63
Test done N
5671100.0 5671100.0 7962100.0 7962100.0 7962100.0 6618100.0 6526100.0
5935100.0 5885100.0
Missing Achieved
N 7033.2
3215.2 13844.7
18860.8 11436.9
4718.3 13753.7
16274.3 4420.4
Not achieved
N 14166.8
17984.8 17155.3
12139.2 19563.1
21081.7 11846.3
5625.7 17279.6
Test done N
211100.0 211100.0
309100.0 309100.0
309100.0 257100.0
255100.0 218100.0
216100.0
64
2.1.1.5 Serum creatinine Serum profile
The mean serum creatinine in the study population was 88.45 µmolL with standard deviation of 49.84 µmolL. The mean serum creatinine for males 102.92 ± 56.00 µmolL was higher than for females
79.01±42.86 µmolL. There was an increasing trend of serum creatinine in the age groups of 30 years and above Table 2.1.23. Among the Malaysians, Malays had the highest mean serum creatinine
103.19±83.60 µmolL; followed by Chinese 100.91± 82.52 µmolL, Indians 85.75±53.88 µmolL and other Malaysian 85.59±20.53 µmolL. The longer the duration of disease, the higher the mean of
serum creatinine is Table 2.1.25.
Table 2.1.21 Distribution of serum profile for patients with T2DM, DRM-ADCM, January 1
st
– December 31
st
2009 Measurement
Not done N
Missing Mean SD
Median IQR
Min, Max
Serum creatinineumolL
1165916 4612165
1310918 88.4549.84
8033 301,322
Table 2.1.22 Distribution of serum profile for patients with T2DM by gender, DRM-ADCM, January 1
st
– December 31
st
2009 Measurement
Statistics Male
Female Missing
Serum creatinine N
18170 27874
77 Missing
5733 7358
18 Mean SD
102.9256.00 79.0142.86
88.4836.78 Min, Max
30.0,1322.0 30.0,1126.0
40.0,225.0 Median IQR
93.030.0 70.026.0
83.040.0
Table 2.1.23 Distribution of serum profile for patients with T2DM by age group, DRM-ADCM, January 1
st
– December 31
st
2009 Serum
profile
Age group
years
Not done N
Missing Mean SD
Median IQR
Min, Max
Serum creatinine
18 – 19 1025
2153 923
72.3315.98 7025
52,109 20 – 24
3121 8054
3725 71.6726.49
6522 38,165
25 – 29 9623
22554 9222
67.2016.35 6720
33,121 30 – 34
20523 49556
18121 74.5136.90
6825 30,429
35 – 39 33518
111561 36620
75.0447.22 6725
30,958 40 – 44
72917 268364
76118 76.1046.57
7026 30,907
45 – 49 124017
491166 130017 78.3640.79
7228 30,823
50 – 54 177116
714666 185617 83.1153.99
7529 301,322
55 – 59 207016
879867 223717 86.8548.88
7931 301,160
60 – 64 182216
789768 197517 91.9547.76
8434 30,840
65 – 69 137316
565566 151818 95.2349.77
8634 301,038
70 – 74 106216
402362 142722 98.9550.33
8938 30,907
75 – 79 51516
197460 78224
105.0556.05 9340
30,821 80
40019 109853
56827 108.4858.14
9741 30,882
65
Table 2.1.24 Distribution of serum profile for patients with T2DM by ethnicity, DRM-ADCM, January 1
st
– December 31
st
2009 Serum
profile
Ethnicity Not done
N Missing
Mean SD Median
IQR Min,
Max
Serum creatinine
Malay 247527
210923 452350 103.1983.60 8336
301,322 Chinese
247545 155529 142026 100.9182.52
8237 321,012
Indian 247538
194230 204432 85.7553.88
7627 35,891
Other Malaysian
247598 100
301 85.5920.53
8633 61,121
Non Malaysian
2475100 30
10 49.3316.74
5929 30,59
Missing 247596
713 301
103.1167.09 8949
40,380
Table 2.1.25 Distribution of serum profile for patients with T2DM by groups of duration of diabetes, DRM-ADCM, January 1
st
– December 31
st
2009 Serum
profile Duration of
diabetes
years
Not done N
Missing Mean SD
Median IQR
Min, Max
Serum creatinine
5 634522
2283978 00
84.1942.03 7731
301,160 5 – 10
361518 1632782
00 89.3047.58
8135 30,973
10 163820
669880 00
100.9472.79 8539
301,322 Missing
610 2572
1310998 86.4234.60
8133 31,366
2.1.1.6 Clinical examinations
More than half of the study population had not tested their urine protein 52.3, urine microalbumin 64.4 and electrocardiography 63.7 and had not had their fundus examined 73.9. Only 9.6
of the study’s male population had been screened for erectile dysfunction. Half of the study populations 53.7 have had their foot examined.
Table 2.1.26 Distribution of clinical examination for patients with T2DM, DRM-ADCM, January 1
st
– December 31
st
2009 Clinical examination
Done N Not done N
Profile renal Urine microalbumin
2520835.6 4568164.4
Urine protein 3381547.7
3707452.3 Fundus examination
1852626.1 5236373.9
Foot examination 3803653.7
3285346.3 Electrocardiography
2576536.3 4512463.7
66
Table 2.1.27 Distribution of screening for erectile dysfunction for patients male with T2DM, DRM-ADCM, January 1
st
– December 31
st
2009 Clinical examination
Done N Not done N
Screening for erectile dysfunction 27869.6
6810390.4 Out of those who had clinical examinations, one-third had abnormal urine microalbumin 29.0. One-
fifth had abnormal urine protein 22.0, abnormal finding in their fundus examination 19.9, and were positive for erectile dysfunction 18.7. Less than 10 of the population who had examined
their foot 6.1 and tested for electrocardiography 7.9 had abnormal finding.
Table 2.1.28 Distribution of clinical examination test for patients with T2DM, DRM-ADCM, January 1
st
– December 31
st
2009 Clinical examination
Done Negative N
Positive N Total
Profile renal Urine microalbumin
1789571.0 731329.0
25208 Urine protein
2637578.0 744022.0
33815 Fundus examination
1483980.1 368719.9
18526 Foot examination
3571593.9 23216.1
38036 Electrocardiography
2372692.1 20397.9
25765
Table 2.1.29 Distribution of screening for erectile dysfunction for patients male with T2DM, DRM-ADCM, January 1
st
– December 31
st
2009 Clinical examination
Done Negative N
Positive N Total
Screening for erectile dysfunction 226481.3
52218.7 2786
The proportion of males and females with abnormal findings in the parameters mentioned above were not much different. The proportion of males who had abnormal finding in electrocardiography was 9.2
compared with 7.0 in females.
67
Table 2.1.30 Distribution of clinical examination test for patients with T2DM by gender, DRM-ADCM, January 1
st
– December 31
st
2009 Gender
Status Urine micro.
N Urine protein
N Fundus Exam.
N Foot exam.
N ECG
N ED
N
Male Negative
691669.5 990475.1
569379.0 1390393.6
940290.8 226481.3
Positive 304230.5
329124.9 151021.0
9536.4 9579.2
52218.7
Done
9958100.0 13195100.0
7203100.0 14856100.0
10359100.0 2786100.0
Female Negative
1097372.0 1645479.9
913280.9 2177994.1
1431093.0 NA
Positive 426628.0
414020.1 216119.1
13565.9 10767.0
NA
Done 15239100.0
20594100.0 11293100.0
23135100.0 15386100.0
NA Missing
Negative 654.5
1765.4 1446.7
3373.3 1470.0
NA
Positive
545.5 934.6
1653.3 1226.7
630.0 NA
Done 11100.0
26100.0 30100.0
45100.0 20100.0
NA For urine microalbuminuria, fundus examination, foot examination and electrocardiography test, the proportion of abnormal findings increased in the older age
group. One-fifth of the males aged 45 and above had abnormal findings when screened for erectile dysfunction. However, the reported erectile dysfunction reduced to 13 in those aged 80 years and above.
