Antidiabetic Prescription and Glycemic Control in Patients With Type 2 Diabetes Mellitus

Objective: To detertmine the antidiabetic treatment among individuals with type 2 diabetic patients in Mosul city, the number of patients who attained the glycemic target (good glycemic control) and patients who failed to attained glycemic target (poor glycemic control) and to investigate factors that may be associated with poor glycemic control. Patients and Methods: 299 patients with type 2 diabetes mellitus of both sexes were participated in this study. The patients were divided into 2 groups according to the values of HbA1C: Group 1 (good glycemic control) and group 2 (poor glycemic control). A questionnaire form was prepared to record detailed informations about each patient such as age, drugs used, education level, diabetic family history, adherence to treatment, exercise, and diet. HbA1c level was analyzed using high performance liquid chromatography. Other parameters including total cholesterol, high density lipoprotein-cholesterol (HDL), triglycerides, low density lipoproteincholesterol (LDL) and serum glucose concentration were measured using special kits. Results: The antidiabetic drugs used including metformin, glibenclamide and glimepiride, used alone and in combinations including metformin plus glibenclamide and metformin plus insulin. Fifty patients (16.7%) have good glycemic control and 249 patients (83.3%) have poor glycemic control. Comparison between number of poor glycemic control of metformin and glibenclamide showed non significant difference. Comparison between poor glycemic control of metformin plus glibenclamide and metformin plus insulin showed highly significant difference. Comparison between mono-therapy and combination therapy showed highly significant difference. High proportions of poor glycemic control were obtained with ages >40 males, overweight and obese, low educational level, family history of diabetes, use of herbs, long duration of the disease, low HDL-cholesterol, high atherogenic index, non adherence to treatment, diet and exercise. Conclusion: This study showed that high proportions of type 2 diabetic patients were on combination therapy and the high proportions of the patients were poor glycemic control. Many factors were found to be associated with poor glycemic control including age >40 males, overweight and obesity, low educational level, family history of diabetes, use of herbs, long duration of the disease, non adherence to treatment, diet, and exercise. ركسلا ىوتسم ىلع ةرطيسلاو يركسلا ةيودأ فصو يناثلا عونلا يركسلا ءادب نيباصملا ىضرملل ةصلاخلا فده ةساردلا : عت ي يتلا يركسلا دض ةيودأ ني كسلا ضرم جلاعل مدختست و لصوملا ةنيدم يف يناثلا عونلا ير لصحي مل نيذلا ىضرملا ددعو ركسلل ةديج ةرطيس ىلع اولصح نيذلا ىضرملا ددع ةديج ةرطيس ىلع او اولصحي مل نيذلا ىضرملاب ةطبترملا لماوعلا ضعب نع فشكلاو .يركسلل ةديج ةرطيس ىلع Iraq J Pharm Vol. 15, No.1, 2018 2 لمعلا قئارط و ىضرملا يف كراش : ةساردلا 299 .يناثلا عونلا يركسلا ضرمب نوباصم ضيرم مت ت سق ي م ةميق ىلع اءانب نيتعومجم ىلا ىضرملا ركسملا نيبولكوميهلا لأا ةعومجملا . ىلو ىلع اولصح نيذلا ىضرملا .يركسلل ةديج ةرطيس ىلع اولصحي مل نيذلا ةيناثلا ةعومجملاو يركسلل ةديج ةرطيس ينايبتسا لكش رضح دقو ليجستل لثم ضيرم لكل ةدئاعلا تامولعملا ةلمعتسملا ةيودلااورمعلا ميلعتلا ىوتسمو ةلئاعلل يركسلا نايبلاو .ةضايرلاو ءاذغلاو ةيودلااب جلاعلا ةمزلامو ةطساوب ركسملا نيبولكوميهلا سايق مت دقو يلاع يفاركوتاموركلا ةدع مادختساب ركسلا ةحفص و ركسلا ىوتسم سايق مت امك .ةءافكلا .ةصاخ جئاتنلا : تمض ىضرملا اهلمعتسا يتلا يركسلا دض ةيودلاا مهدحول اما داريبميلكو ديامأ لكنبيلكلاو نيمروفتملا ديامأ لكنبيلكو نيمروفتم لثم ىرخا ةيودا عم داحتاوا .نيلوسنا عم نيمروفتيم و ةساردلا ترهظا دوجو 50 و يركسلل ةديج ةرطيس مهدنع ضيرم 249 .يركسلل ةديج ريغ ةرطيس مهدنع ضيرم ترهظا ددع نيب ةنراقملا ا و يونعم ريغ قرف دوجو ديامأ لكنبيلكلا عم نيمروفتملل يركسلل ةديج ريغ ةرطيس مهل نيذلا ىضرملا ظ تره نيمروفتملا عم ديامأ لكنبيلكلا و نيمروفتملل يركسلل ةديج ريغ ةرطيس مهل نيذلا ىضرملا ددع نيب ةنراقملا نيلوسنلااو نراقملا ترهظا و يونعم قرف دوجو يركسلل ةديج ريغ ةرطيس مهل نيذلا ىضرملا ددع نيب ة .يونعم قرف دوجوب ةدحتم ذخؤت يتلا ةيودلاا عم اهدحول ذخؤت يتلا ةيودلال ا ظ ةقلاع دوجو ةساردلا تره ةرطيسلل نم رثكا رمعلا عم ركسلل ةديج ريغلا 40 ةنس و روكذلاو ضفخنملا ميلعتلاو يلاعلا نزولا لامعتسا و باشعلاا نايبلاو ىوتسملاو يركسلل يلئاعلا ضفخنملا جلاعلل ةمزلاملا مدع و ةفاثكلا يلاعلا نيتوربوبيلال .