PROCEEDINGS of 2nd Endocrine Pharmacy Conference 2025

23^th – 24^th August 2025

Theme: Restoring Balance: Hormones in Harmony

Venue: The Vertical, Connexion Conference & Event Centre (CCEC) Kuala Lumpur

Editors

• Navin Kumar Loganadan
• Selvakumari Selvadurai
• Won Zi Yun
• Chan Siok Yee  
  

CONTENTS

RESENTATIONS

Abstract 001

Assessment of Glycemic Control with Human Insulin 30/70 Versus Basal-Bolus Regimen in Geriatric Patients with Type 2 Diabetes in Seremban Health Clinic

Lai Lin Hui, Nurul Afina binti Fadzil, Nabila Farhana binti Abu Bakar, Nur Erinayati binti Sawardi Lukman, Ratna binti Hj Silong

Abstract 002

Exploring The Impact of Insulin Deintensification on Body Weight and Glucose Control in Patients with Type 2 Diabetes Mellitus

Nur Aflyn Fatinah Faiza, Ernieda Md Hatah, Sarah Anne Robert, Yeap Yoon See, Afifah Azhari, Noorlita Adam

Abstract 003

Evaluation of The Effect of High Versus Standard Dose of Insulin on Body Weight and Glucose Control among Type 2 Diabetes Mellitus Patients

Meredith We, Ernieda Mohd Hatah, Munirah Mohd Basar, Soon Keat Shio, Mohd Safiee bin Daud

Abstract 004

Characterising Inpatient Hypoglycaemia and Identifying Risk Factors for Level 2 Hypoglycaemia

Andrew Gerald Tan Hua Kion, Yong Wai Yin, Florence Tan Hui Sieng, Ernieda Md Hatah, Adyani Md Redzuan.

Abstract 005

Incidence of Hypoglycaemia among Diabetes Mellitus Patients in Hospital Kuala Lumpur: A Descriptive Study

Michelle Liew Chee Hui, Fiona Tong Hui Ling, Marilyn Tan May Yeen, Sia Wei Wei, Yeak Chee Yan, Liang Kai Hsien, Liew Xin Wei, Safawati Binti Samsuri, Farizan Binti Abdul Ghaffar, Tay Chan Yen, Lee Lai Fong

Abstract 006

Barriers to Medications Adherence in Type 2 Diabetes Mellitus Patients: A Qualitative Study in a Pharmacist-Managed Clinic

Farhani Nor Haslan, Angeline Yee Zhi Xin, Nurantasha Zulhazman, Ho Siew Ching

Abstract 007

A Scoping Review and Bibliometric Analysis of Type 1 Diabetes Mellitus and Mental Health

Lim JH, Hoo YF, Wong YJ

Abstract 008

Impact of Sglt-2 Inhibitors as Add-on Therapy to Insulin in Type 2 Diabetes: A Real-World Study

Lee Wai Han, Noor Lita Binti Adam, Nor Afidah Binti Karim, Navin Kumar Loganadan

Abstract 009

Suboptimal Insulin Injection Technique and Associated Factors among Type 1 Diabetes Patients

Albert Ting Siong Hung, Oh Ai Ling, Chai Siew Khiuk, Flora Sim Wang Ying, Laura Kuek Hui Shi, Tan Yi Jing, Florence Tan Hui Sieng, Navin Kumar Loganadan

Abstract 010

Exploring Barriers and Enablers for Self-Adjustment of Insulin Doses in Type 2 Diabetes Patients in a Tertiary Endocrine Centre

Selvakumari Selvadurai, A. Yaashini Anamalai, Navin Kumar Loganadan , Nor Farzana Mhd Zambri, Siti Nur Shahirah Mhd Hazam, Nur Aisyah Ismail , Najiha Abu Hasan , Adliah Mhd Ali

 

 

Abstract 001

Assessment of Glycemic Control with Human Insulin 30/70 Versus Basal-Bolus Regimen in Geriatric Patients with Type 2 Diabetes in Seremban Health Clinic

Lai Lin Hui¹*, Nurul Afina binti Fadzil¹, Nabila Farhana binti Abu Bakar¹, Nur Erinayati binti Sawardi Lukman¹ , Ratna binti Hj Silong²

¹ Unit of Pharmacy, Seremban Health Clinic, Negeri Sembilan 70300 Seremban, Malaysia.

