Real-world evaluation of care for type 2 diabetes in Malaysia: A cross-sectional analysis of the treatment adherence to guideline evaluation in type 2 diabetes (TARGET-T2D) study

PLoS One. 2024 Jan 2;19(1):e0296298. doi: 10.1371/journal.pone.0296298. eCollection 2024.

Abstract

Aim: Given a lack of data on diabetes care performance in Malaysia, we conducted a cross-sectional study to understand the clinical characteristics, control of cardiometabolic risk factors, and patterns of use of guideline-directed medical therapy (GDMT) among patients with type 2 diabetes (T2D), who were managed at publicly-funded hospitals between December 2021 and June 2022.

Methods: Patients aged ≥18 years with T2D from eight publicly-funded hospitals in the Greater Kuala Lumpur region, who had ≥2 outpatient visits within the preceding year and irrespective of treatment regimen, were eligible. The primary outcome was ≥2 treatment target attainment (defined as either HbA1c <7.0%, blood pressure [BP] <130/80 mmHg, or low-density lipoprotein cholesterol [LDL-C] <1.8 mmol/L). The secondary outcomes were the individual treatment target, a combination of all three treatment targets, and patterns of GDMT use. To assess for potential heterogeneity of study findings, all outcomes were stratified according to prespecified baseline characteristics namely 1) history of atherosclerotic cardiovascular disease (ASCVD; yes/no) and 2) clinic type (Diabetes specialist versus General medicine).

Results: Among 5094 patients (mean±SD age 59.0±13.2 years; T2D duration 14.8±9.2 years; HbA1c 8.2±1.9% (66±21 mmol/mol); BMI 29.6±6.2 kg/m2; 45.6% men), 99% were at high/very high cardiorenal risk. Attainment of ≥2 treatment targets was at 18%, being higher in General medicine than in Diabetes specialist clinics (20.8% versus 17.5%; p = 0.039). The overall statin coverage was 90%. More patients with prior ASCVD attained LDL-C <1.4 mmol/L than those without (13.5% versus 8.4%; p<0.001). Use of sodium-glucose cotransporter-2 (SGLT2) inhibitors (13.2% versus 43.2%), glucagon-like peptide-1 receptor agonists (GLP1-RAs) (1.0% versus 6.2%), and insulin (27.7% versus 58.1%) were lower in General medicine than in Diabetes specialist clinics.

Conclusions: Among high-risk patients with T2D, treatment target attainment and use of GDMT were suboptimal.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cholesterol, LDL
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 2*
  • Female
  • Glycated Hemoglobin
  • Humans
  • Malaysia / epidemiology
  • Male
  • Middle Aged
  • Treatment Adherence and Compliance

Substances

  • Glycated Hemoglobin
  • Cholesterol, LDL

Grants and funding

The TARGET-T2D study is funded by Boehringer Ingelheim (website URL: boehringer-ingelheim.com) via an unrestricted educational grant to the Malaysian Endocrine and Metabolic Society. The funder contributed scientific expertise to the study design. Co-authors from the funder had reviewed and edited the manuscript for intellectual content; however, the funder had no role in data collection, data analysis, and final review and approval of the manuscript for submission. The corresponding authors have full access to all data in the study and have the final responsibility for the decision to submit for publication.