open access

Vol 9, No 6 (2020)
Research paper
Published online: 2020-11-19
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Optimization of type 2 diabetes mellitus control in Egyptian patients

Abdelhamid Ebid, Mohamed Ahmed Mobarez, Ramadan Ahmed Ramadan, Mohamed Adel
DOI: 10.5603/DK.2020.0059
·
Clinical Diabetology 2020;9(6):433-441.

open access

Vol 9, No 6 (2020)
ORIGINAL ARTICLES
Published online: 2020-11-19

Abstract

Background. Optimum management for a patient with type 2 diabetes mellitus (T2DM) requires periodic evaluation and monitoring of the patient’s risk factors to measure its impact on different classes of treatment. Also the diabetes complications must be evaluated and initial review of drug history. This study aims to analyze clinical characteristics, risk factors, and contributions of each variable on predictive performances of each protocol used in the treatment of T2DM patients. Methods. A comparative description, a study of 2000 Egyptian patients. Patients were categorized into eight groups according to the treatment protocol used. Multivariate logistic regression was applied to assess the probability of each protocol to reach target glycated hemoglobin A1c (HbA1c) in comparison to the standard protocol metformin + SU (protocol A) Results. The proportion of patients in our study reaching HbA1c ≤ 7% ranged between 48.9% in dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors) group (protocol H), and 59.2% in metformin + DPP-4 inhibitors group (protocol B). In subgroup analysis according to disease duration (≤ 8 years duration), mean HbA1c spanned from 7.4 ± 0.49% in SU monotherapy (protocol D) to 8.6 ± 0.5% in metformin + SU; the likelihood of reaching HbA1c > 7 was lower in the protocol A and protocol B. Conclusion. Patients not controlled on metformin alone with lifestyle modification should be switched to either protocol A or protocol B based on the preferential clinical outcome if there is no contraindication, as these two protocols are associated with the best result and a high percentage of patients reaching target HbA1c.

Abstract

Background. Optimum management for a patient with type 2 diabetes mellitus (T2DM) requires periodic evaluation and monitoring of the patient’s risk factors to measure its impact on different classes of treatment. Also the diabetes complications must be evaluated and initial review of drug history. This study aims to analyze clinical characteristics, risk factors, and contributions of each variable on predictive performances of each protocol used in the treatment of T2DM patients. Methods. A comparative description, a study of 2000 Egyptian patients. Patients were categorized into eight groups according to the treatment protocol used. Multivariate logistic regression was applied to assess the probability of each protocol to reach target glycated hemoglobin A1c (HbA1c) in comparison to the standard protocol metformin + SU (protocol A) Results. The proportion of patients in our study reaching HbA1c ≤ 7% ranged between 48.9% in dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors) group (protocol H), and 59.2% in metformin + DPP-4 inhibitors group (protocol B). In subgroup analysis according to disease duration (≤ 8 years duration), mean HbA1c spanned from 7.4 ± 0.49% in SU monotherapy (protocol D) to 8.6 ± 0.5% in metformin + SU; the likelihood of reaching HbA1c > 7 was lower in the protocol A and protocol B. Conclusion. Patients not controlled on metformin alone with lifestyle modification should be switched to either protocol A or protocol B based on the preferential clinical outcome if there is no contraindication, as these two protocols are associated with the best result and a high percentage of patients reaching target HbA1c.

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Keywords

type 2 diabetes, HbA1c, metformin, likelihood, clinical characteristics, multivariate analysis

About this article
Title

Optimization of type 2 diabetes mellitus control in Egyptian patients

Journal

Clinical Diabetology

Issue

Vol 9, No 6 (2020)

Article type

Research paper

Pages

433-441

Published online

2020-11-19

DOI

10.5603/DK.2020.0059

Bibliographic record

Clinical Diabetology 2020;9(6):433-441.

Keywords

type 2 diabetes
HbA1c
metformin
likelihood
clinical characteristics
multivariate analysis