²  Unit of Pharmacy, Seremban District Health Office, 70590 Seremban, Negeri Sembilan, Malaysia.

Corresponding author: linhui@moh.gov.my  

ABSTRACT

Background and Objectives: Despite numerous studies comparing basal bolus regime and human insulin 30/70, gaps remain in real-world data for elderly patients. Older adults are more vulnerable to hypoglycemia- related complications like falls, fractures, and cardiovascular events. The objective of the study was to compare glycemic control and hypoglycemia risk between these two regimens in elderly patients attending our clinic. Methods: A retrospective cohort study (with ethical approval number NMRR ID-24-02446-HCF) was conducted in KK Seremban, focusing on geriatric patients with T2DM who were using either Human Insulin 30/70 or basal-bolus insulin regimens. Descriptive statistics were used to describe demographic characteristics and incidence of over-insulinization while comparative analysis were performed to investigate HbA1c reduction, and hypoglycemia incidence between the two insulin regimens. Results and Discussion: The study found that 22.36% of patients in the premixed Human Insulin 30/70 group required total daily insulin doses exceeding 1 unit/kg/day, while 22.06% of patients on the basal-bolus regimen were prescribed doses greater than 1.5 units/kg/day, raising concerns about potential over-insulinization in this population.  HbA1c reduction did not differ significantly between the regimens (p = 0.402), and endpoint HbA1c values were also comparable (p = 0.117). Hypoglycemia requiring hospitalization was rare, with two cases in the premixed group and none in the basal-bolus group (p = 0.581). Conclusions: Both regimens achieved comparable glycemic control, with premixed insulin offering a simpler alternative for patients who face adherence challenges. Treatment decisions should be individualized, considering each patient’s functional status, comorbidities, meal patterns, and ability to self-monitor blood glucose. A structured insulin-prescribing flowchart is recommended to guide clinicians in optimizing dosing and avoiding overtreatment in this vulnerable population.

Abstract 002

Exploring The Impact of Insulin Deintensification on Body Weight and Glucose Control in Patients with Type 2 Diabetes Mellitus

Nur Aflyn Fatinah Faizal^1,3*, Ernieda Md Hatah ¹, Sarah Anne Robert² , Yeap Yoon See³, Afifah Azhari³, Noorlita Adam⁴

¹ Faculty of Pharmacy, University Kebangsaan Malaysia, 50586 Kuala Lumpur  Malaysia.

² Department of Pharmacy, Hospital Canselor Tuanku Mukhriz UKM

Kebangsaan Malaysia, 56000 WP Kuala Lumpur, Malaysia.

³ Department of Pharmacy, Hospital Tuanku Ja’afar, 70300 Seremban Malaysia.

⁴ Department of Endocrine, Hospital Tuanku Ja’afar, 70300 Seremban Malaysia.

