{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T12:42:31Z","timestamp":1793104951063,"version":"4.5.0"},"reference-count":46,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2024,1,2]],"date-time":"2024-01-02T00:00:00Z","timestamp":1704153600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Malaysian Endocrine and Metabolic Society"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Aim<\/jats:title>\n<jats:p>Given a lack of data on diabetes care performance in Malaysia, we conducted a cross-sectional study to understand the clinical characteristics, control of cardiometabolic risk factors, and patterns of use of guideline-directed medical therapy (GDMT) among patients with type 2 diabetes (T2D), who were managed at publicly-funded hospitals between December 2021 and June 2022.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Patients aged \u226518 years with T2D from eight publicly-funded hospitals in the Greater Kuala Lumpur region, who had \u22652 outpatient visits within the preceding year and irrespective of treatment regimen, were eligible. The primary outcome was \u22652 treatment target attainment (defined as either HbA<jats:sub>1c<\/jats:sub> &lt;7.0%, blood pressure [BP] &lt;130\/80 mmHg, or low-density lipoprotein cholesterol [LDL-C] &lt;1.8 mmol\/L). The secondary outcomes were the individual treatment target, a combination of all three treatment targets, and patterns of GDMT use. To assess for potential heterogeneity of study findings, all outcomes were stratified according to prespecified baseline characteristics namely 1) history of atherosclerotic cardiovascular disease (ASCVD; yes\/no) and 2) clinic type (Diabetes specialist versus General medicine).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Among 5094 patients (mean\u00b1SD age 59.0\u00b113.2 years; T2D duration 14.8\u00b19.2 years; HbA<jats:sub>1c<\/jats:sub> 8.2\u00b11.9% (66\u00b121 mmol\/mol); BMI 29.6\u00b16.2 kg\/m<jats:sup>2<\/jats:sup>; 45.6% men), 99% were at high\/very high cardiorenal risk. Attainment of \u22652 treatment targets was at 18%, being higher in General medicine than in Diabetes specialist clinics (20.8% versus 17.5%; p = 0.039). The overall statin coverage was 90%. More patients with prior ASCVD attained LDL-C &lt;1.4 mmol\/L than those without (13.5% versus 8.4%; p&lt;0.001). Use of sodium-glucose cotransporter-2 (SGLT2) inhibitors (13.2% versus 43.2%), glucagon-like peptide-1 receptor agonists (GLP1-RAs) (1.0% versus 6.2%), and insulin (27.7% versus 58.1%) were lower in General medicine than in Diabetes specialist clinics.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Among high-risk patients with T2D, treatment target attainment and use of GDMT were suboptimal.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0296298","type":"journal-article","created":{"date-parts":[[2024,1,2]],"date-time":"2024-01-02T19:35:03Z","timestamp":1704224103000},"page":"e0296298","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":12,"title":["Real-world evaluation of care for type 2 diabetes in Malaysia: A cross-sectional analysis of the treatment adherence to guideline evaluation in type 2 diabetes (TARGET-T2D) study"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6214-6924","authenticated-orcid":true,"given":"Lee-Ling","family":"Lim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zanariah","family":"Hussein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nurain Md","family":"Noor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4500-2857","authenticated-orcid":true,"given":"Anis S. Abd","family":"Raof","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norlaila","family":"Mustafa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed B. Long","family":"Bidin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohana Abdul","family":"Ghani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syahrizan","family":"Samsuddin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sy-Liang","family":"Yong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5635-4508","authenticated-orcid":true,"given":"Siew-Hui","family":"Foo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kavitha","family":"Raghuram","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Payiarat","family":"Suwannasri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wan Mohamad","family":"W. B.","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thiam-Kian","family":"Chiew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siew-Pheng","family":"Chan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,1,2]]},"reference":[{"key":"pone.0296298.ref001","article-title":"National Health and Morbidity Survey (NHMS) 2019: Vol. I: NCDs\u2013Non-Communicable Diseases: Risk Factors and other Health Problems","author":"Institute for Public Health (IPH), National Institutes of Health, Ministry of Health Malaysia","year":"2020"},{"issue":"10267","key":"pone.0296298.ref002","doi-asserted-by":"crossref","first-page":"2019","DOI":"10.1016\/S0140-6736(20)32374-6","article-title":"The Lancet Commission on diabetes: using data to transform diabetes care and patient lives","volume":"396","author":"JCN Chan","year":"2021","journal-title":"Lancet"},{"key":"pone.0296298.ref003","unstructured":"Direct Health-care Cost of Noncommunicable Diseases in Malaysia (2022). Putrajaya, Malaysia: Ministry of Health Malaysia."