GRF 2nd One Health Summit 2013: Presentation by RAHMAN, Dr. Zairina, UNIVERSITI SAINS ISLAM MALAYSIA

1. Perception and Support for
Uncontrolled Diabetes Mellitus Patients:
Study among the Population at Rural
Setting in Malaysia
Dr. Zairina A. Rahman
(MD, MPH)
Faculty of Medicine & Health Sciences
Universiti Sains Islam Malaysia (USIM)

2. INTRODUCTION
• Diabetes mellitus is a chronic debilitating
disease
• Reached epidemic proportions in Asia and
globally and prevalence are expected to be
increasing.
• 347 million people worldwide have diabetes 1
1 Danaei G, Finucane MM, Lu Y, Singh GM, Cowan MJ, Paciorek CJ et al. National, regional, and global trends in fasting plasma glucose and diabetes
prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million
participants. Lancet, 2011, 378(9785):31–40.

3. Malaysia

4. Prevalence of Diabetes in Malaysia
from NHMS
14.9
16
14
percentages
12
10
8.3
6.3
8
6
4
2
0
NHMS 1 (1986)
NHMS II (1996)
NHMS III (2006)

5. Uncontrolled Diabetes
Uncontrolled diabetes mellitus status (HbA1c
more than 7%) in Malaysia:
• Suhaiza et.al (2004)
: 73%
• Mafauzy (2006)
: 80%
• Hasimah et.al (2011) : 85%
1 Suhaiza
et.al. Glycemic control among type 2 diabetic patient in Kelantan. 2004. NCD
2 Hasimah et.al. Control of glycosylated haemoglobin (hba1c) among Type 2 diabetes mellitus patients attending an urban
health clinic in malaysia. 2011. Medical and Health Siences Journal
3 Mafauzy. Diabetes Mellitus in Malaysia Editorial. Medical Journal of Malaysia. 2006.61 (4);

6. Social support for diabetic patients
• Social support plays and important role in
diabetes management (Kadirvelu et al. 2012).
• MOH Malaysia implemented self-care among
diabetes patients:
– The empowerment on diabetes care focused on
patients and family
– enhanced patients and their family to be more
proactive and responsible about their disease
condition
– need to be adequately educated on diabetes care and
control.

7. Negeri Sembilan
14 states in Malaysia: diabetes prevalence was highest
in the state of Negeri Sembilan 15.3%

8. RESEARCH OBJECTIVE
• Explore patients’ perception towards their
understanding on diabetes care and control
• Assess social support from family and health
care personnel.

9. METHODS
Ethical approval: Ethical Committee Ministry of
Health Malaysia
Location:
– Rural setting
– 5 health district government clinic (covering about
50,000 population each clinic)
– Clinics funded by government of Malaysia

11. METHODS
Sample characteristics:
• Diabetic patients attending four government
Health Care clinic at District of Tampin, Negeri
Sembilan
• Randomly selected from list of uncontrolled
diabetes patients in the clinic (blood HbA1c
level ≥ 6.5%)
Clinical Practice Guidelines, Management of Type 2 Diabetes Mellitus (Ministry of Health
Malaysia, 2009)

12. Government Health clinic

13. In the clinic

14. METHODS
Inclusion criteria:
• Type-2 uncontrolled diabetes mellitus
• age ≥ 30 years
• diagnosed with type-2 diabetes at least one year

15. METHODS
Data collection:
• Voluntary basis and written consent
• Face to face interview by trained interviewer
• Guided by standardised questionnaire:
– sociodemographic profile
– perception about diabetes (“agree” or “do not agree”)
– social and emotional support
• blood HbA1c result from patient’s clinic record (at
least 6 months)

16. RESULTS

17. RESULTS
• Total of 346 respondents
• Mean (SD) of age was 59.2(8.9)

18. AGE GROUPS
50
43.4
45
40
33.2
35
30
25
20
15
11.9
9.2
10
5
2.3
0
30-40
41-50
51-60
61-70
>70

19. RESULTS
GENDER
MALE
35%
FEMALE
65%

20. MARITAL STATUS
Single
0.3
Marital Status
Divorced
3.8
Widowed
11.6
Married
84.4
0
20
40
60
Percentages
80
100

21. HbA1c Level
Percentages of patients
43
45
40
35
30
25
20
15
10
5
0
32
25
6.5-8.0
8.0-10.0
HbA1c level (%)
Mean (SD) of HbA1c: was 9.1 (1.8)%
>10.0

22. DURATION DIABETES
• Median (IQR) of duration of having diabetes
was 6 (7) years.
• There was a significant positive correlation
between HbA1c level and duration of suffering
from diabetes (r=0.27, p<0.001)
• 49.1% monitored their blood glucose level

23. UNDERSTANDING DIABETES
UNDERSTANDING ABOUT
DIABETES
AGREE
%
I understand the importance of
diabetic medication in controlling
blood glucose level
78.6
DO NOT
AGREE
%
21.4
I understand how to prevent from
developing hyperglycemic
50.3
49.7
I understand how to control my
diabetes diet
72.0
28.0

24. FAMILY SUPPORT
FAMILY SUPPORT
My family members give support and
help me to follow my diabetes diet
My family members encourage and
remind me on medication intake
My family members accompany me for
clinic follow-up
My family members support me to deal
with my emotion when thinking about
my disease
AGREE
%
84.7
DO NOT
AGREE
%
15.3
81.6
18.4
83.6
16.4
87.8
12.2

25. ADDED VALUE TO ONE HEALTH
APPROACH
• Diabetes patients at the rural area may face
problems of lack of medical consultation by
doctors as the number of doctors smaller
compared to urban area and number of
patients are big
• Rural people should have equal opportunity
and availability for good healthcare services as
the people in urban area.

26. CONCLUSION & RECOMMENDATION
• need for holistic diabetes management
approach with family participation-patients
claimed received good support from their
family members in dealing with their disease.
• This positive situation should be taken as
opportunity for better diabetes management
by engaging their family members to support
patients’ care.

27. CONCLUSION & RECOMMENDATION
• Need to explore how the family support
patients in their diabetic management
• Qualitative research to explore diabetic
education

28. THANK YOU