Malaysian Healthy Ageing Society Chew Boon How 1* MMed (FamMed) , - - PowerPoint PPT Presentation

Chew Boon How1*MMed (FamMed), Sazlina Shariff-Ghazali 1MMed (FamMed), Zaiton Ahmad1MMed (FamMed), Mastura Ismail2MMed (FamMed), Jamaiyah Haniff3(MPH), Mustapha Feisul Idzwan4(MPH), Mohd Adam Bujang3(Bsc Statistic)

Research Centre, Hospital Kuala Lumpur,4Disease Control Division, Ministry of Health Malaysia, Putrajaya.

• Age has long been recognised as a significant

factor for health.1 2

• Many cardiovascular disease risk scoring

systems give larger weightage or marks for the older age groups.

• 1. de Craen AJ et al. Tijdschr Gerontol Geriatr 2009;40(6):237-43.
• 2. Jaakko T. Cardiovascular Risk Through The Ages, Proceedings of the Future Forum Conference held in Noordwijk, The

• Children of long-living parents, suggesting

that they had advantageous cardiovascular risk profiles

 (the Leiden research program on ageing and

Framingham offspring study.)1 6

• The association of ageing and many

cardiometabolic diseases were degenerative processes leading to cellular apoptosis beyond regeneration or repairs.5

• 1. de Craen AJ et al. Tijdschr Gerontol Geriatr 2009;40(6):237-43.
• 5. Navarro A et al. American Journal of Physiology - Cell Physiology 2007;292(2):C670-C86.
• 6. Terry DF et al. Archives of Internal Medicine 2007;167(5):438-44.

• Cardiometabolic diseases cause premature

ageing and death.7

• Vascular ageing and remodelling 9
• Many studies had reported positive relationship
• f disease control (glycaemic, blood pressure and

lipid) in T2D and diabetes-related complications and death, but the evidence was inconclusive and even against intensive control in the older group

• f patients.8
• 7. Girndt M et al. Biomarkers of Ageing: from Molecular Biology to Clinical Perspectives 2010;45(10):797-800.
• 8. Huang ES et al. Diabetes Care 2011;34(6):1329-36.
• 9. Bachschmid MM et al. Annals of Medicine 2012:1-20.

• We examined the independent effect of age

≥ 60 years on disease control and its relationship with diabetes-related complications.

• Adult Diabetes Control and Management (

) public health centres (289 health clinics, hospitals) patients ( patients were from hospital) health clinics hospitals (8 states and 2 federal territories) of 15 states and federal territories in Malaysia.

• The proportion of T2D patients notified in this

database as compared to the estimated total T2D patients in these states and federal territories was .

• Only adult patients (

).

• All patients were
• f the on-going

registry and given the opportunity to .

• Participation in ADCM was non-mandatory for

patients and health centres.

• Registrations at local centers were generally

performed by trained physicians, assistant physicians and nurses. , developed and maintained by Clinical Research Centre (CRC), Ministry of Health, Malaysia.

• The

was as when their case record fulfilled all these criteria:

 (i) either

• r

 (ii) those whose current

.

• Comparisons were performed regarding mean

levels by use of the Student’s t test for unpaired samples and regarding proportions by use of the Chi square test/Fisher Exact’s Test. as dependent variables and with indentified significant registered variables as mentioned above as independent variables.

• A P value < 0.05 was considered to be significant

Result

was female.

• Malay consisted of

, Chinese and Indian .

< 60 years, n (%) ≥ 60 years, n (%) χ2 or t Statistic p

• 41.74

• 40.38

• 32.85

• 11.10

• 15.90

• 0.24

Discussion- Risk Control & Age

• The proportion of our older patients achieving

HbA1c and LDL-C targets were comparable to the Asian countries (Hong Kong, India, Korea, Philippines, Singapore, Taiwan, and Thailand) in the (Joint Asia Diabetes Evaluation) program (35.3% achieved HbA1c < 7% and 34% achieved LDL-C < 2.6 mmol/L).26

• 26. So W-Y et al. Journal of Diabetes 2011;3(2):109-18.

Discussion- Age & Risk

• The attenuated association between

cardiometabolic risk markers and older people was also reported in United States and these Asian countries.25 26

• Inverse relationship of glycaemic control

(HbA1c ≤ 7.5%) and age among the T2D patients was also reported in a primary care setting in UK.27

• 25. Janssen I. Nutr Metab Cardiovasc Dis. 2009;19(3):163-69.
• 26. So W-Y et al. Journal of Diabetes 2011;3(2):109-18.
• 27. Nagrebetsky A et al. Diabetes Res Clin Pract. 2012 Jan 17.

Discussion-Risk & Complication

• Despite good control of most cardiovascular risk

factors, the elderly patients with T2D were still suffering from all types of diabetes complications.

• Improving diseases control and increasing

complications were observed in French elderly T2D.30

• In a 15-years follow-up Chinese Multi-provincial

study, diabetes and older age (≥ 45 years) were predictors of coronary heart disease and ischaemic stroke despite well controlled LDL-C.31

• 30. Pornet C et al. Diabetes Metab 2011;37(2):152-61.
• 31. Liu J et al. Diabetes Res Clin Pract. 2012 Jan 11. [Epub ahead of print]

Limitations

• Missing data/unknown status for many

complications

• Representativeness
• Not generalizable to east Malaysia
• Could not ascertain the sequence of events

between onset of the diabetes-related complications and diseases control

• Unobservable confounders may still exist and bias

the results as evidenced by the modest effect of the models

Conclusions

• 1. Age ≥ 60 years was an independent risk factor

for diabetes-related complications despite good control of cardiovascular risk factors.

• 2. Diabetes in the older patients could be a

significant cause of morbidity in this country.

• 3. It was very likely that good diseases control

were only achieved after the onset of complications.

• 4. Caution on the current recommended clinical

targets control in these patients who were already having more longstanding diseases and complications.48

• 5. The goals of therapy have to be safe and more

holistic diabetes care including having quality

• f life as one of the aims of treatment for

elderly T2D.

• 48. Boussageon R et al. BMJ 2011;343:d4169.

The End