Clinical outcome of treatment intensification in type 2 diabetes mellitus patients with suboptimal glycemic control on two oral antidiabetic agents.

Abstract

Management of type 2 diabetes mellitus (DM) is a challenge for both physician and patient. The range of available therapeutic options includes large pool of oral antidiabetic drugs (OADs), noninsulin injectable therapies, and insulin therapy. The decision to initiate and intensify treatment depends on multiple factors. To achieve optimal glycemic control, a structured approach is required with more focus on correct treatment intensification. It is a longitudinal observational study conducted in a tertiary care hospital in Punjab in which out of a total of 400 patients attending out patient department, 286 were finally enrolled in the study. Patients already taking two OADs and still having uncontrolled Type 2 DM with HbA1c >7% were included in the study. They were followed up for next 3 months from the time of enrolment, to study the effects of the intensified drug (3^rd ADA) and compare the clinical outcome of different drugs. The unpaired <i>t</i>-test and analysis of variance was used for statistical analysis. Out of 286 patients, 155 (54.1%) HbA1c were significantly improved after adding SGLT-2 inhibitor who were previously on Metformin and DPP-4 inhibitor (mean HbA1c 9.29 ± 1.84 at baseline, reduced to 8.59 ± 1.74 at 12 weeks; <i>P</i> = 0.000646). In 24 patients taking sulfonylureas and metformin, the addition of SGLT-2 inhibitor helped in improving HbA1c (mean HbA1c 8.99 ± 1.56 at baseline, reduced to 7.91 ± 1.55 at 12 weeks; <i>P</i> = 0.0207). Type 2 DM patients reported with greater percentage reduction in HbA1c after intensification with SGLT-2 inhibitors as compared with other drugs.