Cardiovascular risk assessment and glycaemic control among type-2 diabetes mellitus patients at selected primary care clinics (KK) and diabetic mellitus specialist clinic (hospital-based) in Kuantan

Cardiovascular risks assessment and good glycemic control are important for better risk reduction management in preventing and improving CVD outcomes. The Ministry of Health (Malaysia) has carried out tremendous efforts in improving diabetic care in primary and hospital settings. Therefore, it is imperative to revisit the current situation on cardiovascular disease risk assessment and glycemic control at both hospital-based and primary care clinics. The study aimed to determine the assessment of CVD risk and glycemic control among T2DM patients at selected two public primary care clinics (PCCs) and one hospital-based diabetic specialist (endocrine) clinic (DMSC) in Kuantan, Pahang state. A prospective comparative study design was applied among 423 T2DM patients who sought treatment – 281 patients at two public PCCs and 153 at hospital DMSC. Data were collected from the face-to-face interview using a validated pretested questionnaire and patients’ records at the 1st, 6-month, and 12-month visits. A cross-analysis was done to compare the patients’ demographic characteristics, CVD risk factors assessment, and glycemic control between PCCs and DMSC. This study highlighted a higher percentage of Chinese T2DM, and higher education groups attending hospital DMSC compared to PCCs, while Malay and dependents were seen more at the PCCs. A higher percentage of assessment on exercise (82% vs 62%), smoking status (63% vs 48%) and family history of CVD (80% vs 65%); and more referral to a dietician (61% vs 47%) and ophthalmologist (81% vs 61%) were found at the hospital DMSC. On average, the assessment for height, weight, body mass index (BMI), and waist circumference (WC) was 83.9%, 95.9%, 0.7%, and 1.6%, respectively. 1st visit reading of the HbA1C target achieved for PCCs and MOPD were 14.5% and 9.5%, which no difference at 12-month 16.5% and 4.5%, respectively. Among T2DM patients, 74.4% were associated with hypertension and 83.9% were overweight or obese. The average BP target achieved at 1st and 12-months was 21.3% and 29.2%, respectively (increment of 7.9%). No changes in lipid profile after one year were noted at both sites. On average, the target achieved at 12-month for TG, HDL-C, and LDL-C were 53.5%, 32.1%, and 43.5%, respectively. Conclusion: Generally, assessments for CVD risks were sufficient except for BMI calculation and waist circumference measurement, which need to be enhanced further. Comorbidities: hypertension and obesity were highly associated with T2DM. Both primary and hospital-based specialist clinics have a small percentage of diabetes targets achieved, indicating the need for more enforcement to strengthen both pharmaco- and non-pharmacotherapy. In addition, this enforcement will also improve the BP and lipid profile targets achieved. Assessment and counselling on exercise, weight reduction, and smoking status, referral to a dietician, smoking cessation program for smokers, and an ophthalmologist, should be performed on every T2DM patient for better prevention and early intervention of its complication