---
title: "Quality of Type 2 Diabetes Care in Malaysian Primary Care: ABC (HbA1c, BP, LDL-C) Scoping Review"
id: "plos-one-3-the-quality-of-care-for-type-2-diabetes-mellitus-management-in-malaysian"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-3-the-quality-of-care-for-type-2-diabetes-mellitus-management-in-malaysian"
content_type: "clinical_feed_article"
specialty: "Endocrinology"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355227"
published_at: "2026-07-31T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Quality of Type 2 Diabetes Care in Malaysian Primary Care: ABC (HbA1c, BP, LDL-C) Scoping Review
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-one-3-the-quality-of-care-for-type-2-diabetes-mellitus-management-in-malaysian
- **Specialty:** [Endocrinology](https://medichelpline.com/clinical-feed/endocrinology.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355227)
- **Published At:** 2026-07-31T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- This scoping review synthesised published evidence on type 2 diabetes mellitus (T2DM) management in Malaysian primary health care (PHC), focusing on the three key quality indicators: **HbA1c**, **BP**, and **LDL-C** (collectively **ABC control**). - The review followed Joanna Briggs Institute (JBI) methodology and PRISMA-ScR reporting, searching PubMed, Embase, Scopus, and MyMedR plus grey literature through 31 December 2024; EndNote and Rayyan were used for deduplication and screening. - A total of 109 publications (1999–2024) met inclusion criteria; publication volume rose markedly after 2010 and remained concentrated in urban states, notably Selangor. - Large-scale studies often depended on the **National Diabetes Registry** and other routine datasets; HbA1c was the most frequently reported indicator. - Over two decades there was no evidence of improvement in **HbA1c** and **BP** control: achievement rates ranged about 30–45% for HbA1c <7.0% and about 20–50% for combined BP <130/80 mmHg across studies. - **LDL-C** control (≤2.6 mmol/L) showed modest gains, with achievement rates increasing from roughly 30% to about 50% over a decade. - Heterogeneity in study designs, target thresholds, and reporting formats prevented meta-analysis; narrative synthesis and visual evidence maps (heatmaps, scatterplots) were used instead. - The findings highlight a persistent gap between guideline recommendations and real-world outcomes in Malaysian PHC, indicating systemic barriers and uneven geographical coverage. - Authors recommend balanced policy attention to all three ABC indicators, strategies to address system-level barriers, and ongoing investment in national registry infrastructure to inform evidence-based improvements.
## Clinical Analysis & Structured Key Points
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The quality of care for type 2 diabetes mellitus management in Malaysian primary health care settings: A scoping review of ABC (glycated haemoglobin A1c, blood pressure, and LDL-cholesterol) * Mohamad Zulfikrie Abas , Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing * E-mail: zulfikrie@moh.gov.my Affiliation Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0001-9170-2099 ](https://orcid.org/0000-0001-9170-2099 "ORCID Registry") ⨯ * Norshahiratul Atiqah Mohd Zaidi, Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Software, Validation, Visualization, Writing – review & editing Affiliation Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0009-0003-9042-5618 ](https://orcid.org/0009-0003-9042-5618 "ORCID Registry") ⨯ * Pei Jia Lee, Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Writing – review & editing Affiliation Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia ⨯ * Xin Rou Teh, Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Writing – review & editing Affiliation Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia ⨯ * Kim Sui Wan, Roles Conceptualization, Data curation, Formal analysis, Methodology, Supervision, Validation, Writing – review & editing Affiliation Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia ⨯ * Azah Abdul Samad, Roles Supervision, Validation, Writing – review & editing Affiliation Primer Health Branch, Family Health Development Division, Ministry of Health Malaysia, Putrajaya, Malaysia ⨯ * Huan Keat Chan, Roles Conceptualization, Supervision, Validation, Writing – review & editing Affiliation Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia ⨯ * Sheamini Sivasampu, Roles Conceptualization, Supervision, Validation, Writing – review & editing Current Address: National Public Health Laboratory, Ministry of Health Malaysia, Sungai Buloh, Selangor, Malaysia Affiliation Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0003-2314-6048 ](https://orcid.org/0000-0003-2314-6048 "ORCID Registry") ⨯ * Swee Hung Ang Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Supervision, Validation, Writing – review & editing Affiliation Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0001-6676-6269 ](https://orcid.org/0000-0001-6676-6269 "ORCID Registry") ⨯ # The