Malaysian Diabetics Develop Complications After Delayed Screening, Treatment

A medical doctor says the proportion of diabetes cases that developed complications may have risen by roughly 15 to 20 per cent.

KUALA LUMPUR, Nov 25 — Late detection and interruptions to clinic visits for diabetic treatments during the Covid-19 pandemic have led to complications in some patients.

Many had their appointments deferred as the government imposed a nationwide lockdown in March last year, while fears of contracting the coronavirus at health facilities continue to keep some patients away until their conditions worsen.

A medical doctor who spoke to CodeBlue recently on condition of anonymity said the proportion of diabetes cases that developed complications may have risen by roughly 15 to 20 per cent, according to his own estimates at ground level.

“Because of the first movement control order (MCO 1.0), there is a higher chance for us to see patients who are coming in, not only with diabetic foot ulcers, but some may have rot their toes and limbs,” the doctor said. Kidney disorders are also another common complication.

He said diabetic patients are supposed to be attached to doctors, with follow-ups given every three to six months.

Most major public hospitals had directed their resources towards Covid-19 treatment, forcing patients with diabetes to be transferred to district health clinics or hospitals in outskirt areas. Some opted to consult private general practitioners (GPs) instead, while others felt they were better off without any treatment for fear of contracting Covid-19 in hospitals.

“I don’t think there is a backlog (in diabetic cases) because many have pushed some patients to outer centres, some patients have been pushed back to primary care. But I think, generally, the problem is fear because the appointments are there but patients don’t turn up.

“The worst part is a loss to follow-up, which means you call them (patients) and you cannot reach them… and then they turn up at your doorstep three more months later with a diabetic foot. Now, these are all avoidable scenarios,” the anonymous medical doctor said.

Paediatric Diabetes Care

University Malaya Medical Centre (UMMC) consultant paediatric endocrinologists Prof Dr Muhammad Yazid Jalaludin and Assoc Prof Dr Azriyanti Anuar Zaini, in a joint response to CodeBlue’s queries on diabetic cases during the pandemic, said diabetes care has been “compromised” as some appointments were deferred or postponed to accommodate Covid-19 services.

At UMMC, Dr Muhammad Yazid and Dr Azriyanti said about 30 to 50 per cent of clinic appointments were either rescheduled to be reviewed at day care or referred to a different date for stable cases.

“Poorly controlled diabetes mellitus paediatric patients were reviewed regardless of clinic limitations. Although there is a reduction in the clinic appointment quota, the prescribed medications are still dispensed at the appropriate timing to the patients or parents either through UMMC’s Outpatient Pharmacy or by post (for certain medications),” they both said.

UMMC’s paediatric endocrinology team will screen each case before a decision is made to defer or postpone a particular case.

“Only stable cases with good A1C are allowed to be deferred or postponed. We have never refused diabetic ketoacidosis (DKA) cases should they come to our emergency department during Covid. We also accommodate and accept cases from other Covid hospitals that cannot manage DKA at their centres,” said Dr Muhammad Yazid and Dr Azriyanti, adding that they do not have patients with kidney complications for paediatric diabetes.

The Way Ahead

In September, Health Minister Khairy Jamaluddin said the Ministry of Health (MOH) was considering designating special non-Covid hospitals to perform procedures and surgeries deferred during the pandemic.

Health director-general Dr Noor Hisham Abdullah told the health, science and innovation parliamentary special select committee on September 14 that backlogged surgeries and procedures in MOH hospitals were estimated to number between 150,000 and 200,000.

The medical doctor who spoke to CodeBlue anonymously welcomed the idea of having designated non-Covid hospitals as it could help allay some fears in the public on the coronavirus. However, greater detail is needed to gauge if the plan will be sustainable.

Alternatively, he said the MOH could either set up more district health clinics or rope in more private GPs to address piling NCD cases, including diabetes.

Meanwhile, both Dr Muhammad Yazid and Dr Azriyanti said medical funds to care for children, young people, and people with diabetes should not be compromised and that the need to take care and assist these people should be given priority.

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