An investigation of the therapeutic approach and outcome of type 2 diabetes mellitus management in Yaounde

Marie Chantal Suinyuy LUKONG (lukongmarie@gmail.com)
Pharmacotoxicology and Pharmacokinetics, University of Yaounde I
June, 2018
 

Abstract

Introduction: Type 2 diabetes mellitus (T2DM) is a metabolic disorder characterised by chronic hyperglycaemia, leading to long-term complications. The prevalence of diabetes mellitus in Cameroon was estimated at 5.9 % in 2017. In a study done in 2011, only about 41 % of patients had a good glycaemic control that is, HbA1c < 6.5 %. Amongst several factors, poor glycaemic control may be due to failure of clinicians to intensify diabetes treatment when required, known as therapeutic inertia. The aim of this study was to evaluate the treatment intensification over time in T2DM patients.

Methods: This was a hospital-based cross-sectional analytical study with diabetic outpatients at the Yaoundé Central Hospital. In a group of T2DM patients followed up at the National Obesity Center (NOC) with poorly controlled blood sugar (HbA1c ≥ 7 %), we evaluated the treatment intensification and outcome between the period January 2016 to April 2018. Data was collected from patients’ medical booklet and by a face-to-face interviewer-administered questionnaire. Therapeutic inertia was defined as the failure to intensify therapy (addition of a new oral anti-diabetic drug (OAD) or insulin) when indicated.

Results: One hundred and eleven patients (31 males, 27.9 % and 80 females, 72.1 %) were recruited. The mean age was 59 ± 10 years and the mean duration of diabetes 8.6 ± 7.0 years. The patients’ treatment consisted: 1) oral anti-diabetic (OAD) agents, monotherapy (24.3 %), bitherapy (28.8 %), tritherapy (2.7 %), 2) insulin only, (19.8 %) and 3) insulin mixture, (24.3 %). The mean baseline HbA1c was 9.3 ± 2.0 %. Within the given follow-up time of 16 [11-21] months, only 40 out of the 111 patients had their treatment intensified and 71 had no intensification (therapeutic inertia) despite poor HbA1c levels. The median time to treatment intensification was 1.4 month. The age, index treatment, duration of diabetes and number of non-diabetic treatment were variables significantly associated to treatment intensification. A second HbA1c was available in 83 patients. Forty five (45) % of the patients had HbA1c level < 7 %. Their mean HbA1c was 7.4 ± 1.7 %.

Conclusion: Therapeutic inertia affected two third of our population. Despite the high level of inertia, both patients with intensified treatment and non-intensified treatment reached treatment targets.


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