quality of care for type 2 diabetes mellitus management in Malaysian primary health care settings: A scoping review of ABC (glycated haemoglobin A1c, blood pressure, and LDL-cholesterol) * Mohamad Zulfikrie Abas, * Norshahiratul Atiqah Mohd Zaidi, * Pei Jia Lee, * Xin Rou Teh, * Kim Sui Wan, * Azah Abdul Samad, * Huan Keat Chan, … * Sheamini Sivasampu, * Swee Hung Ang ![PLOS](https://journals.plos.org/resource/img/logo-plos-full-color.svg) x * Published: July 31, 2026 * * [Article](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355227) * [Authors](https://journals.plos.org/plosone/article/authors?id=10.1371/journal.pone.0355227) * [Metrics](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0355227) * [Comments](https://journals.plos.org/plosone/article/comments?id=10.1371/journal.pone.0355227) * [Media Coverage](http://plos.altmetric.com/details/doi/10.1371/journal.pone.0355227) * [Abstract](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355227#abstract0) * [Introduction](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355227#sec005) * [Methods](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355227#sec006) * [Results](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355227#sec017) * [Discussion](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355227#sec026) * [Conclusion](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355227#sec035) * [Supporting information](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355227#sec036) * [Acknowledgments](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355227#ack) * [References](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355227#references) * [Reader Comments](https://journals.plos.org/plosone/article/comments?id=10.1371/journal.pone.0355227) * [Figures](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355227) ## Abstract ### Background Diabetes is a major health concern in Malaysia, yet no comprehensive review has assessed the quality of care for these patients. This study aims to systematically review published evidence on type 2 diabetes mellitus (T2DM) management in Malaysian primary health care (PHC), focusing on the achievement of glycated haemoglobin (HbA1c), blood pressure (BP), and LDL-cholesterol (LDL-C) targets (ABC control). ### Methods A scoping review was conducted, involving a comprehensive search of four databases (PubMed, Embase, Scopus, and MyMedR) and grey literature for publications up to December 2024. Studies were included if they reported on at least one ABC indicator among the general adult T2DM population in Malaysian PHC settings. The scoping review followed the Joanna Briggs Institute (JBI) methodology and PRISMA-ScR guidelines. EndNote was used for deduplication, and Rayyan was utilised for the screening process. Data were extracted and synthesised narratively. ### Results A total of 109 publications were included. Publications increased post-2010 but remained geographically concentrated in urban states. Large-scale studies heavily relied on the National Diabetes Registry. HbA1c was the most reported indicator. Findings revealed no evidence of improvement in HbA1c and BP control over two decades; achievement rates were 30–45% for HbA1c ( . The sponsors or funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. **Competing interests:** The authors have declared that no competing interests exist. ## Introduction Diabetes mellitus (DM) is a critical global public health challenge [[1](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355227#pone.0355227.ref001)]. In 2024, approximately 11.1% adults (589 million adults) were living with the condition, and this figure is projected to reach 13.0% (852.5 million adults) by 2050 [[2](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355227#pone.0355227.ref002)]. Malaysia, a Southeast Asian nation comprising 13 states and three federal territories, mirrors this alarming trend. The country reported a national DM prevalence of 15.6% in 2023, which is largely driven by rapid urbanisation, population ageing, and lifestyle shifts [[2](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355227#pone.0355227.ref002),[3](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355227#pone.0355227.ref003)]. In Malaysia, the public primary health care (PHC) system serves as the essential cornerstone for chronic disease management across these regions and bears the primary responsibility for the diagnosis, treatment, and long-term care of patients with diabetes [[4](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355227#pone.0355227.ref004)]. Effective management centres on three key clinical indicators: glycated haemoglobin (HbA1c), blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C), collectively known as ABC control. These indicators are widely recognised as essential proxies for evaluating the quality of diabetes care and are critical for reducing long-term microvascular and macrovascular complications [[5](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355227#pone.0355227.ref005),[6](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355227#pone.0355227.ref006)]. Despite