Table 2.1.31 Distribution of clinical examination test for patients with T2DM by age group, DRM-ADCM, January 1
st
– December 31
st
2009 Age group
years
Status Urine
microalbumin N
Urine protein N
Fundus exam. N
Foot exam. N
ECG N
ED N
18 – 19 Negative
777.8 1575.0
990.0 17100.0
11100.0 00.0
Positive
222.2 525.0
110.0 00.0
00.0 00.0
Done 9100.0
20100.0 10100.0
17100.0 11100.0
00.0 20 – 24
Negative 2873.7
5179.7 3278.0
6693.0 4497.8
480.0
Positive
1026.3 1320.3
922.0 57.0
12.2 120.0
Done
38100.0 64100.0
41100.0 71100.0
45100.0 5100.0
25 – 29 Negative
8768.5 14976.4
9691.4 20197.1
11593.5 11100.0
Positive 4031.5
4623.6 98.6
62.9 86.5
00.0
Done
127100.0 195100.0
105100.0 207100.0
123100.0 11100.0
30 – 34 Negative
19473.5 31078.5
17592.1 43397.3
26797.4 2787.1
68
Age group years
Status Urine
microalbumin N
Urine protein N
Fundus exam. N
Foot exam. N
ECG N
ED N
Positive 7026.5
8521.5 157.9
122.7 72.6
412.9
Done
264100.0 395100.0
190100.0 445100.0
274100.0 31100.0
35 – 39 Negative
41573.6 64777.8
40390.2 92897.0
54996.1 4384.3
Positive 14926.4
18522.2 449.8
293.0 223.9
815.7
Done 564100.0
832100.0 447100.0
957100.0 571100.0
51100.0 40 – 44
Negative 110073.5
158878.7 102490.6
221595.9 144995.4
12984.9
Positive
39726.5 43121.3
1069.4 954.1
704.6 2315.1
Done 1497100.0
2019100.0 1130100.0
2310100.0 1519100.0
152100.0 45 – 49
Negative 194572.7
279978.3 184587.7
399695.6 261895.0
21779.5
Positive
73127.3 77421.7
25812.3 1824.4
1385.0 5620.5
Done
2676100.0 3573100.0
2103100.0 4178100.0
2756100.0 273100.0
50 – 54 Negative
286672.6 405678.3
252584.3 561894.4
390493.6 37283.2
Positive 108427.4
112321.7 47015.7
3365.6 2676.4
7516.8
Done
3950100.0 5179100.0
2995100.0 5954100.0
4171100.0 447100.0
55 – 59 Negative
342770.3 508778.6
298382.4 693594.7
458193.1 44481.2
Positive 144929.7
138821.4 63917.6
3895.3 3406.9
10318.8
Done 4876100.0
6475100.0 3622100.0
7324100.0 4921100.0
547100.0 60 – 64
Negative 306270.2
453778.2 247376.8
611093.6 400092.1
39981.3
Positive
129829.8 126721.8
74623.2 4196.4
3437.9 9218.7
Done 4360100.0
5804100.0 3219100.0
6529100.0 4343100.0
491100.0 65 – 69
Negative 218170.4
322777.2 162474.2
425692.7 281289.7
29482.8
Positive
91729.6 95422.8
56525.8 3347.3
32310.3 6117.2
Done
3098100.0 4181100.0
2189100.0 4590100.0
3135100.0 355100.0
70 – 74 Negative
154170.2 225577.1
103669.4 287491.4
196888.5 18573.1
Positive 65429.8
67022.9 45630.6
2698.6 25611.5
6826.9
Done
2195100.0 2925100.0
1492100.0 3143100.0
2224100.0 253100.0
75 –79 Negative
68368.3 103976.5
39662.4 132789.9
92386.1 9279.3
Positive 31731.7
32023.5 23937.6
14910.1 14913.9
2420.7
Done 1000100.0
1359100.0 635100.0
1476100.0 1072100.0
116100.0 80
Negative 35964.8
61577.5 21862.6
73988.5 48580.8
4787.0
Positive
19535.2 17922.5
13037.4 9611.5
11519.2 713.0
Done 554100.0
794100.0 348100.0
835100.0 600100.0
54100.0
69
ED is for male patients only.
The proportions of abnormal findings for fundus urine microalbumin and urine protein were comparable among the Malays, Chinese and Indians. The Chinese had the highest proportion of abnormal findings in fundus examination and electrocardiography followed by Indians and Malays. Indians had the
highest proportion of abnormal finding during foot examination 9.3 while Malays had the highest proportion of abnormal finding when screened for erectile dysfunction 23.1.
Table 2.1.32 Distribution of clinical examination for patients with T2DM by ethnicity, DRM-ADCM, January 1
st
– December 31
st
2009 Ethnicity
Status Urine
microalbumin N
Urine protein N
Fundus exam. N
Foot exam. N
ECG N
ED N
Malay Negative
1113271.1 1663176.7
967082.6 2385495.1
1506893.5 126676.9
Positive
452928.9 504223.3
203617.4 12324.9
10506.5 38123.1
Done
15661100.0 21673100.0
11706100.0 25086100.0
16118100.0 1647100.0
Chinese Negative
360968.9 535679.1
259974.4 629892.4
442788.6 60589.6
Positive
162831.1 141720.9
89525.6 5197.6
56911.4 7010.4
Done 5237100.0
6773100.0 3494100.0
6817100.0 4996100.0
675100.0 Indian
Negative 301773.3
406682.2 241577.2
518690.7 399491.2
36885.0
Positive 109826.7
88017.8 71322.8
5339.3 3848.8
6515.0
Done
4115100.0 4946100.0
3128100.0 5719100.0
4378100.0 433100.0
Other Malaysian
Negative 11572.8
25577.5 12082.2
30694.7 20090.9
2482.8
Positive
4327.2 7422.5
2617.8 175.3
209.1 517.2
Done
158100.0 329100.0
146100.0 323100.0
220100.0 29100.0
Non Malaysian
Negative 1659.3
4977.8 2291.7
3882.6 2573.5
150.0
Positive
1140.7 1422.2
28.3 817.4
926.5 150.0
Done
27100.0 63100.0
24100.0 46100.0
34100.0 2100.0
Missing Negative
660.0 1858.1
1346.4 3373.3
1263.2 00.0
Positive 440.0
1341.9 1553.6
1226.7 736.8
00.0
Done
10100.0 31100.0
28100.0 45100.0
19100.0 00.0
ED is for male patients only.
70 The longer the duration of diabetes, the higher is the proportion of study population with abnormal findings for urine microalbumin, urine protein, fundus
examination, foot examination and electrocardiography. The proportion of abnormal findings from erectile dysfunction screening was comparable for those with disease duration 5 years and those with disease duration 5 to 10 years. Those with disease duration of more than 10 years had the least rate of
abnormal findings for erectile dysfunction 14.4.
Table 2.1.33 Distribution of clinical examination for patients with T2DM by groups of duration of diabetes, DRM-ADCM, January 1
st
– December 31
st
2009 Duration of
diabetes years
Status Urine
microalbumin N
Urine protein N
Fundus exam. N
Foot exam. N
ECG N
ED N
5 Negative
920874.3 1378581.1
775286.0 1872395.2
1207693.6 119381.2
Positive
318325.7 321718.9
126614.0 9384.8
8296.4 27718.8
Done 12391100.0
17002100.0 9018100.0
19661100.0 12905100.0
1470100.0 5 – 10
Negative 632069.9
894276.3 539978.7
1253794.2 836391.9
68979.3
Positive 272030.1
278423.7 146221.3
7705.8 7348.1
18020.7
Done
9040100.0 11726100.0
6861100.0 13307100.0
9097100.0 869100.0
10 Negative
226862.2 350171.4
159963.2 425887.6
315787.1 36985.6
Positive
137637.8 139928.6
93036.8 60412.4
46612.9 6214.4
Done
3644100.0 4900100.0
2529100.0 4862100.0
3623100.0 431100.0
Missing Negative
9974.4 14778.6
8975.4 19795.6
13092.9 1381.3
Positive
3425.6 4021.4
2924.6 94.4
107.1 318.8
Done 133100.0
187100.0 118100.0
206100.0 140100.0
16100.0
ED is for male patients only.
