Poorer Attainment of Hemoglobin A1C, Blood Pressure and LDL-Cholesterol Goals among Younger Adults with Type 2 Diabetes

Abstract

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.

Baseline treatments and metabolic control of 288,913 type 2 diabetes patients in a 10-year retrospective cohort in Malaysia

“…Some of our patients had young-onset T2D, which was associated with higher risks of mortality, macrovascular, and microvascular complications 14 , 23 . Previous Malaysian studies found that younger adults with T2D had poorer control of HbA1c, BP, and LDL-cholesterol 24 , 25 . Thus, there is a need to intensify metabolic control among this subpopulation to prevent adverse outcomes, especially after accounting for the legacy benefits of multifactorial risk interventions 26 .…”

Treatment intensification and therapeutic inertia of antihypertensive therapy among patients with type 2 diabetes and hypertension with uncontrolled blood pressure

“…We conducted secondary data analysis of a five-year retrospective open cohort of T2DM patients under the care of all public health clinics in Negeri Sembilan state, Malaysia, and the particulars had been previously published 4 , 19 , 20 . Negeri Sembilan is one of the sixteen states and federal territories in Malaysia and is located south of the capital city, Kuala Lumpur.…”

“…Negeri Sembilan is one of the sixteen states and federal territories in Malaysia and is located south of the capital city, Kuala Lumpur. The state was chosen due to its high prevalence of diabetes in Malaysia, potentially better data quality, and similar demographic characteristics and degree of urbanisation as the national average 4 , 5 , 19 . In an open cohort, patients could leave or be added over the study period, and this dynamic membership mirrored the real-world scenario 21 .…”

“…The prevalence of diabetes and hypertension among the general adult population was 18.3% and 30.0%, respectively 3 . Among people with type 2 diabetes mellitus (T2DM), over 80% have hypertension comorbidity 4 , 5 , and most of them receive treatments at public healthcare facilities, which are heavily subsidised by general taxation 3 .…”

“…Clinical practice guidelines recommend the achievement of glycosylated haemoglobin A1c (HbA1c), lipid, and BP targets to prevent diabetes complications 6 – 8 . Among these parameters, BP is often the most challenging target to achieve, as reported in Europe, Canada, China, and Malaysia 4 , 9 – 11 . One main reason for suboptimal risk factor control in clinical practice is the lack of treatment intensification, an established indicator of therapeutic inertia 12 .…”