Diabetes in Malaysia: How Insurance Can Make Care Accessible

Food is broken down into glucose (a simple sugar found in blood) when eaten. This process is referred to as metabolism. When food is digested, glucose makes its way into our bloodstream and is transported by the blood to all body parts to deliver energy.

The hormone that assimilates glucose from the bloodstream into body cells is insulin. Produced by the pancreas, insulin helps keep blood sugar levels normal.

The main disease related to insulin production is diabetes. However, many Malaysians may not fully understand diabetes and its corresponding health complications. So, let’s delve into some basics and how this disease can be treated, shall we? 

What is diabetes?

Diabetes mellitus, commonly referred to as diabetes, is a metabolism disorder where an individual has high blood glucose (blood sugar). This condition occurs due to inadequate insulin production, body cells not responding properly to insulin, or both.

A diabetic individual maintains elevated quantities of glucose in their blood (hyperglycemia). This excess blood glucose usually passes out of the body in urine. However, even when the bloodstream has substantial glucose, with diabetics, their cells aren’t receiving it for energy and growth requirements.

There are two main types of diabetes:

• Type 1 diabetes fundamentally occurs when the body stops making insulin. This diabetes variation is more prevalent in children and young adults in Malaysia.

• Type 2 diabetes develops when some insulin is manufactured, but the body cannot use it well. Type 2 diabetes is more prevalent in Malaysia and accounts for approximately 90-95% of all diabetes cases.
  
  

What are the symptoms of diabetes?

Symptoms of diabetes include:

• Blurred vision

• Rapid weight loss (Type 1 diabetes)

• Unexplained tiredness

• Unusual hunger (polyphagia)

• Erectile dysfunction

• Slow-healing cuts

• Unusual thirst(polydipsia)

• Frequent urination

• Numbness or tingling in hands or feet
  
  

Diabetes statistics in Malaysia

The Malaysian Diabetes Index (MDI) survey conceived by AstraZeneca in partnership with the Malaysian Endocrine & Metabolic Society (MEMS) revealed that most Malaysians had a limited awareness and understanding of diabetes.

For context, over 52% of respondents did not know that diabetes cannot be cured. Similarly, 51% of respondents believed that diabetes isn’t challenging to manage. Relatedly, 37% of respondents with diabetes did not know what qualified as abnormal blood sugar level readings.

How many Malaysians are diabetic?

According to the International Diabetes Federation, approximately 537 million adults are living with diabetes globally.

A National Health and Morbidity Survey conducted in 2019 approximated that 3.9 million Malaysians were living with diabetes. This signified a prevalence rate increment from 13.4% in 2015 to 18.3% in 2019. By the same token, diabetes is unfortunately expected to affect 7 million Malaysian adults by 2025.

Another study published in January 2022 on the ‘Prevalence of type-2 diabetes in Malaysia’ to enhance diabetes awareness, prevention, control and treatment suggested that the prevalence of diabetes was 14.39%. This is approximately 1 out of every 7 people living in Malaysia.

Causes of diabetes in Malaysia

The following are the key causes of diabetes in an individual:

Obesity and physical inactivity

According to researchers, there is a strong correlation between diabetes, obesity and physical inactivity.

Unfortunately, being overweight can pose the risk of insulin resistance. However, the location of body fat makes a difference. For example, individuals with extra belly fat are more prone to insulin resistance and hence, Type 2 diabetes occurrences.

Hormonal diseases

Hormonal diseases can cause the body to produce specific hormones in large quantities, which can sometimes trigger insulin resistance, and, thus, diabetes. For example, Cushing’s syndrome, a condition whereby the body generates too much cortisol (the ‘stress hormone’), can put individuals at risk of prediabetes.

Insulin resistance

Type 2 diabetes usually commences with insulin resistance. Insulin resistance is fundamentally a condition where the muscle, liver, and fat cells don’t use insulin well. As such, your body needs more insulin to help glucose enter body cells, leading to diabetes.

Genetics and family history

Specific genes can make an individual more likely to develop type 2 diabetes. This is especially if the disease tends to run in one’s family or racial/ethnic group.

For example, Monogenic diabetes is caused explicitly by mutations in a single gene, usually passed through families.

However, in some rare instances, the gene mutation happens independently. In practice, most of these gene mutations trigger the emergence of diabetes by making the pancreas less capable of making insulin. Scientists believe that Type 1 diabetes is mostly genetic but can be triggered by environmental factors, like viruses.

Diabetes care in Malaysia

As we speak, there is no defined “cure” for diabetes. However, there are multiple ways of keeping diabetes under control, with treatments designed to help the body maintain blood sugar levels.