},{"key":"pone.0296298.ref004","volume-title":"The Impact of Noncommunicable Diseases and Their Risk Factors on Malaysia\u2019s Gross Domestic Product","year":"2020"},{"issue":"25","key":"pone.0296298.ref005","doi-asserted-by":"crossref","first-page":"2982","DOI":"10.1016\/j.jacc.2020.11.010","article-title":"Global Burden of Cardiovascular Diseases and Risk Factors, 1990\u20132019: Update From the GBD 2019 Study","volume":"76","author":"GA Roth","year":"2020","journal-title":"J Am Coll Cardiol"},{"issue":"9677","key":"pone.0296298.ref006","doi-asserted-by":"crossref","first-page":"1765","DOI":"10.1016\/S0140-6736(09)60697-8","article-title":"Effect of intensive control of glucose on cardiovascular outcomes and death in patients with diabetes mellitus: a meta-analysis of randomised controlled trials","volume":"373","author":"KK 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disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial","volume":"392","author":"AF Hernandez","year":"2018","journal-title":"Lancet"},{"key":"pone.0296298.ref023","unstructured":"Malaysian Clinical Practice Guidelines on Management of Type 2 Diabetes, 6th Edition, December 2020. Available from http:\/\/www.acadmed.org.my\/index.cfm?&menuid=67."},{"key":"pone.0296298.ref024","article-title":"Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD).","author":"MJ Davies","year":"2022","journal-title":"Diabetes Care"},{"key":"pone.0296298.ref025","author":"MI Feisul","year":"2013"},{"issue":"2","key":"pone.0296298.ref026","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1093\/eurheartj\/ehz486","article-title":"2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD","volume":"41","author":"F Cosentino","year":"2020","journal-title":"Eur Heart J"},{"issue":"Supplement_1","key":"pone.0296298.ref027","doi-asserted-by":"crossref","first-page":"S83","DOI":"10.2337\/dc22-S006","article-title":"6. 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Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes-2022","volume":"45","author":"B Draznin","year":"2022","journal-title":"Diabetes Care"},{"issue":"6","key":"pone.0296298.ref029","doi-asserted-by":"crossref","first-page":"426","DOI":"10.7326\/M20-0529","article-title":"Conversion of Urine Protein-Creatinine Ratio or Urine Dipstick Protein to Urine Albumin-Creatinine Ratio for Use in Chronic Kidney Disease Screening and Prognosis: An Individual Participant-Based Meta-analysis","volume":"173","author":"K Sumida","year":"2020","journal-title":"Ann Intern Med"},{"key":"pone.0296298.ref030","volume-title":"R: A language and environment for statistical computing","author":"R Core Team","year":"2018"},{"issue":"3","key":"pone.0296298.ref031","first-page":"175","article-title":"The status of diabetes control in Malaysia: results of DiabCare 2008.","volume":"66","author":"M Mafauzy","year":"2011","journal-title":"Med J Malaysia"},{"issue":"4","key":"pone.0296298.ref032","first-page":"177","article-title":"DiabCare 2013: A cross-sectional study of hospital based diabetes care delivery and prevention of diabetes related complications in Malaysia.","volume":"71","author":"M Mafauzy","year":"2016","journal-title":"Med J Malaysia"},{"issue":"11","key":"pone.0296298.ref033","doi-asserted-by":"crossref","first-page":"2022","DOI":"10.2337\/dci19-0003","article-title":"From Hong Kong Diabetes Register to JADE Program to RAMP-DM for Data-Driven Actions","volume":"42","author":"JCN Chan","year":"2019","journal-title":"Diabetes Care"},{"key":"pone.0296298.ref034","article-title":"Diabetes Management in Chronic Kidney Disease: A Consensus Report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO).","author":"IH de Boer","year":"2022","journal-title":"Diabetes Care"},{"issue":"10","key":"pone.0296298.ref035","doi-asserted-by":"crossref","first-page":"e0240531","DOI":"10.1371\/journal.pone.0240531","article-title":"Clinical inertia in type 2 diabetes management in a middle-income country: A retrospective cohort study","volume":"15","author":"KS Wan","year":"2020","journal-title":"PLoS One"},{"issue":"1","key":"pone.0296298.ref036","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1186\/s12933-021-01344-0","article-title":"CAPTURE: a multinational, cross-sectional study of cardiovascular disease prevalence in adults with type 2 diabetes across 13 countries.","volume":"20","author":"O Mosenzon","year":"2021","journal-title":"Cardiovasc Diabetol"},{"key":"pone.0296298.ref037","author":"Ministry of Health Malaysia","year":"2021","journal-title":"National Diabetes Registry Report 2020"},{"issue":"3","key":"pone.0296298.ref038","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1111\/jch.13721","article-title":"Asian management of hypertension: Current status, home blood pressure, and specific concerns in Malaysia.","volume":"22","author":"YC Chia","year":"2020","journal-title":"J Clin Hypertens (Greenwich)."},{"key":"pone.0296298.ref039","article-title":"Population-Based Salt Intake Survey To Support The National Salt Reduction Programme For Malaysia (Malaysian Community Salt Survey\u2013MyCoSS).","author":"Institute for Public Health (IPH) 2019"},{"issue":"1","key":"pone.0296298.ref040","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s12944-019-1158-5","article-title":"Low-density lipoprotein cholesterol goal attainment rates in high-risk patients with cardiovascular diseases and diabetes mellitus in Korea: a retrospective cohort study","volume":"19","author":"YS Yang","year":"2020","journal-title":"Lipids Health Dis"},{"issue":"11","key":"pone.0296298.ref041","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.1177\/2047487316647827","article-title":"Simplifying the audit of risk factor 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Heidenreich","year":"2022","journal-title":"Circulation"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0296298","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,2]],"date-time":"2024-01-02T19:35:23Z","timestamp":1704224123000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0296298"}},"subtitle":[],"editor":[{"given":"Hean Teik","family":"Ong","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,1,2]]},"references-count":46,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1,2]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0296298","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,2]]}}}