Corresponding author: aflynfaizal@gmail.com

ABSTRACT

Background and Objectives:  Deintensification of insulin regimens and doses has the potential to prevent overtreatment and hypoglycaemia. This study aims to assess the impact of insulin deintensification on glycaemic effect and body weight with Type 2 Diabetes Mellitus(T2DM) patients. The objectives of this study were to identify the characteristics of T2DM patients receiving insulin deintensification and reason of deintensification, Additionally, to evaluate the glycaemic efficacy and changes in body weight following insulin deintensification as well as the factors that may influence these outcomes. Methods: A retrospective cohort observational study (with ethical approval number NMRR ID-24-00459-4DK) was conducted among T2DM patients from Hospital Tuanku Ja’afar and Hospital Canselor Tuanku Mukhriz. Data were collected from patient records receiving insulin deintensification from January 2020 to January 2024 using data collection form consisting of six sections. Results and Discussion: A total of 134 patients from two hospitals were included in this study, with 75 patients from HTJ and 59 patients from HCTM. The mean age was 57.25±14.02 years, with an equal distribution of male and female participants. The majority were Malay(n=69,51.5%), followed by an equal number of Chinese and Indian (n=32,23.9% each), with most patients on a basal bolus regimen(n=69,51.5%), followed by a premixed(n=63,47%) and a basal(n=2,1.5%). The mean duration of diabetes was 17.54±8.28 years. Baseline HbA1c was 9.38±1.86% and most patients used insulin four times a day(n=59,44%). The mean total daily insulin dose decreased from 77.99±30.18 units to 60.11±25.39 units. Hypoglycaemia events reduced from 98 to 11 episodes. The main reason for deintensification was hypoglycaemic events(n=98,73.1%). HbA1c reduced from 9.38±1.86% to 8.72±1.78% (t (133) =5.57, p<0.001), and weight decreased from 77.27±15.83kg to 75.80±15.75kg (t(133) =6.19,p<0.001). Factors significantly associated with changes in HbA1c includes baseline HbA1c (p< 0.001), use of basal-only insulin (p=0.002), and reduction in insulin injection frequency by one(p=0.002) and two (p=0.004) times per day. Conclusion: Insulin deintensification significantly improves glycaemic control and reduces body weight in T2DM patients. Key factors influencing these improvements include baseline HbA1c levels and the type and frequency of insulin used. Monitoring for signs of overinsulinization and hypoglycaemia, particularly those with high HbA1c, is crucial for optimizing diabetes management.

Abstract 003

Evaluation of the Effect of High Versus Standard Dose of Insulin on Body Weight and Glucose Control among Type 2 Diabetes Mellitus Patients

Meredith Wee^1,3*, Ernieda Mohd Hatah¹, Munirah Mohd Basar² Soon Keat Shio², Mohd Safiee bin Daud³

¹ Faculty of Pharmacy, University Kebangsaan Malaysia, 50586 Kuala Lumpur  Malaysia. 

² Klinik Kesihatan Merlimau, 77300 Merlimau, Melaka, Malaysia.

³ Klinik Kesihatan Umbai, 77300 Merlimau, Melaka, Malaysia.

Corresponding Author: meredith.wee@hotmail.com

ABSTRACT

Background and Objectives: The use of insulin is warranted in Type 2 Diabetes Mellitus (T2DM) when glycaemic targets are not achieved by diet control or oral glucose lowering drugs only. Since diabetes is a progressive disease due to the declining function of beta cells, most guidelines recommend insulin initiation, followed by optimization of dose and intensification of insulin types, which can result in potentially high doses of insulin. The use of insulin is associated with weight gain. Hence, there is a need to evaluate the impact of high dose insulin on weight and glucose control. The objectives of this study were to analyse the treatment effects of high versus standard insulin doses on body weight changes and glucose control in addition to predictors of body weight changes and glucose control in individuals with T2DM. Methods: A retrospective cohort study involving T2DM individuals on insulin treatment at Klinik Kesihatan Merlimau and Umbai, Melaka from 2020 to 2023. Ethical approval number NMRR ID-24-00392-WLQ.   Results and Discussion: Standard dose insulin (SDI) group had a lower mean body weight change (3.07 ± 4.90 kg) compared to the high dose insulin (HDI) group (5.57 ± 6.69 kg) with a mean difference of -2.50 kg (95% CI -4.95 kg, -0.05 kg), t (82.51) = -2.03, p = 0.045. In terms of glycemic control, the SDI group demonstrated a lower current HbA1c than the HDI group. Patients who were prescribed SDI had a mean HbA1c of 9.55 ± 1.95%. The mean HbA1c was reportedly higher in patients on HDI, with a mean reading of 10.39 ± 1.86%. The mean difference in HbA1c between the SDI and HDI groups was -0.84% (95% CI -1.64, -0.04, t (88) = -2.09, p = 0.040. Total daily dose (TDD) and duration of insulin treatment were found to be statistically significant predictors of body weight difference, F (2, 45) = 11.183, p < 0.0005, R2 = 0.332. Among the variables tested, age, combined metformin and DPP4i therapy, analogue insulin, and combination of human/analogue insulin significantly predict current HbA1c, F (4, 85) = 7.786, p < 0.0005, R2 = 0.268. Conclusion: This study demonstrated that HDI, in comparison to SDI, resulted in greater weight gain, supporting our initial hypothesis. HDI group achieved a higher mean HbA1c than the SDI group. Dose classification is not a predictor of body weight changes and glucose control.  

