THE ABC TARGETS AND USE OF ORGANPROTECTIVE MEDICATIONS AMONG THAI PEOPLE WITH YOUNG-ONSET TYPE 2 DIABETES

Abstract

INTRODUCTION
Young-onset Type 2 Diabetes (YOD) is associated with premature death and worse microvascular and cardiovascular outcomes. Our recent study which recruited all individuals with the onset of DM before 30 years revealed that YOD had a three times higher prevalence of diabetic kidney disease (DKD) than young-onset T1D despite similar disease duration, glycemic control, and age. This study aimed to evaluate the rate of RAAS blockade (ACEi or ARB), SGLT2i, GLP-1 RA, and statin use among YOD. The proportion of patients who attained various multiple treatment targets was also evaluated.

METHODOLOGY
Data from all participants with T2D enrolled between 2022- 2023 into the Thai Type 1 Diabetes and Diabetes Diagnosed Before Age 30 Years Registry, Care and Network (T1DDAR CN) from Theptarin Hospital, a tertiary diabetes center in Bangkok, were analyzed. The various ABC targets defined as standard targets (A1C <7.0%, BP <140/90 mmHg, and LDL <100 mg/dL), ADA-recommended targets (A1C <7.0%, BP <130/80 mmHg, and LDL <100 mg/dL) and tight targets (A1C ≤6.5%, BP <130/80 mmHg, and LDL <70 mg/ dL) were examined.

RESULTS
A total of 50 patients (42.0% were females, current age of 46.6±12.4 years, age at DM diagnosis of 24.4 ± 5.2 years, duration of diabetes of 23.1 ± 11.2 years, BMI of 28.4±5.5 kg/m2, prevalence of hypertension of 48.0%, insulin usage in 54.0%, and A1C of 7.5 ± 1.7%) were included. Statin medications were prescribed in 86.0%, RAAS inhibitors in 42.0%, SGLT2i in 32.0%, and GLP-1 RA in 28.0% of all patients. Among the DKD patients (N = 24), the rate of RAAS blockade was 66.7% and SGLT2i was 45.8%. The glycemic targets at ≤6.5% and <7.0% were achieved in 20.8% and 25.0%, respectively. The standard ABC targets, ADArecommended targets, and tight targets were achieved in only 20.0%, 14.0%, and 6.0%, respectively.

CONCLUSION
Our routine clinical practice among diabetologists showed that achievement of treatment targets and use of organprotective medications remain considerably suboptimal in individuals with YOD. Efforts to evaluate and improve the quality of care of these patients should be done to ensure the provision of adequate organ-protective medications.