A Call to Action on World Diabetes Day: From Risk to Remission

Artikel oleh: Dr Ooi Poh Siang, Family Medicine Specialist

14 November 2025

World Diabetes Day, observed on November 14th, is a timely reminder for Malaysians to confront the ongoing silent epidemic of Type 2 Diabetes Mellitus (T2DM). Diabetes is now among the leading causes of death in Malaysia, and the increasing prevalence is deeply alarming.

The Scale of the Problem

The most recent data from the National Health and Morbidity Survey (NHMS) reveals a concerning reality:

• 1 in 6 adults in Malaysia has diabetes.
• Perhaps most worryingly, 2 in 5 adults with diabetes do not even know they have the condition. This lack of awareness is even higher among young adults, with 84% of those aged 18-29 years being undiagnosed.

The etiology of T2DM is complex, involving intricate interactions between genetic and environmental factors. Essentially, the disease develops when a diabetogenic lifestyle, characterised by excessive caloric intake, inadequate caloric expenditure, and obesity is superimposed on a susceptible genetic profile.

The Critical Need for Screening

When asked why they do not get screened, most adults report feeling healthy (90%) or having no symptoms (84%). This mindset must be corrected. Diabetes is often a silent disease in its early stages. Waiting for symptoms like excessive thirst, frequent urination, or unexplained weight loss, means the disease has likely already progressed.

Early detection is paramount, as early intervention offers the best chance for successful management and even remission. Screening should be done based on risk criteria, not just symptoms. Fortunately, many healthcare facilities now offer flexible health screening services to address concerns like time constraints.

The Core Risk Factors in Our Community

Our lifestyle habits are directly contributing to the rising incidence of T2DM. The NHMS 2023 findings highlight several concerning trends:

1. Obesity and Overweight:
   We are getting heavier. The trend of overweight and obesity has been increasing, reaching 54.4% among Malaysian adults in 2023. Excess body fat, particularly around the abdomen, is a major contributor to insulin resistance. Adipose (fat) tissue in obese individuals releases non-esterified fatty acids and promotes a low-grade chronic inflammatory state, which actively impairs the body's ability to use insulin effectively.

2. Poor Dietary Choices:
   The quality of our diet directly impacts our risk:

1. Excess Fat and Sugar: A staggering 68% of adults consume excess fat, and 59% take more than one serving of sugar-sweetened beverages (SSB) per day. A diet high in refined carbohydrates and sugars causes rapid spikes in blood glucose, placing heavy demands on the insulin-producing cells of the pancreas, which can eventually lead to burnout and failure.
2. Lack of Protective Foods: Only 17% of adults meet the daily recommendation for fruit intake, and only 12% meet the recommendation for vegetable intake. Foods rich in dietary fiber, such as whole grains and vegetables, are vital, as they moderate digestion, help control blood sugar levels, and can increase insulin sensitivity.
3. Late Heavy Meals: A heavy supper, where a third of adults consume both dinner and a heavy supper at least once a week, is a habit that can disrupt metabolism and increase the risk of T2DM.

3. Physical Inactivity:
   Movement is medicine. Unfortunately, 1 in 3 adults is not physically active. Physical inactivity is an independent risk factor because it leads to reduced glucose uptake by the muscles and rapidly induces insulin resistance. Regular physical activity, even moderate walking, helps cells take in insulin, stabilising glucose levels and improving metabolic health. Adults who are healthy should aim to achieve 150 minutes (2.5 hours) of moderate intensity exercise per week or 75 minutes (1.25 hours) of vigorous intensity exercise per week.

4. Inadequate sleep:
   Poor sleep hygiene is a significant and often overlooked risk factor for chronic diseases, including diabetes. 2 in 5, or 38%, of adults in Malaysia are not getting enough sleep which is defined as getting less than 7 hours of sleep on average within a 24-hour period. There is a well-established U-shaped association between sleep duration and T2DM incidence. Both short sleep (typically defined as <6 hours) and long sleep (typically defined as >9 hours) duration can increase the risk of T2DM (including progression from prediabetes) by up to 50%. Inadequate sleep disrupts the balance of appetite hormones, leading to reduced leptin and increased ghrelin. Leptin is a hormone that signals fullness, so lower levels can make you feel hungrier, while ghrelin, the "hunger hormone," increases appetite and motivates you to eat. This hormonal imbalance, along with more waking hours, can lead to increased food intake and contribute to weight gain.

The Window of Opportunity: Prediabetes and Remission

Before a diagnosis of T2DM, many people pass through the stage of prediabetes, a condition where blood sugar levels are elevated but not yet high enough for a diabetes diagnosis. This is a crucial window of opportunity, as prediabetes is a potentially reversible condition with lifestyle modification.

Furthermore, prediabetes is a significant risk factor for the progression to diabetes, as well as for developing cardiovascular disease. The presence of prediabetes should prompt a comprehensive screening for other cardiovascular risk factors, including hypertension, dyslipidemia (high triglycerides and/or low HDL cholesterol), and obesity.

The concept of T2DM remission has brought new hope and is becoming a new mission in diabetes care. Remission is defined as a return of the HbA1c (a marker of average blood sugar over three months) to less than 6.5% that persists for at least three months in the absence of usual glucose-lowering pharmacotherapy.

While metabolic/bariatric surgery has highlighted the reversibility of T2DM, recent focus has shifted to the power of intensive lifestyle interventions. Research indicates that sufficiently intensive lifestyle changes—involving the adoption of a predominantly whole-food, plant-based dietary pattern, exercise, and adequate sleep—may be comparable to bariatric surgery in effectively achieving T2DM remission, and without the associated side effects.

On this World Diabetes Day, I urge you to take charge of your health. Schedule a health screening today, embrace a whole-food diet rich in fiber, commit to regular physical activity, and get adequate rest. Your small, consistent steps can make a profound difference in preventing T2DM, reversing prediabetes, and even achieving remission from T2DM.

References

• National Health and Morbidity Survey (NHMS) 2023
• National Health and Morbidity Survey (NHMS) 2024
• Type 2 Diabetes Mellitus, Medscape 2025
• Prevention or Delay of Diabetes and Associated Comorbidities: Standards of Care in Diabetes, American Diabetes Association 2025
• Type 2 Diabetes Remission: A New Mission in Diabetes Care, American Diabetes Association 2023
• International Experts Outline Diabetes Remission Diagnosis Criteria, American Diabetes Association 2021
• American College of Lifestyle Medicine