{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T10:57:31Z","timestamp":1781607451407,"version":"3.54.5"},"reference-count":0,"publisher":"Academy of Family Physicians of Malaysia","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>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.\nMethods: 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 &gt;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 \u2018garbage and lorry\u2019 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.\nResults: Eighty-nine patients completed follow-up (mean age=57.2 years; women=57.5%). The mean baseline HbA1c and FBS levels were 11.88% (\u00b11.84) and 12.54 mmol\/L (\u00b16.32), respectively. After 6 months, the HbA1c level decreased by 1.57% (95% CI=1.14, 2.00; P&lt;0.001) and the FBS level by 3.32 mmol\/L (95% CI=2.21, 4.44; P&lt;0.001). The HbA1c and FBS levels improved in 63 (70.8%) and 59 (66.3%) patients, respectively.\nConclusion: Consultations incorporating the M2-PRIME were associated with clinically meaningful pre\u2013post 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.<\/jats:p>","DOI":"10.51866\/oa.1119","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T10:42:28Z","timestamp":1781606548000},"source":"Crossref","is-referenced-by-count":0,"title":["Metaphoric medicine: A retrospective clinical audit of glycaemic outcomes associated with an analogy-based consultation framework for insulin-treated type 2 diabetes mellitus"],"prefix":"10.51866","volume":"21","author":[{"given":"Muhammad Hanif","family":"Omar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zainal Fitri","family":"Zakaria","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wan Nusairi","family":"Wan Mohd Nasruddin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muzawani","family":"Mokhlis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"28286","published-online":{"date-parts":[[2026,5,24]]},"container-title":["Malaysian Family Physician"],"original-title":[],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T10:42:28Z","timestamp":1781606548000},"score":1,"resource":{"primary":{"URL":"https:\/\/e-mfp.org\/wp-content\/uploads\/21.29_24May2026.pdf"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,24]]},"references-count":0,"URL":"https:\/\/doi.org\/10.51866\/oa.1119","relation":{},"ISSN":["1985-207X","1985-2274"],"issn-type":[{"value":"1985-207X","type":"print"},{"value":"1985-2274","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,24]]},"article-number":"29"}}