Malaysian Healthy Ageing Society Determinants of Poor Glycemic - - PowerPoint PPT Presentation

Organised by:

Malaysian Healthy Ageing Society

Co-Sponsored:

Determinants of Poor Glycemic Control in Elderly with Type 2 Diabetes Mellitus: Data from the Adult Diabetes Control and Management

Sazlina

a SG,1,2 Mastura I, I,3 Zaiton

• n A,

A,1,2 Cheong g AT,1 Ad Adam MB,4 Jamaiyah ah H, H, 4 Lee PY,1 SSyed ed-Alw lwi SAR5 Chew BH, 1 and SriWah ahyu T6

1 1 Departme

tment t of Family ly Medicine ine, , Faculty lty of Medicine ine and Health h Sciences nces, , Univ iver ersit iti i Putra Malaysia, ia, 43400, , Serdang, , Selangor gor, , Malaysia ia

2 Institut

tute e of Geront ntology

• logy,

, Univ iver ersit iti i Putra Malaysia, ia, 43400, , Serdang ng, , Selangor gor, , Malaysia ia

3 Seremban

an 2 Health Clinic ic, , Seremban an 70300, , Negeri ri Sembila ilan, n, Malaysia ia

4 Clinic

ical al Research Centre, e, Ministr try of Health, , Malaysia ia

5 5 Departme

tment t of Family ly Medicine ine, , Faculty lty of Medicine ine and Health h Sciences nces, , Univ iver ersit iti i Malaysia ia Sarawak, k, 91350, , Kuching, hing, Sarawak, k, Malaysia ia

6 6 Bandar Sungai

ai Pe Petani ni Health h Clinic ic, , 08000, , Sungai i Pe Petani ani, , Kedah, , Malaysia ia

O Diabetes mellitus in elderly – a global health problem

(International Diabetes Federation, 2010)

O The prevalence of diabetes mellitus among Malaysians

• ver 30 years old increased from 8.2% in 1996 to

14.9% in 2006

O It increases with age & 1/3 were above 60 years old (Institute of Public Health 2008)

O Management in elderly differs to younger adults

(Araki et al 2009, Hendra et al 1997)

O Determinants of poor glycemic control among adult with

T2DM:

O Malay and Indian ethnicities O Diabetes complications O Elevated low density lipoprotein cholesterol levels O Insulin use O Non-adherence to medications

(Toh et al 2011, Thaneerat et al 2009, Benoit et al 2005)

O Little is known on the glycemic control and its

determinants for the elderly Asians

O Aim of study to determine the prevalence of poor

glycemic control and its determinants among elderly with T2DM in Malaysia.

O A registry-based study using data from the Adult

Diabetes Control and Management (ADCM)

O A web-based registry (initiated in May 2007)

involving 303 public primary healthcare clinics and hospitals in Malaysia

O 10,363 data of patients aged ≥ 60 years seen

between 1st January and 31st December 2009 were analyzed

O The Medical Research and Ethics Committee,

Ministry of Health, Malaysia approved this study

O A structured clinical report form was used:

O Demographic data (age, gender, and ethnicity) O Clinical history (diabetes duration, co-morbid conditions,

complications, treatment modalities)

O CV risk factors: BP, body composition (BMI & WC), fasting lipid

profiles

O Data analysis:

O Descriptive & analytical (Pearson’s Chi square) O Determinants of glycaemic control: multivariate logistic

regression backward likelihood ratio stepwise method

O P-value, adjusted odds ratio (OR) and 95% confidence interval

(CI)

O Analysis performed using PASW 18.0

Variable ables Defin init ition

• n

Glycaemic control Poor glycemic control HbA1c ≥7.0% Comorbid conditions Either concomitant hypertension or dyslipidaemia or both Treatment modalities Diet and exercise, used oral anti-diabetic medications or insulin, or both Hypertension

• A history of hypertension on medication, or persistent

systolic BP ≥130 mmHg or diastolic BP ≥80mmHg

• Good control: BP< 130/80 mmHg

Body mass index Classified into:

• Underweight (< 18.5 kg/m2)
• Normal (18.5 – 22.9 kg/m2)
• Pre-obese (23 – 27.4 kg/m2)
• Obese (≥ 27.5 kg/m2)

Waist circumference < 90 cm (men); <80 cm (women) Lipid profiles

• HDL-C> 1.0 mmol/L (men) & > 1.3 mmol/L (women)
• LDL-C < 2.6 mmol/L
• Triglycerides (TG) <1.7 mmol/L

Characteristics of study population

Characteristics n (%) Age: mean (standard deviation) 60 – 74 years ≥ 75 years 71.28 (5.30) 7904 (76.3) 2459 (23.7) Gender Male Female 4320 (41.7) 6027 (58.3) Ethnicity Malay Chinese Indian Indigenous Bumiputera 5355 (51.7) 3372 (32.5) 1536 (14.8) 85 (1.0) Duration of illness < 5 years 5 -10 years > 10 years 3872 (37.4) 4006 (38.7) 2425 (23.9) Presence of co-morbid conditions Hypertension Dyslipidemia Both None 789 (7.6) 3353 (32.4) 552 (5.3) 5669 (54.7) Treatment modalities Diet and exercise Oral anti-diabetic medications only Insulin only Oral anti-diabetic medications and insulin 158 (1.5) 8916 (87.0) 333 (3.2) 845 (8.3)

O 58.3% patients had poor glycaemic control O Factors associated with poor glycemic control:

O Age (p< 0.001) O Ethnicity (p<0.001) O Diabetes duration (p< 0.001) O Presence of co-morbid conditions (p<0.001) O Treatment modalities (p<0.001) O Blood pressure (p=0.001) O Low density lipoprotein cholesterol (LDL-C) (p<0.001) O High density lipoprotein cholesterol (HDL-C)

(p<0.001)

O Triglycerides (TG) (p<0.001)

Determinants of poor glycaemic control (HbA1c >7.0%) in the elderly

Determinants Beta Standard Error Odds Ratio 95% CI† P-value Age group in years 60 – 74 ≥ 75 0.52 0.16 1.69 ref 1.23, 2.31 0.001* Ethnicity Malay Indian Indigenous Bumiputera Chinese 0.21 0.11 0.34 0.06 0.07 0.26 1.23 1.11 1.41 ref 1.10, 1.37 0.96, 1.28 0.84, 2.34 <0.001* 0.153 0.191 Duration of illness <5 years 5 – 10 years >10 years 0.30 0.58 0.06 0.07 ref 1.34 1.79 1.21, 1.50 1.57, 2.03 <0.001* <0.001* LDL-C‡ < 2.6 mmol/L ≥ 2.6 mmol/L 0.34 0.05 ref 1.41 1.27, 1.55 <0.001* HDL-C§ Target achieved Target not achieved 0.18 0.06 ref 1.19 1.07, 1.33 0.001* Triglycerides < 1.7 mmol/L ≥ 1.7 mmol/L 0.46 0.05 ref 1.58 1.43, 1.75 <0.001* Treatment modalities Diet and exercise Oral anti-diabetic medications only Insulin only Oral anti-diabetic medications and Insulin Constant 2.14 2.91 3.79

• 3.16

0.31 0.35 0.33 ref 8.47 18.43 44.20 4.61, 15.57 9.32, 36.46 22.98, 85.01 <0.001* <0.001* <0.001*

O Identification of these determinants in

elderly with diabetes would facilitate health care professionals to provide more comprehensive care

O Measures to improve lipid profile and the

possibility of non-adherence to treatment needs to be addressed

O We would like to thank the Director General

• f the Ministry of Health for his support in
• ur effort in the registry & Clinical Research

Centre, Kuala Lumpur for its support

1.

International Diabetes Federation. Diabetes Atlas, 4th edn (updated). Brussels: International Diabetes Federation, 2010.