ةضايرلاو ءاذغلاى ةيودلااب جاتنتسلاا : نم ةريبكلا ةبسنلا ناو ةدحتملا ةيودلاا نومدختسي ىضرملا نم ةريبك ةبسن نا ةساردلا ترهظا يركسلل ةديج ريغ ةرطيس نوكلمي ىضرملا دوجوبو يتلا و يركسلل ةديج ريغلا ةرطيسلل ةمزلام لماوع ةدع مضت نم رثكا رمعلا 40 يلئاعلا نايبلاو باشعلاا لامعتسا و ضفخنملا ميلعتلاو يلاعلا نزولاو روكذلاو ةنس ةضايرلاو ءاذغلاى ةيودلااب جلاعلل ةمزلاملا مدع و ةفاثكلا يلاعلا نيتوربوبيلال ضفخنملا ىوتسملاو يركسلل . iabetes mellitus (DM) is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of different organs, especially the eyes, kidneys, nerves, heart, and blood vessels. DM, long considered a disease of minor significance to world health, is now taking its place as one of the main threats to human health in the 21 century. It is the most common non-communicable disease worldwide and the fourth to fifth leading cause of death in developed countries. The number of people with diabetes is increasing due to population growth, aging, urbanization, and increasing prevalence of obesity and physical inactivity. The world prevalence of diabetes among adults (aged 20-79 years ) will be 6.4%, affecting 285 million adults, in 2010, and will increase to 7.7%, and 439 million adults by 2030. Between 2010 and 2030, there will be a 69% increase in number of adults with diabetes in developing countries and a 20% increase in developed countries. Diabetes mellitus is a chronic disease, for which there is no known cure except in very specific situations. Management concentrates on keeping as possible, blood sugar levels as close to normal without causing hypoglycemia. This can usually be accomplished with diet, exercise, and use of appropriate medications (insulin in the case of type 1 diabetes; oral medications, as well as possibly insulin in type 2 diabetes). Patient education, understanding and participation is vital since the complications of diabetes are far less common and less severe in people who have well-managed blood sugar levels. In clinical practice, optimal glycemic control is difficult to obtain on a long-term basis because the reasons for poor glycemic control in type 2 diabetes are complex . Both patient and health care provider related factors may contribute to poor D Iraq J Pharm Vol. 15, No.1, 2018 3 glycemic control. Despite the evidence from large randomized controlled trials establishing the benefit of intensive diabetes management in reducing microvascular and macrovascular complications, high proportion of patients remain poorly controlled. Poor and inadequate glycemic control among patients with type 2 diabetes constitutes a major public health problem and major risk factor for the development of diabetes complications. Glycemic control remains the major therapeutic objective for prevention of target organ damage and other complications arising from diabetes. Khattab et al. reported that diabetes was more likely to be poorly controlled among those with increased duration of diabetes, lower level of education, higher body mass index (BMI), hypercholesterolemia, hypertriglyceridemia, and elevated LDL. The highest level of poor glycemic control was among patients on combination of oral antidiabetic agent and insulin. Poor glycemic control was more common among patients who did not follow dietary regimens, did not practice any physical activity, who were not adherent for medications and did not regularly perform home glucose monitoring. The present study was designed: To detertmine the antidiabetic treatment among individuals with type 2 diabetes mellitus in Mosul city. To determine the number of patients who attained the glycemic target (good glycemic control) and patients who failed to attained glycemic target (poor glycemic control) although they continue to take antidiabetic treatment. To investigate factors that may be associated with poor glycemic control. Patients and Methods: A sample of 299 patients with type 2 diabetes mellitus was collected from Al-Salam Teaching Hospital and AlWafaa Clinic for Treatment and Researches of diabetes mellitus in Mosul over a period of 5 months. They consist of 121 males and 178 females with a mean ages ±SD of 53.56±9.33 years. The patients were divided into 2 groups according to the values of HbA1C: Group 1 (good glycemic control) and Group 2 (poor glycemic control). Good glycemic control is defined as an HbA1C of ≤ 7 for the past 3 months. Poor glycemic control is defined as an HbA1C value of more than 7% for the past 3 months. The data was obtained by direct interviewing of researcher with the patients who visited Al-Salam Teaching Hospital and AlWafaa Clinic. A questionnaire form was prepared to record detailed information about each patient. The data involved in the questionnaire form including patient name, age, sex, body weight, length, BMI, education level, diabetic family history, use of herbs, duration of the disease, drugs used, BP, lipid profile, adherence to treatment, adherence to diet and exercise, presence of complications and the use of non diabetic drugs. Inclusion criteria: including patients with type 2 diabetes mellitus who were on antidiabetic therapy for not less than 6 months. Exclusion criteria: including type 1 DM, gestational diabetes mellitus, type 2 diabetic patients on antidiabetic treatment for a period of less than 6 months, pregnant and lactating women. About 10 ml of venous blood samples were taken from each patient after 15 hour fasting. Serum was Iraq J Pharm Vol. 15, No.1, 2018 4 obtained from each blood sample and used for the estimation of serum glucose concentration, H