PUTRAJAYA, Dec 19 — Specialist doctors in the Health Ministry have called for a “War on Diabetes”, similar to that on Covid-19 and HIV, amid the normalisation of diabetes and lack of diabetes educators.
Putrajaya Hospital consultant nephrologist Dr Rafidah Abdullah, who proposed the idea, envisioned it as a multisectoral and multidisciplinary effort to combat diabetes.
She argued that it was illogical to have many individual programmes for the treatment of specific organs and proposed that the disparate programmes be combined as a large-scale effort to combat diabetes.
“I think if we put everything together, in a sort of war against diabetes or something like that, that would be huge. Then everybody would be part of it. I’m very, very interested in that,” Dr Rafidah told the Galen Centre for Health and Social Policy’s roundtable discussion on “Managing the National Cost of Cardiorenal Metabolic Diseases: A Focus on Diabetes and Stroke” held last September 20, with support from Boehringer Ingelheim.
Putrajaya Hospital senior consultant endocrinologist Dr Zanariah Hussein stressed that it is important to impress upon patients that they are being managed by a team of medical health care workers.
She said most patients are under the impression they need to only see their local general practitioner (GP), medical officer, or specialist to treat and manage their diabetes.
“Often, we think that the doctor has to do everything, and they have such a short period of time, especially in primary care. We have to elevate the role of paramedics in the NCD (non-communicable disease) diabetes care – the dietitian role, the diabetes educator (DE) role. We’ve invested so much in training nurses to be the person to educate the patient,” Dr Zanariah told the roundtable discussion.
“We haven’t done so much in terms of exercise experts. We have physiotherapists, but we don’t have exercise or physical activity experts, which is not physio, but somewhere there. So, that is really important in primary care and hospital care, and I think we should acknowledge that we doctors are just one member of the team. In fact, the other members are just as crucial.”
Dr Zanariah highlighted the role of the DE and the dietitian who are just as important as doctors.
“Now, [to] the patient, ‘Everything is my doctor’. Sometimes they miss their dietitian visits because they put that aside because they don’t prioritise the dietitian, the diabetes educator. But that is a really important part of their overall management,” she told the panel discussion.
Dr Rosnah Ramly – head of sector at the Ministry of Health’s (MOH) Sector of Control and Prevention of CVD, Diabetes, Cancer – highlighted the need to train more DE nurses in primary care.
“There is a small issue with the number of nurses who want to become diabetic educators because of the promotion [issue]; diabetic educators are not really recognised like that. If we can suggest that DE is also a recognised platform for them to move forward, I think that is a good idea.”
DEs are crucial to the management of diabetes, according to Dr Rosnah, as they are the ones who spend the most time with patients and dole out advice for the management of diabetes.
DEs can be nurses or other health care professionals who have specialised expertise in diabetes and plenty of experience working with diabetics. They help people learn about the day-to-day things that can help control diabetes.
Dr Zanariah asserted that the MOH must sell patients on the message that early diabetes can be reversed through lifestyle interventions.
She said most doctors are still too focused on medicating patients, “which does not solve the problem”, and called for investment and training in more human resources to facilitate the shift from the reliance on medication to lifestyle restructuring.
Intensive lifestyle programmes, said Dr Zanariah, is something that must be developed and implemented at the primary care level.
“It is amazing how much you can save when people start losing weight, keeping that off, reversing diabetes, preventing complications; all the costs that come with it.
“I don’t know what MOH is going to do. I think it’s starting already. The awareness and the plans; the pilot projects are starting. They should really bulldoze in that direction.”