the existence of established clinical practice guidelines, national data from the National Health and Morbidity Survey (NHMS) and the National Diabetes Registry (NDR) consistently indicate that many patients in Malaysian PHC settings fail to achieve optimal ABC targets [[3](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355227#pone.0355227.ref003),[7](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355227#pone.0355227.ref007),[8](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355227#pone.0355227.ref008)]. While numerous studies have addressed specific aspects of diabetes control, these existing publications typically report findings from isolated cohorts or specific registry datasets. For example, research has ranged from multi-centre clinical audits such as the Malaysian DiabCare studies to various population-based longitudinal analyses and localised medical record reviews [[8](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355227#pone.0355227.ref008),[9](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355227#pone.0355227.ref009)]. To date, however, there has been no comprehensive synthesis that integrates these disparate findings to map the broader landscape of collective ABC control in Malaysia. Thus, a significant gap exists in understanding the extent and characteristics of existing research, particularly regarding the reported indicators and the various clinical targets utilised across different studies. This lack of synthesis obscures the ability to identify established patterns and detect longitudinal trends in control levels across the years, which may help in recognising common systemic failures across the PHC network. To address these gaps, this scoping review aims to systematically map and synthesise the published evidence on the quality of T2DM care within Malaysian PHC settings. The review is guided by two research questions: 1. i. What are the characteristics of studies reporting estimates of ABC control among patients with T2DM in Malaysian PHC settings? 2. ii. What are the reported measures and estimates of ABC control among patients with T2DM treated in PHC settings in Malaysia? Given the observational nature of these questions and the expected variability in study designs and outcome reporting, a scoping review was deemed the most appropriate methodological approach. By mapping the nature, range, and extent of research activity, this review specifically examines the characteristics of the evidence base, the heterogeneity in clinical target definitions, and the trends in control achievement to clarify the current state of diabetes care quality research. Ultimately, this synthesis intends to identify knowledge gaps, inform future research directions, and support the development of targeted health policies aimed at bridging the gap between clinical guidelines and real-world outcomes in Malaysia. ## Methods The scoping review was conducted in accordance with the methodological guidance of the Joanna Briggs Institute (JBI) for scoping reviews [[10](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355227#pone.0355227.ref010)]. Reporting adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) [[11](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355227#pone.0355227.ref011)], ensuring methodological rigour, transparency, and reproducibility. ### Eligibility criteria The eligibility criteria were defined using the Population, Concept, and Context (PCC) framework, as recommended by the JBI manual for scoping reviews [[10](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355227#pone.0355227.ref010)]. This review was conducted as part of a larger scoping review (MyABCMap) that aimed to systematically map the literature on the quality of care for adult patients with T2DM, hypertension, or dyslipidaemia in Malaysia. #### Population. This review included studies involving adult patients (aged 18 years and above) diagnosed with T2DM. To ensure comparability and relevance to system-wide diabetes care delivery, only studies reporting outcomes for the general adult T2DM population were included. Studies that focused exclusively on restricted subpopulations, such as older adults only, women only, or patients with specific isolated comorbidities like T2DM with chronic kidney disease, were excluded. This restriction was applied to avoid selection bias and overrepresentation of subgroup-specific outcomes that may not reflect the broader quality of care provided at the PHC level. However, we acknowledge that while this approach is essential for a system-level assessment, it may potentially underestimate specific inequities in care quality existing within these distinct subgroups. #### Concept. The primary concept was the mapping of the quality of diabetes care as measured by three key clinical indicators: HbA1c, BP, and LDL-C, collectively referred to as ABC control. Studies were included if they reported at least one of these indicators. These clinical
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