Optimization of type 2 diabetes mellitus control in Egyptian patients

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.