Insights in Management of Type 2 diabetes (IMD): a Pan India Survey
Abstract
Background: Different classes of oral anti-diabetic drugs are available. Management of diabetes is also individualised depending on doctor and patient.
Objective: The objective of the survey was to understand the insights in the management of diabetes in the real world Indian scenario and preference in second choice of oral anti-diabetic drug.
Method: 350 physicians/diabetologist all over India participated in the questionnaire based survey from January 2014 to April 2014. The questions were related to the current prescription patterns
of doctors in management of type 2 diabetes and drug preferences and goals in management of type 2 diabetes mellitus.
Results: 91.4% doctors preferred metformin as the first oral agent in pharmacotherapy of type 2 diabetes mellitus. 83.8% preferred sulphonylurea as the second agent in combination with metformin, glimepiride (92.4%) being the preferred sulphonylurea. 25.1% considered addition of second agent when HbA1c > 7%, while 36.7% considered when HbA1c was > 7.5% and 35.8% considered second agent after HbA1c > 8%. 53% doctors directly started dual drug combination treatment when the HbA1c of patients is ≥ 9%.
Conclusion: Metformin is the initial agent in management of diabetes while the second drug in treatment is sulphonylurea with glimepiride being the preferred agent. Significant patient populations do not achieve their HbA1c goals on monotherapy. It is important to avoid clinical inertia in treatment of type 2 diabetes for patients to achieve adequate glycaemic control.
References
2. IDF Diabetes Atlas Sixth edition. Available from http:// www.idf.org/sites/default/files/EN_6E_Atlas_Full_0. pdf. Last accessed 4 October 2014.).
3. Mohan V. Why are Indians more prone to diabetes? J Assoc Physicians India. 2004;52:468-74.
4. Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, Peters AL, Tsapas A, Wender R, Matthews DR. Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach: Position Statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2012; 35:1364-1379.
5. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998;352:837-53.
6. Berkowitz SA, Krumme AA, Avorn J, Brennan T, Matlin OS, Spettell CM, Pezalla EJ, Brill G, Shrank WH, Choudhry NK. Initial Choice of Oral Glucose-Lowering Medication for Diabetes Mellitus. A Patient-Centered Comparative Effectiveness Study. JAMA Intern Med. Published online October 27, 2014.
7. Lipska KJ, Bailey CJ, Inzucchi SE. Use of metformin in the setting of mild-to-moderate renal insufficiency. Diabetes Care. 2011;34(6):1431-7.
8. American Diabetes Association. Standards of medical care in diabetes—2011. Diabetes Care. 2011;34 no. Supplement 1 S11-S61.
9. Mohan V, Shah SN, Joshi SR, Seshiah V, Sahay BK, Banerjee S, Wangnoo SK, Kumar A, Kalra S, Unnikrishnan AG, Sharma SK, Rao PV, Akhtar S, Shetty RV, Das AK. DiabCare India 2011 Study Group.
Current status of management, control, complications and psychosocial aspects of patients with diabetes in India: Results from the DiabCare India 2011 Study. Indian J Endocrinol Metab. 2014;18(3):370-8.
10. Strain WD, Cos X, Hirst M, Vencio S, Mohan V, Vokó Z, Yabe D, Blüher M, Paldánius PM. Time to do more: Addressing clinical inertia in the management of type 2 diabetes mellitus. Diabetes Res Clin Pract. 2014;105(3):302-12.
11. Kaku K. Efficacy of voglibose in type 2 diabetes. Expert Opin Pharmacother. 2014;15(8):1181-90.
12. González-Ortiz M1, Guerrero-Romero JF, Violante- Ortiz R, Wacher-Rodarte N, Martínez-Abundis E, Aguilar-Salinas C, Islas-Andrade S, Arechavaleta- Granell R, González-Canudas J, Rodríguez-Morán M, Zavala-Suárez E, Ramos-Zavala MG, Metha R, Revilla- Monsalve C, Beltrán-Jaramillo TJ. Efficacy of glimepiride/ metformin combination versus glibenclamide/metformin in patients with uncontrolled type 2 diabetes mellitus. J Diabetes Complications. 2009;23(6):376-9.
13. Pantalone KM1, Kattan MW, Yu C, Wells BJ, Arrigain S, Jain A, Atreja A, Zimmerman RS. The risk of overall mortality in patients with type 2 diabetes receiving glipizide, glyburide, or glimepiride monotherapy: a retrospective analysis. Diabetes Care. 2010;33(6):1224- 9.
14. Mohan V, Shah S, Saboo B. Current glycemic status and diabetes related complications among type 2 diabetes patients in India: data from the A1chieve study. J Assoc Physicians India. 2013; 61(1 Suppl):12-5.
15. AACE Comprehensive Diabetes Management Algorithm. Endocr Pract. 2013;19 (No.2).
16. International Diabetes Federation. Managing older people with type 2 diabetes. IDF, 2013.
17. (Gerstein HC, Miller ME, Byington RP, Goff DC Jr, Bigger JT, Buse JB, Cushman WC, Genuth S, Ismail-Beigi F, Grimm RH Jr, Probstfield JL, Simons-Morton DG, Friedewald WT. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;12;358(24):2545- 59.
18. Fowler M. J. Diabetes Treatment, Part 2: Oral Agents for Glycemic Management Clinical Diabetes • Volume 25, Number 4, 2007
19. JB, Conner C, Nichols GA. Secondary failure of metformin monotherapy in clinical practice. Diabetes Care. 2010;33(3):501-6.
20. Nichols GA1, Alexander CM, Girman CJ, Kamal-Bahl SJ, Brown JB. Contemporary analysis of secondary failure of successful sulfonylurea therapy. Endocr Pract. 2007;13(1):37-44.