Abstract 004

Characterising Inpatient Hypoglycaemia and Identifying Risk Factors for Level 2 Hypoglycaemia

Andrew Gerald Tan Hua Kiong^1,2,*, Yong Wai Yin³, Florence Tan Hui Sieng⁴, Ernieda Md Hatah¹, Adyani Md Redzuan¹.

¹ Centre for Quality Management of Medicine, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia.

² Training Management Division, Kementerian Kesihatan Malaysia, 62675 Putrajaya, Malaysia.

² Pharmacy Department, Hospital Raja Permaisuri Bainun, 30450 Ipoh, Perak, Malaysia.

² Endocrine Unit, Medical Department, Hospital Umum Sarawak, 93586 Kuching, Sarawak, Malaysia.

Corresponding Author: andrewgtan@gmail.com

ABSTRACT

Background and Objectives: Inpatient hypoglycaemia is a significant clinical concern linked to adverse outcomes such as prolonged hospitalization, cardiac events, and mortality. Level 2 hypoglycaemia (blood glucose <3.0 mmol/L) represents a more severe subtype that requires prompt recognition and management. Despite its relevance, the clinical profile of inpatient hypoglycaemia and specific risk factors contributing to Level 2 events remain inadequately understood. This study aims to characterize the clinical characteristics and temporal distribution of inpatient hypoglycaemia episodes and to identify risk factors for level 2 hypoglycaemia. Methods: A retrospective cohort study (with ethical approval number NMRR ID-24-00438-HYG) involving adult inpatients in general medical, surgical, and orthopaedic wards across two hospitals from two states was conducted between April and December 2024. The subset of patients with at least one hypoglycaemic episode during admission were included for analysis. The full dataset was used for descriptive analyses. To identify risk factors for level 2 hypoglycaemia, only the first episode per admission was analysed. Univariable and multivariable logistic regression were sequentially performed to identify the risk factors. Results and Discussion: A total of 415 cases recruited had experienced 671 hypoglycaemia episodes, of which 20.1% were classified as Level 2 events. Most of the episodes (n=218, 32.5%) occurred between dawn and noon (06:00-11:59 hours). Almost one-third (32.0%) of the episodes occurred on a non-working day. Additionally, 85.4% of all hypoglycaemia episodes were associated with the exposure to glucose-lowering drugs, of which 62.0% were exposed to insulin. Insulin use [adjusted Odds Ratio (aOR): 2.41, p = 0.006] and lower blood glucose levels at admission (aOR: 0.93, p = 0.003) were identified as significant risk factors for Level 2 hypoglycaemia. In contrast, dipeptidylpeptidase-4 inhibitor use (aOR: 0.25, p = 0.004) was a protective factor.  Conclusion: Insulin use and lower admission blood glucose levels were identified as significant risk factors for level 2 hypoglycaemia, while dipeptidylpeptidase-4 inhibitors offered protective effects. These findings highlight the importance of careful management of glucose-lowering therapies in hospitalized individuals, while paying attention to admitting blood sugar levels to mitigate the risk of level 2 hypoglycaemia.

Abstract 005

Incidence of Hypoglycaemia Among Diabetes Mellitus Patients in Hospital Kuala Lumpur: A Descriptive Study

Michelle Liew Chee Hui*, Fiona Tong Hui Ling, Marilyn Tan May Yeen, Sia Wei Wei, Yeak  Chee Yan, Liang Kai Hsien, Liew Xin Wei, Safawati Binti Samsuri, Farizan Binti Abdul  Ghaffar, Tay Chan Yen, Lee Lai Fong

Pharmacy Department, Hospital Kuala Lumpur, Ministry of Health Malaysia, 50586 Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia.

