Effectiveness of Insulin Deintensification and Predictors of Glycemic Control in Poorly Controlled Type 2 Diabetes Mellitus: A Retrospective Cohort Study in Malaysian Primary Care
https://doi.org/10.15605/jafes.041.S1
- Author:
Anuar Mohamad
1
;
Mohd Ali ‘Imran Ab Rahaman
2
;
Ping Foo Wong
1
;
Mohammad Zainie Hassan
3
;
Miguelinda Vitus Kimsin
1
;
Hiang Ngee Chan
4
;
Megat Muhammad Haris Megat Zainal
5
Author Information
1. Klinik Kesihatan Cheras
2. Pejabat Kesihatan Cheras
3. Klinik Kesihatan Temerloh
4. Klinik Kesihatan Batu Muda
5. Klinik Kesihatan Muhibbah
- Publication Type:Journal Article
- MeSH:
Diabetes Mellitus, Type 2;
Glycemic Control;
Retrospective Studies;
Primary Health Care;
Insulins
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):41-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Insulin deintensification is an emerging strategy to reduce
hypoglycemia and treatment burden in patients on
multiple daily injection (MDI ≥3), with potential to improve
adherence and glycemic control. However, evidence in
poorly controlled type 2 diabetes mellitus (T2DM) remains
limited. This study evaluated its effectiveness and identified
factors associated with achieving adequate glycemic
control following deintensification among patients with
poorly controlled T2DM attending Malaysian primary care.
Methodology:A retrospective cohort study was conducted among
107 T2DM patients with hemoglobin A1c (HbA1c) >9%,
attending Enhanced Diabetic Clinic at Cheras Health Clinic
between 2021 and 2025. All patients on basal-bolus insulin
(BBI) underwent deintensification. Multivariate logistic
regression was performed to identify factors associated
with achieving adequate glycemic control (HbA1c <7.5%).
Changes in HbA1c following deintensification were
assessed using paired t-tests.
Results:Overall, 50.5% of patients achieved adequate glycemic
control. Hypoglycemia events (AOR 9.5, 95% confidence
interval [CI] 1.6–58.3; p = 0.015), MDI (AOR 9.6, 95% CI
1.4–67.1; p = 0.023) and Diabetes Medication Therapy
Adherence Clinic (DMTAC) visits (AOR 1.1, 95% CI 1.0–
1.2; p = 0.039) were significantly associated with achieving
HbA1c <7.5%. Conversely, patients transitioned from BBI
to premixed regimens were less likely to achieve HbA1c
<7.5% (AOR 0.22, 95% CI 0.05–0.93, p = 0.039). All insulin
deintensification strategies were associated with significant
HbA1c improvements with transitioned from BBI to premixed human insulin (mean difference -2.54%, 95%
CI 1.77–3.31, p <0.001, Cohen’s d = 1.09), BBI to premixed
analogue insulin (mean difference -3.38%, 95% CI 2.26–
4.49, p <0.001, Cohen’s d = 1.62), BBI to basal insulin (mean
difference -3.67%, 95% CI 1.79–5.54, p = 0.004, Cohen’s
d = 2.05).
Conclusion:Insulin deintensification is an effective strategy for
improving glycemic control in poorly controlled T2DM.
These findings highlight the importance of deintensification
with careful consideration of hypoglycemia, MDI-related
treatment burden, and patient engagement through regular
DMTAC visits, which are integral to achieving optimal
outcomes and support a personalized approach to diabetes
management in primary care.
- Full text:2026072916421050468EP_A040.pdf
