A Pharmacoepidemiological evaluation of glycaemic control among diabetes patients receiving different treatment regimens at Penang General Hospital
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Date
2010-06
Authors
A. Ibrahim, Kansaa
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Abstract
Generally, type 2 diabetes mellitus cannot be managed with a single drug or
lifestyle changes alone; therefore, adding anti-diabetic agents or increasing the dose is
recommended to control the disease progression. This study aimed to evaluate the antidiabetic
drugs used at Penang General Hospital in relation to the clinical outcomes of the
disease management and to detennine the proportions of diabetic patients who achieved
the target levels. The association between diabetes duration and each of: treatment
strategies, number of complications, comorbidities and clinical outcomes was also
evaluated. This was a cross-sectional retrospective observational study involving 1014
patients with type 2 diabetes mellitus who attended the outpatient diabetes clinic at the
Penang General Hospital in Malaysia. Each patient's medical record from 2005 to 2007
was reviewed. The primary and secondary clinical outcomes for treatment of diabetes
that are recommended to be monitored include fasting plasma glucose, haemoglobin
Ale (HbAlc), blood pressure (BP) and the lipid profile. All the collected data were
analysed using the SPSS (version 15.0) software package (SPSS Inc., Chicago, IL) and
Microsoft Excel. Female patients constituted 54% of the study population, and 54.1% of
the sample was Chinese. There were significant differences in glycaemic control
between the treatment strategies, and patients receiving monotherapy with oral
hypoglycaemic agents (OHA) had the lowest HbA1c level. Furthermore, high glucose
levels were observed in spite of the treatment intensification either by addition of antidiabetic
agents or increment of the drug dose (p <0.001). About half of the diabetic
patients who were on rrionotherapy with OHAs had no complications. A large proportion
(92.8%) of the study population had uncontrolled diabetes even though they were
receiving anti-diabetic medications. There was an association between the diabetes
duration and each of the following: treatment strategies, number of complications, and
co-morbidities (p <0.001). On the basis of these results, we conclude that monotherapy
with OHAs therapy had better outcomes (glycaemic control, BP, high density
lipoprotein cholesterol, and the number of complications) than the other treatment
regimens. Moreover, more than half of those who were on monotherapy with OHA
therapy had relatively shorter treatment period. The differences observed in the study
outcomes may not necessarily reflect the failure of the other treatment modalities
recommended by the Malaysian Clinical Practice Guidelines. Rather, these findings
could be due to the progression of the disease and possibly inadequate patient
compliance to the anti-diabetic medications. These findings provide an input to the
Malaysian Ministry of Health to take steps for improving the management and quality of
life of patients with type 2 diabetes.
Keywords: OHAs, type 2 diabetes, glycaemic control, disease duration, co-morbidities,
complications.
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Glycaemic control among diabetes patients receiving different treatment regimens , Penang General Hospital