Gycaemic control and treatment profile amongst 20646 adult type 2 diabetes mellitus: a descriptive report

An audit of Diabetes Control and Management-Diabetes Registry Malaysia (ADCM-DRM) was started to monitor the provision of diabetes care in the country. A total of 20,646 patients were registered in the registry until 31st December 2008. This report set out to determine the Type 2 diabetes controls and treatment profiles of these cohorts of patients. This was a registry-based observational study conducted from May to December, 2008. An online standard case record form was available for site data providers to register their diabetic patients aged 18 years old and above annually. Demographic data, diabetes duration, treatment modalities, as well as various risk factors and diabetes complications were reported. Data were analyzed using Data Analysis and Statistical Software (Stata) version 9. A total of 81 centres, 6 of which were hospitals, participated in this registry until 31st December 2008, contributing a total of 20646 patients. A majority of them (99.2%) had Type 2 diabetes mellitus. The mean HbA1c was 8.0% (SD 2.10), with 30.1% and 17.9% of the patients who attained HbA1c < 7% and HbA1c < 6.5%, respectively. Metformin was prescribed more than sulfonylurea while only 11% had insulin. A review of the diabetic care policy and strategies in the primary health care clinics is needed to implement a more effective treatment of diabetes in this country

Ethnic differences in glycaemic control and complications: the adult diabetes control and management (ADCM), Malaysia

INTRODUCTION: Ethnicity is an important factor in diabetes care. The understanding of its effect in this country may help to improve diabetes care, glycaemic control and diabetic complication rates. This study was to determine the diabetes control profile in relation to complication rates between the three main ethnics group in Malaysia. METHODS: This nested cross-sectional study was part of the Audit of Diabetes Control and Management (ADCM), an ongoing cohort patient registry focused on diabetes control and management in the primary care setting in Malaysia. This registry registers all diabetes patients aged 18 years old and above. Demographic data, diabetes duration, treatment modalities, as well as various risk factors and diabetes complications are reported. Data was handled by statisticians using STATA version 9. RESULTS: A total of 20330 patients from 54 health centers were registered at the time of this report. The majority were type 2 diabetics (99.1%) of whom 56.6% were female. The mean age was 57.9 years (SD 11.58). Malay accounted for 56.3%, Chinese 19.5% and Indian 22.5%. There were 30.3% who attained HbA1c < 7%. Among three main races more Chinese had HbA1c < 6.5% (Chi-square: X2 = 71.64, p < 0.001), but did not show less complications of nephropathy (Indian suffered significantly more nephropathy, Chi-square: X2 = 168.76, p < 0.001), ischaemic heart disease (Chi-square: X2 = 5.67, p = 0.532) and stroke (Chi-square: X2 =15.38, p = 0.078). CONCLUSION: This study has again emphasized the existence of ethnic differences in glycaemic control and complication profiles. The Chinese diabetics suffer as many diabetes-related complications despite better glycaemic control. Further studies will need to look into other socio-genetic factors in order to provide a more personalized effective diabetes care

Short-acting β2-agonist prescription patterns for asthma management in the SABINA III primary care cohort

CKNOWLEDGEMENTS AstraZeneca funded all the SABINA studies and was involved in designing the study, developing the study protocol, conducting the study and performing the analyses. AstraZeneca was given the opportunity to review the manuscript before submission and funded medical writing support. Writing and editorial support was provided in accordance with Good Publication Practice (GPP3) guidelines (http://www.ismpp.org/gpp3) and fully funded by AstraZeneca.Peer reviewedPublisher PD

Determinants of uncontrolled dyslipidaemia among adult type 2 diabetes in Malaysia: the Malaysian Diabetes Registry 2009

Numerous studies with compelling evidence had shown a clear relationship between dyslipidaemia and cardiovascular (CV) events in patients with diabetes mellitus. This was an observational study based on secondary data from the online registry database Adult Diabetes Control and Management (ADCM) looking into the determinants of uncontrolled dyslipidaemia in type 2 diabetes mellitus patients. Independent predictors were identified using multivariate logistic regression. A total of 303 centres (289 health clinics, 14 hospitals) contributed a total of 70,889 patients (1972 or 2.8% patients were from hospital). About thirty eight percent were reported to have dyslipidaemia. There were 40.7% patients on lipid-lowering agents and of those above age 40 years old, only 38.1% of them were on a statin. Malay ethnicity and younger age groups (<50 years old) were two major determinants of uncontrolled LDL-C, TG and HDL-C. Female gender and uncontrolled blood pressure were determinants of uncontrolled LDL-C, and poor glycaemic control was related independently to high TG. This study has highlighted the suboptimal management of diabetic dyslipidaemia in Malaysia. Pharmacological treatment of dyslipidaemia could be more effective. Healthcare stakeholders in this country, especially in the primary care, have to recognize these shortfalls and take immediate remedial measures

