Changes in body mass index, glycosylated hemoglobin A1C, blood pressure, and LDL‐cholesterol among type 2 diabetes patients in Malaysia: A population‐based longitudinal study

Abstract

Background This study aimed to describe changes in body mass index, glycosylated hemoglobin A1C, blood pressure, and low‐density lipoprotein (LDL)‐cholesterol among type 2 diabetes patients in Malaysia. Methods A five‐year retrospective cohort study was conducted using data from the National Diabetes Registry. Type 2 diabetes patients aged ≥18 years and had ≥2 clinical audits between 2013 and 2017 were included in the analysis. The first audit information formed the baseline characteristics, and the last audit information was used for comparison. Individualized A1C, blood pressure, and LDL‐cholesterol goals were adapted from Malaysian Clinical Practice Guidelines on Type 2 Diabetes Management 2020, American Diabetes Association 2020, and European Association for the Study of Diabetes 2019. Results Of the 18 341 patients, 55.8% were female and 64.9% Malay ethnicity. The baseline mean age was 59.3 ± 10.6 years. During an average of 2.5 person‐years of follow‐up, the mean body mass index dropped by 0.16 kg/m2 to 27.9 kg/m2, A1C increased by 0.16% to 8.0%, systolic blood pressure increased by 1.4 mm Hg to 136.2 mm Hg, diastolic blood pressure decreased by 1.0 mm Hg to 77.3 mm Hg and LDL‐cholesterol reduced by 0.12 mmol/L to 2.79 mmol/L, P < 0.001 for all. Out of eight categories of individualized goals, most patients achieved the A1C goal of ≤8.0%. The new LDL‐cholesterol goal of <1.4 mmol/L was least likely to be achieved. Conclusions The body mass index, A1C, blood pressure, and LDL‐cholesterol performance remained suboptimal. Standards of care for these clinical parameters remain to be achieved by the majority of diabetes patients.

Five-year LDL-cholesterol trend and its predictors among type 2 diabetes patients in an upper-middle-income country: a retrospective open cohort study

“…Our study findings can be externally generalized to the Malaysian population because of similar demographic characteristics, as previously reported ( Ministry of Health Malaysia, 2013 ; Wan et al, 2021a ; Wan et al, 2021b ). A previous study found that the mean LDL-C decreased from 3.2 mmol/L in 2009 to 3.1 mmol/L in 2012 ( Ministry of Health Malaysia, 2013 ).…”

“…This was a retrospective open cohort study of T2D patients receiving diabetes care from public primary care clinics in Negeri Sembilan state, Malaysia, the details of which had been reported previously ( Wan et al, 2021a ; Wan et al, 2021b ). This population-based open cohort dataset was sourced from Malaysia’s National Diabetes Registry, and adult T2D patients with at least two diabetes clinical audits between 2013 to 2017 were included.…”

“…This population-based open cohort dataset was sourced from Malaysia’s National Diabetes Registry, and adult T2D patients with at least two diabetes clinical audits between 2013 to 2017 were included. The characteristics of patients in this cohort were representative of the national average due to sharing similar demographic and comorbidity characteristics ( Ministry of Health Malaysia, 2013 ; Wan et al, 2021a ; Wan et al, 2021b ). Out of 18,341 eligible patients, 29, or 0.2%, had missing LDL-C values at baseline and were excluded from the analysis.…”

Association of long-term visit-to-visit variability of HbA1c and fasting glycemia with hypoglycemia in type 2 diabetes mellitus

“…Despite there being no comprehensive consensus on clinical significance of glycemic variability, studies showed that FPG variability is associated with increased risk of adverse events and specific diseases, including cardiovascular events, peripheral neuropathy, retinopathy, and arterial stiffness ( 9 – 13 ). Clinical practice and research have focused on HbA1c in T2DM patients, rather than the potential role of HbA1c variability ( 14 – 16 ). Our results suggest that higher HbA1c variability increases the incidence of severe hypoglycemia, indicating that it is important to carefully observe in T2DM patients with higher HbA1c variability and take precautions, even when acceptable levels of HbA1c and FPG are achieved.…”

Prevalence of diabetic kidney disease and the associated factors among patients with type 2 diabetes in a multi-ethnic Asian country

“…The prevalence of DKD among type 2 diabetes (T2D) patients in the country was reported to be only 14.6% in 2019 11 . As the reported prevalence was relatively lower than that reported elsewhere across the globe 1 , 5 , underreporting of the condition and under-screening for DKD were postulated as potential explanations 11 , 12 . For perspective, the prevalence of CKD among the general adult population in Malaysia was 15.5% in 2018 13 .…”