Association between sex, age, temporal trends, and glycemic control of 221,769 adults with type 2 diabetes in a multi-ethnic middle-income Asian country

Aims: We examined the association between sex, age, temporal trends, and glycemic control among people with type 2 diabetes (T2D) in a multi-ethnic middle-income Asian country.

Methods: Using the National Diabetes Registry (2011-2020), we analyzed data for 221,769 adult Malaysians with T2D.We used quantile regressions to estimate the association of sex, age, and their interaction on HbA_1clevels at the 5th, 50th, and 95thpercentile and logistic regression to estimate the odds of good control (HbA_1c < 7 %).

Results: The participants were Malays (61·8 %), females (59·3 %), and aged 50-69 years (63·5 %). The median (interquartile range [IQR]) HbA_1c was 7·2 % (6·4 %, 8·9 %) for males and 7·3 % (6·4 %, 9·0 %) for females. The prevalence of good control was 42·8 % for males and 41·8 % for females. Glycemic control improved from 2011 to 2020 for both females and males above 40. Control significantly improved with age among both sexes. However, females had increasingly better control than men with increasing age (P_{Heterogeneity} < 0.001). The adjusted odds (95 % CI) of good control comparing females to males at 30, 50, and 70 years was 0·90 (0·81, 0·99), 0·93 (0·90, 0·97), and 1·12 (1·08, 1·16) respectively.

Conclusions: A more aggressive approach to type 2 diabetes management is needed for both sexes, targeting especially the younger age groups, to improve glycemic control and reduce diabetes burden.