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
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