Determinants of HbA1c variability among type 2 diabetes mellitus patients in Malaysian primary care setting

Diabetes complications were shown to be associated with glycaemic control and variability. This study aims to identify the factors associated with HbA1c variability in type 2 diabetes mellitus (T2DM) patients. A retrospective cohort of T2DM patients who visited the clinics between January 2017 and October 2022 were included. HbA1c variability were measured using coefficient of variation and standard deviation, and stratified using medians of 9.16 and 0.75, respectively. Logistic regressions was performed and subgroup analyses based on HbA1c control were included. We included 2,532 T2DM patients with a mean age of 61.7 years, predominantly female (55.8%) and of Chinese ethnicity (39%). Mean diabetes duration was 5.9 years and 45.8% were obese. Prevalence of HbA1c < 7.0% was about one-third. Predominant prescription choices were biguanides and sulphonylureas. Malays, insulin usage, and elevated triglyceride levels were associated with high HbA1c variability across both HbA1c variability models. This study highlights that by recognizing the factors linking to HbA1c variability, clinicians can have more insights during patient monitoring and management. HbA1c variability can be a valuable measure as it does not require additional cost and can provide extra insight about patient's condition. Further investigation is needed to explore the impact of ethnicity on HbA1c variability.