ObjectiveTo determine glycemic control in adult patients with type 2 diabetes receiving antidiabetic therapy as part of routine healthcare in India.Research design and methodsThis was a retrospective analysis of cross-sectional data of patients with type 2 diabetes receiving oral hypoglycemic agents (OHAs) with or without insulin between 2015 and 2017. We assessed proportion of patients with uncontrolled glycemia and performed logistic regression to evaluate its association with various risk factors and microvascular complications.ResultsA total of 55 639 eligible records were identified; mean age of patients was 54.31 (±11.11) years. One-third of the study population had microvascular complications, predominantly neuropathy. Nearly 76.6% of patients had uncontrolled glycated hemoglobin (HbA1c) ≥7% (53 mmol/mol); 62% of these patients had HbA1c between 7% and 8% (53–64 mmol/mol). Glycemic control from combination of OHAs with or without insulin varied between 14.2% and 24.8%. In multivariate analysis, factors statistically associated with uncontrolled glycemia were obesity (OR: 1.15), hypertension (stage I OR: 1.65 and stage II OR: 2.73) and diabetes duration >5 years (OR: 1.19) (p<0.001). Similarly, the odds of having any microvascular complication increased with duration of diabetes (past 1–2 years, OR: 1.67; 2–5 years, OR: 2.53; >5 years, OR: 4.01; p<0.0001), hypertension (stage I, OR: 1.18 and stage II, OR: 1.34; p<0.05) and uncontrolled HbA1c (OR: 1.28; p<0.0001).ConclusionsIndian population with type 2 diabetes has a high burden (76.6%) of poor glycemic control. This study highlights the need for early implementation of optimum diabetes pharmacotherapy to maintain recommended glycemic control, thereby reducing burden of microvascular complications.
Despite the established clinical effectiveness of statin therapy, a substantial proportion of patients fail to attain the target low-density lipoprotein cholesterol (LDL-C) levels and remain at risk for cardiovascular events. This study aimed to evaluate the proportion of patients achieving the guideline recommended LDL-C levels in real-world settings after receiving statins for primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD) in India. The study included a cross-sectional retrospective analysis of medical records from 2281 private healthcare facilities between 2017 and 2018. Overall, 15879 patients aged 20-80 years irrespective of their ASCVD status were included. Mean (±SD) age of patients was 55.96±10.41 years; 62.8% were men, and 44.6% (n=7076) had clinical ASCVD. Overall, 96.2% (n=15271) patients were receiving statins, 99.3% in the secondary prevention and 93.6% in the primary prevention cohort. Most patients were receiving moderate-intensity statins for primary (89.7%, n=7391) and secondary ASCVD prevention (73.4%, n=5159). None of the patients in the secondary prevention cohort achieved the recommended LDL-C level of <70 mg/dL. Approximately 25.3% (n=2089) individuals in the primary prevention and 20.2% (n=1418) in the secondary prevention cohort achieved LDL-C <100 mg/dL. Similar proportion (23.2%, n=3361) of patients with LDL-C control (<100 mg/dL) were found among the high-risk coronary heart disease (CHD) or CHD-equivalent group (including those with diabetes). This large real-world study demonstrated levels of LDL-C that were higher than guideline recommended targets, especially among ASCVD patients, despite receiving statin therapy. The results highlight major gaps in the real-world practice of prescribing statin therapy for both primary and secondary prevention of ASCVD. Concordance to guideline recommended therapy, timely dose titration, use of alternative drugs, and patient adherence can bridge this gap and help achieve optimal control of LDL-C. Further intensification of therapy with addition of non-statins is recommended if LDL-C goals are not achieved among high-risk population.
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