Diabetes mellitus (DM) is a major public health concern in Malaysia and has been shown to be closely related to increased premature and preventable mortality.
It can also result in macro and microvascular complications such as heart disease, stroke, end-stage renal failure, blindness and amputation.
Besides, the burden of diabetes continues to increase in Malaysia. The National Health and Morbidity Survey (NHMS) 2011 has shown that the prevalence of diabetes in Malaysia has increased by 31.0% in the space of just 5 years, from 11.6% in 2006 to 15.2% in 2011.
As a result, there are currently about 2.6 million adults age 18 years and above living with diabetes.
Lifestyle Modification to Prevent and Manage Diabetes Mellitus
Based on Clinical Practice Guideline by MOH Malaysia:
1. Medical Nutritional Therapy
Individualization according to nutritional needs, severity of the disease, cultural preferences and willingness to change.
On top of that, a balanced diet consisting of 45–60% energy from carbohydrate, 15–20% energy from protein and 25–35% energy from fat are encouraged.
*Medical nutrition therapy (MNT) is important in preventing diabetes, managing existing diabetes, and delaying complications.
2. Weight loss of 5-10% of initial body weight
Achieving the weight loss target over a 6-month period for all overweight or obese patients who have or at risk for diabetes.
- A reduced-calorie diet. Standard weight-loss diets reduce daily energy by 500–1,000 kcal to achieve an initial weight loss of 0.5–1.0 kg per week.
- For example, physical activity of 150 minutes per week i.e. 30 minutes five days or more per week.
- Meal replacements (MRPs) as part of a comprehensive meal plan for weight loss and weight maintenance
- A high dietary fibre diet for the prevention of diabetes. Example, a high fibre diet (20–30 g fibre/day) consisting of vegetables, fruits, legumes and whole-grain cereals is encouraged.
- Whole grains should form 50% of the total grain intake as recommended by the Malaysian Dietary Guidelines, 2010. Higher consumption of whole grains can contribute to the prevention of T2DM.
3. In normotensive and hypertensive patients
A reduced sodium intake (<2000mg sodium/day or 5g of salt/day or 1 teaspoon), as such, with a diet high in fruits, vegetables, and low-fat dairy products lowers blood pressure.
4. Low Glycemic Index (GI) Diet
The glycaemic index (GI) is a measure to classify the type of CHO based on their effect on the blood glucose level. It is a ranking system that indicates how quickly CHO food raises blood glucose level.
For instance, food with high GI value raises blood glucose more than food with a medium or low GI.
5. Physical Activity
Individuals should exercise 5 days a week.
As such, preferably most days of the week and with no more than 2 consecutive days without physical activity.
Moreover, the duration of exercise should be at least 150 minutes/week of moderate-intensity and/or at least 90 minutes/week of vigorous aerobic. At least two sessions per week of resistance exercise.
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Malaysian Endocrine & Metabolic Society, Ministry of Health Malaysia, Academy of Medicine Malaysia, Malaysian Diabetes Association. Clinical practice guidelines: management of type 2 diabetes mellitus. 5th Malaysia: Ministry of Health Malaysia; 2015.