Diabetes Care in Malaysia: Problems, New Models, and Solutions

Background: Diabetes is a major public health concern in Malaysia, and the prevalence of type 2 diabetes(T2D) has escalated to 20.8% in adults above the age of 30, affecting 2.8 million individuals. The burden of managing diabetes falls on primary and tertiary health care providersoperating in various settings. Objectives: This review focuses on the current status of diabetes in Malaysia, including epidemiology, complications, lifestyle, and pharmacologic treatments, as well as the use of technologies in its management and the adoption of the World Health Organization chronic care model in primary care clinics. Methods: A narrative review based on local available health care data, publications, and observations from clinic experience. Findings: The prevalence of diabetes varies among the major ethnic groups in Malaysia, with Asian Indians having the highest prevalence of T2D, followed by Malays and Chinese. The increase prevalence of overweight and obesity has accompanied the rise in T2D. Multidisciplinary care is available in tertiary and primary care settings with integration of pharmacotherapy, diet, and lifestyle changes. Poor dietary adherence, high consumption of carbohydrates, and sedentary lifestyle are prevalent in patients with T2D. The latest medication options are available with increasing use of intensive insulin regimens, insulin pumps, and continuous glucose monitoring systems for managing glycemic control. A stepwise approach is proposed to expand the chronic care model into an Innovative Care for Chronic Conditions framework to facilitate implementation and realize better outcomes in primary care settings. Conclusions: A comprehensive strategy and approach has been established by the Malaysian government to improve prevention, treatment, and control of diabetes as an urgent response to this growing chronic disease

The primary health care performance initiative (PHPCI): issues and challenges for Malaysia as a trailblazer country / Anis Safura Ramli … [et al.]

A strong and robust Primary Health Care system is essential to achieving universal health coverage and to save lives. The Global Conference on Primary Health Care 2018: from Alma-Ata towards achieving Universal Health Coverage and the Sustainable Development Goals at Astana, Kazakhstan provided a platform for low‐ and middle‐ income countries to join the Primary Health Care Performance Initiative (PHCPI). At this Global Conference, Malaysia has declared to become a Trailblazer Country in the PHCPI and pledged to monitor her Vital Signs Profiles (VSP). However, the VSP project requires an honest and transparent data collection and monitoring of the Primary Health Care system, so as to identify gaps and guide policy in support of Primary Health Care reform. This is a huge commitment and can only be materialised if there is a collaborative partnership between Primary Care and Public Health providers. Fundamental to all of these, is the controversy concerning whether or not ‘Primary Care’ and ‘Primary Health Care’ represent the same entity. Confusion also occurs with regards to the role of ‘Primary Care’ and ‘Public Health’ providers in the Malaysian Primary Health Care system. This review aims to differentiate between Primary Care, Primary Health Care and Public Health, describe the relationships between the three entities and redefine the role of Primary Care and Public Health in the PHCPI-VSP in order to transform the Malaysian Primary Health Care system

Predictive factors of follow-up non-attendance and mortality among adults with type 2 diabetes mellitus- an analysis of the Malaysian Diabetes Registry 2009

This study examined the factors associated with follow-up non-attendance (FUNA) and mortality among the adult patients with type 2 diabetes mellitus (T2DM). Data on 57780 T2DM patients from the 2009 diabetes registry were analyzed using multinomial logistic mixed model. Out of 57780 patients, 3140 (5.4%) were lost to follow-up and 203 (0.4%) patients had died. Compared with patients who were under active follow-up, men (OR 1.37), neither on insulin (OR 1.72), nor on antiplatelet agents (OR 1.47), having higher HbA1c (OR 1.15), higher LDL-C (OR 1.18) and complications (OR 1.33) were associated with FUNA. Older age (OR 1.09) and higher LDL-C (OR 2.27) have higher mortality. Across the four different health facilities, medication use (insulin and anti-platelet agents) to achieve better disease control in the younger age when diabetes complication is absent would not cause FUNA and might reduce mortality

Control and treatment profiles of 70,889 adult type 2 diabetes mellitus patients in Malaysia - a cross sectional survey in 2009