Corresponding Author: michellecheehui@moh.gov.my  

ABSTRACT

Background and Objectives: National Health and Morbidity Survey (NHMS) reported diabetes prevalence has shown increasing trend, surging from 11.2% in 2011 to 13.4% in 2015 and further escalating to 15.6% in 2023, representing that approximately 1 out of adults in Malaysia are now struggling with diabetes. Hypoglycaemia has been shown to elevate likelihood of diabetes-related micro- and macrovascular complications with severe hypoglycaemia being associated with higher mortality rates. Currently, there is lack of data for hypoglycaemia incidence experienced by diabetes patients within tertiary care settings. This study aimed to determine the incidence of hypoglycaemia among diabetes patients in Hospital Kuala Lumpur (HKL). Method: A prospective observational study (with ethical approval number NMRR ID-24-02664-WKQ) by universal sampling was carried out from August 2024 until February 2025. Demographic data were traced from patients’ medical records in General Internal Medicine and Endocrine Clinics. Clinical data were obtained through interviewed patients during Diabetes Medication Therapy Adherence Clinic (DMTAC) counselling sessions based on data collection form created. Adult patients diagnosed with Diabetes Mellitus who were followed up under pharmacists-led DMTAC in HKL were included.  Patients who were followed up under other facilities, those defaulted pharmacists-led DMTAC follow up and those with incomplete data from the patient’s medical record were excluded.  Descriptive data were computed by using IBM® Statistical Product and Service Solutions (SPSS) Desktop version 26. Results and Discussion: Among 64 patients recruited during the study period, 23 (36%) of them were reported with history of hypoglycaemia. Most of the hypoglycaemia patients were elderly with age 60 years and above (n=16/23, 70%). Among patients with hypoglycaemia, 52% of them (n=12/23) using Human Recombinant Insulin, only 17% of them (n=4/23) using Insulin Analogue and 30% (n=7/23) using both Human Recombinant Insulin and Insulin Analogue. One fifth of the patients (n=4/23, 17%) were not compliant to medications. There were 7% (n=2/23) of the hypoglycaemia patients reported to inject insulin at incorrect injection timing and were not able to manage hypoglycaemia properly. Conclusion: The prevalence of hypoglycaemia in patients with diabetes is high. Therefore, it is vital to counsel diabetes patients on managing hypoglycaemia events and enforce the preventive measures of hypoglycaemia to improve their overall clinical outcomes.

Abstract 006

Barriers to Medications Adherence in Type 2 Diabetes Mellitus Patients: A Qualitative Study in a Pharmacist-Managed Clinic

Farhani Nor Haslan*, Angeline Yee Zhi Xin, Nurantasha Zulhazman, Ho Siew Ching

Department of Pharmacy, Ampang Hospital, 68000  Selangor, Malaysia.

Corresponding author: Farhani.haslan@moh.gov.my  

ABSTRACT

Background and Objectives: Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic disorder and a growing global health challenge, with medication adherence playing a critical role in achieving glycaemia control and complication prevention. Despite structured interventions like the pharmacist-managed diabetes clinic (DMTAC) in Malaysia, adherence remains suboptimal. This study aimed to explore the multifaceted barriers to medication adherence among patients with uncontrolled T2DM in a DMTAC setting. Method: A grounded theory approach was used to explore the barriers to medications adherence among T2DM patients. A purposive sampling method was used to recruit patients from the DMTAC program of a government-run hospital in Malaysia, ensuring diversity in gender and ethnicity. Data were collected through semi-structured and individual in-depth interviews. Audio-recorded responses were transcribed verbatim and analyzed thematically using MAXQDA software. Ethical approval number NMRR ID-24-03304-IPS (IIR). Results and Discussion: Data saturation was achieved with 10 patients. Four major categories of barriers emerged from the interviews: patient-related, medication-related, social-related, and financial-related factors. Patient-related barriers included psychological resistance, lifestyle challenges, lack of knowledge, forgetfulness and low self-efficacy. Medication-related issues focused on side effects and the inconvenience of insulin administration. Social-factors were unique to this region, and included caregiving responsibilities, insufficient family support, and cultural beliefs promoting alternative treatments. Financial constraints, particularly high medication and transportation costs, were also identified as significant obstacles. These interconnected barriers highlight the complexity of adherence behaviour in this population. Conclusion: Adherence challenges in T2DM are multifactorial, requiring patient-centered, tailored interventions. This study highlights the distinctive concept of collectivism, filial piety and traditional health beliefs of the Asian population. The barriers identified potentially underscore the need for enhanced education, psychosocial support and affordability measures to improve adherence and clinical outcomes in DMTAC programs. Furthermore, cultural sensitivity training for healthcare professionals to address alternative medicine beliefs could be valuable.

