5-Year longitudinal study of determinants of glycemic control for multi-ethnic Asian patients with type 2 diabetes mellitus managed in primary care. Issue 2 (November 2015)

• Record Type: Journal Article
• Authors: Tan, Ngiap Chuan; Barbier, Sylvaine; Lim, Wei Yen; Chia, Kee Seng
• Is Part Of: Diabetes research and clinical practice. Volume 110:Issue 2(2015)
• Page Start: 218
• Page End: 223
• Publication Date: 2015-11
• Subjects: Primary care -- Diabetes mellitus -- Glycaemic control; Diabetes -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462
• DOI: 10.1016/j.diabres.2015.07.010
• Languages: English
• ISSNs: 0168-8227

Abstract

Highlights: A real-life non-interventional cohort study of multi-ethnic Asian patients with type 2 diabetes mellitus in a developed nation. Longitudinal data analysis of glycaemic control using Generalised Estimating Equation (GEE). Maintenance of glycaemic control amongst the cohort subjects within the first three years of review in primary care. Young patients of Malay or Indian ethnic groups and those treated with insulin, biguanide, AGI and thiazide were associated with deteriorating glycemic control after 2 years. Abstract: Aim: This study aims to determine the risk factors associated with glycaemic control of ambulatory patients with type 2 diabetes mellitus (T2DM) who are managed in primary care. Method: The data was retrieved from a primary care site within the Singapore Consortium of Cohort Studies-Diabetes Cohort (SCCS-DC). Demographic and clinical variables were described, in association with the risk of having a deteriorating glycaemic control (defined as an absolute increase of at least 1% HbA1c from one year to a subsequent year). Next, multivariate model was performed to define the independent effect of each factor. The longitudinal analysis of the HbA1c was performed using Generalised Estimating Equation (GEE). Results: The 5 year longitudinal data of 1256 patients (54% Chinese, 25% Malays, 12% Indians, 9% others) were analysed. Their mean HbA1c decreased by <0.1% in the initial 3 years, but increased thereafter. 12% of them had absolute HbA1c increment of ≥1% in the first year, and 22% over 5 years. Based on GEE analysis, insulin, was associated with an increase of HbA1c (≥1%) from one year to another (all p < 0.05). Compared with Chinese patients, Malays had higher HbA1c (+0.3%), Indians (+0.3%), and others (+0.2%), (all p < 0.01). Patients with retinopathy had higher HbA1c (+0.2%) and those with cataract had lower mean HbA1c (−0.2%) ( p < 0.01). Conclusion: Most cohort patients achieved glycaemic control within the initial 3 years. Patients of Malay and Indian ethnicity and those with retinopathy were associated with subsequent risk of glycaemic control deterioration. Those with cataract were associated with trend towards improved glycaemic control.