NUTRITION CAN BE THE KEY TO MALAYSIA'S FIGHT AGAINST DIABETES

Malaysia faces a significant challenge with diabetes. With nearly one in five adults living with the disease, the country now has the highest diabetes prevalence in ASEAN, according to the 2025 International Diabetes Federation (IDF) Diabetes Atlas.

Yet, many Malaysians remain unaware of the danger until complications such as heart disease or kidney failure emerge. Experts warn that while medications play a vital role in controlling diabetes, an often overlooked weapon that could help turn the tide is nutrition.

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Beyond simply cutting out sugar from the diet, good nutrition is increasingly recognised as a form of medical therapy that could prevent or delay diabetes and help those already diagnosed to manage their condition better. Without early action, dietitians caution, the human and economic toll of the disease will continue to escalate.

“Diabetes is a very serious disease, yet many people don’t treat it as such because symptoms may not cause immediate pain,” said Prof Dr Winnie Chee Siew Swee, Malaysian Dietitians Association (MDA) vice president, when met by Bernama recently.

“The good news is that, with early nutrition intervention, we can take meaningful steps to prevent complications and support healthier outcomes in the long run.”

ADAPTING TO LOCAL CULTURE

While lifestyle interventions have been found to deliver meaningful results, their feasibility and sustainability in real-life situations are often challenging. This is why Dr Chee emphasised the need for practical and culturally appropriate meal plans that patients can realistically follow over time.

 To address this need, Malaysian researchers from various medical specialities have adapted an international guideline known as the Transcultural Diabetes Nutrition Algorithm (tDNA), producing a framework that provides a step-by-step method for tailoring nutrition therapy to a patient’s cultural background, food preferences and lifestyle.

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Rather than imposing a one-size-fits-all diet, the tDNA — developed by an international task force of diabetes and nutrition experts — helped local dietitians incorporate familiar Malaysian staples such as rice, noodles and traditional dishes into carefully planned meals with healthier cooking methods and controlled portions.

“Our research showed that when patients followed a personalised plan based on the tDNA and included diabetes-specific formula (DSF, a type of nutritional supplement or food replacement to help persons with diabetes to manage their blood sugar levels) as a partial meal replacement, adherence to the programme improved by up to 90 percent,” Dr Chee said, adding, “This also meant patients were far more likely to maintain the plan long enough to see meaningful outcomes. Many achieved significant weight loss, better HbA1c levels and reduced medication needs.”

(HbA1c is a simple blood test that shows the average amount of sugar in a patient’s blood over the past two to three months to help doctors see how well their blood sugar is being controlled.)

 She also pointed to strong clinical evidence supporting the use of DSF as part of structured nutrition therapy.

“A recent study by (global healthcare company) Abbott involving 235 adults in Malaysia and Thailand with type 2 diabetes and who were overweight or obese found that integrating diabetes-specific formula as a partial or total meal replacement, alongside standard care, led to significant improvements in glycaemic control, body composition and cardio metabolic risk factors,” she said. 

 Notably, participants achieved up to twice the reduction in weight and body fat percentage, along with lower systolic and diastolic blood pressure, compared with the control group after a 90-day intervention.

Dr Chee said to her knowledge, that was the first study in Asia to demonstrate that such an intervention could significantly improve body composition when combined with standard care. The findings, she added, underscored the role of DSF as a practical first-line nutritional strategy and its potential to reduce the risk of cardiovascular disease, which remains Malaysia’s leading cause of death.

HOW TO TAKE DSF

 For overweight or obese individuals, she recommended reducing total calorie intake with the help of one to two servings of DSF as a meal or snack replacement, combined with fresh fruits, vegetables and lean protein to ensure balanced nutrition.

 To illustrate, a 1,200-calorie plan might begin with a breakfast of one serving of DSF (220 kcal) and a small banana (75 kcal), while lunch could include one serving of DSF (220 kcal), a piece of non-fried popiah (100 kcal) and a medium apple (60 kcal). Dinner might feature two scoops of brown rice (150 kcal), a cup of stir-fried vegetables (50 kcal), a bowl of spinach soup (50 kcal) and one whole grilled ikan kembung (150 kcal).

 For those requiring a 1,500-calorie plan, breakfast might combine one serving of DSF (220 kcal) with a piece of kuih (100 kcal), while lunch could include a bowl of kuey teow soup (450 kcal), a medium sliced papaya (70 kcal) and a glass of unsweetened iced tea. Simple snacks such as guava (70 kcal) or a wholemeal tuna sandwich (180 kcal) could be added to maintain satiety and balance.

With guidance from a dietitian and at least 150 minutes of exercise weekly, these customised plans have been shown to help patients maintain a calorie deficit while meeting their nutritional needs.

Dr Chee observed that when such culturally tailored nutrition therapy is implemented consistently, it not only improves individual health outcomes but also holds the potential to slow Malaysia’s growing diabetes burden, reinforcing the message that nutrition is as vital as medication in managing the disease.

FOOD, CULTURE AND INEQUALITY

 But even the best-designed nutrition plans face obstacles outside the clinic, no thanks to the lifestyles of Malaysians. The typical Malaysian diet is rich in white rice, fried foods and sweetened drinks, while traditional social eating habits, such as late-night suppers or festive feasts, make it difficult for people to adhere to standard diabetes diets, which are often modelled on Western patterns.

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 “Food is tied to our identity, family and traditions,” said Dr Chee, adding that telling people to give up rice completely is unrealistic. “What works better is portion control, healthier cooking methods and gradual changes.”

Stressing that adapting meal plans to local culture is essential, she said replacing a high-glycaemic breakfast like roti canai and teh tarik with alternatives, such as grilled wholemeal sandwiches, fruits or a structured local meal plan, can significantly reduce blood sugar spikes.

OVERCOMING BARRIERS, MOVING FORWARD

Meanwhile, Dr Nina Mazera Mohd Said, Abbott’s nutrition medical director in Malaysia, said findings from the National Diabetes Registry Report 2023 showed that only 34.38 percent of patients achieved the Ministry of Health’s HbA1c target of below 6.5 percent.

 “An estimated 3.6 million Malaysian adults live with diabetes, and one in two adults is overweight or obese. Many of those diagnosed have type 2 diabetes, which increases the risk of developing cardiovascular disease due to high blood sugar, insulin resistance and other metabolic abnormalities. This reflects an urgent need for early intervention through personalised nutrition plans and lifestyle changes,” she said.  

Dr Chee pointed out that misinformation also misleads diabetes patients into delaying seeking proven treatments.

“Online platforms, including social media and e-commerce sites, are rife with unverified ‘miracle cures’ or cheap supplements marketed as diabetes solutions.

“There is also a misconception that medication alone is enough to control diabetes… but, without lifestyle changes, patients will likely require higher dosages over time, which can cause side effects. That’s why diet and lifestyle changes are essential to managing diabetes in the long term,” she said.

Dr Nina Mazera agreed, adding that nutrition is the foundation of diabetes management, yet it is often underutilised.

“DSF in particular contains the essential micronutrients that support overall health while also clinically proven to improve glycaemic control, among others. In addition, we should focus on what we can control: maintaining a good lifestyle with a proper diet. With the right support, it can make managing diabetes much more effective,” she added.

She also said raising awareness of diabetes prevention and control requires a multi-sectoral effort involving healthcare professionals, the food industry, media and the government.

“They all play a big role in encouraging Malaysians to ask themselves, ‘Am I at risk? Have I had my health screened?’ Creating this awareness is the first step toward prevention and better health outcomes.”