[AVBC 2025] Improving Diabetes Care in Non-Endocrinology Outpatient Clinics in TTSH: Quality Improvement
Care Process & Redesign
Appropriate & Value-based Care Conference
National Healthcare Group
3 December 2025
This study aimed to identify barriers and implement interventions to support non-Endocrinology doctors in optimising DM. The 'DM Kit' represents a unique, cost-effective solution for improving DM care among patients with suboptimal control in.
Year Submitted: 2025
Published Date: 03 December 2025
Tags: Care Process ＆ Redesign, Quality Improvement, Workflow Redesign, Productivity, Cost Saving, Time Saving, Prototyping Resources
About this Content
Aims
This study aimed to identify barriers and implement interventions to support non-Endocrinology doctors in optimising DM care, with specific goals to: (i) increase the prescribing of GLP-1 RA by 30% and Insulin Glargine by 20% and (ii) improve average HbA1c in a cohort of patients with poorly controlled DM on follow-up with non-endocrinology outpatient clinics from 9.97% to 9.0% within 18 months from September 2024.
Background
Diabetes mellitus (DM) is a growing health concern in Singapore, with prevalence at 11.4% in 2024, slightly above the global average of 10.9%. For patients with poorly controlled DM or those not achieving glycaemic targets despite maximal oral agents, insulin therapy and GLP-1 receptor agonists are typically warranted.
Methods
A single-centre prospective study was conducted, identifying patients with HbA1c 9% on follow-up with non-Endocrinology clinics from April - September 2024. Root cause analysis with clinic staff identified key barriers. Through PDSA cycles, the 'DM Kit' prototype was iteratively refined, including demonstration pens, educational materials, drug initiation guidelines, and streamlined referral workflows.
Results
In the GM clinic, GLP-1 RA prescriptions increased by 53.4% and Insulin Glargine by 14.7%. In the ID clinic, GLP-1 RA prescriptions increased by 52.6% and Insulin Glargine by 28.4%. The average HbA1c in the cohort decreased from 10.48% to 9.33% in 8 months.
Conclusion
The 'DM Kit' represents a unique, cost-effective solution for improving DM care among patients with suboptimal control in non-Endocrinology settings. Coupled with streamlined drug initiation guides and workflows, this intervention shows promise for wider implementation across other clinics.
Lessons Learnt
The intervention exceeded targets, achieving over 50% increase in GLP-1 RA prescribing in both clinics. The ID clinic showed a greater improvement in insulin Glargine prescribing due to their lower baseline usage. The intervention was low-cost and required no additional funding or manpower, optimizing existing resources.
Keywords
Diabetes, GLP-1 RA, Insulin Glargine, HbA1c, Workflow
Innovators' Details
Innovators' Details
Healthcare Cluster(s) | National Healthcare Group |
Organization(s) Involved | Tan Tock Seng Hospital |
Platform(s) | Appropriate & Value-based Care Conference |
Healthcare Professional Group(s) | Medical |
Applicable Specialty or Discipline | Endocrinology |
Project Lead(s) | Zhuang Sijia Brenda |
Project Member(s) | Chen Weiliang Abel |
Connect with this contributor!
Zhuang Sijia Brenda - brenda.zhuang@nhghealth.com.sg