Diabetes care in the Malaysia primary care setting, MDES 2014
Diabetes Care in the Malaysia
Primary Care Setting
Feisul Idzwan Mustapha, MBBS, MPH, AM(M)
Public Health Physician
Disease Control Division
Ministry of Health, Malaysia
MDES Conference 2014
26 April 2014
Hotel Summit USJ
Ministry of Health
Population of Malaysia
• 2000: 23.3 mil
• 2010: 28.3 mil
• Life expectancy:
• Total pop : 70.83 (2000), 73.79 (2011).
• Male: 71.05
• Female: 76.73
• Average annual population growth
• 1996 to 2000: 2.65%
• 2000 to2010: 2.0%
• Fertility rate :
• 2000: 3.0%
• 2010: 2.6%
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Est. population, 2006 Est. population, 2011 Prevalence projection, 2006 Prevalence projection, 2011
Sources: NHMS I (1986), NHMS II (1996), NHMS III (2006) and NHMS 2011
National Strategic Plan for
• Presented and approved by the Cabinet on 17 December 2010.
• Provides the framework for strengthening NCD prevention & control
program in Malaysia.
• Adopts the “whole-of-government” and “whole-of-society approach”.
• Diabetes & obesity are used as the entry points.
1. Prevention and Promotion
2. Clinical Management
3. Increasing Patient Compliance
4. Action with
NGOs, Professional Bodies &
5. Monitoring, Research and
6. Capacity Building
7. Policy and Regulatory
care team (in health
Management at the primary care level
• Web-based application.
• Went live on 1 January 2011.
• Supports the implementation of the
annual “Diabetes Clinical Audit” amongst
Type 2 Diabetes patients in MOH Health
• First report, “NDR Report, Volume 1, 2009-
2012” was published in August 2013,
available at the MOH website
Number of Active Registered
Patients; as of 28 Feb 2014
State Number of active patients
WP Labuan 1,534
WP Putrajaya 2,983
Initiativesto Improve Clinical Outcome
• The formation of Diabetes Team which consists of Diabetes Educator, Medical
Officer, Family Medicine Specialist (FMS), Nutritionist and Pharmacist in every clinic as
appropriate to their burden of diabetes patients.
• FMS or senior Medical Officer in the clinic to do regular audits on green book.
• Intensify and more frequent supervision especially by FMS of clinical staff to ensure
compliance to CPGs and related guidelines.
• Regular training and CMEs on diabetes care for all clinic staffs, and the state office to
monitor the numbers of training sessions conducted.
• Availability of module for health education for patients and a set of pre- and post-test
for patients, as published by Disease Control Division, MOH.
• The usage of the Diabetes Conversation Map.
• Further development of a Peer Support Group.
• Personalized care by Medical Officer in clinics with low to moderate burden of
loads, as appropriate in the individual clinic settings.
Overview of a Peer Support Group
• Patients becomes a trainer / facilitator, training his/her fellow
colleagues with the same disease.
• MOH responsible for developing the training modules,
conduct training and develop the implementation guidelines.
• Successful implementation of a Peer Support Group Program
has been shown to:
• Help patients understand their disease better;
• Help patients achieve good disease control; and
• Reduce rates of referral to hospitals due to complications.
• Rationale – patients are more likely to accept advise from
their peers or people living with the same condition.
Implementation in KK Padang Rengas,
Kuala Kangsar, Perak
Workshop Name Description Items needed
I’m a diabetes: is it the end of
What is diabetes?
How do I get better?
Use of medications
Diabetes learning poster & slides
Samples of medications (including
Food for thoughts- what will be
What can I eat
Do I need to stop sugar - Is sugar the
Food models, posters
Complication of diabetes: Foot
Practical tips to care for your foot (actual
examining foot and hygiene tips)
Pail, water and sponge
Complication of diabetes: Blind
as a bat
Practical walking with covered eye
(experience as a blind and amputated
Practical session 1:
I’m a diabetes: is it the end of the world?
Practical Session 2:
Food for thoughts - what will be my food?
peers on how
their diet in
Practical Session 3:
Complication of diabetes: Foot to Care
Practical Session 4:
Complication of diabetes: Blind as a bat
1. The prevalence of diabetes has increased 31.0% in 5
years, from 11.6% in 2006 to the current 15.2%.
• Mostly contributed by increase of “undiagnosed”.
• Increase in prevalence occurring across all age-groups.
2. Increasing challenge in providing satisfactory quality of care to
patients with diabetes.
• Number of patients in MOH health clinics will continue to
• Referrals for specialists management will also continue to
increase due to late diagnosis and sub-optimal control.
• Need to address “patient-related factors” i.e. patient
at Point of
Facebook: Feisul Mustapha