Sains Malaysiana 50(12)(2021): 3631-3645

http://doi.org/10.17576/jsm-2021-5012-14

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

(Pencapaian Matlamat Hemoglobin A1C, Tekanan Darah dan Kolesterol LDL yang Lemah dalam Kalangan Orang Muda Dewasa yang Menghidap Diabetes Jenis 2)

KIM SUI WAN¹, NORAN NAQIAH HAIRI¹*, FEISUL IDZWAN MUSTAPHA², KHALIJAH MOHD YUSOF³, ZAINUDIN MOHD ALI³ & FOONG MING MOY¹

¹Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine

Faculty of Medicine, University of Malaya, Jalan Profesor Diraja Ungku Aziz, 50603 Kuala Lumpur, Wilayah Persekutuan, Malaysia

²Disease Control Division, Ministry of Health, Level 3 Block E10, Kompleks E, Pusat Pentadbiran Kerajaan Persekutuan, 62590 Putrajaya, Wilayah Persekutuan, Malaysia

³State Health Department of Negeri Sembilan, Jalan Rasah, 70300 Seremban, Negeri Sembilan, Malaysia

Received: 13 June 2020/Accepted: 15 April 2021

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.

Keywords: Blood pressure; cholesterol; haemoglobin A1C; primary care; type 2 diabetes

ABSTRAK

Pencapaian sasaran hemoglobin A1C, tekanan darah dan kolesterol LDL yang juga dikenali sebagai sasaran ‘ABC’ mampu mencegah komplikasi kardiovaskular dalam kalangan pesakit diabetes jenis dua (T2D). Kajian ini bertujuan untuk mengenal pasti peratusan pesakit T2D yang mencapai kesemua tiga sasaran ABC di klinik kesihatan di Malaysia. Kami juga mengkaji hubungan antara kumpulan umur dengan pencapaian kesemua sasaran ABC. Satu analisis keratan rentas daripada penemuan kajian kohort retrospektif terbuka antara tahun 2013 sehingga 2017 di Negeri Sembilan, Malaysia telah dijalankan. Data telah diambil daripada pangkalan data National Diabetes Registry . Keputusan utama adalah peratusan pesakit yang mencapai kesemua tiga sasaran ABC. Pendedahan yang dikaji adalah kumpulan umur pesakit iaitu 18-44, 45-59 dan ≥ 60 tahun. Analisis regresi logistik multivariat digunakan untuk mengawal faktor demografi, komorbiditi, komplikasi dan profil rawatan. Dalam kalangan 17,592 pesakit, min umur adalah 59.1 tahun, dengan 56.3% jantina perempuan dan 64.9% pesakit berbangsa Melayu. Secara keseluruhannya, 4.5% (95% CI: 4.2-4.8) pesakit mencapai semua sasaran ABC. Berbanding dengan kumpulan umur ≥ 60 tahun, didapati bahawa pesakit dalam kumpulan umur 18-44 dan 45-59 masing-masing mempunyai 0.50 dan 0.72 nisbah ganjil terlaras untuk mencapai semua sasaran ABC. Kumpulan etnik, indeks jisim badan, mod rawatan diabetes, ubat lipid dan polifarmasi adalah faktor tidak bersandar yang berkaitan dengan keputusan kajian ini. Kesimpulannya, pencapaian semua sasaran ABC bagi pesakit T2D merupakan satu cabaran, terutamanya dalam kalangan golongan muda. Hasil kajian kami menunjukkan bahawa intervensi perlu disasarkan terhadap golongan yang berisiko tinggi ini.

Kata kunci: Diabetes jenis dua; hemoglobin A1C; kesihatan primer; kolesterol; tekanan darah

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*Corresponding author; email: noran@um.edu.my