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Effect of Hypertension and Dyslipidemia on glycemic control among Type 2 Diabetes patients in Thailand Dr. Mya Thandar Dr.PH. Batch 5. Background and Rationale.

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Effect of Hypertension and Dyslipidemia on glycemic control among Type 2 Diabetes patients in ThailandDr. MyaThandarDr.PH. Batch 5

Background and rationale
Background and Rationale

  • Diabetes, a lifelong chronic disease, is a global endemic with rapidly increasing prevalence in both developing and developed countries

  • Hypertension, overweight and dyslipidemia are often accompanied with Type 2 diabetes that affect morbidity and mortality

Background and rationale1
Background and Rationale

  • Dyslipidemia: if there was at least one abnormal level in the lipid profile (LDL >100 mg/dl, HDL <40 mg/dl, and triglycerides >150 mg/dl)

  • Hypertension: if the blood pressure was more than 130/80 mmHg

    (Standards of Medical care in DM, ADA)

Background and rationale2
Background and Rationale

  • Good glycemic control is essential in preventing diabetic complications

  • The level of glycosylated hemoglobin (HbA1c) provides a useful measure of the glycemic control of diabetes patients

  • Each 1% reduction in HbA1c was associated with a 37% decrease in risk for microvascular complications and a 21% decrease in the risk of diabetic related death (UKPD)

  • The targeted goal of HbA1c level for glycemic control - <7% (ADA Guideline)

Background and rationale3
Background and Rationale

In Thailand

  • NCDs are estimated account for 71% of all deaths in which diabetes was contributed 6%

  • 7.3% of the individuals living with diabetes (WHO,2010)

  • Little information about the effect of co-morbidities of hypertension and dyslipidemia on glycemiccontrol

  • There were controversies in association between hypertension, age, body mass index (BMI) and HbA1c level

Research question
Research question

  • What is the magnitude of effect of Hypertension and Dyslipidemia on glycemic control among Type 2 DM patients in Thailand?


  • To determine effect of Hypertension and Dyslipidemia on glycemic control in Type 2 Diabetes patients in Thailand

Primary outcome of the study

  • Glycemic control by HbA1c level

    Independent variables

  • Hypertension

  • Dyslipidaemia


  • Age, Gender, BMI, Duration of DM

Research methodology
Research Methodology

  • Study design

    Hospital based Cross-sectional study

  • Study area

    Hospitals under Ministry of Public Health and Bangkok Metropolitan Administration in Thailand

  • Study population

    Type 2 DM patients in Thailand

Research methodology1
Research Methodology

  • Sampling method

    The sample was selected based on the probability proportional to size of the patients for each hospital.

  • Sample size


  • Study period

    2010 to 2012

Research methodology2
Research Methodology

Data Analysis

  • Baseline characteristics of the participants

    -frequency and percentage for categorical data

    -mean and standard deviation for continuous


  • Bivariate analysis

  • Multiple logistic regression analysis

  • Statasoftware version 12.0

The inclusion flow chart
The inclusion flow chart

Total No. of patients visiting 600 Hospitals across the Thailand

(N= 6,277,543)

Type 2 DM & HT patients

(N= 174,578)

Exclude Patients

Without DM


Type 2 DM & HT patients

( N= 79,543)

Missing (20,800)

Sample size of the Study


Results characteristics of the participants
ResultsCharacteristics of the participants

Crude and Adjusted Odds ratios (ORs) for getting poor glycemic control and their 95% confidence intervals

Crude and Adjusted Odds ratios (ORs) for getting poor glycemic control and their 95% confidence intervals

Discussion Hba1C level

  • Out of total 58,743 patients, only 34.46 % of the type 2 DM patients had good glycemic control

  • Achievement of glycemic control varied widely on the life style, type of medication, patients’ education as well as data collection method

Discussion Hba1C level

  • Attaining the targeted goal of HbA1c level in some research were 56.1% in Jordan, 51% in Canada, 55.7% in USA and 31.78% in China respectively

  • Thai Diabetes Registry Project in 2006, only 37.7% of their participants were getting control of HbA1c <7%

Discussion Hba1C level

  • The majority of the patients achieving the targeted goal of HbA1c level were old age group of more than 60 years

  • Mature patients perceived themselves to have better glycaemic control over their lives

  • More motivated to take care of their health than younger age group

  • Poor glycaemic control was associated with longer duration of diabetes

    (consistent with other studies)

Discussion Hba1C level

  • Only one third of the patients from DM with both comorbidities had good glycemic control.

  • Poor glycemic control could be due to the presence of comorbidities of Hypertension and Dyslipidemia

  • No significant association between hypertension and HbA1c level which was not consistent with other studies

  • Dyslipidemia, due to elevated TG and LDL, was significantly associated with poor glycaemic control

Strength of the study Hba1C level

  • This study consisted of Nationally representative sample of larger sample size

    Limitation of the study

  • This cross- sectional study was limited to data available in hospital .

  • Insufficient data and missing values were unavoidable because of the secondary data.

  • The design of study was cross-sectional study that showed the association of each factor might not be able to determine the cause and effect of each associated factor.

Recommendation Hba1C level

  • Effective control of Dyslipidemia with intervention among Type 2 DM patients is urgently needed to prevent or reduce the risk of developing the complications.

  • An educational program that emphasizes lifestyle modification with importance of adherence to

    treatment regimen would be of great benefit in glycemic control.

  • Population based and prospective study should be conducted in the future.

Conclusion Hba1C level

  • Majority of the type 2 DM patients in Thailand had poor glyeacmic control

  • More than half of the patients have hypertension and almost all the patients were coexisting with dyslipidaemia

  • Dyslipidaemia was significantly associated with Hba1c level

  • DM patients with dyslipidaemia had 1.5 time odds of getting poor glycemic control than patients with DM alone