopenia, an often-overlooked condition that occurs in people with type 2 diabetes.

MUSCLE LOSS IS NORMAL WHEN WE AGE

It is normal for individuals to lose 3% to 8% of their muscle mass per decade beginning at age 30, and the rate of decline is even higher after the about age 60. Muscle strength declines even more rapidly; at a rate of 3% to 4% per year in men and 2.5% to 3% per year in women by the age of 75.

HOWEVER, PEOPLE WITH TYPE 2 DIABETES ARE LIKELY TO EXPERIENCE ACCELERATED MUSCLE LOSS OR SARCOPENIA

While some muscle loss is typical, sarcopenia refers to a condition of accelerated muscle loss.

An overview of sarcopenia compared to healthy muscle mass. Click on the image to get a larger, clearer version.

Earlier definitions of sarcopenia focused exclusively on loss of muscle mass as the key determinant of the condition, but more recent definitions have recognized that muscle strength and function are equally important for predicting adverse outcomes.

Thus, newer definitions for sarcopenia have included low walking speed and grip strength alongside low muscle mass.

Sarcopenia is associated with an increased risk of falls, functional decline, frailty, and mortality.

THE LINK BETWEEN SARCOPENIA AND TYPE 2 DIABETES

The link is well established.

In a study of Korean adults, 15.7% of participants with diabetes were found to have sarcopenia, compared with just 6.9% of participants without diabetes.

A later study led by the same author, also in Korea, produced similar findings: in a sample of 414 adults aged 65 or older, participants with type 2 diabetes had significantly lower muscle mass.

A link between low muscle mass and diabetes has been found in several other populations as well.

Multiple studies have also linked diabetes to reduced muscle strength. The effect sizes were smaller in women, but the trend was the same for both genders.

This association between sarcopenia and diabetes has led some researchers to argue that sarcopenia is probably one of the underlying mechanisms that explains the reduced functional ability and mobility that is often seen in older patients with type 2 diabetes.

HOW TYPE 2 DIABETES LEADS TO SARCOPENIA

While diabetes accelerates the process of muscle loss, the mechanisms aren’t yet thoroughly understood.

The presence of insulin resistance, which is the key feature of type 2 diabetes, appears to be a major pathway.

Inability to make new proteins at a rapid pace to replace muscles that have been degraded naturally

One of the key roles of insulin is to drive nutrients, such as glucose, from the blood into skeletal muscle tissues and stimulate protein synthesis.

In type 2 diabetes, however, insulin signaling is impaired; insulin is not able to effectively drive glucose into the muscle tissues, and the muscles cannot synthesize new protein rapidly enough to keep pace with natural muscle degradation.

Decreased function of mitochondria

The mitochondrion is the ‘energy plant’ structure in most cells of the body.

Individuals with diabetes frequently have decreased mitochondrial function, which appears to contribute to the impairment of muscle function.

Type 2 diabetes can damage the nerves outside of the brain and spinal cord, usually at the hands and feet (peripheral neuropathy)

Diabetes can promote sarcopenia via peripheral neuropathy. This condition can affect nerves that control proper muscle contraction.

Approximately 30% to 50% of diabetes mellitus patients experience peripheral neuropathy, and the condition has been shown to be an independent risk factor for sarcopenia in individuals with diabetes.

Other possible factors?

Still, other factors also may play a role in causing muscle loss in the context of diabetes.

Thus, a wide variety of factors likely contribute to the connection between diabetes and sarcopenia. Some data suggest that these varying mechanisms come into play even in individuals who are comparatively young or who are comparatively early in the disease process.

CAN LOWERING BLOOD GLUCOSE HELP PREVENT MUSCLE LOSS?

The growing body of research on the connection between diabetes and sarcopenia has raised an important question of whether lowering blood glucose help preserve muscle mass.

There’s currently little research on that question, but diabetes medications that control blood glucose levels likely do have a role to play in treating and preventing muscle loss among older adults with diabetes.

However, key clinical trials on which clinical management guidelines for blood glucose have been based on unfortunately often exclude the participation of older adults, so there’s no way to know at present.

Hence, future research is needed to better understand the effects of glucose-lowering on muscle mass in older adults.

