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

Abstract

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.

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 ).…”

“…Chinese ethnic T2D patients had the best LDL-C control, followed by Indian and Malay ethnic groups, as reported in a previous study ( Lee et al, 2013 ). These could be due to lower body mass index, better health behavior, higher health literacy level, and higher socioeconomic status among Chinese ethnic patients ( Azreena et al, 2016 ; Department of Statistics Malaysia, 2020a ; Wan et al, 2021a ). Female T2D patients had higher LDL-C, as similarly reported in other studies ( Stone et al, 2013 ; Wong et al, 2016 ).…”

“…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.…”

“…Clinical practice guidelines recommend three primary treatment targets in diabetes management, namely glycosylated hemoglobin (HbA1c), low-density lipoprotein cholesterol (LDL-C), and blood pressure (BP), to reduce adverse outcomes ( International Diabetes Federation, 2017 ; Ministry of Health Malaysia, 2015 ). We had previously investigated the HbA1c trend and its predictors among T2D patients in Malaysia ( Wan et al, 2021a ). However, among the three treatment targets, LDL-C is the most crucial factor in lowering CVD risks, and efforts should be prioritized on attaining the LDL-C target ( Wan et al, 2017 ).…”