Management and glycemic control of patients with type 2 diabetes mellitus at primary care level in Kedah, Malaysia: A statewide evaluation


Autoři: Sharifah Saffinas Syed Soffian aff001;  Shahrul Bariyah Ahmad aff001;  Huan-Keat Chan aff002;  Shahrul Aiman Soelar aff002;  Muhammad Radzi Abu Hassan aff002;  Norhizan Ismail aff001
Působiště autorů: State Health Department, Ministry of Health Malaysia, Alor Setar, Kedah, Malaysia aff001;  Clinical Research Center, Hospital Sultanah Bahiyah, Ministry of Health Malaysia, Alor Setar, Kedah, Malaysia aff002
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0223383

Souhrn

Introduction

While Kedah has recorded the highest prevalence of diabetes among all the states in Malaysia, the information on the practice and effectiveness of disease management in public health institutions remains limited. This study aimed to evaluate the management and glycemic control of patients with type-2 diabetes mellitus (T2DM) at the primary care level in Kedah.

Methods

All T2DM patients, who made at least one visit to any of the 58 public health clinics in Kedah during August 2016 and July 2017, were included in this study. The sample was selected from the National Diabetes Registry using the stratified random sampling method. The information on the demographic and clinical characteristics, laboratory findings and pharmacological treatment was gathered from medical records of patients. The differences in mean HbA1C levels across subgroups of each variable were tested using the general linear model. The evaluation of the appropriateness of treatment was performed based on the recommendations of the latest Clinical Practice Guidelines for T2DM.

Results

The patients (n = 23,557) were mainly female (63.4%), of Malay ethnicity (80.1%) and middle-aged (62.2%), with a mean duration of T2DM of 6.2±7.16 years. Only 15.6% of them had a HbA1C level <6.5%, and 28.6% did not have their HbA1C levels tested over the 12-month period. Yet, the underutilization of combination treatment (≥2 antidiabetic agents) and insulin in the patients with a poor glycemic control was evident. Retinopathy emerged as the most prevalent diabetes-related complication (12.6%). Along with those with a longer duration of T2DM, the patients who were younger, female and of Indian ethnicity were found to generally have a poorer glycemic control.

Conclusion

This study discloses the suboptimal T2DM management at the primary care level in Kedah, which warrants a statewide plan for improvement.

Klíčová slova:

Diabetes mellitus – Drug therapy – HbA1c – Hypertension – Insulin – Malaysia – Public and occupational health – Type 2 diabetes


Zdroje

1. NCD Risk Factor Collaboration. Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants. Lancet. 2016;387(10027):1513–1530. doi: 10.1016/S0140-6736(16)00618-8 27061677

2. Hieng YC. An internal audit of diabetes care for type 2 diabetic patients in a public hospital diabetes clinic in Malaysia. Malays J Med Sci. 2017;24(2):55–60. doi: 10.21315/mjms2017.24.2.7 28894404

3. Hussein Z, Taher SW, Gilcharan Singh HK, Chee Siew Swee W. Diabetes care in Malaysia: problems, new models, and solutions. Ann Glob Health. 2015;81(6):851–862. doi: 10.1016/j.aogh.2015.12.016 27108152

4. Zhang P, Zhang X, Brown J, Vistisen D, Sicree R, Shaw J, et al. Global healthcare expenditure on diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010;87(3):293–301. doi: 10.1016/j.diabres.2010.01.026 20171754

5. Papatheodorou K, Banach M, Bekiari E, Rizzo M, Edmonds M. Complications of diabetes 2017. J Diabetes Res. 2018;2018:3086167. doi: 10.1155/2018/3086167 29713648

6. Deshpande AD, Harris-Hayes M, Schootman M. Epidemiology of diabetes and diabetes-related complications. Phys Ther. 2008;88(11):1254–1264. doi: 10.2522/ptj.20080020 18801858