Abstract 007

A Scoping Review and Bibliometric Analysis of Type 1 Diabetes Mellitus and Mental Health

Lim JH¹*, Hoo YF¹, Wong YJ²

¹ School of Pharmacy, Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya, 47500, Selangor, Malaysia.

² School of Pharmacy, Monash University Malaysia, Subang Jaya, 47500, Selangor, Malaysia.

Corresponding author: jiahui.lim@taylors.edu.my

ABSTRACT

Background and Objectives: Type 1 diabetes mellitus (T1DM) is an autoimmune disorder characterized by absolute insulin deficiency, typically diagnosed before adulthood, and often associated with increased psychological vulnerability. To date, no scoping review has integrated bibliometric methodology to comprehensively summarize scientific productivity and collaboration across countries and institutions in this area of interest. This study aimed to conduct a scoping review incorporating bibliometric analysis to explore mental health impacts associated with T1DM. Methods: This retrospective study used Elsevier’s Scopus database, a leading multidisciplinary resource, to identify relevant literature. We searched for English-language articles published between 2015 and 2025 using keywords related to T1DM and mental health. Two researchers (LJH & WYJ) independently screened and selected studies according to the PRISMA guidelines, resulting in 100 included articles. Bibliometric analysis was conducted with VOSviewer, and descriptive findings were summarized using Excel for the scoping review. Results and Discussion: Global contributions to research focusing on mental health impacts associated with T1DM were visualized using VOSviewer, identifying two main country clusters: the United States, Canada, and Brazil in one, and the United Kingdom and Australia in the other. Tricia Tang was the most prolific author, while Beatriz D Schaan, Gabriela Telo, and Reinhard W Holl had the highest citation counts. The review highlighted five key domains: T1DM prevalence and mental health associations, mental health complications due to T1DM, impacts of T1DM on caregiver mental health, healthcare professionals’ perspectives on the subject matters, and interventions to address these issues. Conclusion: This scoping review with bibliometric analysis pinpointed a gap in the regional research for mental health impacts associated with T1DM. This highlights the potential for more clinical and scientific collaborations within the Southeast Asian region, in contributing to understanding the regional needs in mental health support among people with T1DM. In addition, therapeutic strategies for T1DM should consistently consider the mental health aspects of people with T1DM and caregivers as a part of the holistic healthcare service and management.

Abstract 008

Impact of Sglt-2 Inhibitors as Add-on Therapy to Insulin in Type 2 Diabetes: A Real-World Study

Lee Wai Han¹*, Noor Lita Binti Adam², Nor Afidah Binti Karim², Navin Kumar Loganadan³

¹ Pharmacy Department, Hospital Tuanku Ja’afar, Ministry of Health, Malaysia, 70300 Seremban, Negeri Sembilan, Malaysia.

² Endocrinology Department, Hospital Tuanku Ja’afar, Ministry of Health, Malaysia, 70300 Seremban, Negeri Sembilan, Malaysia.

³ Pharmacy Department, Hospital Putrajaya, Ministry of Health, Malaysia, 62250 Putrajaya, Malaysia.

