Persistent poor glycaemic control in individuals with type 2 diabetes in developing countries: 12 years of real-world evidence of the International Diabetes Management Practices Study (IDMPS)

Abstract

Aims/hypothesis We evaluated the secular trend of glycaemic control in individuals with type 2 diabetes in developing countries, where data are limited. Methods The International Diabetes Management Practices Study provides real-world evidence of patient profiles and diabetes care practices in developing countries in seven cross-sectional waves (2005-2017). At each wave, each physician collected data from ten consecutive participants with type 2 diabetes during a 2 week period. The primary objective of this analysis was to evaluate trends of glycaemic control over time. Results A total of 66,088 individuals with type 2 diabetes were recruited by 6099 physicians from 49 countries. The proportion of participants with HbA 1c <53 mmol/mol (<7%) decreased from 36% in wave 1 (2005) to 30.1% in wave 7 (2017) (p < 0.0001). Compared with wave 1, the adjusted ORs of attaining HbA 1c ≤64 mmol/mol (≤8%) decreased significantly in waves 2, 5, 6 and 7 (p < 0.05). Over 80% of participants received oral glucose-lowering drugs, with declining use of sulfonylureas. Insulin use increased from 32.8% (wave 1) to 41.2% (wave 7) (p < 0.0001). The corresponding time to insulin initiation (mean ± SD) changed from 8.4 ± 6.9 in wave 1 to 8.3 ± 6.6 years in wave 7, while daily insulin dosage ranged from 0.39 ± 0.21 U/kg (wave 1) to 0.33 ± 0.19 U/kg (wave 7) for basal regimen and 0.70 ± 0.34 U/kg (wave 1) to 0.77 ± 0.33 (wave 7) U/kg for basal-bolus regimen. An increasing proportion of participants had ≥2 HbA 1c measurements within 12 months of enrolment (from 61.8% to 92.9%), and the proportion of participants receiving diabetes education (mainly delivered by physicians) also increased from 59.0% to 78.3%. Conclusions In developing countries, glycaemic control in individuals with type 2 diabetes remained suboptimal over a 12 year period, indicating a need for system changes and better organisation of care to improve self-management and attainment of treatment goals.

Current State of Diabetes Mellitus Prevalence, Awareness, Treatment, and Control in Latin America: Challenges and Innovative Solutions to Improve Health Outcomes Across the Continent

“…The findings described above denote critical aspects of the state of diabetes care in Latin America. The achievement of glycemic goals reported by the studies included in our review is similar to previously published studies [164,179,180,187,210]. This implies seriously chronic and inadequate glycemic control at the population level across the region.…”

Suboptimal glycemic control among subjects with diabetes mellitus in India: a subset analysis of cross-sectional wave-7 (2016) data from the International Diabetes Management Practices Study (IDMPS)

“…The cross-sectional study (seventh wave, 2016) was carried out in 24 countries. 9 This study was conducted between 7 March 2016 and 15 May 2016 in India as part of the seventh wave (2016) of the IDMPS, in accordance with the principles of the 18th World Medical Assembly (Helsinki, 1964) and all applicable amendments, and the study was in compliance with the guidelines for Good Epidemiological Practice. All participating study sites were approved by Ethics Committee (Supplemental Table S1).…”

“…Physicians experienced in prescribing insulin therapy and managing patients with diabetes were selected randomly after stratification based on speciality. 9 The number and profile of the physicians required to participate in the study was country-specific, depending on the sample size of the subjects, as in the following.…”

“…Recent data showed that glycemic control has remained suboptimal in developing nations for over a decade. 9 In India, a high potential disease burden, combined with early onset of the disease, predisposes people to diabetes-related micro-and macro-vascular complications, and these changes are significantly associated with higher rates of morbidity and mortality. 4,9 These complications can often be attributed to poor glycemic control, 4,[10][11][12] and can be averted by adopting several measures, such as early insulinisation, continuing medical care and educational initiatives to improve self-management in those afflicted, as specified by published guidelines.…”

Comparison of the Effect of Dapagliflozin on Contrast to Standard Therapy of the Patients With Type 2 Diabetes Mellitus and Concomitant Obesity, Their Effect on Laboratory and Anthropometric Parameters

“…• In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose ≥200 mg/ dL (11.1 mmol/L). There are a number of recommendations for the treatment of T2DM by The European Foundation for the Study of Diabetes (EFSD), ADA [6], International Diabetes Federation (IDF) [7], but despite some differences, they all agree on because the treatment should be complex and include: diet therapy, rational step-by-step pharmacotherapy (starting with metformin and depending on the level of glycosylated hemoglobin (HbA1c) after treatment -transition to combinations with the following drug groups), dosed physical activity and altered physical activity .…”