Diabetes control and complications in public hospitals in Malaysia

The Diabcare-Asia project was initiated to study the status of diabetes care and prevalence of diabetic complications in Asia and this study was done to evaluate the above in public hospitals in Malaysia and compare to a similar study done in 1998. A total of 19 public hospitals participated in this study from which a total of 1099 patients were included and analysed. The majority of patients (94.8%) had type 2 diabetes mellitus and 66.5% were overweight or obese. As for glycaemic control only 41.0% of the patients had HbA1c < 7% and 18% had FPG < 6.1 mmol/L. As for lipid levels, only 32.0% of the patients had total cholesterol < 4.8 mmol/L; 59.6% had HDL-cholesterol > 1.1 mmol/L and 51.1% had triglycerides < 1.7 mmol/L. Despite the high proportion of patients having dyslipidaemia, only 52.8% of the patients were on lipid lowering therapy. As for blood pressure, 15.0% of the patients had blood pressure < 130/80 mmHg. Although 75.9% of the patients were on antihypertensive medication only 11.3% had blood pressure < 130/80 mmHg. Only 54.8% of patients admitted to adhering to a diabetic diet regularly and 38.9% exercised regularly. As for glucose monitoring, only 26.8% of the patients did home blood glucose monitoring and 1.8% did home urine glucose testing. There was also a high complication rate with the commonest being neuropathy (19.0%) followed by albuminuria (15.7%), background retinopathy (11.1%) and microalbuminuria (6.6%). Compared to the 1998 study, there was some improvement in the percentage of patients achieving target levels and a reduction in the prevalence of complications. In conclusion, the majority of diabetic patients treated at the public hospitals were still not satisfactorily controlled and this was still associated with a high prevalence of complications. There is still an urgent need to educate both patients and health care personnel on the importance of achieving the clinical targets and greater effort must be made to achieve these targets.