Corresponding author: brendy2992@gmail.com  

ABSTRACT

Background and Objectives: The emergence of sodium-glucose cotransporter-2 (SGLT-2) inhibitor has transformed the treatment paradigm for type 2 diabetes (T2D), especially in patients with cardiorenal complications, following the promising outcomes from cardiovascular outcome trials (CVOTs). In Malaysia, the use of SGLT-2 inhibitor has increased notably in recent years, particularly following a national shortage of human insulin. A real-world study is warranted to evaluate the effectiveness and safety of SGLT-2 inhibitor as an add-on therapy to insulin in the local population. The objectives of this study were to evaluate the impact of adding SGLT2 inhibitor in patients whose T2D is inadequately controlled with insulin. Methods: This retrospective cohort study (with ethical approval number NMRR ID-24-04057-SGA) included adult T2D patients with glycated haemoglobin (HbA1c) >7%, receiving insulin therapy and newly initiated on SGLT-2 inhibitors between July 2021 and June 2024 at Hospital Tuanku Ja’afar Seremban. Patients were identified via the Drug Database and Pharmacy Information System (PhIS). Those with hospital admissions within six months post-initiation or documented medication non-compliance were excluded. Eligible subjects were followed for 24 weeks. Baseline demographics, clinical characteristics and laboratory parameters were obtained from electronic health records. Primary outcomes included changes in HbA1c, fasting plasma glucose (FPG), body weight and total daily dose (TDD) of insulin.Results and Discussion: A total of 144 patients receiving five different SGLT-2 inhibitor regimens were included: Dapagliflozin 5mg (n=3), Dapagliflozin 10mg (n=25), Empagliflozin 10mg (n=31), Empagliflozin 12.5mg (n=22), and Empagliflozin 25mg (n=63). At 24 weeks, there were significant reductions in HbA1c (-0.83±1.56%, p<0.001), FPG (-1.46±3.62mmol/L, p<0.001), and body weight (-0.80kg; IQR -2.40 to 0.40; p<0.001) compared to baseline. All SGLT-2 inhibitor groups showed significant HbA1c reductions (p<0.05) except for Dapagliflozin 5mg group. No significant differences were observed among the groups in changes to HbA1c, FPG, body weight, or TDD of insulin. Hypoglycaemia was reported in 13.2% (n=19) of patients, with only 5.6% deemed related to SGLT-2 inhibitor therapy. Conclusion: SGLT-2 inhibitors used as add-on therapy to insulin resulted in significant improvements in HbA1c, FPG, and body weight, with a low incidence of hypoglycaemia. These findings support the clinical benefit of incorporating SGLT-2 inhibitors in the management of patients with suboptimal glycaemic control on insulin therapy.

Abstract 009

Suboptimal Insulin Injection Technique and Associated Factors among Type 1 Diabetes Patients

Albert Ting Siong Hung¹*, Oh Ai Ling¹, Chai Siew Khiuk¹, Flora Sim Wang Ying¹, Laura Kuek Hui Shi¹, Tan Yi Jing², Florence Tan Hui Sieng¹, Navin Kumar Loganadan³

¹ Hospital Umum Sarawak, Ministry of Health Malaysia, 93586 Kuching, Sarawak, Malaysia.

¹ Hospital Jempol, Ministry of Health Malaysia, 72120 Bandar Seri Jempol, Negeri Sembilan, Malaysia.

¹ Hospital Putrajaya, Ministry of Health Malaysia, 62250 Putrajaya, Malaysia.