Background: Understanding the current diabetes care in Malaysia is the first step towards successful control. Many local studies have contributed toward knowledge of diabetes control and treatment profile but none had reported from such a large cohort of patients as in this registry. Aim & Objectives: To describe glycaemic control, risk factors, and treatment profile for quality assessment of diabetes care in Malaysia. Methods: This is a descriptive study based on secondary data from the online Adult Diabetes Control and Management (ADCM) looking into the control and treatment profiles of type 2 diabetes mellitus patients aged 18 years old and above from 1st January until 31st December 2009. Clinical characteristics included were age, sex, diabetes duration and treatment, glycaemic control, blood pressure, body mass index, and treatment for co-morbidity. Results: A total of 303 centres contributed a total of 70889 patients. Fifty-nine percent was female. The study population included 61.9% Malay, 19% Chinese and 18% Indian. The mean age at diagnosis was 52.3 years old (SD 11.10) and the mean duration of diabetes was 5.9 years (SD 5.56). The mean of HbA1c was 8.3% (SD 2.10); only 18.1% attained HbA1c < 6.5%. There were 61.8% diabetic hypertensive patients based on blood pressure measurements and about one third were treated to target BP ≤ 130/80 mmHg. The mean of low density lipoprotein-cholesterol was 3.2 mmol/L (SD 1.10); one-third achieved the target of ≤ 2.6 mmol/L. Eighteen percent was on more than two anti-hypertensive agents and 41.6% were on anti-lipid agents. Metformin (83.2%), angiotensin-converting enzyme inhibitors (63.9%) and statin (89.8%) were the mostly prescribed anti-diabetic, anti-hypertensive and anti-lipid agents respectively. Conclusion: Diabetes and its co-morbidities (hypertension and hyperlipidaemia) were less satisfactorily controlled. The choice of drugs was appropriate but probably inadequate. More effort and resources are needed to improve diabetes care in this country especially in the primary healthcare

Type 2 diabetes mellitus patient profiles, diseases control and complications at four public health facilities: a cross-sectional study based on the Adult Diabetes Control and Management (ADCM) Registry 2009

INTRODUCTION: Diabetes care at different healthcare facilities varied from significantly better at one setting to no difference amongst them. We examined type 2 diabetes patient profiles, disease control and complication rates at four public health facilities in Malaysia. MATERIALS AND METHODS: This study analyzed data from diabetes registry database, the Adult Diabetes Control and Management (ADCM). The four public health facilities were hospital with specialist (HS), hospital without specialist (HNS), health clinics with family physicians (CS) and health clinic without doctor (CND). Independent risk factors were identified using multivariate regression analyses. RESULTS: The means age and duration of diabetes in years were significantly older and longer in HS (ANOVA, p< 0.0001). There were significantly more patients on insulin (31.2%), anti-hypertensives (80.1%), statins (68.1%) and antiplatelets (51.2%) in HS. Patients at HS had significantly lower means BMI, HbA1c, LDL-C and higher mean HDL-C. A significant larger proportion of type 2 diabetes patients at HS had diabetes-related complications (2-5 times). Compared to the HS, the CS was more likely to achieve HbA1c ≤ 6.5% (adjusted OR 1.2) and BP target < 130/80 mmHg (adjusted OR 1.4), the HNS was 3.4 times more likely not achieving LDL-C target < 2.6 mmol/L. CONCLUSION: Public hospitals with specialists in Malaysia were treating older male Chinese type 2 diabetes patients with more complications, and prescribed more medications. Patients attending these hospitals achieved better LDL-C target but poorer in attaining BP and lower HbA1c targets as compared to public health clinics with doctors and family physicians

Control of glycemia and other cardiovascular disease risk factors in older adults with type 2 diabetes mellitus: data from the adult diabetes control and management

Aim: The aims of the present study were to assess the control of glycemia and other cardiovascular disease risk factors, and the association between age and these controls among older adults with type 2 diabetes in Malaysia. Methods: A cross‐sectional study was carried out using cases notified to the Adult Diabetes Control and Management database between 1 January and 31 December 2009. A total of 10 363 people aged over 60 years with type 2 diabetes mellitus were included in the analyses. A standard online case report form was used to record demographic data, clinical factors (diabetes duration, comorbid condition and treatment modalities), cardiovascular disease risk factors, diabetes complications and laboratory assessments. The cardiovascular disease risk factors controls assessed included glycosylated hemoglobin (HbA1c) <7.0%, blood pressure, body mass index, waist circumference and lipid profiles. Results: The proportion of older adults who achieved target HbA1c (<7.0%) was 41.7%. A greater proportion of older adults aged ≥80 years significantly achieved the targets of HbA1c <7% (P  < 0.001), waist circumference (P  < 0.001), low‐density lipoprotein cholesterol <2.6 mmol/L (P  = 0.007) and triglycerides <1.7 mmol/L (P  = 0.001) when compared with the younger elderly groups. They were also associated with achieving target HbA1c <7.0% (OR  = 1.90, 95% CI 1.68–2.26) and triglycerides <1.7 mmol/L (OR  = 1.20, 95%CI 1.04–1.46) than those aged 60–69 years. Conclusion: The control of cardiovascular disease risk factors was suboptimal in older adults with type 2 diabetes. The oldest elderly were more likely to achieve target HbA1c (<7.0%) and triglycerides (<1.7 mmol/L) than older adults aged 60–69 years