Unravelling the association of glycosylated haemoglobin A1c, blood pressure, and LDL-cholesterol (ABC) with all-cause mortality in Type 2 diabetes patients: insights from a middle-income country.

INTRODUCTION

This study evaluated the risk of all-cause mortality among Type 2 Diabetes (T2D) patients in Malaysia, correlating it with glycosylated haemoglobin A1c (HbA1c), blood pressure (BP), and LDL-Cholesterol (LDL-C) - the ABC parameters. This would fill the evidence gap from middle-income countries like Malaysia.

METHODS

This retrospective cohort study analysed data from National Diabetes Registry and death records for 90,933 T2D patients in southern Malaysia (2011-2021). ABC parameters were categorized into quantiles, and adjusted hazard ratios (aHR) were estimated using Cox regression with the lowest-risk quantile as reference.

RESULTS

All-cause mortality showed a 'J-shaped' association across ABC parameters. For HbA1c, aHRs (95% CI) were 1.11 (1.03-1.19) and 1.51 (1.40-1.63) in the first and last deciles (reference: fourth decile). For BP and LDL-C (reference: third quantile), aHRs were 1.11 (1.05-1.17) and 1.19 (1.13-1.24) for systolic BP, and 1.08 (1.03-1.14) and 1.16 (1.11-1.22) for LDL-C at the lowest and highest quintiles. For diastolic BP, aHRs were 1.09 (1.02-1.16) and 1.11 (1.04-1.19) at the lowest and highest quartiles.

CONCLUSION

Maintaining optimal ABC parameters is crucial to reduce mortality in T2D patients. These findings fill critical gap in the literature, particularly for the Malaysian population.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40200-025-01620-w.