7. Macioch T, Sobol E, Krakowiecki A, Mrozikiewicz-Rakowska B, Kasprowicz M, Hermanowski T. Health related quality of life in patients with diabetic foot ulceration—translation and Polish adaptation of Diabetic Foot Ulcer Scale short form. Health Qual Life Outcomes. 2017;15:15. doi: 10.1186/s12955-017-0587-y 28109278

8. Carey IM, Critchley JA, DeWilde S, Harris T, Hosking FJ, Cook DG. Risk of infection in type 1 and type 2 diabetes compared with the general population: a matched cohort study. Diabetes Care. 2018;41(3):513–521. doi: 10.2337/dc17-2131 29330152

9. Moodahadu LS, Dhall R, Zargar AH, Bangera S, Ramani L, Katipally R. Tight glycemic control and cardiovascular effects in type 2 diabetic patients. Heart Views. 2014;15(4):111–120. doi: 10.4103/1995-705X.151084 25774253

10. Morgan L. Challenges and opportunities in managing type 2 diabetes. Am Health Drug Benefits. 2017;10(4):197–200. 28794823

11. Ong SE, Koh JJK, Toh SES, Chia KS, Balabanova D, McKee M. Assessing the influence of health systems on type 2 diabetes mellitus awareness, treatment, adherence, and control: a systematic review. PLoS One. 2018;13(3):e0195086. doi: 10.1371/journal.pone.0195086 29596495

12. Pfeiffer AFH, Klein HH. The treatment of type 2 diabetes. Dtsch Arztebl Int. 2014;111(5):69–82. doi: 10.3238/arztebl.2014.0069 24612534

13. Selvin E, Parrinello CM, Daya N, Bergenstal RM. Trends in insulin use and diabetes control in the U.S.: 1988–1994 and 1999–2012. Diabetes Care. 2016;39(3):e33–e35. doi: 10.2337/dc15-2229 26721815

14. Ross SA. Breaking down patient and physician barriers to optimize glycemic control in type 2 diabetes. Am J Med. 2013;126(9 Suppl 1):S38–48. doi: 10.1016/j.amjmed.2013.06.012

15. Reaney M. The need for a tool to assist health care professionals and patients in making medication treatment decisions in the clinical management of Type 2 diabetes. Diabetes Spectr. 2015;28(4):227–229. doi: 10.2337/diaspect.28.4.227 26600722

16. Malaysian Healthcare Performance Unit. Diabetes Care Performance Report 2016. 2016; http://www.moh.gov.my/english.php/pages/view/418. Accessed 11st November 2018.

17. Thomas S, Beh L, Nordin RB. Health care delivery in Malaysia: changes, challenges and champions. J Public Health in Africa. 2011;2(2):e23. doi: 10.4081/jphia.2011.e23

18. Endocrine Malaysian and Society Metabolic. Management of type 2 diabetes mellitus. 5th Edition. 2016; http://www.moh.gov.my/index.php/pages/view/134. Accessed 11th November, 2018.

19. Krejcie RV, Morgan DW. Determining sample size for research activities. Educ Psychol Meas. 1970;30(3):607–610.

20. Ministry of Health Malaysia. National Diabetes Registry Report Volume 1 (2009–2012); http://www.moh.gov.my/moh/resources/Penerbitan/Rujukan/NCD/Diabetes/National_Diabetes_Registry_Report_Vol_1_2009_2012.pdf. Accessed 11th November, 2018.

