Improving HbA1c control among newly initiated insulin Type II Diabetes Mellitus patients in Klinik Kesihatan Kelana Jaya
Chong, Yee Theng1, Lim, Sue Yee2, Nik Mazlina Mohammad3, Rupinder Kaur Hardyal Singh4, Lim, Ying Jun5, Goh, Chong Yong6.
HbA1c is an important indicator of glycaemic control as it correlates with the risk of long-term
diabetes complications. In 2017, only 17.4% of Type II Diabetes Mellitus (T2DM) patients at Klinik
Kesihatan Kelana Jaya (KKKJ) newly initiated on insulin achieved at least a 1% reduction in
HbA1c after six months. This contributed to 40.9% of patients developing diabetic nephropathy,
48.6% experiencing diabetic neuropathy, and 20.1% being diagnosed with diabetic retinopathy.
Our study indicator is the percentage of T2DM patients who achieved at least a 1% reduction in
HbA1c six months after insulin initiation. A target of 80% was set, based on consensus reached
during 2018 Non-Communicable Disease (NCD) meeting at KKKJ. This quality improvement
study employed a universal sampling method from July 2018 to July 2020. Data were collected
using questionnaires distributed to healthcare professionals (HCPs), an audit checklist, and a
patient assessment form completed during clinic visits. The data were analysed using Microsoft
Excel. During the verification study, the achievement rate was 23.8%. The identified contributing
factors to poor HbA1c control were poor patient adherence to insulin, lack of awareness among
HCPs regarding the latest insulin guidelines, insufficient coordination among the multidisciplinary
team, lack of self-monitoring of blood glucose and self-adjustment of insulin doses, and patient’s
non-adherence to lifestyle interventions. Several strategies were introduced, including the “One
Sweet Centre,” which involved a multidisciplinary team comprising a medical officer, pharmacist,
dietitian, diabetes educator, and occupational therapist. Additionally, glucometers were loaned to
patients with financial difficulties. Phone consultations and a drive-through service were offered
during the Movement Control Order (MCO) period of the Covid-19 pandemic. Post-intervention
results showed that the percentage of T2DM patients achieving at least a 1% reduction in
HbA1C after six months of insulin initiation increased from 23.8% to 50% in cycle one, 70% in
cycle two, and 83.3% in cycle three. Moving forward, we plan to share our remedial actions with
other clinics and expand this initiative by setting up a peer support club and collaborating with
Non-Governmental Organisations (NGOs) to empower the community.
Affiliation:
- Kelana Jaya Health Clinic, Selangor State Health Department, Ministry of Health Malaysia, Malaysia
- Kuala Lumpur Health Clinic, Kuala Lumpur and Putrajaya Federal Territory Health Department, Ministry of Health Malaysia, Malaysia
- Putrajaya Presint 18 Health Clinic, Kuala Lumpur and Putrajaya Federal Territory Health Department, Ministry of Health Malaysia, Malaysia
- Kelana Jaya Health Clinic, Selangor State Health Department, Ministry of Health Malaysia, Malaysia
- Kelana Jaya Health Clinic, Selangor State Health Department, Ministry of Health Malaysia, Malaysia
- Kelana Jaya Health Clinic, Selangor State Health Department, Ministry of Health Malaysia, Malaysia
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