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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

Lim LL 1 , Hussein Z 2 , Noor NM 2 , Raof ASA 1 , Mustafa N 3 , Bidin MBL 4 Show all authors , Ghani RA 5 , Samsuddin S 6 , Yong SL 7 , Foo SH 8 , Raghuram K 9 , Suwannasri P 9 , W B WM 10 , Chiew TK 11 , Chan SP 1

Affiliations 

  • 1 Faculty of Medicine, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  • 2 Department of Medicine, Hospital Putrajaya, Putrajaya, Malaysia
  • 3 Faculty of Medicine, Department of Medicine, Universiti Kebangsaan Malaysia, Selangor, Malaysia
  • 4 Department of Medicine, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
  • 5 Faculty of Medicine, Department of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
  • 6 Department of Medicine, Hospital Serdang, Selangor, Malaysia
  • 7 Department of Medicine, Hospital Tengku Ampuan Rahimah, Selangor, Malaysia
  • 8 Department of Medicine, Hospital Selayang, Selangor, Malaysia
  • 9 Boehringer Ingelheim Singapore Pte. Ltd, Singapore
  • 10 School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
  • 11 Faculty of Computer Science and Information Technology, Department of Software Engineering, University of Malaya, Kuala Lumpur, Malaysia
PLoS One, 2024;19(1):e0296298.
PMID: 38166049 DOI: 10.1371/journal.pone.0296298

Abstract

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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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