Organised by: Co-Sponsored: Malaysian Healthy Ageing Society
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 on A, A, 1,2 Cheong g AT, 1 Ad Adam MB, 4 Jamaiyah ah H, H, 4 Lee PY, 1 SSyed ed-Alw lwi SAR 5 Chew BH, 1 and SriWah ahyu T 6 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 ology, , 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 over 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 1 st January and 31 st 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 on 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/m 2 ) Normal (18.5 – 22.9 kg/m 2 ) • • Pre-obese (23 – 27.4 kg/m 2 ) • Obese (≥ 27.5 kg/m 2 ) 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) 71.28 (5.30) 60 – 74 years 7904 (76.3) ≥ 75 years 2459 (23.7) Gender Male 4320 (41.7) Female 6027 (58.3) Ethnicity Malay 5355 (51.7) Chinese 3372 (32.5) Indian 1536 (14.8) Indigenous Bumiputera 85 (1.0) Duration of illness < 5 years 3872 (37.4) 5 -10 years 4006 (38.7) > 10 years 2425 (23.9) Presence of co-morbid conditions Hypertension 789 (7.6) Dyslipidemia 3353 (32.4) Both 552 (5.3) None 5669 (54.7) Treatment modalities Diet and exercise 158 (1.5) Oral anti-diabetic medications only 8916 (87.0) Insulin only 333 (3.2) Oral anti-diabetic medications and insulin 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 Odds Ratio 95% CI † P-value Standard Error Age group in years 60 – 74 0.52 0.16 1.69 1.23, 2.31 0.001* ≥ 75 ref Ethnicity Malay 0.21 0.06 1.23 1.10, 1.37 <0.001* Indian 0.11 0.07 1.11 0.96, 1.28 0.153 Indigenous Bumiputera 0.34 0.26 1.41 0.84, 2.34 0.191 Chinese ref Duration of illness <5 years ref 5 – 10 years 0.30 0.06 1.34 1.21, 1.50 <0.001* >10 years 0.58 0.07 1.79 1.57, 2.03 <0.001* LDL-C ‡ < 2.6 mmol/L ref ≥ 2.6 mmol/L 0.34 0.05 1.41 1.27, 1.55 <0.001* HDL-C § Target achieved ref Target not achieved 0.18 0.06 1.19 1.07, 1.33 0.001* Triglycerides < 1.7 mmol/L ref ≥ 1.7 mmol/L 0.46 0.05 1.58 1.43, 1.75 <0.001* Treatment modalities Diet and exercise ref Oral anti-diabetic medications only 2.14 0.31 8.47 4.61, 15.57 <0.001* Insulin only 2.91 0.35 18.43 9.32, 36.46 <0.001* Oral anti-diabetic medications and Insulin 3.79 0.33 44.20 22.98, 85.01 <0.001* Constant -3.16
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 of the Ministry of Health for his support in our effort in the registry & Clinical Research Centre, Kuala Lumpur for its support
International Diabetes Federation. Diabetes Atlas , 4th edn 1. (updated). Brussels: International Diabetes Federation, 2010. Institute for Public Health. The Third National Health and Morbidity 2. Survey (NMHS III), Diabetes . Ministry of Health, Malaysia, 2008. Hendra TJ, Sinclair AJ. Improving the care of older diabetic patients: 3. The final report of the St Vincent Joint Task Force for Diabetes. Age Aging 1997; 26 26: 3-6. Araki A, Ito H. Diabetes mellitus and geriatric syndrome. Geriatri 4. Gerontol Int 2009; 9: 105-114 Toh MPHS, Wu CX, Leong HSS. Association of younger age with poor 5. glycemic and cholesterol control in Asians with type 2 diabetes mellitus in Singapore. J Endocrinol Metab 2011; 1: 27-37. Thaneerat T, Tangwongchai S, Worakul P. Prevalence of depression, 6. hemoglobin A1C level, and associated factors in outpatients with type-2 diabetes. Asian Biomedicine 2009; 3: 383 – 390. Benoit S, Fleming R, Philis-Tsimikas A, Ji M. Predictors of glycemic 7. 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 Poor control P -value (HbA1c≥7.0%) (HbA1c<7.0%) N (%) N (%) Age group (years) 60 – 74 3086 (71.4) 4818 (79.7) <0.001* ≥ 75 1235 (28.6) 1224 (20.3) Gender Male 1811 (42.0) 2509 (41.6) 0.703 Female 2504 (58.0) 3523 (58.4) Ethnicity Malay 2104 (48.8) 3251 (53.9) <0.001* Chinese 1541 (35.7) 1831 (30.4) Indian 635 (14.7) 901 (14.9) Indigenous Bumiputera 35 (0.8) 50 (0.8) Duration of diabetes <0.001* < 5 years 1180 (44.2) 2692 (35.1) 5 -10 years 975 (36.9) 3031 (39.6) > 10 years 484 (18.8) 1941 (25.3) Presence of co-morbid conditions <0.001* Hypertension 1522 (35.2) 1831 (30.3) Dyslipidemia 174 (4.0) 378 (6.3) Both 2314 (53.6) 3355 (55.5) None 311 (7.2) 478 (7.9) Treatment modalities <0.001* Diet and exercise 141 (3.3) 17 (0.3) Oral anti-diabetic medications only 3920 (92.0) 4996 (83.4) Insulin only Oral anti-diabetic medications and insulin 83 (2.0) 250 (4.2) 115 (2.7) 730 (12.1)
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