Background Clinical inertia can lead to poor glycemic control among type 2 diabetes patients. However, there is paucity of information on clinical inertia in low-and middle-income countries including Malaysia. This study aimed to determine the time to treatment intensification among T2D patients with HbA1c of �7% (�53 mmol/mol) in Malaysian public health clinics. The proportion of patients with treatment intensification and its associated factors were also determined. Material and methods This was a five-year retrospective open cohort study using secondary data from the National Diabetes Registry. The study setting was all public health clinics (n = 47) in the state of Negeri Sembilan, Malaysia. Time to treatment intensification was defined as the number of years from the index year until the addition of another oral antidiabetic drug or initiation of insulin. Life table survival analysis based on best-worst case scenarios was used to determine the time to treatment intensification. Discrete-time proportional hazards model was fitted for the factors associated with treatment intensification. Results The mean follow-up duration was 2.6 (SD 1.1) years. Of 7,646 patients, the median time to treatment intensification was 1.29 years (15.5 months), 1.58 years (19.0 months) and 2.32 years (27.8 months) under the best-, average-and worst-case scenarios respectively. The proportion of patients with treatment intensification was 45.4% (95% CI: 44.2-46.5), of which 34.6% occurred only after one year. Younger adults, overweight, obesity, use of antiplatelet medications and poorer HbA1c were positively associated with treatment intensification. Patients treated with more oral antidiabetics were less likely to have treatment intensification.

Good control of glycosylated haemoglobin A1C in diabetes patients prevents cardiovascular complications. We aim to describe the A1C trend and determine the predictors of the trend among type 2 diabetes patients in Malaysia. Longitudinal data in the National Diabetes Registry from 2013 to 2017 were analysed using linear mixed-effects modelling. Among 17,592 patients, 56.3% were females, 64.9% Malays, and the baseline mean age was 59.1 years. The U-shaped A1C trend changed marginally from 7.89% in 2013 to 8.07% in 2017. The A1C excess of 1.07% as reported in 2017 represented about 22% higher risk of diabetes-related death, myocardial infarction, and stroke, which are potentially preventable. The predictors for higher baseline A1C were non-Chinese ethnicity, younger age groups, longer diabetes duration, patients on insulin treatment, polypharmacy use, patients without hypertension, and patients who were not on antihypertensive agents. Younger age groups predicted a linear increase in the A1C trend, whereas patients on insulin treatment predicted a linear decrease in the A1C trend. Specifically, the younger adults and patients of Indian and Malay ethnicities had the poorest A1C trends. Targeted interventions should be directed at these high-risk groups to improve their A1C control.

Concurrent attainment of glycated haemoglobin A1C, blood pressure, and LDL-cholesterol goals, or collectively known as the ‘ABC’ goals, help prevent cardiovascular complications in patients with type 2 diabetes (T2D). We aimed to determine the proportion of T2D patients who achieved all three ABC goals in Malaysia’s public health clinics. We also determined the association between age groups with the attainment of all the ABC goals. A cross-sectional analysis of the baseline findings from a retrospective open cohort study between 2013 and 2017 in Negeri Sembilan, Malaysia was conducted. The data was extracted from the National Diabetes Registry. The primary outcome was the proportion of patients who attained all three ABC goals. The exposure of interest was patients’ age groups, namely 18-44, 45-59 and ≥ 60 years. Multivariate logistic regression analysis was used to adjust demographics factors, comorbidities, complications and treatment profiles. Among 17,592 patients, the mean age was 59.1 years, with 56.3% females and 64.9% Malays. Overall, 4.5% (95% CI: 4.2-4.8) of the patients attained all the ABC goals. Compared to older adults aged ≥ 60 years, patients aged 18-44 and 45-59 years had adjusted odds ratios of 0.50 and 0.72, respectively, to achieve all the ABC goals. Ethnicity, body mass index, diabetes treatment modality, lipid-lowering agent and polypharmacy were independent factors associated with the outcome. In summary, achieving all the ABC goals in T2D patients is challenging, especially among younger adults. Our findings suggest that more targeted interventions should be directed towards this high-risk subpopulation.