71
2.1.1.7 Glomerular filtration rate GFR
The GFR in this study was derived from the Cockcroft-Gault formula. About one-fifth 18.7 of the study population had GFR60mlmin. The proportion of females
19.7 who had GFR60mlmin was higher than the proportion of males 17.4. The proportion of patients who had GFR60mlmin was increased in the older age group. The ethnic group with the
highest proportion of patients who had GFR60mlmin was the Chinese 24.1, followed by the Malays 18.9 and the Indians 12.9. The proportion of patients who had GFR60mlmin
increased with age.
Table 2.1.34 Distribution of glomerular filtration rate GFR based on cut-off points in patients with T2DM, DRM-ADCM, January 1
st
– December 31
st
2009 GFR60mlmin
N GFR 60mlmin
N Missing
N GFR
1327618.7 3178644.8
258236.4
Table 2.1.35 Distribution of glomerular filtration rate GFR based on cut-off points in patients with T2DM by gender, DRM-ADCM, January 1
st
– December 31
st
2009 Gender
GFR60mlmin N
GFR 60mlmin N Missing N
Male 504517.4
1268043.8 1121438.8
Female 823119.7
1910645.7 1450434.7
Table 2.1.36 Distribution of glomerular filtration rate GFR based on cut-off points in patients with T2DM by age group, DRM-ADCM, January 1
st
– December 31
st
2009 Age group
years
GFR60mlmin N
GFR 60mlmin N Missing N
18 – 19 00.0
1947.5 2152.5
20 – 24 32.0
7550.7 7047.3
25 – 29 20.5
21652.3 19547.2
30 – 34 182.0
46552.8 39845.2
35 – 39 321.8
105858.3 72640.0
40 – 44 952.3
254461.0 153436.8
45 – 49 2984.0
452460.7 262935.3
50 – 54 7446.9
627358.2 375634.9
55 – 59 164412.5
696953.2 449234.3
60 – 64 255721.9
519344.4 394433.7
65 – 69 273932.1
279132.7 301635.3
70 – 74 264140.6
125619.3 261540.2
75 – 79 155547.5
32810.0 138842.4
80 94845.9
753.6 104350.5
72
Table 2.1.37 Distribution of glomerular filtration rate GFR based on cut-off points in patients with T2DM by ethnicity, DRM-ADCM, January 1
st
– December 31
st
2009
Ethnicity GFR60mlmin
N GFR 60mlmin N
Missing N
Malay 828018.9
1972044.9 1590236.2
Chinese 323524.1
569642.3 452033.6
Indian 164012.9
601347.2 508639.9
Other Malaysian 10618.0
29650.3 18631.6
Non Malaysian 910.2
5663.6 2326.1
Missing 65.0
54.1 11090.9
Table 2.1.38 Distribution of glomerular filtration rate GFR based on cut-off points in patients with T2DM by groups of duration of diabetes, DRM-ADCM, January 1
st
– December 31
st
2009
Duration of diabetes years
GFR60mlmin N
GFR 60mlmin N
Missing N
5 years 529818.2
1714158.7 674523.1
5 – 10 years 514625.8
1085754.4 393919.8
10 years 276033.1
360843.3 196823.6
Missing 720.5
1801.3 1317598.1
73
2.1.1.8 Body mass index BMI and waist circumference
There were 53915 subjects with their BMI measured but only 16.4 had normal BMI Table 2.1.39. The proportion of females with normal BMI was 15.6 and it was slightly higher in males 17.5. Table 2.1.40
More elderly patients above the age of 65 years were within the normal BMI range Table 2.1.41. The Chinese had a higher percentage of patients with normal BMI at 22.1 than the Indians 16.9 and Malays 14.5. Those with duration of diabetes of more than 10 years had the highest rate of normal BMI at
23.1 in contrast to only 14.2 of those with diabetes less than 5 years. For waist circumference, 10324 males and 16156 females were measured. For males, 35.9 n=3711 had waist circumference of less than 90 cm while for
females, only 16.6 n=2681 attained target level of less than 80 cm. Similar to BMI, the elderly of above the age of 65 years had higher percentages of normal waist circumference for both males and females. The Malay males had higher normal waist circumference 38.0 compared with the Chinese
36.3 and Indians 28.7. Eighteen percent of the Malay and Chinese females and 10.4 of the Indian females had normal waist circumference. The number of subjects with normal waist circumference slightly increased with the duration of diabetes as shown in Table 2.1.48.
Table 2.1.39 Distribution of body mass index BMI based on cut-off points in patients with T2DM, DRM-ADCM, January 1
st
– December 31
st
2009
BMI classification is based on the Malaysian Clinical Practice Guideline for Obesity 2004 Clinical information
n
Underweight 18.5 kgm
2
8931.7 Normal 18.5 – 22.9 kgm
2
883416.4 Overweight 23.0
4418882.0 Pre-obese 23.0 – 27.4 kgm
2
2095238.9 Obese I 27.5 – 34.9 kgm
2
1942136.0 Obese II 35.0 – 39.9 kgm
2
28295.2 Obese III 40 kgm
2
9861.8 Test Done
53915100.0
74
Table 2.1.40 Distribution of body mass index BMI on cut-off points in patients with T2DM by gender, DRM-ADCM, January 1
st
– December 31
st
2009
Gender Test done for
BMI N
BMI kgm
2
Underweight 18.5
Normal 18.5 – 22.9
Overweight 23.0
Pre-obese 23.0 – 27.4
Obese I 27.5 – 34.9
Obese II 35.0 – 39.9
Obese III 40
Male N 21436
3471.6 375517.5
1733480.9 918442.8
716533.4 7543.5
2311.1 Female N
32406 5461.7
506815.6 2679282.7
1174136.2 1223137.7
20676.4 7532.3
Missing N 73
00.0 1115.1
6284.9 2737.0
2534.2 811.0
22.7
Table 2.1.41 Distribution of body mass index BMI based on cut-off points in patients with T2DM by age group, DRM-ADCM, January 1
st
– December 31
st
2009 Age group
years
Test done for BMI
N BMI kgm
2
Underweight 18.5
Normal 18.5 – 22.9
Overweight 23.0
Pre-obese 23.0 – 27.4
Obese I 27.5 – 34.9
Obese II 35.0 – 39.9
Obese III 40
18 – 19 N
27 27.4
27.4 2385.2
518.5 1140.7
622.2 13.7
20 – 24 N
103 32.9
1615.5 8481.6
2221.4 4139.8
1211.7 98.7
25 – 29 N
293 31.0
299.9 26189.1
6622.5 15151.5
299.9 155.1
30 – 34 N
643 121.9
538.2 57889.9
16926.3 27642.9
7411.5 599.2
35 – 39 N
1345 70.5
1128.3 122691.2
38928.9 63547.2
13810.3 644.8
40 – 44 N
3229 371.1
3019.3 289189.5
110734.3 141443.8
2648.2 1063.3
45 – 49 N
5813 530.9
59210.2 516888.9
214536.9 241041.5
4658.0 1482.5
50 – 54 8423
690.8 102612.2
732887.0 308336.6
345441.0 5997.1
1922.3
75 N
55 – 59 N
10223 1341.3
147714.4 861284.2
387937.9 398239.0
5705.6 1811.8
60 – 64 N
9161 1181.3
152116.6 752282.1
390742.6 311734.0
3834.2 1151.3
65 – 69 N
6568 1482.3
142821.7 499276.0
272841.5 204231.1
1662.5 560.9
70 – 74 N
4620 1332.9
117925.5 330871.6
201643.6 117625.5
912.0 250.5
75 – 79 N
2218 904.1
67030.2 145865.7
92141.5 50422.7
241.1 90.4
80 N 1249
846.7 42834.3
73759.0 51541.2
20816.7 80.6
60.5
Table 2.1.42 Distribution of body mass index BMI based on cut-off points in patients with T2DM by ethnicity, DRM-ADCM, January 1
st
– December 31
st
2009
Ethnicity Test done for
BMI N
BMI kgm
2
Underweight 18.5
Normal 18.5 – 22.9
Overweight 23.0
Pre-obese 23.0 – 27.4
Obese I 27.5 – 34.9
Obese II 35.0 – 39.9
Obese III 40
Malay N 33686
5421.6 487414.5
