Page 49 - 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
11 National QA Convention, 4 – 6 October 2022
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PP-11

An Improvised Strategy to Improve Glycaemic Control among Diabetic Women of
Reproductive Age Under Follow-Up at Health Clinics in Perlis

Norhana Z , Siti Hajar O , Shariza Azizah MS , Raudzah R , Norhayati A , Muhammad Faiz R , Junaidah I 6
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1 Klinik Kesihatan UTC Kangar, Perlis
2 Klinik Kesihatan Kangar, Perlis
3 Klinik Kesihatan Kampung Gial, Perlis
4 Klinik Kesihatan Beseri, Perlis
5 Klinik Kesihatan Arau, Perlis
6 Pejabat Kesihatan Daerah Kangar, Perlis
SELECTION OF OPPORTUNITIES FOR IMPROVEMENT:
Pre-pregnancy care (PPC) is an important part of diabetic care among women in the reproductive age group.
However, the verification study in October 2021 showed that 77.8% of diabetic women registered in the PPC
program had poor glycaemic control (HbA1c ≥6.5%). Poor optimisation of the glycaemic index may worsen
clinical and feto-maternal outcomes if these women become pregnant.

KEY MEASURES FOR IMPROVEMENT:
The key measure for improvement was the percentage of diabetic women in PPC with HbA1c reduction ≥0.5%.
The standard was ≥35% of diabetic women, based on an interventional study that re-emphasised lifestyle
modification to patients and the State Diabetes Clinical Meeting consensus.

PROCESS OF GATHERING INFORMATION:
Questionnaires were used to assess Knowledge, Attitude, and Practice among staff and patients to identify the
contributing factors. Implementation of remedial measures was conducted from November 2021-March 2022.
A post-intervention evaluation was performed in April 2022 by auditing patients’ diabetic records and HbA1c
readings.

ANALYSIS AND INTERPRETATION:
The pre-remedial percentage of diabetic women of reproductive age registered in the PPC program with good
glycaemic control was only 22.2%. The main contributing factors were poor patient diabetes knowledge
(58.9%), poor self-care behaviour among patients (57.0%) and lifestyle modification intervention not being
given (51.2%).

STRATEGIES FOR CHANGE:
A lifestyle modification intervention program was conducted involving a multidisciplinary team. Patients were
invited into a broadcasting information WhatsApp group and enrolled on a Self-Monitoring Blood Glucose
(SMBG) program. An education kit, available as printed and e-documents, was created to aid medical personnel
in educating about diabetes and pregnancy. Staff training was conducted to empower staff in facilitating the
lifestyle modification intervention.

EFFECT OF CHANGE:
Analysis showed that post-intervention, 31.8% of diabetic women showed a reduction of HbA1c reading
≥0.5%.

THE NEXT STEP:
Further measures to strengthen the lifestyle intervention diabetes program are needed to ensure diabetic
women achieve good glycaemic control. Community involvement in the KOSPEN programme would ensure
its sustainability as a patient-centred community-based program.

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