PDB12 - The Prevalence of Comorbidities and Its Association with Poor Glycemic Control in Malaysian Patients with Type 2 Diabetes Mellitus

Abstract

The aim of the study was to determine the prevalence of comorbidities among Malaysian patients with Type 2 Diabetes Mellitus (T2DM) and examine the association between number and types of comorbidities and poor glycemic control. We utilized data from the Malaysian National Diabetes Registry consisting of T2DM patients followed up in public sector primary care clinics between 2013 and 2016. Descriptive analysis was used to determine the prevalence of comorbidities. Multiple logistic regression was used to examine the association between number and type of comorbidities (hypertension, dyslipidemia, retinopathy, ischemic heart disease (IHD), cerebrovascular disease (CeVD), nephropathy, diabetic foot and amputation) and poor glycemic control as measured by HbA1c. A total of 285,761 patients were included in the analysis. Mean age was 62 years and mean duration of diabetes was 7.3 years; 61.2% were female and 61.6% had waist circumference above threshold (male: >90cm, female: >80cm). Most patients (68.9%) did not achieve glycemic control (i.e. had HbA1c >6.5%). A majority (88%) of patients had at least one comorbidity, with hypertension being the most common (76.4%) followed by dyslipidemia (67.5%) and nephropathy (10.9%). Factors that were significantly associated with increased odds of an elevated HbA1c were a longer duration of diabetes (OR:3.06), waist circumference above threshold (OR:1.30), dyslipidemia (OR:1.21) and presence of IHD (OR:1.12). In contrast, age (OR:0.96), female sex (OR:0.95), presence of hypertension (OR:0.84) and CeVD (OR:0.85) reduced the odds of poor control. Total number of comorbidities and presence of retinopathy, nephropathy, diabetic foot ulcer and amputation were not associated with elevated HbA1c. In terms of the impact of comorbidities, our results were mixed. Impact depended on the type of comorbidity present. The total number of comorbidities did not affect outcome. Our analysis did not allow directionality of the association to be ascertained.