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. Issue 11 (6th July 2021) - Wan, Kim Sui
Abstract: 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/m 2 to 27.9 kg/m 2, 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. Abstract : Highlights Changes in body mass index, glycosylated hemoglobin A1C, blood pressure, and LDL‐cholesterol over an average of 2.5 person‐years of follow‐up were not encouraging in the real‐world clinical settings in Malaysia. The standards of care for body mass index, A1C, blood pressure, and LDL‐cholesterol remain to be achieved by the majority of diabetes patients. There appears to be a disconnection between clinical recommendations and real‐world practice in public health clinics. 摘要: 背景: 本研究旨在描述马来西亚2型糖尿病患者体重指数, 糖化血红蛋白, 血压和低密度脂蛋白(LDL)胆固醇的变化。 方法: 使用国家糖尿病注册中心的数据进行了一项为期五年的回顾性队列研究。分析包括年龄≥18岁的2型糖尿病患者, 他们在2013年至2017年期间进行了≥2个临床审计。第一个审计信息形成基线特征, 最后一个审计信息用于比较。个性化的糖化血红蛋白, 血压和LDL‐胆固醇目标参考自2020年马来西亚2型糖尿病临床实践指南, 2020年美国糖尿病协会和2019年欧洲糖尿病研究协会。 结果: 18341例患者中, 女性占55.8%, 马来族占64.9%。基线平均年龄(59.3±10.6)岁。平均随访2.5年, 平均体重指数下降0.16 kg/m2至27.9 kg/m2, 糖化血红蛋白上升0.16%~8.0%, 收缩压上升1.4mmHg至136.2 mmHg, 舒张压下降1.0mmHg至77.3mmHg, 低密度脂蛋白胆固醇下降0.12mmolL至2.79mmolL, P均<0.001。在8类个性化目标中, 大多数患者达到了≤8.0%的糖化血红蛋白目标。低密度脂蛋白‐胆固醇<1.4 mmol/L的目标实现的可能性最小。 结论: 体重指数, 糖化血红蛋白, 血压和低密度脂蛋白‐胆固醇表现仍不理想。大多数糖尿病患者仍未达到这些临床参数的控制标准。