Clinical inertia in type 2 diabetes management in a middle-income country: A retrospective cohort study

Wan, Kim Sui; Moy, Foong Ming; Yusof, Khalijah Mohd; Mustapha, Feisul Idzwan; Ali, Zainudin Mohd; Hairi, Noran Naqiah

doi:10.1371/journal.pone.0240531

Cited by 12 publications

(7 citation statements)

References 26 publications

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“…One of the potential reasons for poor A1C control among our patients is clinical inertia in hyperglycemia management. A study involving this cohort of patients found that the median time to treatment intensification among those with A1C ≥7% was more than 1 year, and only 45% of them had treatment intensification 13 . It was worrying that our patients with the most stringent A1C goal had the worst glycemic control and exhibited the largest decline in A1C performance.…”

Section: Discussionmentioning

confidence: 85%

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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

Wan

Moy

Mustapha

et al. 2021

Journal of Diabetes

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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.

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Section: Discussionmentioning

confidence: 85%

“…All patient identifiers were removed after the formation of the cohort dataset 10 . Some results from the analysis of this merged cohort dataset have been published 13 …”

Section: Methodsmentioning

confidence: 99%

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

Wan

Moy

Mustapha

et al. 2021

Journal of Diabetes

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“…Clinical inertia-a delay in treatment intensification among patients with poor glycaemic control-was postulated as the primary reason for the A1C increase among their patients 31 . Clinical inertia may also play a role in our cohort as a recent study reported evidence of clinical inertia in the management of T2D patients in Malaysia 32 .…”

Section: Discussionmentioning

confidence: 99%

Predictors of glycosylated haemoglobin A1C trend among type 2 diabetes patients in a multi-ethnic country

Wan

Hairi

Mustapha

et al. 2021

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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.

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“…Fourthly, clinical inertia, defined as a delay in treatment intensification among patients with poor glycaemic control, can also explain the suboptimal ABC control (Mata-Cases et al 2016). In support of this possible cause, a recent study in Malaysia has reported evidence of clinical inertia in the management of T2D patients (Wan et al 2020).…”

Section: Attainment Of All Three Abc Goalsmentioning

confidence: 99%

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

Kim¹,

Hairi²,

Mustapha³

et al. 2021

JSM

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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.

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Clinical inertia in type 2 diabetes management in a middle-income country: A retrospective cohort study

Cited by 12 publications

References 26 publications

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

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

Predictors of glycosylated haemoglobin A1C trend among type 2 diabetes patients in a multi-ethnic country

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

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