Identifying Gaps in Real-World Management of Diabetes in Nigeria: A Subset Analysis of Cross-Sectional Wave-7 Data from the International Diabetes Management Practices Study

Abstract

Background/Purpose: Poor glycemic control in Nigeria necessitates assessment and standardization of diabetes care. This study aimed to assess real-world management of people with type 2 diabetes mellitus (T2DM) and type 1 diabetes mellitus (T1DM) in Nigeria. Methods: This cross-sectional phase of the seventh wave of International Diabetes Management Practices Study, conducted between 22nd August and 30th September 2016, included adults with T1DM or T2DM during a two-week recruitment period. Results: Of 304 people with T2DM, 187 received oral glucose lowering drugs (OGLDs) only; 88 received OGLDs + insulin; 27 received insulin only. Metformin + sulfonylureas (128/187; 68.45%) and premix only (76/115; 66.09%) were the most used OGLD and insulin regimens respectively. Of 77 people with TIDM, all received insulin; six (7.79%) received OGLDs. Insulin initiation was noted around five years after diabetes diagnosis in T2DM (diabetes duration: 8.69 + 7.16 years; duration of insulin treatment: 3.17 ± 4.49 years). Proportion of people achieving glycemic targets (HbA1c < 7%: T2DM [66/202, 32.67%], T1DM [6/56, 10.71%]; clinical targets: T2DM [28/112, 25.00%], T1DM [14/74, 18.92%]; triple targets: T2DM [7/286, 2.45%], T1DM [3/64, 4.69%]) was low. Cost of medications/strips (92/144; 63.89%) and lack of experience in self-managing insulin (46/144; 31.94%) were main reasons for non-achievement of glycemic targets. Diabetes complications (253/372; 68.01%), hypoglycemia (symptomatic in the preceding three months: total = 97/373 [26.01%], T2DM = 61/300 [20.33%], T1DM = 36/73 [49.32%]; severe in the preceding 12 months: total = 32/368 [8.70%], T2DM = 17/298 [5.70%], T1DM = 15/70 [21.43%]) and hospitalizations (90/369; 24.39%) were common. Most participants (T2DM: 216/304 [71.05%]; T1DM: 62/76 [81.58%]) had a glucometer at home; few (T2DM: 44/113 [38.94%]; T1DM: 38/73 [52.05%]) self-managed both blood glucose and insulin. Conclusion: Early insulinization and subsidized healthcare can improve long-term diabetes outcomes in Nigeria.