Glycemic control is difficult to attain in type 2 diabetes mellitus despite insulin therapy

Abstract

The standard way of treating a type 2 diabetic patient is to start them on monotherapy with oral hypoglycemic agents (OHAs), then proceed to combination therapy, and when OHAs are no longer found to control blood glucose adequately, start them on insulin with or without stopping the OHAs in the hope that addition of insulin will achieve euglycemia [1]. But in practice, we often find that glycemic control is not optimal in majority of type 2 diabetic patients more so when patients are on insulin than when they are on OHAs [2]. There was not enough scientific data to support this view. Hence, a study aiming to assess the level of glycemic control in type 2 diabetic patients and to compare the glycemic control in type 2 diabetic patients taking insulin with or without OHAvs those on OHA alone was planned. Adult type 2 diabetic patients who were on treatment for their diabetes started by a general practitioner at their local place for atleast 2 years were included in the study. All these patients were coming to a tertiary referral university teaching hospital for the first time in 2010. One hundred patients taking insulin with or without OHAs and 100 on OHA alone were included in the study. The former was taken as group 1 and the latter as group 2. Details of duration of diabetes, HbA1c, FPG, PPPG, presence of diabetic retinopathy, nephropathy and neuropathy were analyzed. The details of treatment are given in Table 1. The results comparing the different parameters between groups 1 and 2 are given in the Table 2. The study revealed an overall poor control of type 2 diabetes mellitus in our community in a general practice set up, especially when they are in an advanced stage of their disease inspite of insulin therapy. Only 16 % of the total population ( 9% on insulin and 24 % on OHAs) had the target HbA1c of < 7 %. Those on insulin had longer duration of disease, higher HbA1c, higher FPG and PPPG, and higher incidence of microvascular complications. The reasons for a poor glycemic control in those on insulin with or without OHA compared to OHA alone may be manifold.