Corresponding author: birdncol@gmail.com  

ABSTRACT

Background and Objectives: Suboptimal insulin injection technique (IIT) is an under-recognised barrier to diabetes management. IIT errors can lead to erratic insulin absorption, suboptimal glycaemic control, and higher healthcare costs. Despite global error rates of 20–50%, local data among Malaysians with type 1 diabetes mellitus (T1DM) are limited. The objectives of this study were to determine the prevalence of specific IIT errors and identify factors associated with suboptimal IIT among T1DM patients. Methods: A cross-sectional study (with ethical approval number NMRR ID-24-04017-XG2) was conducted from February to June 2025 at the outpatient diabetes clinic of Hospital Umum Sarawak. Universal sampling included all T1DM patients aged ≥13 years who had been on insulin therapy for at least 3 months. IIT was evaluated using a validated 13-item Insulin Injection Technique Score (IITS) tool. Scores <18 (out of 26) indicating suboptimal IIT. Demographic and clinical data, including HbA1c, were collected. Logistic regression was used to identify predictors of suboptimal IIT, while the association between IITS and HbA1c was analysed using Spearman’s correlation. A p-value of <0.05 was considered statistically significant.  Results and Discussion: Eighty patients, mostly female (68.8%, n=55), with a median age of 29.5 years (IQR: 23.0–40.0) were enrolled. The mean IITS was 18.1 (SD = 3.1), and 31 patients (38.8%) had suboptimal technique (IITS <18). The most common injection technique errors were premature post-injection needle withdrawal (82.5%), needle reuse (81.3%), failure to verify insulin expiry dates (80.0%), inadequate injection site rotation (66.3%), and inappropriate skin-fold application (37.5%). Diabetes duration of ≥10 years was the sole independent predictor significantly associated with suboptimal IIT (OR = 5.41; 95% CI: 1.95–15.00; p = 0.001). A weak, negative correlation was observed between IITS and HbA1c (rs = –0.147; p = 0.192), though it was not statistically significant. Conclusion: Over one-third of T1DM patients exhibited suboptimal IIT, particularly those with longer diabetes duration. Routine technique assessment and targeted pharmacist-led education are essential to minimise preventable complications and optimize insulin therapy outcomes.

Abstract 010

Exploring Barriers and Enablers for Self-Adjustment of Insulin Doses in Type 2 Diabetes Patients in a Tertiary Endocrine Centre

Selvakumari Selvadurai¹*, A. Yaashini Anamalai¹, Navin Kumar Loganadan¹ , Nor Farzana Mhd Zambri¹, Siti Nur Shahirah Mhd Hazam¹, Nur Aisyah Ismail¹ , Najiha Abu Hasan¹ , Adliah Mhd Ali²

¹ Pharmacy Department, Hospital Putrajaya, 62250 Putrajaya, Malaysia.

² Centre for Quality Management of Medicine, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia.

Corresponding author: selva5102@gmail.com

ABSTRACT

Background and Objectives: Diabetes Medication Adherence Therapy Clinic (DMTAC) is a pharmacist-led intervention clinic among chronic diabetic patients. Patients recruited under DMTAC in Hospital Putrajaya undergo intensive education sessions on self-adjustment of insulin dose. Therefore, this study was conducted to explore barriers and enablers of effective insulin self-adjustment among type 2 diabetes patients to empower patients in the future. Methods: This qualitative study was conducted using face-to-face interviews (NMRR-20-2254-56103(IIR)). Patients were recruited from DMTAC using purposive sampling. The interview questions were derived from Mcbain et al (2016) which outlines 14 domains consisting of barriers and enablers of changing behaviour among diabetes patients receiving insulin therapy. Interviews were audio-recorded and transcribed verbatim. The data were coded according to the 14 domains, belief statements were created within each domain, and a frequency count of the most reported barriers and enablers was then carried out. Data collection and analysis were conducted by 6 researchers (SS, NFZ, NAI, SSH, AYA and NNH) and discrepancies were agreed with the other 2 researchers (AMA and NKL). Results and Discussion: A total of 11 diabetic patients with the mean age of 62 years old and the duration of diagnosis of type 2 diabetes of 19 years participated in this study. Knowledge domain was found to have the highest number of belief statements (n=12) followed by behavioural regulation domain (n=10). Belief statements “I am confident about adjusting my dose of insulin” had the highest count of enablers (n=14) and “Dependent on the caregiver (n=3) as barriers. Conclusions: Patients who participated in this study were optimistic that they were able to perform insulin dose self-adjustment with intensive education sessions by the pharmacists provided at the DMTAC.