There is a saying that the smallest leak can sink the largest ship. For many Malaysians, diabetes begins as that small, almost invisible leak – a little extra sugar in the blood, an unchecked lifestyle habit. Left unattended, it swells into a flood that damages the kidneys, strains the heart, and burdens families.
Tackling diabetes beyond sugar control
THERE is a Chinese proverb – duì zhèng xià yào – which translates to fixing the root cause of the problem. This rings true in many issues within society: to choose a problem-solving method tailored to a specific situation.
In Malaysia, the Department of Statistics Malaysia (DOSM) recorded diabetes as one of the principal causes of death. Meanwhile, the National Health and Morbidity Survey (NHMS) revealed that 3.6 million adults, or 15.6 per cent of Malaysians, have diabetes. Alarmingly, two in five adults are not aware they are diabetic.
In an interview with KPJ Kuching Specialist Hospital’s endocrinologist, Dr Lau Bik Kui, raised concerns about the incidence of diabetes affecting younger people.
“The risk is actually highest when you are of elderly age, but these days, we start to notice people who are between 20 and 40 years old have increased,” he said.
Furthermore, the same NHMS reported that two in five adults aged 18 and above do not undergo any health screening. The top three reasons for not screening were that 90 per cent felt healthy, 84 per cent had no symptoms, and 39 per cent attributed it to time constraints.
And the concern continues. According to Dr Lau, with the healthcare system improving, diabetes patients are living longer. The challenge lies in diabetes-related complications such as kidney disease.
“So that will actually eventually translate into a lot of difficulties. On an individual basis, of course, it decreases your quality of life. It can affect the family members,” he said.
“In society, there will be a need to build more dialysis centres. Nationally, the productivity of citizens will become lower, and the burden of healthcare will be higher.”
Hence, Dr Lau believes there is a need to nip renal failures in the bud. Diabetes is just one cause. Obesity, hypertension, and cholesterol also contribute, leading not only to kidney disease but also to other non-communicable diseases such as cardiovascular-disease.
With the progression of medical science, researchers realised that when a patient treats only blood sugar but not hypertension and cholesterol, the risk of cardiovascular disease and related complications ultimately increases.
“Therefore, health screening and early awareness are important. When we combat one problem, we can solve the root cause of a disease. You can’t wait for a complication to happen, only then you look for the cure. Prevention is always better than cure,” said the endocrinologist.
Breakthrough in medical science
“Despite the years of treatments, non-pharmacological interventions, and holistic approaches, our doctors continue to diagnose more than 50 per cent of diabetes patients with renal impairments. So, what went wrong?” Dr Lau added.
According to Dr Lau, since 2015, the medical industry had a breakthrough by introducing new classes of medication such as GLP-1RA and SGLT2 inhibitors as a tool to modify the trajetory of disease progression among people with T2D.
SGLT2 inhibitors are treatments provided by endocrinologists for Type 2 diabetes. They work by removing excess glucose from the body via urine, lowering blood sugar levels while also providing significant cardiovascular and kidney protection.
Meanwhile, GLP1RA, which has a significant role in curbing obesity among people with diabetes, also has proven itself as a game changer in improving diabetes related complication outcomes.
“We can’t prevent the complication, but we are aiming at this moment to have all these drug-modifying medications to help actually delay the progression of the disease, if we can’t stop them,” Dr Lau said.
In fact, more interest are moving into identifying people with good chance of diabetes remission, he added. Briefly, Dr Lau shared the set parameter at which, when a patient is below the age of 40, or is obese, when detected early, there is a better chance of diabetes remission.
For patients in the pre-diabetes stage, interventions such as losing weight, eating healthier, and exercising also increase the likelihood of remission.
The goal is to identify high-risk or diabetic patients as early as possible for timely intervention, which can make a significant difference. The key takeaway is that early diagnosis and intervention greatly impact patient outcomes, though age may limit discussions about remission.
Determining the safe point
When a patient walks into the clinic with an HbA1c reading of 8 per cent, the conversation does not stop at blood sugar. It is about more than numbers on a chart – it is about how to safely bring that number down to a range that reduces complications and improves quality of life.
According to the KPJ Specialist’s doctor, the safe target for HbA1c is between 6.5 per cent and 7 per cent.
“Reports have been telling us that for every 1 per cent reduction in HbA1c, that can cut diabetes complications by roughly 25 per cent. The key word is to bring down the glycaemic control to as ideal as possible,” Dr Lau shared.
Zooming in on microvascular complications, patients who consistently maintain their HbA1c around 6.5 per cent can often protect their eyes and kidneys as effectively as those without diabetes. For many patients, that’s both reassuring and motivating.
Explaining further, Dr Lau shared the four pillars of diabetes management:
- Sugar control: The most obvious and essential. Without managing glucose levels, there is no diabetes management at all.
- Risk factor management: Hypertension and cholesterol need equal attention, since both magnify the risk of stroke, heart disease, and kidney damage.
- Obesity management: Even if sugar, cholesterol, and blood pressure are under control, obesity itself remains a major driver of complications. Heart attack, stroke, and kidney failure risks remain high if weight isn’t addressed.
- Organ-protective medications: The latest generation of drugs, such as SGLT2 inhibitors and GLP-1 receptor agonists, not only help with sugar control but also offer specific benefits for the heart and kidneys, changing the trajectory of the disease.
The bigger picture
The role of the physician is to minimise risks from every angle so patients can live healthier, longer lives. Sugar may be the “headline act” of diabetes, but it is only part of the story. Addressing cholesterol, blood pressure, and obesity, alongside using the right medications, forms a comprehensive shield against complications.
Ultimately, controlling blood sugar is not just about avoiding insulin injections or skipping desserts – it’s about preventing kidney failure, protecting eyesight, and keeping the heart strong. For patients, each small percentage drop in HbA1c is not just a number – it is a step towards a longer, healthier life.
