Glycemic control of adult patients with type 2 diabetes mellitus treated by oral antidiabetic drugs in combination with insulin in China in 2009

Abstract

Objective To assess current treatment and glycaemic control of adult subjects with type 2 diabetes mellitus (T2DM) in China, focusing on the therapy of oral anti-diabetic drugs (OAD) in combination with insulin. Methods From July to September in 2009, 400 hospitals from 75 cities across China were selected by Chinese Diabetes Society for this cross-sectional study. All the T2DM patients (over 18 years) with oral antidiabetic drug (OAD) with/without insulin were eligible for this study. General information of the patients, duration of diabetes, medical history, diabetes complications and concomitant diseases, glycated hemoglobin A1c(HbA1c), fasting blood glucose (FBG), postprandial blood glucose (PBG) and treatment regimen were recorded. All data were analyzed by using SAS 9.13 software. Results A total of 143 123 eligible T2DM patients were enrolled in this study (73 544 males and 69 579 females, median age 59 years, median duration of diabetes 6 years). Among the patients treated with insulin plus OADs, the most frequently used insulin is pre-mix insulin (65.5%, 34 487/52 649), followed by basal insulin (24.3%, 12 794/52 649) and basal-bolus insulin (8.5%, 4492/52 649). The percentage of patients achieved HbA1c<6.5% was 20.2% (28 985/143 123) for the overall populations, and 23.4% (21 163/90 474) and 14.9% (7822/52 649) for the patients treated with OADs only and insulin plus OADs respectively. Within patients treated with insulin plus OADs, the percentage of patients achieving HbA1c<6.5% were 15.2% (1944/12 794), 14.9% (5150/34 487) and 14.6% (656/4492) for basal insulin group, pre-mixed insulin group and basal-bolus insulin group respectively. The percentage of patients achieving HbA1c target decreased with the increase of duration of diabetes (all P<0.05). Patients initiated insulin therapy in the earlier stage had more chance to achieve HbA1c target (all P<0.01). Data from this study also indicated that the percentage of patients achieving blood pressure and blood lipid profile target remained low in China. In total, there were 23.5% (33 676/143 123) of the subjects reached blood pressure target and 37.4% (53 550/143 123), 41.4% (59 320/143 123), 19.2% (27 418/143 123) and 41.4% (59 671/143 123) of subjects reached triglyceride(TG), total cholesterol(TC), high-density lipoprotein cholesterol(HDL-C) and low-density lipoprotein cholestorol(LDL-C) targets, respectively. Conclusion The overall rate of achieving glycaemic control target remained low in Chinese patients with T2DM, which was even lower for those treated with insulin plus OADs. This study indicates more effective individualized treatment regimen is needed for most patients. Key words: Diabetes mellitus, type 2; Oral anti-diabetic drugs; Insulin; Glycemic control