Glycemic control in newly insulin-initiated patients with type 2 diabetes mellitus: A retrospective follow-up study at a university hospital in Ethiopia

Abstract

Background Though many trials had examined the effectiveness of taking insulin with or without oral agents, there are limited real-world data, particularly among patients with type 2 diabetes mellitus (T2DM) in the resource limited settings. This study aimed to examine level of glycemic control among patients with T2DM after initiation of insulin and factors associated with poor glycemic control. Methods An analysis of retrospective medical records of patients with T2DM who initiated insulin due to uncontrolled hyperglycemia by oral agents was conducted from 2015–2020 in the University of Gondar Comprehensive Specialized Hospital. Difference in median fasting plasma glucose (FPG) before and after insulin initiations was examined by a Wilcoxon signed-rank test. Kruskal Wallis test was performed to explore difference in the median level of FPG among treatment groups. A logistic regression model was also used to identify associated factors of poor glycemic control after insulin initiation. Statistical significance was declared at p < 0.05. Results Of 424 enrolled patients with T2DM, 54.7% were males and the mean age was 59.3±9.3 years. A Wilcoxon signed-rank test showed that there was significant deference in FPG before and after insulin initiation (P < 0.001). A declining trend of blood glucose was observed during the 1-year follow-up period of post-initiation. However, majority of the participants did not achieve target glucose levels. Participants who had higher FPG and systolic blood pressure (SBP) before insulin initiation were found more likely to have poor glycemic control after insulin initiation. Similarly, patients who received atorvastatin compared with simvastatin were found to have poor glycemic control in the post-period of initiation (P = 0.04). Premixed insulin was associated with a lower likelihood of poor glycemic control than neutral protamine Hagedorn (NPH) insulin (P < 0.001). Conclusion Following insulin initiation, a significant change in glycemic level and declining trend of FPG was observed during a 1-year follow-up period. However, the majority of patients still had a poorly controlled glycemic level. Appropriate management focusing on predictors of glycemic control would be of a great benefit to achieve glycemic control.

Rate of glycaemic control and associated factors in patients with type 2 diabetes mellitus treated with insulin-based therapy at selected hospitals in Northwest Ethiopia: a multicentre cross-sectional study

“…The clinical characteristics of the participants in this study were comparable with the previous studies conducted in the country, which most of the participants had cardiovascular disorders like hypertension and diabetes-related macrovascular complications, and most of the participants received metformin plus insulin combination regimens. 17 This study may reflect the characteristics and management practice of patients with T2DM in the country.…”

“…To the best of authors’ search, there is only a single study in Ethiopia that has determined the level of glycaemic control in newly insulin-initiated patients with T2DM. 17 However, this study is different from the previous study in terms of the study design and settings which the current study is a multicentre prospective cross-sectional study with incorporation of important clinical and sociodemographic variables which can affect glycaemic control. Such variables include BMI, Self-monitoring of blood glucose (SMBG) practice of the patients and other dietary, work and physical exercise-related factors which are not considered in the earlier study because of its retrospective nature of the study.…”

Medication adherence and its impact on glycemic control in type 2 diabetes mellitus patients with comorbidity: A multicenter cross-sectional study in Northwest Ethiopia

“…The problem is more severe in low-income countries and poor settings where there is a low level of patients' educational status, knowledge about diabetes and medications [25][26][27][28]. In Ethiopia, a significant proportion of patients with T2DM have comorbid conditions like hypertension, dyslipidemia and macrovascular and microvascular complications [29]. However, medication adherence can be influenced by the medication regimen complexity and the polypharmacy [30,31,37] used to treat these comorbidities.…”

“…Particularly in Ethiopian settings, most patients are with low socio-economic status [25][26][27][28]. In contrary, most patients with T2DM are with comorbid conditions [29]. Thus, this finding indicates that healthcare providers and prescribers could come up with appreciating the socio-economic status of the patients, and clear and good communication towards the affordability of the prescribed medications.…”

“…Studies also revealed that knowledge about diabetes and medications, level of patient educational status, occupational status, duration of diabetes and its treatments are among the factors that contribute to medication adherence [ 25 – 28 ]. Majority of patients with T2DM in Ethiopia are with comorbidities such as hypertension, dyslipidemia and macrovascular complications and had significantly poor glycemic control [ 28 , 29 ]. Polypharmacy and medication regimen complexity have been considered to be the most factors of poor adherence to medications among patients with chronic disease conditions and comorbidities [ 30 , 31 ].…”