2827083.9 1261537.4
1294638.4 20146.0
6952.1 Chinese N
10463 2222.1
231422.1 792775.8
459843.9 299428.6
2552.4 800.8
Indian N 9165
1211.3 155216.9
749281.7 350038.2
327035.7 5205.7
2022.2 Other Malaysian
N 459
81.7 6915.0
38283.2 18440.1
16235.3 306.5
61.3 Non Malaysian N
72 00.0
1622.2 5677.8
2940.3 2331.9
34.2 11.4
Missing N 70
00.0 912.9
6187.1 2637.1
2637.1 710.0
22.9
76
Table 2.1.43 Distribution of body mass index BMI based on cut-off points in patients with T2DM by groups of duration of diabetes, DRM-ADCM, January 1
st
– December 31
st
2009
Duration of diabetes years
Test done for BMI
N BMI kgm
2
Underweight 18.5
Normal 18.5 – 22.9
Overweight 23.0
Pre-obese 23.0 – 27.4
Obese I 27.5 – 34.9
Obese II 35.0 – 39.9
Obese III 40
5 N 27330
4221.5 387014.2
2303884.3 1011237.0
1057138.7 17246.3
6312.3 5 – 10 N
18858 2981.6
320217.0 1535881.4
763340.5 659335.0
8484.5 2841.5
10 N 7430
1662.2 171923.1
554574.6 309141.6
214928.9 2393.2
660.9 Missing N
297 72.4
4314.5 24783.2
11639.1 10836.4
186.1 51.7
Table 2.1.44 Distribution of waist circumference based on cut-off points in patients with T2DM, DRM-ADCM, January 1
st
– December 31
st
2009
Clinical information Test done
N Achieved
N Not achieved
N
Waist circumference 90cm Male 10324
371136 661364
Waist circumference 80cm Female 16156
268117 1347583
77
Table 2.1.45 Distribution of waist circumference based on cut-off points in patients with T2DM by gender, DRM-ADCM, January 1
st
– December 31
st
2009
Gender Status
Waist circumference 90cm Male
Waist circumference 80cm Female
Male Achieved N
371135.9 Not achieved N
661364.1
Test done N 10324100.0
Female Achieved N
268116.6 Not achieved N
1347583.4
Test done N 16156100.0
Achieved waist circumference for male is 90cm and female 80cm
Table 2.1.46 Distribution of waist circumference based on cut-off points in patients with T2DM by age group, DRM-ADCM, January 1
st
– December 31
st
2009 Age group
years Status
Waist circumference 90cm Male
Waist circumference 80cm Female
18 – 19 Achieved N
00.0 325.0
Not achieved N 3100.0
975.0
Test done N 3100.0
12100.0 20 – 24
Achieved N 646.2
925.7 Not achieved N
753.8 2674.3
Test done N
13100.0 35100.0
25 – 29 Achieved N
1637.2 1515.0
Not achieved N 2762.8
8585.0
Test done N
43100.0 100100.0
30 – 34 Achieved N
3829.5 2111.2
Not achieved N 9170.5
16788.8
Test done N 129100.0
188100.0 35 – 39
Achieved N 6431.2
6814.4 Not achieved N
14168.8 40385.6
Test done N 205100.0
471100.0 40 – 44
Achieved N 19033.4
15114.3 Not achieved N
37966.6 90285.7
Test done N
569100.0 1053100.0
45 – 49 Achieved N
35434.2 30016.2
Not achieved N 68065.8
155283.8
Test done N
1034100.0 1852100.0
50 – 54 Achieved N
50733.1 39514.9
Not achieved N 102566.9
226185.1
Test done N 1532100.0
2656100.0 55 – 59
Achieved N 67533.3
51016.4 Not achieved N
135466.7 259283.6
Test done N 2029100.0
3102100.0
78
Age group years
Status Waist circumference
90cm Male Waist circumference
80cm Female
60 – 64 Achieved N
64534.7 42116.2
Not achieved N 121365.3
217183.8
Test done N
1858100.0 2592100.0
65 – 69 Achieved N
53139.5 31417.1
Not achieved N 81460.5
152282.9
Test done N
1345100.0 1836100.0
70 – 74 Achieved N
38042.4 25819.8
Not achieved N 51657.6
104380.2
Test done N 896100.0
1301100.0 75 – 79
Achieved N 17140.0
11819.3 Not achieved N
25760.0 49280.7
Test done N 428100.0
610100.0 80
Achieved N 13455.8
9828.2 Not achieved N
10644.2 25071.8
Test done N
240100.0 348100.0
Achieved waist circumference for male is 90cm and female 80cm
Table 2.1.47 Distribution of waist circumference based on cut-off points in patients with T2DM by ethnicity, DRM-ADCM, January 1
st
– December 31
st
2009 Ethnicity
Status Waist circumference
90cmMale Waist circumference
80cmFemale
Malay Achieved N
224938.0 182818.0
Not achieved N 366662.0
834782.0
Test done N
5915100.0 10175100.0
Chinese Achieved N
91636.3 53718.0
Not achieved N 161063.7
244882.0
Test done N
2526100.0 2985100.0
Indian Achieved N
50928.7 29710.4
Not achieved N 126271.3
256189.6
Test done N 1771100.0
2858100.0 Other Malaysian
Achieved N 3231.7
1815.4 Not achieved N
6968.3 9984.6
Test done N
101100.0 117100.0
Non Malaysian Achieved N
550.0 16.3
Not achieved N 550.0
1593.8
Test done N
10100.0 16100.0
Missing Achieved N
00.0 00.0
Not achieved N 1100.0
5100.0
Test done N 1100.0
5100.0
79
Table 2.1.48 Distribution of waist circumference based on cut-off points in patients with T2DM by groups of duration of diabetes, DRM-ADCM, January 1
st
– December 31
st
2009 Duration of
diabetes years
Status Waist circumference
90cmMale Waist circumference
80cmFemale
5 Achieved N
200836.0 144316.8
Not achieved N 356764.0
71683.2
Test done N 5575100.0
8607100.0 5 – 10
Achieved N 112935.4
90516.7 Not achieved N
206064.6 451283.3
Test done N 3189100.0
5417100.0 10
Achieved N 55237.0
31815.5 Not achieved N
94163.0 173084.5
Test done N
1493100.0 2048100.0
Missing Achieved N
2232.8 1517.9
Not achieved N 4567.2
6982.1
Test done N 67100.0
84100.0
80
2.1.2 Complications 2.1.2.1 Diabetes complications
Slightly more than a quarter of subjects were screened for diabetes complications; 26.1 N=18526 for retinopathy and 53.7 N=8036 for foot problems. Table 3.1.a However, the pickup rates for
complications were generally low. Only 4.4 N=70889 of total patients registered had documented retinopathy, 9.0 N=1659 had
nephropathy and 7.3 N=70889 had foot problems. A study of diabetes control and complications in private primary healthcare in Malaysia found high complication rates with nephropathy 43.3;
albuminuria: 22.9 and microalbuminuria: 20.4 as the most common. This was followed by neuropathy 30.1 and background retinopathy 23.5.
1
These results were partly due to lack of patients who were screened as well as poor complication assessment at busy primary care clinics.
In terms of gender, more males suffered from complications such as ischaemic heart disease 4.1; N=28939 and nephropathy 8.4; N=2424 compared with the female diabetics 2.6 N=1108 and
6.6 N=2752 respectively Table 2.1.50. The elderly of more than 60 years old had higher rate of complications as shown in Table 2.1.51. Among the three major races in Malaysia, the Chinese seem to
have suffered the highest rates across all evaluated complications Table 2.1.52. Table 2.1.53 shows the
distribution of complications according to duration of illness. More subjects with diabetes more than 10 years had retinopathy 11.2 compared with only 3.2 in the group with less than 5 years of diabetes.
Other complications also increased with longer duration.
