13
2.2.2 Anthropometry and clinical signs at diagnosis of T1DM
Of all T1DM patients, 98.6 289293 had their BMI reported, of whom 29.8 86289 were underweight, 58.5 169289 were of normal weight and 11.8
overweight 34289 Figure 2.2.2.1.
Figure 2.2.2.1: Anthropometry at diagnosis of T1DM, DiCARE 2006-2008
2.3 Management of T1DM
2.3.1 Treatment at diagnosis
All T1DM patients must receive insulin treatment. However, one T1DM patient received no treatment and another received only oral hypoglycaemic agent
OHA at diagnosis in 2006. This is most probably due to misclassification of the type of diabetes. Subsequently all T1DM were reported to be on insulin Table
2.3.1.1.
29.8
58.5 11.8
Underweight Normal
Overweight
14 Intensification of insulin therapy is the treatment strategy to reduce HbA1c to
target, to prevent long-term complications. However 75.0 34 and 87.0 2023 of T1DM patients were reported to be receiving once-a-day insulin in
2006 and 2007 respectively. These figures were likely to be inaccurate and do not represent the current practice in Malaysia. However, there was a trend
towards multiple dose insulin injections. In 2008, none of the T1DM patients were on once a day insulin regimen. In contrast, 64.4 3859 patients were on
twice a day insulin regimen and 33.9 2059 patients were on three or more times a day insulin regimen.
Table 2.3.1.1 Treatment and Insulin Regimen at diagnosis of T1DM patients, DiCARE 2006-2008
Treatment and Regimen 2006
2007 2008
n n
n Treatment
No Medication 1 2.8
0 0.0 0 0.0
Oral Hypoglycaemic Agent Only 1 2.8
0 0.0 0 0.0
Insulin Only 34 94.4 60 100.0 98 99.0
Insulin + Oral Hypoglycaemic Agent 0 0.0
0 0.0 1 1.0
Missing 95
2 1
Insulin regimen if on insulin
Once a day 3 75.0 20 87.0
0 0.0 Twice a day
1 25.0 1 4.3 38 64.4
Three times a day 0 0.0
0 0.0 4 6.8
≥ Four times a day 0 0.0
1 4.3 16 27.1 Insulin pump
0 0.0 1 4.3
1 1.7 Not availablemissing
30 37 40
15
2.3.2 Treatment at year-end annual census
Feedback for year-end annual census had been very poor. There were only 56 and 45 responses regarding treatment at year-end of 2006 and 2007
respectively. Cumulatively at year-end of 2008, 41.3 121293 of T1DM patients in the registry had their annual census reports submitted. Of these,
there were only 121 responses regarding treatment, i.e. 92.6 112121 patients received only insulin, 3.3 4121 received a combination of insulin and
OHA, 2.5 3121 had unknown treatment and surprisingly, 1.7 2121
received OHA alone Table 2.3.2.1.
Table 2.3.2.1 Treatment and Insulin Regimen at year-end annual census of T1DM patients, DiCARE 2006-2008 N =121
Treatment and Regimen 2006
2007 2008
n n
n Treatment
No Medication 0 0.0
0 0.0 0 0.0
Oral Hypoglycaemic Agent Only 1 1.8
0 0.0 2 1.7
Insulin Only 55 98.2 42 93.3 112 92.6
Insulin + Oral Hypoglycaemic Agent 0 0.0
3 6.7 4 3.3
Unknown 0 0.0
0 0.0 3 2.5
Insulin regimen if on insulin
Once a day 8 88.9 14 46.7 28 28.3
Twice a day 0 0.0
3 30.0 25 25.3 Three times a day
0 0.0 0 0.0
4 4.0 ≥ Four times a day
1 11.1 12 40.0 40 40.4 Insulin pump
0 0.0 1 7.3
2 2.0 Missing 46 15 17
16 Among the patients who received insulin treatment, 16.4 955, 66.7 3045
and 85.3 99116 indicated their insulin regimen in years 2006, 2007 and 2008 respectively. In the latest year-end census 2008, 28.3 2899 of T1DM patients
were on once a day insulin regimen and 25.3 2599 were on twice-a-day regimen. Only 46.5 4699 of the T1DM patients were on ≥ three times a day
insulin regimen or on insulin pump Table 2.3.2.1. It is alarming to note that
once-a-day insulin regimen for T1DM is still being practised in the country.
2.3.3 Self-care practice
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