Objectives This study aimed to determine the prevalence of anaemia among patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) at primary care settings and its associated factors. Design, setting and participants This cross-sectional study involved 808 adult patients with T2DM and CKD who were recruited via systematic sampling from 20 public primary care clinics in Peninsular Malaysia. Their sociodemographic, clinical and biomedical profiles were collected through interviews, examination of medical records and blood testing. Results The prevalence of anaemia was 31.7% (256/808). The anaemia was mainly mild (61.5%) and normocytic normochromic (58.7%). About 88.7% of the patients with anaemia were not known to have anaemia prior to the study. Among 36 patients with documented history of anaemia, 80.6% were still anaemic, and only a half received iron therapy. Multivariate regression analysis showed that women (adjusted odd ratio (AOR): 1.57, 95% CI: 1.12 to 2.21, p=0.009) and those with older age (AOR: 1.04, 95% CI: 1.01 to 1.06, p<0.001), CKD stage 3a (AOR: 2.47; 95% CI: 1.25 to 4.87, p=0.009), CKD stage 3b (AOR: 4.36; 95% CI: 2.14 to 8.85, p<0.001), CKD stage 4 (AOR: 10.12; 95% CI: 4.36 to 23.47, p<0.001), CKD stage 5 (AOR: 10.80; 95% CI: 3.32 to 35.11, p<0.001) and foot complication (AOR 3.12, 95% CI: 1.51 to 6.46, p=0.002) were more likely to have anaemia. Having higher body mass index (AOR 0.95, 95% CI: 0.92 to 0.99, p=0.012) and higher diastolic blood pressure (AOR 0.97, 95% CI: 0.95 to 0.99, p<0.001) were associated with lower odds to have anaemia. Conclusion Anaemia among patients with T2DM and CKD in primary care was common, and the majority was unrecognised. Inadequate treatment of anaemia was also prevalent. Therefore, screening of anaemia should be incorporated into the routine assessment of diabetic complications particularly for those with significant associated factors. It is hoped that such strategy could lead to early treatment and hence improve their overall care.

Effect of insulin relies on correct dose and appropriateness of insulin injection technique. However, inappropriate technique is common among diabetes patients. The impact of educating proper technique in these patients is still under studied. To evaluate the outcome of education of insulin injection technique to diabetes patients who are on insulin therapy in a Malaysian primary care clinic. A total of 114 diabetes patients on insulin were randomly selected in this prospective study. Participants' injection technique and HbA1c were assessed at baseline and 3 months later. After initial assessment, all participants were taught on proper technique of injection. Those with inappropriate technique were given individualized coaching. Majority participants (86.8%; 99/144) had appropriate technique at baseline and 67.7% (66/99) of them managed to improve their technique after intervention. There was 0.82% reduction in HbA1c observed among all participants, mean (SD) HbA1c at baseline was 9.9 (2.11)% and at post-intervention was 9.1 (2.16)%, (p < 0.01). Inappropriate insulin injection technique is very common in current study. With focused education, 67.7% (66/99) of the respondents' had improvised their injection technique. There was 0.82% reduction in HbA1c measurements within 3 months post intervention {pre 9.9 (SD 2.16) %, vs post 9.08 (SD 2.16) %}. There is a necessity to assess insulin injection technique during every follow-up. Health care providers need to identify and rectify the incorrect the technique as it may improve the glycaemic control among diabetes patients who are on insulin devices.