THE ROLE OF EXERCISE

While diabetes medications may have a role to play in lowering blood glucose and in staving off muscle loss, no medication is as beneficial for treating sarcopenia as physical activity.

Physical activity is always recommended to promote fat loss and maintain muscle mass, both of which can improve glucose levels in people with type 2 diabetes.

This recommendation applies equally to both younger and older adults.

Researchers especially recommend muscle strengthening exercise and resistance activities.

Progressive resistance training is the proven method for the prevention and improvement of sarcopenia.

Resistance exercises in more detail

Resistance training doesn’t require more than your own body weight.

Using resistance to engage the muscles causes a surge in growth-promoting hormones that signal the body to produce more muscle tissues.

Not only do these signals encourage the growth of new muscle tissue, but they also help to reinforce existing muscle tissues by making them stronger.

Some body weight resistance exercises that you can try include:

  • Push-ups; try an easier version with your knees on the ground, if you need to.
  • Planks.
  • Squats.
  • Lunges.

With progressive resistance training, you need to exercise your muscles against an increasing external force 2 to 3 times a week for at least 8 to 12 weeks.

This is progressive, meaning that the number of repetitions, sets, or load should be increased gradually over time based on your capabilities and progress.

As the resistance exercises programme develops, more advanced resistance exercises that can be done include barbells, kettlebells, and medicine balls or floor-based exercises.

In terms of exercise order, the American College of Sports Medicine (ACSM) recommends multi-joint exercises to be performed before single-joint exercises for a particular muscle group, and that within each session the larger muscle groups be exercised before smaller muscle groups.

As older adults with sarcopenia are also likely to be at an increased risk for falls and display reduced cardiorespiratory fitness, exercise programmes for them often involve a combination of exercise modes that includes resistance exercises, balance training and aerobic training.

For older adults with sarcopenia

Consider:

  • Walking around the block 4 to 5 times.
  • Do some weight lifting.
  • Sit on and get up from a chair as fast as possible and do this 10 times in a row and getting up ten times in a row as fast as possible.
If you are not used to being physically active, or you have health conditions that can affect your ability to exercise, consider consulting a physiotherapist or a personal trainer to advice. They can help you develop an exercise programme tailored to your needs, health status, and personal enjoyment.

If You Have Diabetes, You Need to Do This for Your Kidneys!

WORDS LIM TECK CHOON

FEATURED EXPERT
DR KENNETH LAI KOAH KIEN
Consultant General Physician and Nephrologist
Bukit Tinggi Medical Centre

Diabetic kidney disease, also known as diabetic nephropathy, develops when one’s kidney has trouble filtering waste from the blood.

An overview of diabetic nephropathy. Click the image to view a larger, clearer version.

When left untreated, the affected kidney may eventually fail and one would need either a kidney transplant or dialysis.

SYMPTOMS USUALLY SHOW UP UNTIL THE DISEASE IS AT AN ADVANCED STAGE, AND BY THEN, IT CAN BE MUCH HARDER TO MANAGE

According to Dr Kenneth Lai Koah Kien, it can take many years for diabetes to substantially damage the kidneys.

“Even then, the symptoms usually don’t show up until late in the course of the disease,” he says.

WHAT ARE THE SYMPTOMS, ANYWAY?
  • Unusual weight gain
  • Swollen ankles
  • Nausea or vomiting
  • Frothy urine
  • Lethargy
  • Urine breath
  • Itching
  • Reduced appetite
  • Swelling of the leg.
  • Blurring of visions and floaters (the eye can also be affected by kidney disease)
SO, WHAT SHOULD SOMEONE WITH TYPE 2 DIABETES DO TO DETECT DIABETIC KIDNEY DISEASE EARLY?

Dr Kenneth recommends the following:

If you have other health conditions alongside type 2 diabetes, keep them well-controlled too along with your diabetes

“These patients would need to monitor their co-morbidities closely with their doctors. These include hypertension, obesity, hypercholesterolemia, and smoking. All these are mercenaries of death together with diabetes,” he says.

Go for kidney disease screening

Recommended screening tests include:

  • A urine test called urine ACR to look for protein leakage
  • A simple blood test called serum creatinine test to look at kidney function

As for when one should start screening:

  • For type 2 diabetes, screening should start on the date of diagnosis.
  • For type 1 diabetes, screening should start 5 years after the onset of type 1 diabetes.