Authors

Abdelhamid Ebid
Mohamed Ahmed Mobarez
Ramadan Ahmed Ramadan
Mohamed Adel

References (32)
  1. Afshin A, Forouzanfar MH, Reitsma MB, et al. GBD 2015 Obesity Collaborators. Health Effects of Overweight and Obesity in 195 Countries over 25 Years. N Engl J Med. 2017; 377(1): 13–27.
  2. Menke A, Casagrande S, Geiss L, et al. Prevalence of and Trends in Diabetes Among Adults in the United States, 1988-2012. JAMA. 2015; 314(10): 1021–1029.
  3. International Diabetes Federation (2017) IDF Atlas 8th edition. International Diabetes Federation, Brussels. http://www.diabe tesatlas.org (26.11.2019).
  4. Park J, Peters PA. Mortality from diabetes mellitus, 2004–2008: a multiple-causeof-death analysis. Health Rep. 2014; 25(3): 12–16.
  5. Preis SR, Hwang SJ, Coady S, et al. Trends in all-cause and cardiovascular disease mortality among women and men with and without diabetes mellitus in the Framingham Heart Study, 1950 to 2005. Circulation. 2009; 119(13): 1728–1735.
  6. Pugliese G, Solini A, Bonora E, et al. RIACE Study Group. Chronic kidney disease in type 2 diabetes: lessons from the Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicentre Study. Nutr Metab Cardiovasc Dis. 2014; 24(8): 815–822.
  7. Rao C, Adair T, Bain C, et al. Mortality from diabetic renal disease: a hidden epidemic. Eur J Public Health. 2012; 22(2): 280–284.
  8. Coresh J, Selvin E, Stevens LA, et al. Prevalence of chronic kidney disease in the United States. JAMA. 2007; 298(17): 2038–2047.
  9. Vamos EP, Bottle A, Edmonds ME, et al. Changes in the incidence of lower extremity amputations in individuals with and without diabetes in England between 2004 and 2008. Diabetes Care. 2010; 33(12): 2592–2597.
  10. Jansson SPO, Andersson DKG, Svärdsudd K. Mortality trends in subjects with and without diabetes during 33 years of follow-up. Diabetes Care. 2010; 33(3): 551–556.
  11. American Diabetes Association (2019) Standards of medical care in Diabetes. Diabetes Care. 2019; 42(13): 28.
  12. Orozco-Beltrán D, Gil-Guillen VF, Quirce F, et al. Collaborative Diabetes Study Investigators. Control of diabetes and cardiovascular risk factors in patients with type 2 diabetes in primary care. The gap between guidelines and reality in Spain. Int J Clin Pract. 2007; 61(6): 909–915.
  13. Hermans MP, Brotons C, Elisaf M, et al. (for the OPTIMISE (OPtimal Type 2 dIabetes Management Including benchmarking and Standard trEatment) International Steering Committee). Optimal type 2 diabetes mellitus management: the randomised controlled OPTIMISE benchmarking study: baseline results from six European countries. Eur J Prev Cardiol. 2013; 20(6): 1095–1105.
  14. Standards of Medical Care in Diabetes-2016: Summary of Revisions. Diabetes Care. 2016; 39 Suppl 1: S4–S5.
  15. Holman RR, Paul SK, Bethel MA, et al. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008; 359(15): 1577–1589.
  16. Maruthur NM, Tseng E, Hutfless S, et al. Diabetes Medications as Monotherapy or Metformin-Based Combination Therapy for Type 2 Diabetes: A Systematic Review and Meta-analysis. Ann Intern Med. 2016; 164(11): 740–751.
  17. Bennett WL, Maruthur NM, Singh S, et al. Comparative effectiveness and safety of medications for type 2 diabetes: an update including new drugs and 2-drug combinations. Ann Intern Med. 2011; 154(9): 602–613.
  18. Vijan S, Sussman JB, Yudkin JS, et al. Effect of patients' risks and preferences on health gains with plasma glucose level lowering in type 2 diabetes mellitus. JAMA Intern Med. 2014; 174(8): 1227–1234.
  19. Ford ES. Trends in the control of risk factors for cardiovascular disease among adults with diagnosed diabetes: findings from the National Health and Nutrition Examination Survey 1999-2008*. J Diabetes. 2011; 3(4): 337–347.
  20. Levey AS, Bosch JP, Lewis JB, et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999; 130(6): 461–470.
  21. Ainsworth BE, Haskell WL, Leon AS, et al. Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sports Exerc. 1993; 25(1): 71–80.
  22. Srivastava A. Bringing ADA 2019 and EASD 2018 Guidelines in Clinical Practice. Int J Diab. 2019; 22: 29.
  23. Ackermann RT, Wallia A, O'Brien MJ. Correlates of second-line type 2 diabetes medication selection in the USA. BMJ Open Diabetes Res Care. 2017; 5: e000421.
  24. Zekarias K, Davey C, Seaquist E. Intensification of medical management in type 2 diabetes: A real-world look at primary care practice. J Diabetes Complications. 2020; 34(1): 107477.
  25. Ekström N, Miftaraj M, Svensson AM, et al. Glucose-lowering treatment and clinical results in 163 121 patients with type 2 diabetes: an observational study from the Swedish national diabetes register. Diabetes Obes Metab. 2012; 14(8): 717–726.
  26. Nathan DM, Buse JB, Davidson MB. Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2009; 32(193): 203.
  27. Chamberlain JJ, Herman WH, Leal S, et al. Pharmacologic Therapy for Type 2 Diabetes: Synopsis of the 2017 American Diabetes Association Standards of Medical Care in Diabetes. Ann Intern Med. 2017; 166(8): 572–578.
  28. Wilding J, Godec T, Khunti K. Changes in HbA1c and weight, and treatment persistence, over the 18 months following initiation of second-line therapy in patients with type 2 diabetes: results from the United Kingdom. Clinical Practice Research Datalink BMC Med. 2018; 16: 116.
  29. Handelsman Y, Mechanick JI, Blonde L, et al. AACE Task Force for Developing Diabetes Comprehensive Care Plan. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for developing a diabetes mellitus comprehensive care plan. Endocr Pract. 2011; 17 Suppl 2: 1–53.
  30. Yurgin N, Secnik K, Lage MJ. Antidiabetic prescriptions and glycemic control in German patients with type 2 diabetes mellitus: a retrospective database study. Clin Ther. 2007; 29(2): 316–325.
  31. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). The Lancet. 1998; 352(9131): 854–865.
  32. Bolen SD, Bricker E, Samuels TA, et al. Factors associated with intensification of oral diabetes medications in primary care provider-patient dyads: a cohort study. Diabetes Care. 2009; 32(1): 25–31.

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