81
Table 2.1.49 Documented complications at notification for patients with T2DM, DRM-ADCM,
January 1
st
– December 31
st
2009 Complications
Status N
Retinopathy Yes
31134.4 No
3143344.3 Not known
2323432.8 Missing
1310918.5 Total
70889100.0 Ischaemic heart disease
Yes 23023.2
No 3875554.7
Not known 1672323.6
Missing 1310918.5
Total 70889100.0
Cerebrovascular disease – Stroke TIA Yes
6230.9 No
4329461.1 Not known
1386319.6 Missing
1310918.5 Total
70889100.0 Nephropathy
Yes 51767.3
No 3627951.2
Not known 2932541.4
Missing 1090.15
Total 70889100.0
Diabetes foot problem Yes
51877.3 No
3633751.3 Not known
1625622.9 Missing
1310918.5 Total
70889100.0
82
Table 2.1.50 Documented complications at notification for patients with T2DM by gender, DRM-ADCM, January 1
st
– December 31
st
2009
Gender Status
Retinopathy Ischaemic heart disease
Cerebrovascular disease
Nephropathy Diabetes foot
problem
Male Yes N
12834.4 11804.1
3101.1 24248.4
10523.6 No N
1222042.2 1503351.9
1689258.4 1383647.8
1684358.2 Not known N
1543653.3 1272644.0
1173740.6 1267943.8
1104438.2 Total N
28939100.0 28939100.0
28939100.0 28939100.0
28939100.0 Female
Yes N 18084.3
11082.6 3110.7
27526.6 14263.4
No N 1916945.8
2366456.6 2633162.9
2244353.6 2588561.9
Not known N 2086449.9
1706940.8 1519936.3
1664639.8 1453034.7
Total N 41841100.0
41841100.0 41841100.0
41841100.0 41841100.0
Missing Yes N
2220.2 1412.8
21.8 1110.1
1311.9 No N
4440.4 5853.2
7165.1 5853.2
5954.1 Not known N
4339.4 3733.9
3633.0 4036.7
3733.9 Total N
109100.0 109100.0
109100.0 109100.0
109100.0
Table 2.1.51 Documented complications at notification for patients with T2DM by age group, DRM-ADCM, January 1
st
– December 31
st
2009
Age Group years
Status Retinopathy
Ischaemic heart Disease Cerebrovascular
disease Nephropathy
Diabetes foot problem
18 – 19 Yes N
00.0 00.0
00.0 00.0
00.0 No N
758.3 650.0
866.7 866.7
758.3 Not known
N 541.7
650.0 433.3
433.3 541.7
Total N 12100.0
12100.0 12100.0
12100.0 12100.0
83
Age Group years
Status Retinopathy
Ischaemic heart Disease Cerebrovascular
disease Nephropathy
Diabetes foot problem
20 – 24 Yes N
12.4 00.0
00.0 37.3
00.0 No N
2048.8 2663.4
3073.2 2561.0
2970.7 Not known
N 2048.8
1536.6 1126.8
1331.7 1229.3
Total N 41100.0
41100.0 41100.0
41100.0 41100.0
25– 29 Yes N
43.7 00.0
00.0 32.8
21.9 No N
6358.3 7872.2
8275.9 7771.3
8477.8 Not known
N 4138.0
3027.8 2624.1
2825.9 2220.4
Total N 108100.0
108100.0 108100.0
108100.0 108100.0
30 – 34 Yes N
83.5 41.8
00.0 52.2
10.4 No N
12454.6 16170.9
17074.9 15066.1
17878.4 Not known
N 9541.9
6227.3 5725.1
7231.7 4821.1
Total N 227100.0
227100.0 227100.0
227100.0 227100.0
35– 39 Yes N
142.6 152.8
20.4 387.1
81.5 No N
28152.2 35866.5
39172.7 32660.6
39272.9 Not known
N 24345.2
16530.7 14527.0
17432.3 13825.7
Total N 538100.0
538100.0 538100.0
538100.0 538100.0
40 – 44 Yes N
111.0 343.0
70.6 716.2
171.5 No N
66257.7 79669.3
84373.4 74264.6
86575.3 Not known
N 47541.4
31827.7 29826.0
33529.2 26623.2
Total N 1148100.0
1148100.0 1148100.0
1148100.0 1148100.0
45– 49 Yes N
482.4 1055.2
140.7 1457.1
422.1 No N
112755.4 136867.3
149973.7 129763.8
157777.6 Not known
N 85842.2
56027.5 52025.6
59129.1 41420.4
Total N 2033100.0
2033100.0 2033100.0
2033100.0 2033100.0
50 – 54 Yes N
1053.6 1846.4
451.6 2207.6
732.5 No N
157554.6 190265.9
209772.7 184463.9
220876.5
84 55– 59
Yes N 1705.0
2748.1 581.7
2968.8 922.7
No N 179553.2
218664.8 249073.8
216064.0 257476.3
Not known N
140841.7 91327.1
82524.5 91727.2
70721.0 Total N
3373100.0 3373100.0
3373100.0 3373100.0
3373100.0 60 –64
Yes N 1425.4
2288.7 672.6
28410.9 883.4
No N 135651.8
166263.5 187471.6
158860.7 194874.4
Not known N
111942.8 72727.8
67625.8 74528.5
58122.2 Total N
2617100.0 2617100.0
2617100.0 2617100.0
2617100.0 65– 69
Yes N 1366.1
24110.8 652.9
23410.5 773.5
No N 113451.0
136261.3 154669.6
134160.4 161172.5
Not known N
95242.8 61927.9
61127.5 64729.1
53424.0 Total N
2222100.0 2222100.0
2222100.0 2222100.0
2222100.0 60 –64
Yes N 895.2
17810.3 452.6
19211.2 663.8
No N 86250.1
104160.5 119969.7
101458.9 122871.4
Not known N
77044.7 50229.2
47727.7 51529.9
42724.8 Total N
1721100.0 1721100.0
1721100.0 1721100.0
1721100.0 65– 69
Yes N 667.3
10511.6 283.1
10812.0 404.4
No N 40645.0
52357.9 60567.0
50355.7 62869.5
Not known N
43147.7 27530.5
27029.9 29232.3
23526.0 Total N
903100.0 903100.0
903100.0 903100.0
903100.0 80
Yes N 377.3
7414.5 183.5
6011.8 305.9
No N 21341.8
26652.3 33766.2
26852.7 33465.6
Not known N
25950.9 169 33.2
154 30.3 18135.6
14528.5 Total N
509100.0 509 100.0
509 100.0 509100.0
509100.0
85
Table 2.1.52 Documented complications at notification for patients with T2DM by ethnicity, DRM-ADCM, January 1
st
– December 31
st
2009
Ethnicity Status
Retinopathy Ischaemic heart
disease Cerebrovascular
disease Nephropathy
Diabetes foot problem
Malay Yes N
17203.9 12582.9
3230.7 30236.9
15463.5 No N
2085647.5 2543257.9
2820564.2 2419555.1
2819264.2 Not known N
2132648.6 1721239.2
1537435.0 1668438.0
1416432.3 Total N
43902100.0 43902100.0
43902100.0 43902100.0
43902100.0 Chinese
Yes N 7565.6
5594.2 2261.7
13059.7 4973.7
No N 557441.4
701452.1 797259.3
630546.9 777557.8
Not known N 712152.9
587843.7 525339.1
584143.4 517938.5
Total N 13451100.0
13451100.0 13451100.0
13451100.0 13451100.0
Indian Yes N
5874.6 4483.5
670.5 7806.1
4043.2 No N
466036.6 586846.1
663052.0 542342.6
635149.9 Not known N
749258.8 642350.4
604247.4 653651.3
598447.0 Total N
12739100.0 12739100.0
12739100.0 12739100.0
12739100.0 Other
Malaysian Yes N
254.3 203.4
50.9 467.8
223.7 No N
25843.9 33557.0
36161.4 32054.4
35660.5 Not known N
30551.9 23339.6
22237.8 22237.8
21035.7 Total N
588100.0 588100.0
588100.0 588100.0
588100.0 Non
Malaysian Yes N
33.4 22.3
11.1 1820.5
910.2 No N
4146.6 4551.1
5663.6 3944.3
5764.8 Not known N
4450.0 4146.6
3135.2 3135.2
2225.0 Total N
88100.0 88100.0
88100.0 88100.0
88100.0 Missing
Yes N 2218.2
