Suboptimal glycemic control and prevalence of diabetes-related complications in Kenyan population with diabetes: cohort analysis of the seventh wave of the International Diabetes Management Practices Study (IDMPS)

Abstract

• The 7th wave of the IDMPS is an international, multicenter, non-interventional, cross-sectional, observational study aimed at assessment of current practices in the management of both T1DM and T2DM in 24 countries in Africa, Eurasia, Middle East, and South Asia. It was conducted as a continuation of the previous waves of the IDMPS and data was collected during the period of January to September 2016 • At the time of the study, target HbA1c of <7.0% was reportedly achieved in only 36.6% of subjects with T2DM • The two most cited reasons for not attaining HbA1c targets in insulinized subjects were – lack of appropriate titration of insulin dose and lack of experience among patients in the management of their insulin dose • Diabetes-related complications were reported by 34.6% subjects overall with a predominance of microvascular complications over macrovascular complications. • This study highlights that the achievement of glycemic target in Kenyan subjects with T2DM is suboptimal and further investigations are required to formulate effective health policies to improve rates of glycemic target attainment in Kenya. To identify real-life medical practices in the management of diabetes mellitus (DM) in the Kenyan population. Kenyan subjects with DM were recruited as part of the 7 th wave of the International Diabetes Management and Practices Study in between September and October 2016. Data on demographics; medical history; glycemic control; concomitant anti-diabetic therapy; and hypoglycemic episodes were analyzed using descriptive statistics. Analysis of subjects with type 2 DM (T2DM), representing 96.7% (n/N: 187/194) of evaluable subjects, is presented. Target HbA1c achievement rate and average HbA1c at last measurement were 36.6% (n/N: 68/187) and 8.2% (66 mmol/mol), respectively. Microvascular complications were prevalent in 35.3% (n=65) of subjects, most frequently as neuropathy (n=41, 21.5%) and microalbuminuria (n=27, 14.1%). Most common comorbidities were dyslipidemia (n=125, 73.5%) and hypertension (n=123, 65.8%). Oral antidiabetic drugs, either alone (n=120, 64.2%) or in combination with insulin (n=48, 25.7%), were the preferred treatment. Inability in reaching glycemic targets in insulinized subjects were mostly attributed to lack of appropriate dose titration and lack of experience in management of dose. The achievement of glycemic target in Kenyan subjects with T2DM is suboptimal. Further investigations are required to formulate effective health policies to improve rates of glycemic target attainment in Kenya.