Clinical Practice Guideline for Dm 2

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This is a revised and updated Clinical Practice Guidelines (CPG) on Management of Type 2 Diabetes Mellitus (T2DM). This CPG supersedes the previous CPG on Management T2DM (2004).

This guideline is meant to be a guide for clinical practice, based on the best available evidence at the time of development. Adherence to this guideline may not necessarily guarantee the best outcome in every case. Every health care provider is responsible for the management of his/her unique patient based on the clinical picture presented by the patient and the management options available locally.

This guideline was issued in May 2009 and will be reviewed in May 2013 or sooner if new evidence becomes available. CPG Secretariat Health Technology Assessment Section Medical Development Division Ministry of Health Malaysia 4th Floor, Block E1, Parcel E 62590 Putrajaya Electronic version is available on the following websites:


Despite significant advances in Medicine, Diabetes Mellitus remains a major medical challenge in the 21st century. It is common knowledge that urbanised lifestyle coupled with physical inactivity, together with a higher intake of saturated fats have impacted our population which appears to be genetically predisposed to Type 2 Diabetes. In Malaysia, the prevalence of diabetes continues to rise. What is even more worrying is the fact that almost half of our population with diabetes is unaware that they have the disease. Diabetes is much easier to treat in its early stages, which underscores the critical need for screening at the primary care level. Lifestyle modification including weight loss, changes in diet and increased physical activity also plays a major role in controlling the disease. As more and more novel pharmacological anti-diabetic agents come into the market, we should not lose sight of the importance of patient empowerment to achieve behavioural modification. I wish to congratulate all members of this committee for their hard work in producing the 4th edition of this Clinical Practice Guideline. This document will be an invaluable tool for all health practitioners in improving the delivery of care for our diabetic patients, particularly at the primary care level. Thank you.

Tan Sri Dato’ Seri Dr. Hj. Mohd. Ismail b. Merican Director-General of Health, Ministry of Health, Malaysia


The prevalence of T2DM continues to rise in an exponential rate around the world and much of the global burden of this disease is expected to come from the Western-Pacific as well as the South-East Asia regions. In Malaysia, the Third National Health and Morbidity Survey (3rd NHMS) showed that the prevalence of the T2DM for adults aged 30 years old and above now stood at a staggering 14.9% T2DM, upped by almost 79.5% in the space of 10 years from 1996 to 2006. The prevalence of T2DM is the highest among Indian ethnic at 19.9% for those aged 30 years and above. The Clinical Practice Guidelines (CPG) was developed to provide a clear and concise approach to all health care providers on the current concepts in the management of T2DM. Since T2DM is managed by various health care professionals in Malaysia, attempts were made to ensure the different stakeholders will benefit from this CPG. This is reflected by the representation of the committee members which developed the guideline. There were three previous guidelines on the Management of T2DM; in 1992, 1996 and 2004. This edition is the Fourth in the series and was deemed necessary due to the tremendous body of new evidence that has become available in the last 4-5 years that has major impact on T2DM management including new targets for control, new classes of pharmacological agents targeting novel pathways as well as major outcome studies. All these have changed the algorithms for the management of T2DM....
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