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Associations Between Type 2 Diabetes Subtypes and Complications: Analysis of the Malaysia National Diabetes Registry

15 Pages Posted: 25 Mar 2022

See all articles by Rasa Kazlauskaite

Rasa Kazlauskaite

Rush University - Department of Medicine

Nathan Ellermeier

Duke University - Duke Global Health Institute

Carrie Ngongo

RTI International - Global Health Division

Arunah Chandran

Ministry of Health Malaysia - Disease Control Division

Pankaja Desai

Rush University - Department of Internal Medicine

Ethan Ritz

Rush University - Department of Internal Medicine

Rachel Nugent

RTI International - Global Health Division

Feisul Idzwan Mustapha

Ministry of Health Malaysia - Disease Control Division

More...

Abstract

Background: Type 2 diabetes (DM2) subtypes and associations with complications have not adequately been investigated in Asia-Pacific populations.

Methods: Analytical cohort (n=60946), extracted from 2019 Malaysia National Diabetes Registry, included 63·8% Malay, 16·7% Chinese, 11·3% Indian, and 11·3% other. A k-means cluster analysis was performed with complete data on six variables: age, DM2 duration, body mass index, metabolic syndrome severity, triglyceride-glucose index, and A 1c­ . Separate Cox regression models and time-to-event analysis (from DM2 diagnosis) assessed the hazard ratio and time-to-complications, adjusting for sex, age, and ethnicity.

Findings: Four clusters emerged: Mild Age-Related Diabetes (MARD) in n=21059 (35·6%), Severe Insulin-Deficient Diabetes (SIDD) in n=11751 (19·3%); Mild Obesity-Related Diabetes (MOD) in n=14700 (24·1%); and Severe Insulin-Resistant Diabetes (SIRD) in n=13436 (22·0%). Each cluster was compared to MARD. SIDD had later-onset and lowest hazard ratio (HR) for chronic kidney disease (CKD), HR=0·25 (0·24, 0·26); retinopathy HR=0·28 (0·27, 0·30); cerebrovascular disease HR=0·57 (0·47, 0·69), and ischemic heart disease HR= 0·83 (0·76, 0·91). MOD had lowest HR= 0·53 (0·34, 0·84) for limb amputations, and low HR for CKD, retinopathy, and cerebrovascular disease. SIRD had highest HR=1·43 (1·13, 1·81) for foot ulcers, low HR=0·59 (0·56, 0·63) for retinopathy and CKD, HR=0·77 (0·74, 0·80). Known severe CKD cases were excluded from National Diabetes Registry.

Interpretation: DM2 subtypes associate differently with complications in Malaysia, similar to patterns found in European cohorts. DM2 subtypes complications, particularly for advanced chronic kidney disease, deserve further longitudinal investigation.

Funding Information: This study was funded by the Malaysian Ministry of Health, RTI International, and Rush University (R3 pilot grant 0272101.001.001).

Declaration of Interests: The authors have declared no conflicts of interest.

Ethics Approval Statement: Ethical clearance for this retrospective review of de-identified data from the NDR was granted by the Malaysian Ministry of Health Medical Research and Ethics Committee (NMRR-21-172-58258 (IIR)).

Keywords: Diabetes subtypes, Diabetes classification, Diabetes complications, Registry, Epidemiological analysis

Suggested Citation

Kazlauskaite, Rasa and Ellermeier, Nathan and Ngongo, Carrie and Chandran, Arunah and Desai, Pankaja and Ritz, Ethan and Nugent, Rachel and Mustapha, Feisul Idzwan, Associations Between Type 2 Diabetes Subtypes and Complications: Analysis of the Malaysia National Diabetes Registry. Available at SSRN: https://ssrn.com/abstract=4066411 or http://dx.doi.org/10.2139/ssrn.4066411

Rasa Kazlauskaite (Contact Author)

Rush University - Department of Medicine ( email )

Chicago, IL
United States

Nathan Ellermeier

Duke University - Duke Global Health Institute ( email )

310 Trent Drive
Box 90519
Durham, NC 27710
United States

Carrie Ngongo

RTI International - Global Health Division ( email )

Research Triangle Park, NC
United States

Arunah Chandran

Ministry of Health Malaysia - Disease Control Division ( email )

Putrajaya
Malaysia

Pankaja Desai

Rush University - Department of Internal Medicine ( email )

United States

Ethan Ritz

Rush University - Department of Internal Medicine ( email )

United States

Rachel Nugent

RTI International - Global Health Division ( email )

Research Triangle Park, NC
United States

Feisul Idzwan Mustapha

Ministry of Health Malaysia - Disease Control Division ( email )

Putrajaya
Malaysia

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