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.
Diabetes Mellitus, Type 2 ; Glycemic Control ; Retrospective Studies ; Primary Health Care ; Insulins

Introduction: Human immunodeficiency virus (HIV)-related stigmatisation and discrimination adversely affect health outcomes in terms of timely diagnosis, treatment and care. Despite global efforts, they remain common among healthcare workers worldwide. In Malaysia, family medicine specialists are entrusted with the care of HIV patients at the primary care level. This study aimed to assess HIV-related knowledge, acts of discrimination, stigmatising attitudes and their associated factors among family medicine trainees in Malaysia. Methodology: This cross-sectional study was conducted among 397 family medicine trainees in Malaysia using a validated, self-administered questionnaire that assessed the participants’ sociodemographic information, HIV/AIDS knowledge, stigmatising attitudes (attitudes of blame, attitudes towards imposed measures, comfort in dealing with HIV patients) and acts of discrimination. Results: The most common stigmatisation was “attitudes of blame” (mean [SD] score: 3.0 (0.74); range score:1–5), and the most frequent discriminatory act was breaching patient confidentiality (54.9%). Around 82.1% had good knowledge of HIV/AIDS. Married participants and participants who had 7 years or less in service were more stigmatising in “attitudes of imposed measures” towards people living with HIV (p=0.006). Conclusion Family medicine trainees exhibited stigmatisation and discrimination towards HIV patients despite having good HIV knowledge. Hence, appropriate and concerted health education should be given to all family medicine trainees to eliminate stigmatisation and discrimination.
Discrimination, Psychological ; Social Discrimination ; HIV