Page 26 - Q BULLETIN, Ministry of Health Malaysia, VOLUME 1, NO. 31 (SUPPLEMENT 1), JAN-DEC 2022

Q Bulletin, Volume 1, No. 31 (Supplement 1), Jan - Dec 2022
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11 National QA Convention, 4 – 6 October 2022
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Improving HbA1c Control among Newly Insulin Initiated Type 2 Diabetes Mellitus (T2DM)
Patients in Klinik Kesihatan Kelana Jaya (KKKJ)

Lim SY, Chong YT, Nik Mazlina M, Rupinder K, Lim YJ, Goh CY
Klinik Kesihatan Kelana Jaya, Selangor

SELECTION OF OPPORTUNITIES FOR IMPROVEMENT:
HbA1c is an important indicator of glycaemic control as it correlates with the risk of long-term diabetes
complications. In 2017, 82.6% of T2DM patients in KKKJ who were newly initiated on insulin had failed to
reduce at least 1% in HbA1c after six months. It contributed to 40.93% having diabetic nephropathy, 48.6%
with diabetic neuropathy and 20.1% with diabetic retinopathy.

KEY MEASURES FOR IMPROVEMENT:
Our study indicator is the percentage of T2DM patients who achieved at least a 1% reduction in HbA1c after
six months of insulin initiation. A standard of more than 80% was set during the 2018 non-communicable
disease meeting in KKKJ.

PROCESS OF GATHERING INFORMATION:
A quality improvement study (intervention cycles 1-3) was conducted using a universal sampling method from
July 2018 to July 2020. Data was collected using a questionnaire to healthcare professionals, an audit checklist
and a patient’s assessment form during each clinic visit.

ANALYSIS AND INTERPRETATION:
During the verification study, the achievement was 23.81%. Reasons for a low reduction in HbA1c were poor
patient adherence to insulin, lack of awareness in HCP on the latest guideline, lack of multidisciplinary team
coordination, lack of self-monitoring of blood glucose and self-adjustment on insulin dose and patient’s non-
adherence to lifestyle intervention.

STRATEGIES FOR CHANGE:
Remedial measures were the “One Sweet Centre” program - a dedicated clinic with multidisciplinary
involvement that emphasised patient education, self-empowerment and individualised patient care. Glucometers
were loaned to patients with financial issues and poor insight. In addition, phone calls and instant drive-through
services were offered during the COVID-19 pandemic.

EFFECT OF CHANGE:
Post intervention showed improvement from 23.81% in the verification cycle, 50% in cycle 1, 70% in cycle 2
to 83.3% in cycle 3.

THE NEXT STEP:
We plan to extend this service to all diabetic patients, set up a peer support club, partner with a non-governmental
organisation in community empowerment and share our remedial actions with other clinics.

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