1512.4 10.8
1512.4 1310.7
No N 4436.4
6150.4 7057.9
5545.5 5646.3
Not known N 5545.5
4537.2 5041.3
5142.1 5243.0
Total N 121100.0
121100.0 121100.0
121100.0 121100.0
86
Table 2.1.53 Documented complications at notification for patients with T2DM by groups of duration of diabetes, DRM-ADCM, January 1
st
– December 31
st
2009 Duration of
diabetes years
Status Retinopathy
Ischaemic heart disease
Cerebrovascular disease
Nephropathy Diabetes foot problem
5 Yes N
9263.2 8472.9
2270.8 17215.9
9253.2 No N
1719358.9 2046170.1
2260377.4 1967067.4
2269177.8 Not known N
1106537.9 787627.0
635421.8 779326.7
556819.1 Total N
29184100.0 29184100.0
29184100.0 29184100.0
29184100.0 5 – 10
Yes N 12236.1
8584.3 2041.0
200010.0 8534.3
No N 1065553.4
1318666.1 1474373.9
1224561.4 1468273.6
Not known N 806440.4
589829.6 499525.0
569728.6 440722.1
Total N 19942100.0
19942100.0 19942100.0
19942100.0 19942100.0
10 Yes N
93711.2 5857.0
1892.3 144217.3
7018.4 No N
341340.9 488458.6
570868.5 419750.3
516562.0 Not known N
398647.8 286734.4
243929.3 269732.4
247029.6 Total N
8336100.0 8336100.0
8336100.0 8336100.0
8336100.0 Missing
Yes N 270.2
120.1 30.0
240.2 120.1
No N 1721.3
2241.7 2401.8
2251.7 2491.9
Not known N 1322898.5
1319198.2 1318498.2
1317898.1 1316698.1
Total N 13427100.0
13427100.0 13427100.0
13427100.0 13427100.0
87
2.1.2.2 Complication from Diabetes foot problem A total of 71597 subjects were notified with diabetes mellitus in the Audit Diabetes Control and
Management 2009. More than half 58; 41524 of the subjects had foot assessment; out of this, 5187 12.5 subjects had foot problems. The majority 87.5 had no foot problems. Foot problems
were recorded in 3.6 of males and 3.4 of females. There was no difference for foot problems between these two groups even though there were slightly more 59 females in the total number of
subjects audited. Females had more peripheral neuropathy 62 compared with the males 56.7. There were more
amputations among the males 13.3 compared with the females 8.8. There were not much difference in the observed prevalence among the 3 ethnic groups Malay 3.5, Chinese 3.7 and
Indians 3.2. Surprisingly, 10.2 of foot problems were among non Malaysians. As the data did not depict details of the non Malaysian group, it is difficult to analyse which of the citizens contributed to
the high percentage. The Malays had an 11.3 amputation rate and this is the highest among all ethnic groups. The rate of
peripheral neuropathy was highest among the Chinese 73. Among Malaysians, Indians had the highest rate of peripheral vascular disease 22.8, foot deformity 12.4 and current foot ulcer
18.6. Those categorised as other Malaysians recorded 18.2 of amputations. Foot complications were seen to be more prevalent with age and duration of diabetes. There were
more foot problems documented in the subjects with diabetes of more than 10 years duration. And among this group, peripheral neuropathy and amputation were most prevalent i.e. 67 and 16.1
respectively. However, among the subjects with diabetes duration of less than 5 years, 17.9 had peripheral vascular disease and 17.8 had current foot ulcers. These observations were the highest
compared with other foot problems. Foot deformity was high in the 5 – 10 years diabetes duration 7.6.
Distribution of foot problems varies according to age group. Peripheral neuropathy was most common in the 75 – 79 years age group while peripheral vascular disease was highest among the subjects of
ages 80 years and above. Foot deformity was seen more in the 40 – 44 years age group and foot ulcers were seen highest 29 in the younger age group 35 – 39 years. This could be because of
their active lifestyle and high mobility which may lead to the formation of ulcers. In addition to this, the age group 55 – 59 years documented a 14.9 amputation among the subjects. There is no obvious
explanation for this observation.
88
Table 2.1.54 Distribution of complications from diabetes foot problem for patients with T2DM, DRM-ADCM, January 1
st
– December 31
st
2009 Complications
N
Peripheral neuropathy 149259.9
Peripheral vascular disease 36814.8
Foot deformity 1556.2
Ulcer current 41916.8
Amputation 26510.6
Table 2.1.55 Distribution of complications from diabetes foot problem for patients with T2DM by gender, DRM-ADCM, January 1
st
– December 31
st
2009 Gender
Status Peripheral neuropathy
Peripheral vascular disease
Foot deformity Ulcer current
Amputation
Male Yes N
59656.7 14213.5
605.7 21120.1
14013.3 No N
45643.3 91086.5
99294.3 84179.9
91286.7
Diabetic foot N
1052100.0 1052100.0
1052100.0 1052100.0
1052100.0 Female
Yes N 88462.0
22615.8 956.7
20714.5 1258.8
No N 54238.0
120084.2 133193.3
121985.5 130191.2
Diabetic foot N
1426100.0 1426100.0
1426100.0 1426100.0
1426100.0 Missing
Yes N 1292.3
00.0 00.0
17.7 00.0
No N 17.7
13100.0 13100.0
1292.3 13100.0
Diabetic foot N
13100.0 13100.0
13100.0 13100.0
13100.0
89
Table 2.1.56 Distribution of complications from diabetes foot problem for patients with T2DM by age group, DRM-ADCM, January 1
st
– December 31
st
2009 Age group
years
Status Peripheral neuropathy
Peripheral vascular disease
Foot deformity Ulcer current
Amputation
18 – 19 Yes N
00.0 00.0
00.0 00.0
00.0 No N
00.0 00.0
00.0 00.0
00.0
Diabetic foot N
00.0 00.0
00.0 00.0
00.0 20 – 24
Yes N 375.0
375.0 00.0
00.0 00.0
No N 125.0
125.0 4100.0
4100.0 4100.0
Diabetic foot N
4100.0 4100.0
4100.0 4100.0
4100.0 25 – 29
Yes N 00.0
00.0 00.0
00.0 00.0
No N 00.0
00.0 00.0
00.0 00.0
Diabetic foot N
00.0 00.0
00.0 00.0
00.0 30 – 34
Yes N 853.3
00.0 16.7
426.7 213.3
No N 746.7
15100.0 1493.3
1173.3 1386.7
Diabetic foot N
15100.0 15100.0
15100.0 15100.0
15100.0 35 – 39
Yes N 1858.1
39.7 00.0
929.0 26.5
No N 1341.9
2890.3 31100.0
2271.0 2993.5
Diabetic foot N
31100.0 31100.0
31100.0 31100.0
31100.0 40 – 44
Yes N 4752.2
1011.1 1213.3
2123.3 1314.4