Generally, good control of blood sugar is the core to avoiding diabetic complications. That being said, in Malaysia, diabetic care is mainly administered in two ways.

Type 1 diabetes: This type of diabetes generally requires injected insulin to replace insulin missing in one’s body. Patients are also advised to learn how to balance their insulin intake with their food intake and physical activity with the help of a diabetes educator.

Type 2 diabetes: Type 2 diabetes treatment varies depending on blood sugar levels. On initial diagnosis, patients are typically counselled to change their lifestyle habits and lose weight by a diabetes educator and dietitian. 

However, because diabetes is a progressive disease, treatment regimes may change. For example, increased dosages of oral medications and, eventually, frequent insulin injections if blood glucose is unmanaged.

Diabetes medicine in Malaysia

Unfortunately, individuals with Type 2 diabetes are more likely to develop different medical problems like damage to their eyes and nerves, heart attacks and strokes. So, the cardinal goal of taking medication is to prevent these complications.

However, most medication depends on factors like how severe one’s diabetes is, their age and whether they already have other health problems.

According to Malaysia’s National Diabetes registry report, besides insulin, Metformin is the most common drug used by diabetics, followed by sulphonylureas (particularly, Glipizide and Glimepiride).

Metformin works primarily by lowering glucose production in the liver whilst improving one’s body's sensitivity to insulin so that the body uses insulin more effectively.

 Other drugs extensively utilised by diabetes patients in Malaysia are:

1. Invokana (sodium-glucose cotransporter 2 inhibitor class)

2. Januvia (dipeptidyl peptidase 4 inhibitors)​​​​​​​

3. Jardiance (SGLT2 class)​​​​​​​

Cost of diabetes in Malaysia

According to a report by the Malaysian Ministry of Health (MOH) and the World Health Organization (WHO), the nation’s care costs for diabetes are approximately RM4.38 billion per year.

In essence, the chronic nature of diabetes and its corresponding complications make it a very costly disease. By some estimates, the direct cost per diabetes patient annually is RM 2,684.

Insurance for diabetes in Malaysia

Many existing generic health insurance plans exclude diabetes care and its complications.

However, Prudential’s Diabetes Care Health Insurance allows Malaysians to flexibly manage the high cost of diabetes treatment and related illnesses. 

Prudential’s diabetes medical insurance plans essentially cover hospitalization expenses for Type 1 and Type 2 Diabetes and corresponding complications with cover elements like:

• In-patient hospital expenses (including medications and treatments)

• Pre-hospital and post-hospital charges

• Zero waiting period

• Ambulance costs

• Organ transplant costs

• Reimbursements for check-ups related to the disease
  
  

Benefits of diabetes insurance

If you’re contemplating getting insurance for diabetes, here are some reasons to do so, especially if you have a family history.

• Diabetes medical insurance plans cover doctor consultation fees, enabling policyholders to access the best endocrinologists without worrying about consultation fees.

• It also covers diagnostic costs for approved diabetes drugs that may be expensive.

• It covers medical costs for rare and expensive diabetes drugs.

• It allows policyholders to focus entirely on recovery instead of worrying about hospital bills.
  
  

How can you prevent diabetes?

In many cases, the risk of diabetes can be reduced by lifestyle changes such as:

1. Become more physically active by getting at least 30 minutes of moderate aerobic activity three days a week. Or, aim for 150 minutes of moderate aerobic activity weekly.

2. Lose extra weight to reduce the risk of diabetes.

3. Ensure to always eat healthy foods that are low fat and low calorie but high in fibre. For example, focus on consuming fruits, water, vegetables and whole grains.

4. Discuss with your doctor about considering new diet options.

Conclusion

In summary, diabetes is virtually incurable, and unfortunately, type 2 diabetes lasts a lifetime. However, some people have been known to combat the symptoms via regular exercise, proper dieting and body weight control.

Diabetes bears a substantial economic burden on Malaysia's national healthcare system.

To further exacerbate issues, it also increases one’s risk of developing other health complications like heart problems, kidney disease, blindness, nerve damage, and even amputation.

These complications add to the complexities of diabetes management that revolve around pre-emptive measures like monitoring and controlling blood sugar levels.

However, through early disease management, one can delay or mitigate any severe complications. However, it is imperative to ensure early diagnosis and referral to improve the standard of diabetes care.

For patients constantly living under the diabetes cloud, getting a good health insurance plan for extended protection is advisable. This will ensure you don't feel the pinch of the exhaustive and repetitive elements that constitute effective diabetes management, like frequent consultations and medicine price changes.