Association of Younger Age With Poor Glycemic and Cholesterol Control in Asians With Type 2 Diabetes Mellitus in Singapore

Abstract

Background : The prevalence of type 2 diabetes mellitus (T2DM) in children and adolescents is increasing in both poor and rich countries. Epidemiologic studies have reported significant and continuous associations between HbA1c level and diabetes-related vascular complications. Younger adults with early exposure to hyperglycemia are at high risk for end-organ damage. Few studies have reported the relationship of age to glycemic control in patients with T2DM world-wide and little comparison among young adults and elderly patients especially in the Asian population. This study investigates the relationship of age and glycemic control in Asian patients with T2DM attending primary care clinics in Singapore. Methods : We included T2DM patients who had at least 2 visits to the public-sector primary care clinic for diabetes treatment in 2009 . Demographic characteristics, medical records and laboratory results were extracted from the enterprise-wide chronic disease registry . The mean HbA1c, blood pressure and LDL-cholesterol were trended by age. Multivariate logistic regression was used to identify the factors predicting “poor” glycemic control. Results : There were 58,057 T2DM patients and both the mean HbA1c and LDL-cholesterol were lower among elderly than adult patients. Mean HbA1c was 8.08 ± 1.62% for patients < 45 years old and 6.86 ± 0.99% for patients 85+ years old. Mean LDL-cholesterol levels were 2.84 ± 0.81 and 2.55 ± 0.73 mmol/L for the respective age groups. The Malay and Indian groups had significantly poorer glycemic control compared to the Chinese, AdjOR 1.65 (95% CI: 1.54 - 1.77) and 1.50 (95% CI: 1.40 - 1.61) respectively. Other significant predictors of poor glycemic control included the male gender, presence of maculopathy or retinopathy, peripheral vascular disease, coronary heart disease, heart failure, and being on insulin therapy (AdjOR 8.00; 95% CI: 7.54 - 8.48). Patients with poor LDL-c (4.1+ mmol/L) were 4.2 times more likely to have poor glycemic control (95% CI: 3.78 - 4.66) while those with Grade 2 hypertension were 1.5 times (95% CI: 1.35 - 1.76) more likely than those without hypertension. Conclusions : Younger T2DM patients had poorer glycemic and cholesterol control than older patients in Singapore and they should have targeted interventions to achieve “optimal” glycemic and cholesterol control. J Endocrinol Metab. 2011;1(1):27-37 doi: https://doi.org/10.4021/jem13e