No N 4347.8
8088.9 7886.7
6976.7 7785.6
Diabetic foot N
90100.0 90100.0
90100.0 90100.0
90100.0 45 – 49
Yes N 9549.2
2311.9 126.2
4322.3 2211.4
No N 9850.8
17088.1 18193.8
15077.7 17188.6
Diabetic Foot N
193100.0 193 100.0
193100.0 193100.0
193100.0 50 – 54
Yes N 20256.3
5114.2 246.7
7420.6 339.2
No N 15743.7
30885.8 33593.3
28579.4 32690.8
90
Age group years
Status Peripheral neuropathy
Peripheral vascular disease
Foot deformity Ulcer current
Amputation Diabetic foot
N 359100.0
359100.0 359100.0
359100.0 359100.0
55 – 59 Yes N
24154.5 7015.8
255.7 6614.9
6614.9 No N
20145.5 37284.2
41794.3 37685.1
37685.1
Diabetic foot N
442100.0 442100.0
442100.0 442100.0
442100.0 60 – 64
Yes N 27758.1
7615.9 306.3
8517.8 4910.3
No N 20041.9
40184.1 44793.7
39282.2 42889.7
Diabetic foot N
477100.0 477100.0
477100.0 477100.0
477100.0 65 – 69
Yes N 23466.3
4913.9 246.8
4813.6 329.1
No N 11933.7
30486.1 32993.2
30586.4 32190.9
Diabetic foot N
353100.0 353100.0
353100.0 353100.0
353100.0 70 – 74
Yes N 17467.2
3513.5 114.2
3714.3 259.7
No N 8532.8
22486.5 24895.8
22285.7 23490.3
Diabetic foot N
259100.0 259100.0
259100.0 259100.0
259100.0 75 – 79
Yes N 10973.2
2114.1 96.0
1812.1 117.4
No N 4026.8
12885.9 14094.0
13187.9 13892.6
Diabetic foot N
149100.0 149100.0
149100.0 149100.0
149100.0 80
Yes N 8470.6
2722.7 75.9
1411.8 108.4
No N 3529.4
9277.3 11294.1
10588.2 10991.6
Diabetic foot N
119100.0 119100.0
119100.0 119100.0
119100.0
91
Table 2.1.57 Distribution of complications from diabetes foot problem for patients with T2DM by ethnicity, DRM-ADCM, January 1
st
– December 31
st
2009 Ethnicity
Status Peripheral neuropathy
Peripheral vascular disease
Foot deformity
Ulcer current Amputation
Malay Yes N
91058.9 19712.7
845.4 28018.1
17511.3 No N
63641.1 134987.3
146294.6 126681.9
137188.7
Diabetic foot N
1546100.0 1546100.0
1546100.0 1546100.0
1546100.0 Chinese
Yes N 36373.0
7314.7 193.8
5711.5 428.5
No N 13427.0
42485.3 47896.2
44088.5 45591.5
Diabetic foot N
497100.0 497100.0
497100.0 497100.0
497100.0 Indian
Yes N 19147.3
9222.8 5012.4
7518.6 4310.6
No N 21352.7
31277.2 35487.6
32981.4 36189.4
Diabetic foot N
404100.0 404100.0
404100.0 404100.0
404100.0 Other
Malaysian Yes N
731.8 418.2
29.1 522.7
418.2 No N
1568.2 1881.8
2090.9 1777.3
1881.8
Diabetic foot N
22100.0 22100.0
22100.0 22100.0
22100.0 Non Malaysian
Yes N 888.9
222.2 00.0
222.2 111.1
No N 111.1
777.8 9100.0
777.8 888.9
Diabetic foot N
9100.0 9100.0
9100.0 9100.0
9100.0 Missing
Yes N 13100.0
00.0 00.0
00.0 00.0
No N 00.0
13100.0 13100.0
13100.0 13100.0
Diabetic foot N
13100.0 13100.0
13100.0 13100.0
13100.0
92
Table 2.1.58 Distribution of complications from diabetes foot problem for patients with T2DM by groups of duration of diabetes, DRM-ADCM, January 1
st
– December 31
st
2009
Duration of diabetes years
Status Peripheral neuropathy
Peripheral vascular disease
Foot deformity Ulcer current
Amputation
5 Yes N
50554.6 16617.9
657.0 16517.8
727.8 No N
42045.4 75982.1
86093.0 76082.2
85392.2
Diabetic foot N
925100.0 925100.0
925100.0 925100.0
925100.0 5 – 10
Yes N 51159.9
11914.0 657.6
13816.2 799.3
No N 34240.1
73486.0 78892.4
71583.8 77490.7
Diabetic foot N
853100.0 853100.0
853100.0 853100.0
853100.0 10
Yes N 47067.0
8311.8 253.6
11115.8 11316.1
No N 231 33.0
61888.2 67696.4
59084.2 58883.9
Diabetic foot N
701100.0 701100.0
701100.0 701100.0
701100.0 Missing
Yes N 650.0
00.0 00.0
541.7 18.3
No N 650.0
12100.0 12100.0
758.3 1191.7
Diabetic foot N
12100.0 12100.0
12100.0 12100.0
12100.0
93
2.1.3 Concomitant co-morbidity
Four concomitant co-morbid conditions were documented among the 71597 subjects audited in the ADCM 2009. These were hypertension only, dyslipidaemia only, combination of hypertension
and dyslipidaemia, and hypertension or dyslipidaemia. Females recorded higher numbers in all 4 concomitant co-morbidities. Many of them had either
hypertension or dyslipidaemia 66.8. More than half of the females 59.4 had hypertension only
. ,. About a third of female subjects 31.3 had hypertension and dyslipidaemia.
In the younger age group, at least one of the concomitant co-morbid conditions was present. The presence of either hypertension or dyslipidaemia was recorded as early as 18 years of age. For
the age group 18 – 19 years, 35 had either hypertension or dyslipidaemia and 5 had both. The older subjects showed higher percentage of concomitant co-morbid conditions. Expectedly,
the age group 65 – 69 years showed the highest percentage in all co-morbid conditions except for dyslipidaemia. Dyslipidaemia was the highest among the 60 – 64 years age group 41.6.
Interestingly, as the subjects got older, the percentage of concomitant co-morbid condition started to decline and this was observed in subjects aged 70 and above.
The Chinese showed the highest percentage in all concomitant co-morbid condition with 72.3 having either hypertension or dyslipidaemia. About two-thirds 65.2 of the Chinese had only
hypertension. However among Indians, dyslipidaemia was recorded as the highest percentage 38.4. For the Malays, 56.9 had hypertension. Overall, the audit showed a significant number
of subjects with at least one concomitant co-morbid condition with slightly more than half 57.4 of the subjects with hypertension.
For subjects with diabetes of more than 5 years duration, 88.3 had at least one concomitant co- morbid condition. The audit also showed 80 of subjects with hypertension and 56 with
dyslipidaemia. Surprisingly, subjects with diabetes duration of less than 5 years showed relatively high concomitant co-morbid condition. Among them, 75.4 had either one of the co-morbidity
and 65.3 had hypertension. These subjects showed 32.5 with both hypertension and dyslipidaemia. The high percentage of concomitant co-morbid conditions among the subjects of
less than 5 years diabetes duration may reflect the severity of the disease.
