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.