Advice for People With Health Conditions That Will Be Fasting This Ramadan

WORDS LIM TECK CHOON

For the upcoming fasting month, we are pleased to share some important advice from the good people at Alpro Pharmacy.

WILL THE USE OF INHALERS INVALIDATE YOUR FASTING?
  • There are 2 types of inhalers: ‘preventer’ inhalers and ‘reliever’ inhalers. If you are unsure which of your inhalers is which, check with your doctor.
  • While fasting, you should continue to use your preventer inhalers, typically twice a day—before sahur and before you go to bed. It’s best to check with your doctor how often and when you should use your preventer inhaler.
  • Use your reliever inhalers when you have an asthma attack.
WILL FASTING PUT YOU AT RISK OF DEHYDRATION OR LOW BLOOD GLUCOSE (HYPOGLYCAEMIA)?
  • If you have diabetes, check your blood glucose 2 hours after sahur and when you experience symptoms such as dizziness, cold sweat, blurred vision, and shivering. Checking your blood glucose won’t invalidate your fasting.
  • If your blood glucose level is below 3.9 mmol/L, you will need to break your fast for the sake of your health.
  • People with diabetes shouldn’t delay breaking their fast. Keep some dates with you if you have diabetes and you’re fasting. That way, when you’re still stuck in traffic or at work during iftar, you can break your fast with 1 or 2 dates.
  • Eat foods rich in dietary fibre for optimal blood glucose control during the fasting month. Dietary fibre helps keep you feel full longer and stabilize your blood glucose levels.
HOW TO FAST WHEN YOU HAVE GASTRIC PROBLEMS
  • If you have gastric problems, break your fast by eating moderate amounts of foods.
  • Avoid eating fried foods and gassy drinks in too much amounts or too quickly.
  • Also, it’s best to avoid drinks that are high in caffeine, such as coffee.

Oral Health Tips From a Dentist for People With Diabetes

WORDS DR LAU LAKE KOON

FEATURED EXPERT
DR LAU LAKE KOON
Dentist
Koks Dental Surgery

Most people with diabetes or those that have someone close to them that have this disease will know that the disease can harm many organs in the body—such as the eyes, nerves, kidneys, heart, and more.

DO YOU KNOW THAT DIABETES CAN AFFECT THE TEETH AND GUMS AS WELL?

People with diabetes are more likely to have:

  • Periodontal or gum disease
  • Persistent bad breath
  • Tooth decay or cavities
  • Oral fungal infections
  • Oral ulcers
  • Loss of teeth
Diabetes can cause increased levels of glucose in the blood as well as saliva
Progression of gum disease, from gingivitis to the more serious periodontitis. Click on the image to view a larger, clearer version.

The increase of glucose in the saliva encourages the growth of bacteria in the mouth and together with food particles can build soft sticky whitish layer called plaque.

Plaque is the yucky smelly stuff that you can scrape off from your teeth if you haven’t been cleaning them properly. It is the main cause of bad breath.

If left unchecked, the persistent plaque buildup can cause tooth decay and harden to form tartar.

Persistent plaque or tartar buildup causes irritation to the gums

The gums can become red and swollen, and bleeding may occur.

This is the first warning sign that it’s time to visit the dentist.

Comparison of normal tooth and a tooth with periodontitis. Click on the image for a larger, clearer version.

Otherwise, the infection will go deeper under the gums, causing infection of the bone structure supporting the teeth. This is periodontitis, the second stage of gum disease.

The gums will start to recede, trying to pull away from the tartar formed. Over time the teeth will become unstable, and one may experience pain as a result.

At the final stage of gum disease, the teeth will become so infected and painful that it may need to be removed

In poorly controlled diabetic cases, the gum disease may progress much faster. The severity of the condition may be worse, which is why it is important to visit the dentist early to resolve the issues.

Diabetes and certain drugs can reduce the production of saliva in our mouth

Our saliva contains minerals to protect our teeth from tooth decay, mucin to keep the teeth moist and slippery, antibacterial substances to eliminate potentially harmful bacteria, and it also has the ability to neutralize the acids produced by bacteria in our mouth.

