Observational Study of Patients in Morocco With Uncontrolled Type 2 Diabetes Treated With Metformin and/or Sulfonylurea With or Without Insulin

Abstract

Background: Several types of oral antidiabetic drugs (OADs), with or without insulin, may be used to achieve glycemic control in patients with type 2 diabetes mellitus (T2DM). However, real-life studies assessing diabetes treatments in Morocco are rare. Our aim was to assess the efficacy of various antidiabetic treatment regimens to achieve glycemic control in patients with uncontrolled T2DM, to determine the factors associated with a lack of glycemic control and to compare the clinical outcome after 26 weeks of treatment in a real-life setting. Methods: This prospective, observational study was carried out on 1,377 patients with uncontrolled T2DM in 139 Moroccan centers. Three groups of patients were defined according to the type of treatment: group 1: metformin and/or sulfonylurea only; group 2: metformin and/or sulfonylurea + insulin prior to inclusion; and group 3: metformin and/or sulfonylurea + started on insulin at or after inclusion. Clinical data including glycated hemoglobin (HbA1c), fasting blood glucose (FBG), blood pressure and weight were recorded at inclusion and after 3 and 6 months of treatment. Results: Mean HbA1c decreased from 9.7±1.8% at baseline to 7.5±1.2% at week-26 follow-up (P < 0.001) and the proportion of patients with controlled glycemia (HbA1c < 7%) increased from 10.8% at 12 weeks to 32.4% after 26 weeks of treatment (P < 0.001). Mean decreases in HbA1c at 26 weeks were: -1.8% in group 1 (P < 0.001), -2.7% in group 2 (P < 0.001) and -2.1% in group 3 (P < 0.001). Lack of glycemic control was related to non-observance of lifestyle recommendations, lack of treatment efficacy, poor treatment compliance and absence of diabetes education. Uncontrolled glycemia was significantly associated with obesity, hypertension, dyslipidemia, use of one OAD only and no insulin therapy. Mean weight of all patients decreased over the 26-week period, irrespective of treatment regimen. Conclusion: In a Moroccan primary care setting, observed treatment of T2DM with lifestyle recommendation, metformin, sulfolylurea and insulin was associated with improvement of glycemic control without weight gain. J Endocrinol Metab. 2015;5(6):321-327 doi: http://dx.doi.org/10.14740/jem314w