2.

Institute for Public Health. The Third National Health and Morbidity Survey (NMHS III), Diabetes. Ministry of Health, Malaysia, 2008.

3.

Hendra TJ, Sinclair AJ. Improving the care of older diabetic patients: The final report of the St Vincent Joint Task Force for Diabetes. Age Aging 1997; 26 26: 3-6.

4.

Araki A, Ito H. Diabetes mellitus and geriatric syndrome. Geriatri Gerontol Int 2009; 9: 105-114

5.

Toh MPHS, Wu CX, Leong HSS. Association of younger age with poor glycemic and cholesterol control in Asians with type 2 diabetes mellitus in Singapore. J Endocrinol Metab 2011; 1: 27-37.

6.

Thaneerat T, Tangwongchai S, Worakul P. Prevalence of depression, hemoglobin A1C level, and associated factors in outpatients with type-2 diabetes. Asian Biomedicine 2009; 3: 383–390.

7.

Benoit S, Fleming R, Philis-Tsimikas A, Ji M. Predictors of glycemic control among patients with Type 2 diabetes: A longitudinal study. BMC Public Health 2005; 5:36. doi:10.1186/1471-2458-5-36

Thank you for your kind attention

Demographic and clinical factors of the study population on glycaemic control

Factors Good control (HbA1c<7.0%) N (%) Poor control (HbA1c≥7.0%) N (%) P-value Age group (years) 60 – 74 ≥ 75 3086 (71.4) 1235 (28.6) 4818 (79.7) 1224 (20.3) <0.001* Gender Male Female 1811 (42.0) 2504 (58.0) 2509 (41.6) 3523 (58.4) 0.703 Ethnicity Malay Chinese Indian Indigenous Bumiputera 2104 (48.8) 1541 (35.7) 635 (14.7) 35 (0.8) 3251 (53.9) 1831 (30.4) 901 (14.9) 50 (0.8) <0.001* Duration of diabetes < 5 years 5 -10 years > 10 years 1180 (44.2) 975 (36.9) 484 (18.8) 2692 (35.1) 3031 (39.6) 1941 (25.3) <0.001* Presence of co-morbid conditions Hypertension Dyslipidemia Both None 1522 (35.2) 174 (4.0) 2314 (53.6) 311 (7.2) 1831 (30.3) 378 (6.3) 3355 (55.5) 478 (7.9) <0.001* Treatment modalities Diet and exercise Oral anti-diabetic medications only Insulin only Oral anti-diabetic medications and insulin 141 (3.3) 3920 (92.0) 83 (2.0) 115 (2.7) 17 (0.3) 4996 (83.4) 250 (4.2) 730 (12.1) <0.001*

Cardiovascular risk factors on glycaemic control

Factors Good control (HbA1c<7.0%) N (%) Poor control (HbA1c≥7.0%) N (%) P-value Blood pressure < 130/80 mmHg ≥ 130/80 mmHg 1012 (23.5) 3301 (76.5) 1254 (20.8) 4777 (79.2) 0.001* BMI† status Underweight Normal Pre-obese Obese 137 (3.2) 1002 (23.2) 1741 (40.3) 1441 (33.3) 147 (2.4) 1435 (23.8) 2452 (40.6) 2008 (33.2) 0.145 Waist circumference Target achieved Target not achieved 580 (13.4) 3735 (86.6) 801 (13.3) 5231 (86.7) 0.811 LDL-C ≤ 2.6 mmol/L > 2.6 mmol/L 1389 (40.8) 2014 (59.2) 1530 (33.1) 3091 (66.9) <0.001* HDL-C§ Target achieved Target not achieved 2529 (74.0) 890 (26.0) 3204 (68.5) 1475 (31.5) <0.001* Triglyceride ≤ 1.7 mmol/L > 1.7 mmol/L 2563 (65.4) 1357 (34.6) 2949 (53.0) 2608 (47.0) <0.001*