Without the presence of saliva, there is a higher risk of tooth decay and gum disease.

Dry mouth can increase the risk of developing fungal infections called thrush, which are painful white patches in the mouth.

In denture wearers, the dryness can decrease the suction effect of the denture and increase abrasion against the gums, leading to ulcers and mouth sores.

Smoking will worsen the condition further.

In severe uncontrolled diabetic cases, some people can develop burning mouth syndrome—a continuous burning sensation in the mouth that will alter taste and sensation.

HOW THE DENTIST CAN HELP YOU
Gingivitis or periodontitis

The dentist will need to carry out deep cleaning of the teeth and gums, in order to decrease the bacterial load and to allow the gums to heal.

However, the dentist can only do so much—you have to also keep good oral hygiene and use of mouthwash daily.

Fungal infections

Your dentist may prescribe some medications to kill the fungus responsible for the infection.

If you use dentures, they will be checked to ensure that they are still fitting properly. You must keep them clean in a disinfection solution at night.

Dry mouth

For most non-severe cases, the simplest solution is to keep your body well hydrated at all times. Drinking water regularly also moistens the mouth.

Only in severe cases are saliva substitutes prescribed.

Burning mouth syndrome is usually more complicated and will require specialist attention.

HELPFUL TIPS
  • A well controlled blood glucose level as well as a healthy diet and lifestyle are key to reducing and preventing oral health problems. Keeping your mouth healthy will also prevent diabetes-related health problems such as heart disease and kidney disease.
  • Good oral hygiene will keep your gums and teeth healthy. Brushing twice a day every day, and use a floss or water floss daily.
  • Visit your dentist regularly for a routine checkup. Please make sure you tell your dentist if you have diabetes. Keep your dentist updated about any changes to your health and blood sugar levels.
  • For denture wearers, make sure your dentures fit properly, and clean them by soaking them in denture disinfectant at night.
  • Quit smoking. Smoking will worsen gum condition and overall health.

Have Diabetes? Here’s an Improved Way to Track Your Blood Sugars

WORDS LIM TECK CHOON

Continuous glucose monitoring (often abbreviated as CGM) is basically a system that allows one’s blood glucose levels to be monitored automatically.

HELPS TO IMPROVE YOUR DIABETES MANAGEMENT

This system opens up a world of opportunities for better blood glucose management for people with type 1 diabetes as well as those on type 2 diabetes that require insulin.

After all, with information of their blood glucose levels that can be obtained immediately, they can make quick informed decisions about their food choices and the dosage of their insulin as well as when to administer it.

LETS YOU ANTICIPATE A POTENTIAL INCOMING MEDICAL EMERGENCY

The ability to observe the pattern of the rise and fall of their blood glucose also allows them to be alert of the possibility of a hypo- or hyperglycaemic episode, and take prompt measures accordingly.

NOT JUST FOR PEOPLE WITH DIABETES

Additionally, continuous glucose monitoring can also benefit people with kidney problems as well as pregnant women worried about gestational diabetes.

RECOMMENDED BY EXPERTS 

It’s really not surprising, therefore, that the 23rd Hong Kong Diabetes and Cardiovascular Risk Factors—East Meets West Symposium reported a growing consensus on the definitions and targets of continuous glucose monitoring metrics to allow healthcare professionals and people with diabetes to make full use of this system in diabetes management.

Indeed, the United Kingdom has already taken steps to do this.

All in all, this is a remarkable example of how technology is making diabetes management, which can be complex and confusing to some people, considerably easier to figure out and implement correctly!


Continuous glucose monitoring is a feature in certain types of blood glucose monitor or glucometer. You can talk to your doctor or your pharmacist for more information on continuous glucose monitoring and whether you can benefit from using a glucometer that comes with this feature.


Reference: Oliver, N., Chow, E., Luk, A. O. Y., & Murphy, H. (2023). Applications of continuous glucose monitoring across settings and populations: report from the 23rd Hong Kong Diabetes and Cardiovascular Risk Factors – East Meets West Symposium. Diabetic medicine : a journal of the British Diabetic Association, e15038. Advance online publication. https://doi.org/10.1111/dme.15038