Presentation (CTI)

OBJECTIVES: Clinical trials have demonstrated that anti-diabetic drugs reduce glycated haemoglobin (HbA1c). However, variability in prescribing practices among prescribers may significantly affect glycaemic control, highlighting the need for adherence to guidelines-directed medical therapy (GDMT). The aim is to analyse the five-year HbA1c trajectories in patients with Type 2 Diabetes (T2D) at a Malaysian tertiary hospital. The primary objective is to identify patterns of glycaemic progression and regression in these patients. The secondary objective is to investigate prescribers' adherence to GDMT in managing T2D patients with poor glycaemic progression.
METHODS: A retrospective cohort study over 5 years, from Jan 2018 to Dec 2022, was conducted on a cohort of multi-ethnic adult Asian patients with a clinical diagnosis of T2D managed by physicians. A cohort of patients was categorised into ten groups based on their HbA1c values. Each category was then grouped into four pairs based on the year of results.
RESULTS: Among the cohort of 23,048 patients with 51,587 HbA1c results, 63% were aged below 60 years, and 59.50% were males. Based on HbA1c results 36.81% were normoglycaemia and remain as normoglycaemia, 1.22% normoglycaemia to prediabetic, 0.22% normoglycaemia to diabetic, 0.03% normoglycaemia to prediabetic to diabetic, 1.08% prediabetic to normoglycaemia, 24.02% prediabetic and remain as prediabetic, 1.41% prediabetic to diabetic, 0.43% diabetic to normoglycaemia, 1.41% diabetic to prediabetic, 33.37% diabetic and remain as diabetic. Attainment of good HbA1c control was 46%. For patients in the diabetic and remain diabetic group, anti-diabetic drugs were prescribed based on GDMT in only 17%.
CONCLUSIONS: This study suggests that suboptimal pharmacotherapy is being prescribed to diabetic patients with poorly controlled HbA1c regardless of their age and gender. For these patients, prescribers are non-adherent to GDMT, which gradually worsens disease progression, increases visits to healthcare providers, and escalates costs.