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The Diabetes Dilemma

When it comes to diabetes, experts explain that physiological differences between Western and Asian populations are significant, stressing the urgent needs for local data to guide the development of effective public health policies.

It is important to understand that the epidemiology of diabetes is dynamic, with global ebbs and flows that demonstrate success stories and areas for improvement. Picture courtesy of IMU.

KUALA LUMPUR, April 23 – “Eat less carbs and cut back on sugar!”

With one in five adults in Malaysia diagnosed with diabetes, this advice is doled out freely, but is that all?

Experts say there is much more to it, as diabetes is a complex condition with multiple factors that tip the scales, including family history, physiology, and physical activity, along with diet playing a role.

After years of steady increase, as shown in successive National Health and Morbidity Surveys, diabetes rates in Malaysia have reached alarming levels and, if left unchecked, will escalate from 3.9 million in 2019 to seven million in 2025.

Approximately 34.38 per cent of the population have elevated blood sugar (HbA1c) levels above 6.5 per cent, which is the threshold for diagnosing diabetes.

However, that is not the only concern. The National Diabetes Registry Report 2013-2019 noted an increase in diabetes-related complications such as amputations, blindness (diabetic retinopathy), erectile dysfunction, and kidney disease in Malaysia, contributing to poor health outcomes and quality of life among diabetes patients.

The burden and impact of diabetes is also felt globally, with the World Health Organization (WHO) reporting that prevalence of diabetes has risen dramatically in countries of all income levels.

What’s more, while prevalence of diabetes is highest among those aged between 75 and 79, type 2 diabetes (formerly known as adult-onset diabetes and representing more than 95 per cent of diabetes cases) is occurring more frequently in children

What does this mean for us, and what can we do about it?

Firstly, it is important to understand that the epidemiology of diabetes is dynamic, with global ebbs and flows that demonstrate success stories and areas for improvement, said Prof Edward Gregg, head of the Royal College of Surgeons in Ireland (RCSI) School of Population Health.

For example, between 1960 and 1980, there was a clear upward trend in diabetes with an increased risk for complications.

In response, improvements in quality of care helped to reduce both the incidence of diabetes and its related complications in the years that followed.

Owing to many factors, current data now reveals reduced cardiovascular deaths among older adults, alongside a concerning increase in obesity among younger adults, with more diverse complications.

This complex situation means that more people are living with one or more chronic conditions for longer, presenting a significant challenge to health care practitioners.

However, he also stressed that these trends were reflected in other western countries such as the United Kingdom, while data from other parts of the world were not readily available.

Explaining further, Prof Dr Lokman, deputy vice-chancellor of research at International Medical University (IMU), explained that, while global health care trends are good indicators, most of the existing research on diabetes is based on Western populations.

Because of this, results from these studies do not directly translate to the diet, genetics, culture, and lifestyle of Malaysians.

Likewise, as long-term, longitudinal studies are lacking in Malaysia and many other Asian nations, most of the established guidelines for the prevention and management of diabetes are also based on Western demographics. 

As Asian diets comprise of more carbohydrate-rich foods in the form of rice, noodles, and breads, researchers have looked into the key differences between Western and Asian diets and physiology.

Their work has found that food, especially simple sugars and carbohydrates, affect blood glucose levels differently between people of Caucasian and Asian descent, with a higher glycaemic response among Asians compared to Caucasians after consuming similar amounts of carbohydrates.

While it is normal for blood glucose levels to rise after eating, insulin helps to regulate blood glucose levels.

However, those with diabetes experience dangerously high levels of blood glucose due to insufficient or deficient insulin. 

As Malaysia has one of the highest rates of diabetes in Asia, it is imperative to look even more deeply into the interconnected web of genetics, culture, lifestyle, and diet that influence the development of diabetes in Malaysia.

Towards that end, the Seremban Diabetes (SeDia) Cohort is Malaysia’s first longitudinal study on diabetes, which aims to provide important insights and yield data that is more relevant to the local population, explained Prof Lokman, who is also principal investigator of the SeDia Cohort.

In time, data collected from thousands of diagnosed diabetes patients as well as their family members will reveal greater insights and help to improve guidelines for treating and managing diabetes, while shaping more targeted public health policies.

In the meantime, Malaysians would do well to make some changes in their dietary habits to better manage the effect of a carbohydrate-heavy culture. 

There is promising evidence that small changes to the sequence and timing of eating carbohydrates can help to manage the subsequent glycaemic response, said Prof Dr Christiani Jeyakumar Henry, senior advisor, Biomedical Research Council (BMRC) at A*STAR, who offers the following advice:

  • Eat breakfast like a king, lunch like a prince, and dinner like a pauper. In simple terms, have a hearty breakfast and an early, low-carbohydrate dinner to better manage blood sugar levels throughout the day.
  • Save the carbs for later. Eating some vegetables and protein before carbohydrates can help regulate the body’s glycaemic response. Similarly, amino acids found in chicken essence, consumed 30 minutes before a carbohydrate-rich meal, have a similar effect.
  • Take your time. Small mouthfuls have a big impact on blood sugar levels. Instead of loading your spoon, try using chopsticks instead. 

Lastly, advocates for a healthier approach to food recommend a paradigm shift to address the habit of over-consumption that is common in many cultures in order to appreciate food for its therapeutic and preventative value, which is particularly relevant for diabetes care and management.

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