Characteristics and Treatment Patterns of Patients with Type 2 Diabetes Mellitus in the Middle East and Africa Cohort of the DISCOVER Study Program: a Prospective Study

Abstract

Introduction Despite the high prevalence of type 2 diabetes (T2D) and suboptimal glycemic control in the Middle East and Africa, comprehensive data on the management of T2D remain scarce. The main aim of this study is to describe the characteristics and treatment of patients with T2D initiating second-line glucose-lowering therapy in these regions. Methods DISCOVER is a global, 3-year, prospective observational study of patients with T2D enrolled at initiation of second-line glucose-lowering therapy. Baseline characteristics and treatments are presented for patients from 12 countries divided into three regions: Mediterranean, Gulf Cooperation Council, and South Africa. Results Among 3525 patients (52.5% male, mean age 54.3 years), mean time since T2D diagnosis was 6.2 years [across-region range (ARR) 5.8–7.5 years] and mean glycated hemoglobin levels were 8.7% (72.0 mmol/mol) [ARR 8.6–9.0% (68–75 mmol/mol)]. At first line, metformin was prescribed for 88.1% (ARR 85.4–90.3%) of patients and a sulfonylurea for 34.4% (ARR 12.7–45.4%). Sulfonylureas and dipeptidyl peptidase-4 inhibitors were prescribed at second line for 55.5% (ARR 48.6–82.5%) and 49.0% (ARR 3.7–73.8%) of patients, respectively. Main reasons for choice of second-line therapy were efficacy (73.2%; ARR 60.1–77.7%) and tolerability (26.8%; ARR 3.7–31.2%). Conclusions We demonstrate considerable inter-region variations in the management of T2D, likely affected by multiple factors (health system, physician behavior, and patient compliance), all of which should be addressed to optimize outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s13300-022-01272-6.

Prevalence of type 2 diabetes mellitus and related factors among the general adult population in Saudi Arabia between 2016–2022: A systematic review and meta-analysis of the cross-sectional studies

“…Managing T2DM in the Middle East has shown significant regional variations recently, probably caused by various modifiable factors such as the health system, doctor behavior, and patient compliance. [ 40 ] To achieve the best results, Saudi Arabia should consider and handle each of these to prevent upcoming diabetes in the nation.…”

Pharmacological Treatment of Type-2-Diabetes and Cardiovascular Comorbidities: Differences between Undocumented Migrants and Natives in Italy

“…The fact that they were less frequently prescribed to Italians could be counterbalanced by a more frequent use of SGLT-2 inhibitors, possibly because Italian patients had a greater prevalence of CV diseases and these medications are now recommended even as first-line therapy in this case [16,18]. Interestingly, sulfonylureas and DPP-4 inhibitors were the most prescribed second-line antidiabetic medications in some populations of the DIS-COVER study [20]. GLP-1 analogues could be found only in the group of Italian patients.…”

Regional expert opinion: Management of heart failure with preserved ejection fraction in the Middle East, North Africa and Turkey

“…As such, there is a great focus on treatments with the potential to prevent HF in patients with diabetes. Regional observational studies such as DISCOVER ME 70 and PACT MEA 71 have shown that glucose‐lowering agents such as sulfonylureas, thiazolidinediones and insulin are often used in the MENAT region. However, these therapies are associated with adverse cardiovascular outcomes, such as an increased risk of incident HF and an increase in mortality and hospitalizations associated with HF 69,72 …”