The DiabCare Asia 2008 study – Outcomes on control and complications of type 2 diabetic patients in Indonesia
Aim: To collect information on diabetes management, diabetes complications, and awareness of self-control in diabetic population of the country. This study also evaluated the physician perspectives, psychological aspects, and quality of life of diabetic patients.
Methods: This was a non-interventional, cross-sectional study, which recruited 1832 patients from secondary and tertiary medical centers across Indonesia. Data on demography, medical history, risk factors and clinical examination reports including laboratory assessments were collected from medical records of patients. Blood samples of all patients were collected for centralized HbA1c measurements.
Results: Among 1832 patients, 1785 individuals were eligible for analysis. The mean age of the patients was 58.9+9.6 years. The mean duration of diabetes was 8.5+7.0 years. Majority (97.5%) of the patients had type 2 diabetes. 67.9% had poor control of diabetes (A1c:8.1 ± 2.0%). 47.2% had FPG>130 mg/dL (161.6 ±14.6 mg/dL). Dyslipidemia was reported in 60% (834/1390) and 74% (617/834) of those received lipid lowering treatment. Neuropathy was most common complication (63.5%); other complications were: Diabetic retinopathy 42%, nephropathy 7.3%, severe late complications 16.9%, macrovascular complications 16%, microvascular complications 27.6%. About 81.3% of patients were on OADs (± insulin), 37.7% were on insulin (±OADs). Majority used biguanides followed by sulfonylureas. Human insulin was used by 73.2%, premix regimen 58.5%, analogues usage was 24.9%. Majority of the WHO-5 well being index responses fell in positive territory
Conclusion: Poor glycaemic control in majority of patients is a concern. There is a need for a large proportion of patients to be adjusted to more intensive pharmacotherapy and a multi-disciplinary approach for management should be adopted. The study fi ndings should be communicated to policymakers and physicians to help them provide proper healthcare and its facilities in Indonesia. (Med J Indones 2010; 19:235-44)
Keywords: DiabCare, DiabCare Indonesia, Diabetes complications, Dyslipidaemia, Glycaemic control, Hypertension.
Sutanegara D, Darmono, Budhiaartha AAG.The epidemiology, and management of diabetes mellitus in Indonesia. Diabetes Research and Clinical Practice. 2000;50: S9-S16
IDF Diabetes Atlas, 4th ed. ©International Diabetes Federation, 2009.
Mihardja L, Delima, Siswoyo H, Ghani L, Soegondo S. Prevalence and Determinants of Diabetes Mellitus and Impaired Glucose Tolerance in Indonesia (A Part of Basic Health research/Riskesdas). Acta Med Indones-Indones J Intern Med. 2009:41:169-74.
RISKESDAS SUMATERA BARAT 2007, Basic Health Research of West Sumatera Province, Indonesian Ministry of Health, Health Research and Development Body, 2008.
RISKESDAS BALI 2007, Basic Health Research of Bali Province 2007, Indonesian Ministry of Health, Health Research and Development Body, 2008.
Perkeni. Konsensus Pengelolaan Diabetes di Indonesia; 2006.
Harbuwono DK, Purnamasari D, Soegondo S, Edi TJ, Em YB, Soebardi S, et al. Prevalence of Diabetes Mellitus in Jakarta. AASD Poster Presentation; II-P-41. 2009 May 22; Osaka, Japan
World Health Organization: Regional Office for Europe (1998) Well-Being measures in primary health care: The DiabCare Project. Consensus meeting, Stockholm
Skovlund SE, Peyrot M, on behalf of the DAWN International Advisory Panel.The Diabetes Attitudes, Wishes, and Needs (DAWN) Program: A New Approach to Improving Outcomes of Diabetes Care. 2005; 18:136-42 244 Soewondo Med J Indones
Asia-Pacifi c Type 2 Diabetes Policy Group. Type 2 Diabetes -Practical Targets and Treatments, 2nd edn. Sydney, Australia: Health Communications Australia Pty, 1999.
American Diabetes Association. Standards of medical care for patients with diabetes mellitus. Diabetes Care 2000;23:S32-S42.
Ryde L, Standl E, Bartnik M, Van den Berghe G, Betteridge J et al, The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD). Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary. Eur Heart J. 2007;28:88-136.
IDF Global Guideline for Type 2 Diabetes, 2005
WHO expert consultation. Lancet. 2004;363:157-63
Mafauzy M on Behalf of the Diabcare-Asia 2003 Study Group. An audit on diabetes management in Asian patients treated by specialists: the Diabcare-Asia 1998 and 2003 studies. Curr Med Res Opin. 2008; 24: 507-14.
Data on fi le, Novo Nordisk, 2003.
The QuED Study Group. The relationship between physicians self-reported target fasting blood glucose levels and metabolic control in type 2 diabetes. The QuED Study Group – quality of care and outcomes in type 2 diabetes. Diabetes Care.2001;24:423-9
Wallace TM, and Matthews DR. Tha assessment of insulin resistance in man. Diabet Med. 2002; 19: 527-534.
NIH Publication No. 08-6286; May 2008
Lehto S, Rönnemaa T, Pyörälä K, Laakso M. Predictors of Stroke in Middle-Aged Patients With Non-Insulin- Dependent Diabetes. Stroke. 1996; 27: 63-8.
UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352:837-53.
Ashwell S, Bradley C, Stephens JW, Witthaus E, and Home P. Treatment satisfaction and quality of life with insulin glargine and insulin lispro compared with NPH insulin plus unmodifi ed human insulin in individuals with Type 1 diabetes. Diabetes care 2008;31:1112-7
Turner RC, Cull CA, Frighi V et al. Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus: progressive requirement for multiple therapies (UKPDS 49). JAMA 1999; 281:2005-12.
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