Published online Apr 15, 2019. doi: 10.4239/wjd.v10.i4.249
Peer-review started: January 23, 2019
First decision: February 19, 2019
Revised: March 13, 2019
Accepted: March 26, 2019
Article in press: March 26, 2019
Published online: April 15, 2019
Diabetes mellitus is a common worldwide problem associated with significant morbidities and mortalities. This paper assesses the therapeutic management and control of patients with diabetes mellitus in the current medical practice in the Lebanese population. It identifies the proportion of subjects with target glycosylated hemoglobin (HbA1c) in compliance with the international recommendations’ guidelines, and the factors that would be predictive of reaching target HbA1c. It also identifies the percentage of patients with diabetes who are screened for complications of diabetes. Furthermore, the percentage of patients who have hypertension or dyslipidemia, or who are taking antiplatelet treatment, is also tackled. In addition, the assessment of the health economic impact of patients with type 2 diabetes and its complications is tackled.
The results discuss our findings in relation to the treatment strategies and goals recommended by the American Diabetes Association and the European Association for the Study of Diabetes. This will also help physicians with better management and follow-up practices for patients with diabetes mellitus, and underscores the need for proper screening of complications and other risk factors commonly associated with diabetes mellitus.
In this paper, data from Wave 2013-2014 of the International Diabetes Management Practices Study (IDMPS) were retrieved and analyzed. Endpoints included the proportion of subjects with target HbA1c in compliance with the international recommendations’ guidelines, the frequency of screening for diabetes complications and its risk factors, and the assessment of the health economic impact of type 2 diabetes and its complications.
The IDMPS is an international study, observational in nature, conducted in multiple centers in non-Western countries, and included patients with diabetes mellitus who were randomly selected from a representative pool of diabetic patients. It involved six waves, beginning in 2006 and ending in 2014, with each wave being conducted yearly, and consisting of a cross-sectional and longitudinal phase. The cross-sectional phase was conducted through yearly surveys of 2 wk duration, and tried to assess the demographic characteristics of patients with diabetes mellitus, along with their therapeutic management in the current medical practice. The sixth Wave of the study did not include a longitudinal phase. A total of 60 physicians and 600 adult male or female patients were included into the sixth Wave in the year 2013. A signed written informed consent was obtained from all the participating patients before the application of any study-related procedures. Ethics committee approval was obtained from participating centers where such committees are in place. The SAP (version of 6 November 2014) used for this analysis aimed at describing the cross-sectional analysis of the sixth year (Wave 2013-2014). Proportions are reported as percentages of all the included populations, and means are reported as continuous variables ± standard deviations.
Five hundred and ninety-five patients with type 2 diabetes were included in Wave 6, and only a single patient with type one diabetes mellitus was included. The average age was around 60 years, with a mean BMI of 30. The mean fasting serum glucose was 159.42 mg/dL and mean HbA1c level was 7.98, with around 30% achieving an HbA1c target of less than 7%. More patients were on oral anti-diabetic medications, probably related to the recent introduction of new oral medications. Screening of diabetic complications has improved over the years. A large percentage of patients were diagnosed with hypertension and dyslipidemia, the majority of which were treated, but a small percentage controlled.
The results of the IDMPS study Wave 6 shows that there is a promising improvement in the management of diabetes mellitus; however, it is still obvious that there are not enough patients achieving the target glycemic control. There is still not sufficient screening for diabetes-related complications and its risk factors. This is in concordance with the hypothesis we had prior to study initiation.
This research offers new perspectives concerning the need for more awareness campaigns to both physicians and patients with diabetes mellitus. Thus, a national effort is needed in order to have a more appropriate control of diabetes, hypertension and lipids. Screening of diabetes-related complications is improving, but at a slow rate and not significantly compared to previous years. There should be more emphasis on educating the population about the importance of lifestyle modifications and obesity control, which will eventually help to improve type 2 diabetic patient outcomes.