94
Table 2.1.59 Distribution of concomitant co-morbidity for patients with T2DM, DRM-ADCM, January 1
st
– December 31
st
2009 Types of co-morbidity
N
Hypertension 4065957.4
Dyslipidaemia 2679437.8
Hypertension and Dyslipidaemia 2138130.2
Hypertension or Dyslipidaemia 4607265.0
Table 2.1.60 Distribution of concomitant co-morbidity for patients with T2DM by gender, DRM-ADCM, January 1
st
– December 31
st
2009
Gender Status Hypertension Dyslipidaemia
Hypertension and Dyslipidaemia
Hypertension or Dyslipidaemia
Male Yes N
1575754.4 1052236.4
822828.4 1805162.4
No N 744925.7
1268443.8 1497851.8
515517.8
Total N 28939100.0
28939100.0 28939100.0
28939100.0 Female
Yes N 2483759.4
1621038.7 1310431.3
2794366.8 No N
964623.1 1827343.7
2137951.1 654015.6
Total N 41841100.0
41841100.0 41841100.0
41841100.0 Missing
Yes N 6559.6
6256.9 4945.0
7871.6 No N
2623.9 2926.6
4238.5 1311.9
Total N 109100.0
109100.0 109100.0
109100.0
Table 2.1.61 Distribution of concomitant co-morbidity for patients with T2DM by age group, DRM-ADCM, January 1
st
– December 31
st
2009 Age group
years
Status Hypertension Dyslipidaemia
Hypertension and Dyslipidaemia
Hypertension or Dyslipidaemia
18 – 19 Yes N
820.0 820.0
25.0 1435.0
No N 2357.5
2357.5 2972.5
1742.5
Total N
40100.0 40100.0
40100.0 40100.0
20 – 24 Yes N
3221.6 3423.0
138.8 5335.8
No N 7953.4
7752.0 9866.2
5839.2
Total N 148100.0
148100.0 148100.0
148100.0 25 – 29
Yes N 9021.8
9623.2 338.0
15337.0 No N
23155.9 22554.5
28869.7 16840.7
Total N 413100.0
413100.0 413100.0
413100.0 30 – 34
Yes N 26530.1
25629.1 12414.1
39745.1 No N
43549.4 44450.4
57665.4 30334.4
Total N 881100.0
881100.0 881100.0
881100.0
95
Age group years
Status Hypertension Dyslipidaemia
Hypertension and Dyslipidaemia
Hypertension or Dyslipidaemia
35 – 39 Yes N
62034.1 50627.9
27615.2 85046.8
No N 83045.7
94452.0 117464.6
60033.0
Total N 1816100.0
1816100.0 1816100.0
1816100.0 40 – 44
Yes N 164439.4
132931.8 78718.9
218652.4 No N
176842.4 208349.9
262562.9 122629.4
Total N 4173100.0
4173100.0 4173100.0
4173100.0 45 – 49
Yes N 357047.9
250933.7 171323.0
436658.6 No N
258134.6 364248.9
443859.6 178524.0
Total N 7451100.0
7451100.0 7451100.0
7451100.0 50 – 54
Yes N 594955.2
410838.1 313229.1
692564.3 No N
296827.6 480944.6
578553.7 199218.5
Total N 10773100.0
10773100.0 10773100.0
10773100.0 55 – 59
Yes N 784159.8
531740.6 426532.5
889367.9 No N
302723.1 555142.4
660350.4 197515.1
Total N 13105100.0
13105100.0 13105100.0
13105100.0 60 – 64
Yes N 746763.9
487041.6 411135.2
822670.3 No N
225219.3 484941.5
560848.0 149312.8
Total N
11694100.0 11694100.0
11694100.0 11694100.0
65 – 69 Yes N
568966.6 349740.9
308636.1 610071.4
No N 133915.7
353141.3 394246.1
92810.9
Total N
8546100.0 8546100.0
8546100.0 8546100.0
70 – 74 Yes N
415963.9 248938.2
221534.0 443368.1
No N 92614.2
259639.9 287044.1
65210.0
Total N
6512100.0 6512100.0
6512100.0 6512100.0
75 – 79 Yes N
206363.1 118536.2
107332.8 217566.5
No N 42613.0
130439.9 141643.3
3149.6
Total N 3271100.0
3271100.0 3271100.0
3271100.0 80
Yes N 126261.1
59028.6 55126.7
130163.0 No N
23611.4 90843.9
94745.8 1979.5
Total N 2066100.0
2066100.0 2066100.0
2066100.0
Table 2.1.62 Distribution of concomitant co-morbidity for patients with T2DM by ethnicity, DRM-ADCM, January 1
st
– December 31
st
2009 Ethnicity
Status Hypertension
Dyslipidaemi a
Hypertension and Dyslipidaemia
Hypertension or Dyslipidaemia
Malay Yes N
2500256.9 1567635.7
1261828.7 2806063.9
No N 1080024.6
2012645.8 2318452.8
774217.6
Total N 43902100.0
43902100.0 43902100.0
43902100.0 Chinese
Yes N 876465.2
593644.1 497537.0
972572.3 No N
253418.8 536239.9
632347.0 157311.7
Total N 13451100.0
13451100.0 13451100.0
13451100.0 Indian
Yes N 645350.7
488638.4 356428.0
777561.0 No N
356828.0 513540.3
645750.7 224617.6
Total N 12739100.0
12739100.0 12739100.0
12739100.0 Other
Malaysian Yes N
32755.6 19032.3
14925.3 36862.6
No N 16127.4
29850.7 33957.7
12020.4
Total N 588100.0
588100.0 588100.0
588100.0
96
Non Malaysian
Yes N 4854.5
4652.3 2831.8
6675.0 No N
3337.5 3539.8
5360.2 1517.0
Total N
88100.0 88100.0
88100.0 88100.0
Missing Yes N
6553.7 6049.6
4738.8 7864.5
No N 2520.7
3024.8 4335.5
129.9
Total N
121100.0 121100.0
121100.0 121100.0
Table 2.1.63 Distribution of concomitant co-morbidity for patients with T2DM by groups of duration of diabetes, DRM-ADCM, January 1
st
– December 31
st
2009
Duration of diabetes
years
Status Hypertension
Dyslipidaemia Hypertension and
Dyslipidaemia Hypertension or
Dyslipidaemia
5 Yes N
1906765.3 1243642.6
949832.5 2200575.4
No N 1011734.7
1674857.4 1968667.5
717924.6
Total N 29184100.0 29184100.0
29184100.0 29184100.0
5 – 10 Yes N
1470173.7 955047.9
778339.0 1646882.6
No N 524126.3
1039252.1 1215961.0
347417.4
Total N 19942100.0 19942100.0
19942100.0 19942100.0
10 Yes N
666880.0 466856.0
397847.7 735888.3
No N 166820.0
366844.0 435852.3
97811.7
Total N 8336100.0
8336100.0 8336100.0
8336100.0 Missing
Yes N 2231.7
1401.0 1220.9
2411.8 No N
950.7 1781.3
1961.5 770.6
Total N 13427100.0 13427100.0
13427100.0 13427100.0
97
CHAPTER THREE 3.0 TREATMENT AND MANAGEMENT
DR MASTURA ISMAIL DR G.R LETCHUMAN RAMANATHAN
DR ZANARIAH HUSSEIN
98
3.1 Management
Management of type 2 diabetes comprises glycaemic management and management of co- morbidities such as hypertension and dyslipidaemia. Use of antiplatelet agents in individuals with
high cardiovascular risk is recommended. Non-pharmacological therapy of hyperglycaemia comprises lifestyle intervention diet therapy and
physical activity and pharmacological therapy with oral hypoglycaemic agents and insulin therapy, frequently in combination.
Self blood glucose monitoring SBMG is recommended as an important self-care practice that contributes to improved glycaemic management. For patients requiring insulin therapy, SBMG is
necessary to guide self adjustment of insulin dose towards achieving individualised glycaemic targets.
3.1.1 Glycaemic management
A total of 70889 patients with diabetes were included in this study and they were almost entirely patients with T2DM 99.0 with only 685 patients 1.0 with known T1DM.
Table 3.1.1 Current management method used for patients with T2DM, DRM-ADCM, January 1
st
-December 31
st
2009 No
Current glycaemic control Yes N
1 Diet
22843.2 2
Oral Hypoglycaemics 5408076.3
• Sulphonylureas
3780969.9 •
Alpha glucosidase inhibitor 26114.8
• Thiazolidinediones
810.1 •
Meglitinides 1620.3
• Biguanidas
4500583.2 •
Others 730.1
3 Insulin
706410.0 •
Regular short acting 111415.8
• Rapid acting
60.1 •
Intermediate acting 387854.9
• Long acting
420.6 •
Pre - mixed 254836.1
• Others
120.2
99
Table 3.1.2 Current management method of glycaemic control used for patients with T2DM, DRM-ADCM, January 1
st
-December 31
st
2009 No
Current glycaemic control N
1 Diet only
8391.2 2
Oral anti-diabetic agent OAD only 4737366.8
-Monotherapy OAD 1884939.8
- 2 OAD 2765758.4
3 Oral anti-diabetic agent OAD
Insulin 53537.6
4 Insulin only
16852.4
Table 3.1.3 Current management method of glycaemic control used for patients with T2DM by age group, DRM-ADCM, January 1
st
-December 31
st
2009 Age
group Diet only
N Oral anti-diabetic agent
OAD only N Oral anti-diabetic agent
OAD Insulin N Insulin only
N 20
00.0 2050.0
37.5 615.0
20 - 29 61.1
31255.6 508.9
458.0 30 - 39
391.4 174364.6
1756.5 853.2
40 -49 1421.2
795568.4 8397.2
2011.7 50 - 59
2511.1 1600167.0
21318.9 5082.1
60 - 69 2281.1
1374267.9 15697.8
5182.6 70 - 79
1261.3 633164.7
5105.2 2712.8
80 472.3
126961.4 763.7
512.5
Table 3.1.4 Current management method of glycaemic control used for patients with T2DM by duration of diabetes, DRM-ADCM, January 1
st
-December 31
st
2009 Duration of
diabetes Diet only
N Oral anti-diabetic
agent OAD only
N Oral anti-diabetic
agent OAD Insulin N
Insulin only N
1 year 1613.7
365085.0 1202.8
601.4 5 years
6152.1 2534286.8
12284.2 4171.4
5 – 10 years 1710.9
1622781.4 222611.2
5722.9 10 years
500.6 556266.7
186722.4 6878.2
Unknown 30.0
2421.8 320.2
90.1