21. Mafauzy M, Zanariah H, Nazeri A, Chan SP. DiabCare 2013: A cross-sectional study of hospital based diabetes care delivery and prevention of diabetes related complications in Malaysia. Med J Malaysia. 2016;71(4):177–185. 27770116

22. Firouzi S, Barakatun-Nisak MY, Azmi KN. Nutritional status, glycemic control and its associated risk factors among a sample of type 2 diabetic individuals, a pilot study. J Res Med Sci. 2015;20(1):40–46. 25767521

23. Butt M, Mhd Ali A, Bakry MM, Mustafa N. Impact of a pharmacist led diabetes mellitus intervention on HbA1c, medication adherence and quality of life: A randomised controlled study. Saudi Pharm J. 2016;24(1):40–48. doi: 10.1016/j.jsps.2015.02.023 26903767

24. Samiei V, Wan Puteh SE, Abdul Manaf MR, Abdul Latip K, Ismail A. Are Malaysian diabetic patients ready to use the new generation of health care service delivery? A telehealth interest assessment. Malays J Med Sci. 2016;23(2):44–52. 27547114

25. Tan WL, Asahar SF, Harun NL. Insulin therapy refusal among type II diabetes mellitus patients in Kubang Pasu district, the state of Kedah, Malaysia. Singapore Med J. 2015;56(4):224–227. doi: 10.11622/smedj.2014170 25532511

26. Lee YK, Ng CJ, Lee PY, Khoo EM, Abdullah KL, Low WY, et al. What are the barriers faced by patients using insulin? A qualitative study of Malaysian health care professionals' views. Patient Prefer Adherence. 2013;7:103–109. doi: 10.2147/PPA.S36791 23378747

27. Jimenez-Baez MV, Marquez-Gonzalez H, Barcenas-Contreras R, Morales Montoya C, Espinosa-Garcia LF. Early diagnosis of diabetic retinopathy in primary care. Colomb Med (Cali). 2015;46(1):14–18. 26019380

28. Thompson AE, Anisimowicz Y, Miedema B, Hogg W, Wodchis WP, Aubrey-Bassler K. The influence of gender and other patient characteristics on health care-seeking behaviour: A QUALICOPC study. BMC Fam Pract. 2016;17:38–38. doi: 10.1186/s12875-016-0440-0 27036116

29. Wilmot E, Idris I. Early onset type 2 diabetes: risk factors, clinical impact and management. Ther Adv Chronic Dis. 2014;5(6):234–244. doi: 10.1177/2040622314548679 25364491

30. Jan Mohamed HJ, Yap RW, Loy SL, Norris SA, Biesma R, Aagaard-Hansen J. Prevalence and determinants of overweight, obesity, and type 2 diabetes mellitus in adults in Malaysia. Asia Pac J Public Health. 2015;27(2):123–135. doi: 10.1177/1010539514562447 25524952


Článek vyšel v časopise

PLOS One


2019 Číslo 10

Nejčtenější v tomto čísle

Tomuto tématu se dále věnují…


Kurzy

Zvyšte si kvalifikaci online z pohodlí domova

Léčba bolesti v ordinaci praktického lékaře
nový kurz
Autoři: MUDr. PhDr. Zdeňka Nováková, Ph.D.

Revmatoidní artritida: včas a k cíli
Autoři: MUDr. Heřman Mann

Jistoty a nástrahy antikoagulační léčby aneb kardiolog - neurolog - farmakolog - nefrolog - právník diskutují
Autoři: doc. MUDr. Štěpán Havránek, Ph.D., prof. MUDr. Roman Herzig, Ph.D., doc. MUDr. Karel Urbánek, Ph.D., prim. MUDr. Jan Vachek, MUDr. et Mgr. Jolana Těšínová, Ph.D.

Léčba akutní pooperační bolesti
Autoři: doc. MUDr. Jiří Málek, CSc.

Nové antipsychotikum kariprazin v léčbě schizofrenie
Autoři: prof. MUDr. Cyril Höschl, DrSc., FRCPsych.

Všechny kurzy
Kurzy Doporučená témata Časopisy
Přihlášení
Zapomenuté heslo

Nemáte účet?  Registrujte se

Zapomenuté heslo

Zadejte e-mailovou adresu se kterou jste vytvářel(a) účet, budou Vám na ni zaslány informace k nastavení nového hesla.

Přihlášení

Nemáte účet?  Registrujte se