ArticleMalaysian family physician : the official journal of the Academy of Family Physicians of Malaysia2026
Metaphoric medicine: A retrospective clinical audit of glycaemic outcomes associated with an analogy-based consultation framework for insulin-treated type 2 diabetes mellitus.
Article in Malaysian family physician : the official journal of the Academy of Family Physicians of Malaysia, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Poor glycaemic control among patients with insulin-treated type 2 diabetes mellitus (T2DM) in Malaysia remains a major challenge despite increased insulin use. Patient education is limited by complex medical explanations and lack of standardised consultation protocols. Methods: We conducted a retrospective clinical audit of patients with T2DM attending a structured self-monitoring of blood glucose (SMBG) clinic from January to July 2023. Patients on insulin with glycated haemoglobin (HbA1c) levels of >8.5% were consecutively enrolled into a multicomponent care package comprising the Metaphoric Medicine Practical Roadmap for Insulin Management Essentials (M2-PRIME) consultation framework, an analogy-based educational tool employing the 'garbage and lorry' metaphor as well as structured 6-week follow-ups, SMBG review and insulin dose adjustment. The primary outcomes were changes in HbA1c and fasting blood sugar (FBS) levels at 6 months. Results: Eighty-nine patients completed follow-up (mean age=57.2 years; women=57.5%). The mean baseline HbA1c and FBS levels were 11.88% (±1.84) and 12.54 mmol/L (±6.32), respectively. After 6 months, the HbA1c level decreased by 1.57% (95% CI=1.14, 2.00; P<0.001) and the FBS level by 3.32 mmol/L (95% CI=2.21, 4.44; P<0.001). The HbA1c and FBS levels improved in 63 (70.8%) and 59 (66.3%) patients, respectively. Conclusion: Consultations incorporating the M2-PRIME were associated with clinically meaningful pre-post reductions in HbA1c and FBS levels among poorly controlled insulin-treated T2DM cases. However, without a control group, the independent contribution of the M2-PRIME cannot be isolated from concurrent insulin intensification and structured follow-up. These findings are preliminary and hypothesis-generating. A prospective randomised controlled trial is warranted.
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