Pilot implementation of the newly proposed national indicator approach for diabetes: Quality of diabetes care at ministry of health (MOH) healthcare facilities - Glycaemic control in Negeri Sembilan, Malaysia - alert mechanism

Diabetes mellitus is a growing public health issue in Malaysia and causes serious disabling complications. A new National Indicator Approach was proposed with the main objective to assess the quality of care of patients with diabetes in MOH healthcare facilities through a proxy indicator i.e. HbA1c level.

Proportion of diabetes patients with HbA1c <6.5%	=	Number of diabetes patients with HbA1c <6.5%	x 100%
		Total number of cases sampled

The optimum achievable standard was set at ≥30%. If the patient did undergo an HbA1c test within the past one year, the patient would be deemed as poorly controlled.

For the study population, data is only collected for patients with type 2 diabetes who are still on ‘active follow-up’. The sample size was determined using the ‘Descriptive Study Using Random Sampling’ method (Statcalc, EpiInfo version 6.0). The clinic-held records (variables: HbA1C, blood pressure, total cholesterol, TG, HDL, LDL, BMI and waist circumference) were then selected randomly. The completed dataset was transferred into SPSS format for analysis.Data was collected for total of 4,802 active diabetes patients in all health clinics in Negeri Sembilan. The median age when diabetes was diagnosed for this population is 51.0 years old, with a median duration of clinic follow-up of 4 years. All of the districts fell short of the 30% target, with the overall achievement for Negeri Sembilan was only 12.1%. . In Negeri Sembilan, about 74.2% of the patients had at least one HbA1c investigation done within the past one year. The mean HbA1c for Negeri Sembilan was 8.6%.
This pilot implementation has demonstrated that it is a feasible option to be implemented and it would also serve as an ‘alert mechanism’ and subsequently trigger further action to improve the quality of care and the outcome of patients of diabetes.