Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Jalan Universiti, 50603, Kuala Lumpur, Malaysia.
Disease Control Division, Ministry of Health, Level 3 Block E10, Kompleks E, Pusat Pentadbiran Kerajaan Persekutuan, 62590, Putrajaya, Malaysia.
Sci Rep. 2021 Mar 24;11(1):6803. doi: 10.1038/s41598-021-86277-0.
Good control of glycosylated haemoglobin A1C in diabetes patients prevents cardiovascular complications. We aim to describe the A1C trend and determine the predictors of the trend among type 2 diabetes patients in Malaysia. Longitudinal data in the National Diabetes Registry from 2013 to 2017 were analysed using linear mixed-effects modelling. Among 17,592 patients, 56.3% were females, 64.9% Malays, and the baseline mean age was 59.1 years. The U-shaped A1C trend changed marginally from 7.89% in 2013 to 8.07% in 2017. The A1C excess of 1.07% as reported in 2017 represented about 22% higher risk of diabetes-related death, myocardial infarction, and stroke, which are potentially preventable. The predictors for higher baseline A1C were non-Chinese ethnicity, younger age groups, longer diabetes duration, patients on insulin treatment, polypharmacy use, patients without hypertension, and patients who were not on antihypertensive agents. Younger age groups predicted a linear increase in the A1C trend, whereas patients on insulin treatment predicted a linear decrease in the A1C trend. Specifically, the younger adults and patients of Indian and Malay ethnicities had the poorest A1C trends. Targeted interventions should be directed at these high-risk groups to improve their A1C control.
糖尿病患者良好的糖化血红蛋白 A1C 控制可预防心血管并发症。我们旨在描述马来西亚 2 型糖尿病患者的 A1C 趋势，并确定其趋势的预测因素。使用线性混合效应模型对 2013 年至 2017 年国家糖尿病登记处的纵向数据进行分析。在 17592 名患者中，56.3%为女性，64.9%为马来人，基线平均年龄为 59.1 岁。A1C 趋势呈 U 形，略有变化，从 2013 年的 7.89%上升至 2017 年的 8.07%。2017 年报告的 A1C 超标 1.07%，意味着糖尿病相关死亡、心肌梗死和中风的风险增加了约 22%，这些风险是可以预防的。基线 A1C 较高的预测因素是非华族裔、年龄较小的年龄组、较长的糖尿病病程、接受胰岛素治疗的患者、联合用药、无高血压的患者和未服用抗高血压药物的患者。年龄较小的年龄组预示着 A1C 趋势呈线性上升，而接受胰岛素治疗的患者预示着 A1C 趋势呈线性下降。具体来说，年轻的成年人和印度裔和马来裔患者的 A1C 趋势最差。应针对这些高风险群体进行有针对性的干预，以改善他们的 A1C 控制。
