KUALA LUMPUR, May 19 — A cardiologist has predicted an increase in diabetes and heart disease cases in Malaysia due to disruption of diagnosis and treatment during the Covid-19 epidemic.
According to Dr Azhari Rosman, a senior consultant cardiologist from the National Heart Institute (IJN), some procedures had to be postponed as hospitals are now busy with screening and treating Covid-19 patients.
“The health care system is already under strain during this pandemic,” Dr Azhari told CodeBlue in a recent interview.
“Patients who need to be checked are not coming to hospitals for a few months, resulting in poorly managed diseases; various illnesses may be left untreated or undiagnosed. Heart failure may worsen over the next few months due to poor follow-up,” Dr Azhari added.
Therefore, he stressed that medication for these patients should not be interrupted at any costs and that patients should consult their doctors via phone call or messages to get their medication refilled from the nearest hospitals.
“Family members should also reach out to neighbours or friends to take care of their elderly ones, if traveling home is not possible at this moment.”
The Ministry of Health (MOH) reported yesterday a record high 47 Covid-19 deaths, as well as 4,865 new infections, the highest since January 31. MOH said most government and private hospitals nationwide, as well as low-risk quarantine and treatment centres, have almost reached full capacity for Covid-19 cases.
Dr Azhari also said the Covid-19 epidemic has led to delayed treatments and follow-up sessions for diabetic patients.
“Patients are now unable to come to the clinic for regular follow-ups. Outpatient clinics have reduced the number of patients per day to minimise infection risk,” he said.
“I urge the patients to take initiative to contact their respective hospitals for the earliest available date for follow-up if their appointment was being cancelled. Do not wait for the hospitals to contact you.”
Dr Azhari noted that it is important to have frequent follow-up with doctors, especially if people suffer from chronic illness like diabetes and hypertension, to make sure their treatment is not interrupted.
“If a patient is unable to go to the hospital, contact the doctor and hospital to check if they provide delivery service. Some hospitals, like IJN, offer delivery service to post the drugs to patient’s homes.”
Dr Azhari also highlighted that diabetic patients on insulin treatment may face challenges to receive their medication via delivery services as the insulin is required to be transported in cold chains.
“Hospitals could not post this group of medication to them. In this case the patients need to make their own arrangement to get the medication from the nearer hospitals,” he said.
“Do not stop the medication.”
Besides that, Dr Azhari also cautioned that the number of patients with diabetes and heart disease may rise in the next few months as they may be left untreated or undiagnosed during the Covid-19 epidemic in the country.
According to the National Health and Morbidity Survey (NHMS) 2019, an estimated 3.9 million adults in Malaysia aged 18 and above had diabetes, higher than 3.5 million in 2015. The survey found that 49 per cent of people with diabetes had never been examined or diagnosed with the chronic disease.
Impact Of MCO On Physical Activities
Dr Azhari noted that a sedentary lifestyle has various effects on the development of diabetes and heart failure. According to him, the Movement Control Order (MCO) has halted many opportunities for the people to be involved in physical activities, including school-based physical education and fitness centres.
“Sedentary lifestyle due to the MCO may confer small risk to the patients. However if it’s over long term, it may lead to health complications, especially if they already have risk factors, like diabetes and hypertension.”
At the same time, Dr Azhari also pointed out that the previous MCOs had impacted patients in different ways.
“Some patients inevitably gained weight due to the sedentary lifestyle,” he said.
“Another group of patients manage to shed some pounds because people are not eating out as frequently anymore. As more companies allow staff to work from home, people have more time to prepare home-cooked meals, and some even manage to exercise more due to the time saved from having to travel back-and-forth to the office.”
Dr Azhari, who cited the NHMS 2019 report, mentioned that 25.1 per cent of adults are physically inactive, a reduction compared to 2011 (35.7 per cent) and 2015 (33.5 per cent).
“My advice to my patients is to always check their weight every now and then, once the weight goes up, it’s very hard to bring it down. I also hope that in the future, there will be more open areas designed to exercise, especially in the vicinity of high-rise or high density residential areas.”
Dr Azhari also highlighted some recommendations for the prevention of diabetes and heart disease among the younger population, including lifestyle modifications.
According to NHMS 2019, approximately five per cent of young Malaysians between 18 and 29 years old are diabetic.
“It is worrying to see this trend. I think the MCO has more impact on children than on adults, as there are no interactions with other peers, and no physical activities, games and sports,” said Dr Azhari.
“If they’re living in a high-density area, there’s no opportunity to exercise. Coupled with the convenience of food delivery, there’s better accessibilities to unhealthy fast food.”
Dr Azhari noted that 30 per cent of childhood obesity cases eventually leads to adulthood obesity.
“Therefore, parents play a vital role to monitor children’s diet and engage them in outdoor activities in the park.”
It is to be noted that the top five comorbidities seen among patients who died from Covid-19 in Malaysia last year were hypertension, diabetes, ischaemic heart disease, chronic kidney disease, and high cholesterol
Dr Azhari advised the public that lifestyle changes, including the consumption of less or oil-free food, as well as reduction of sugar and salt in daily diet practices are the key measures to preventing diabetes.
“Moderate-to-vigorous physical activity, such as 50 minutes activities, three times a week or 30 mins activities five times a week is recommended for the prevention and control of diabetes.”
According to the National Diabetes Registry Report 2013-2019, almost half, or 47.87 per cent patients with diabetes, ranged from the age of 45 to 59 in Malaysia.
