Real-world evaluation of care for type 2 diabetes in Malaysia: A cross-sectional analysis of the treatment adherence to guideline evaluation in type 2 diabetes (TARGET-T2D) study.

Autor: Lim LL; Faculty of Medicine, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia.; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR.; Asia Diabetes Foundation, Shatin, Hong Kong, SAR., Hussein Z; Department of Medicine, Hospital Putrajaya, Putrajaya, Malaysia., Noor NM; Department of Medicine, Hospital Putrajaya, Putrajaya, Malaysia., Raof ASA; Faculty of Medicine, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia., Mustafa N; Faculty of Medicine, Department of Medicine, Universiti Kebangsaan Malaysia, Selangor, Malaysia., Bidin MBL; Department of Medicine, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia., Ghani RA; Faculty of Medicine, Department of Medicine, Universiti Teknologi MARA, Selangor, Malaysia., Samsuddin S; Department of Medicine, Hospital Serdang, Selangor, Malaysia., Yong SL; Department of Medicine, Hospital Tengku Ampuan Rahimah, Selangor, Malaysia., Foo SH; Department of Medicine, Hospital Selayang, Selangor, Malaysia., Raghuram K; Boehringer Ingelheim Singapore Pte. Ltd, Singapore., Suwannasri P; Boehringer Ingelheim Singapore Pte. Ltd, Singapore., W B WM; School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia., Chiew TK; Faculty of Computer Science and Information Technology, Department of Software Engineering, University of Malaya, Kuala Lumpur, Malaysia., Chan SP; Faculty of Medicine, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2024 Jan 02; Vol. 19 (1), pp. e0296298. Date of Electronic Publication: 2024 Jan 02 (Print Publication: 2024).
DOI: 10.1371/journal.pone.0296298
Abstrakt: Aim: Given a lack of data on diabetes care performance in Malaysia, we conducted a cross-sectional study to understand the clinical characteristics, control of cardiometabolic risk factors, and patterns of use of guideline-directed medical therapy (GDMT) among patients with type 2 diabetes (T2D), who were managed at publicly-funded hospitals between December 2021 and June 2022.
Methods: Patients aged ≥18 years with T2D from eight publicly-funded hospitals in the Greater Kuala Lumpur region, who had ≥2 outpatient visits within the preceding year and irrespective of treatment regimen, were eligible. The primary outcome was ≥2 treatment target attainment (defined as either HbA1c <7.0%, blood pressure [BP] <130/80 mmHg, or low-density lipoprotein cholesterol [LDL-C] <1.8 mmol/L). The secondary outcomes were the individual treatment target, a combination of all three treatment targets, and patterns of GDMT use. To assess for potential heterogeneity of study findings, all outcomes were stratified according to prespecified baseline characteristics namely 1) history of atherosclerotic cardiovascular disease (ASCVD; yes/no) and 2) clinic type (Diabetes specialist versus General medicine).
Results: Among 5094 patients (mean±SD age 59.0±13.2 years; T2D duration 14.8±9.2 years; HbA1c 8.2±1.9% (66±21 mmol/mol); BMI 29.6±6.2 kg/m2; 45.6% men), 99% were at high/very high cardiorenal risk. Attainment of ≥2 treatment targets was at 18%, being higher in General medicine than in Diabetes specialist clinics (20.8% versus 17.5%; p = 0.039). The overall statin coverage was 90%. More patients with prior ASCVD attained LDL-C <1.4 mmol/L than those without (13.5% versus 8.4%; p<0.001). Use of sodium-glucose cotransporter-2 (SGLT2) inhibitors (13.2% versus 43.2%), glucagon-like peptide-1 receptor agonists (GLP1-RAs) (1.0% versus 6.2%), and insulin (27.7% versus 58.1%) were lower in General medicine than in Diabetes specialist clinics.
Conclusions: Among high-risk patients with T2D, treatment target attainment and use of GDMT were suboptimal.
Competing Interests: LLL report receiving grants through her affiliated institutions and/or honoraria for consultancy and speaker bureau from Abbott, AstraZeneca, Boehringer Ingelheim, Merck Sharp & Dohme, Novo Nordisk, Roche, Sanofi, Servier, and Zuellig Pharma. SPC report receiving the research grant through her affiliated Society (Malaysian Endocrine and Metabolic Society) and honoraria for consultancy and speaker bureau from Abbott, AstraZeneca, Boehringer Ingelheim, Novo Nordisk, Roche, Sanofi, Servier, and Zuellig Pharma. KR and PS are employee of Boehringer Ingelheim. Other co-authors declared no potential conflict of interest. There are no patents, products in development or marketed products associated with this research to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
(Copyright: © 2024 Lim et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
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