The Health | jan/Feb, 2020
14
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Advocacy in better diabetes care
NADI's recent Advocate
programme shows promise in
delivering better knowledge
and understanding on
diabetes care among general
practitioners
D
iabetes is a prevalent condi-
tion. This statement rings true
for most countries around
the world, given the lifestyle
changes we have had over the
last century. And although the
awareness for diabetes among the general
public is statistically high, the prevalence of
the disease has not reflected said statistics.
That means even though we know certain
unhealthy lifestyle can lead to diabetes
(specifically Type-2 diabetes), we are not
doing enough to prevent it. The burden now
lies upon the general practitioners (GPs), the
family doctors at the clinics we often go to
seek treatment.
The National Diabetes Institute (NADI)
sees the level of responsibility our GPs have
in caring for their patients with diabetes,
and have made an effort to strengthen their
capabilities in diabetes care through the NADI
Advocate Programme.
The programme
If you have missed the feature on our last
issue, here’s a description of what NADI
Advocate Programme entails.
It is a new programme for healthcare
professionals comprising a series of Semi-
nars (lectures / workshops) that will be held
regionally throughout the country.
Through the NADI Advocate Programme,
NADI hopes to help healthc are professionals
specifically the general practitioners to fur-
ther improve the quality of diabetes care and
achieve conformity of standards in diabetes
care in Malaysia.
First meeting of the doctors
The inaugural NADI Advocate Programme was
held in the city of Melaka, and have attracted
GPs all around the country to better them-
selves in diabetes care.
The two-day course started with a refresher
course on diabetes – the presentation, diag-
nosis, and the principle of management. The
first speaker of the day was Dr Ng Ooi Chuan,
Medical Lecturer and Head Endocrine Unit at
University Putra Malaysia (UPM), speaking
about Type-1 diabetes.
The second and third session discussed
about Type-2 diabetes as well as gestational
diabetes, and was delivered by Associate Pro-
fessor Norlaila Mustaffa of Hospital Canelor
Tuanku Muhriz Universiti Kebangsaan
Malaysia (HCTM UKM).
The fourth session discussed about the
lesser known and lesser common Type-3
diabetes, presented by Dr G R Letchuman,
Senior Consultant Physician from Hospital
Raja Permaisuri Bainun (HRPB).
The management of patients
After the prompt refresher course, the floor
was taken by Dr Radhakrishna Sothiratnam,
Consultant Physician for Columbia Asia
Hospital, Seremban.
Dr Radhakrishna discussed in detail
proper care for diabetes patients such as the
why, when, and how the insulin is used in
real world cases. He states that in regards to
diabetes care, Malaysia has seen success in
diagnosing more people with diabetes.
Prof Dato Mustaffa
Embong with the
Duopharma Biotech
Berhad team at
the inaugural NADI
Advocate Programme.
The doctors striving
to enhance their
understanding
and capabilities in
providing the best
diabetes care for their
patients.
We have become more
active in seeking out
patients with diabetes
compared to say, 10 years
ago." - Dr Radhakrishna
Dr Radhakrishna
presented statistics
on diabetes patients
to the GPs, explaining
how diabetes care
is still not as strong
as it should be in the
country given the
success we had in
detecting diabetes
among Malaysians.
“We have become more active in seeking
out patients with diabetes compared to say,
10 years ago. There were more undiagnosed
diabetics before, and we have improved in
regards to detection and prescribing treat-
ment,” said Dr Radhakrishna.
However, the statistics he presented
showed a significant stagnation in terms of
lowering patient’s blood glucose levels.
“Despite our success in detecting diabetic
patients, we have not been successful in keep-
ing them at a healthy level while they are on
insulin,” he added.
Dr Radhakrishna then discussed about
how GPs can be more precise in prescribing
their patients with insulin, depending on each
of their patients’ condition.
After the morning break, Dr Radhakrishna
continued with a case discussion with the
attending GPs.
The case studies looked at two cases in par-
ticular, one titled ‘Insulin Naïve Patients’, and
the other is ‘Insulin premix versus Basal Patient’.
The case study session was chaired by
Associate Professor Norlaila Mustafa, with a
panel consisting of Professor Dato Mafauzy
Mohamed from Hospital Universiti Sains
Malaysia (HUSM), Dr G R Letchuman, Dr
Ng Ooi Chuan, and Poh Kai Ling, Dietitian
from University Malaya Medical Centre
(UMMC).
The challenges our doctors face
During the case study, the GPs were asked a
question: What is the most challenging part of
treating diabetes patients? In consensus, the
GPs agree that the number one challenge is
to convince patients who are diagnosed with
diabetes to star taking insulin.
The reason for this is simple, diabetes can
be an asymptomatic condition for some. They
don’t even know that they have diabetes until
the GP diagnose them with it. Therefore, for
them to start administering insulin, perhaps
permanently for the rest of their lives, is
tremendously daunting.
The GPs agree however, that people with
more considerable symptoms are more ready
and accepting to start with insulin.
The other ever-present challenge for the
GPs is to manage the patients in keeping
with their insulin jabs. A discipline problem
more than anything, the doctors hope to have
the capability to assure their patients better
through the NADI Advocate Programme.
The last and truly the most debilitating
factor in diabetes care is the cost. The cost
for insulin alone can get up to RM200 and
above per month, which is a hefty monthly
commitment for many patients — The
Health