Comparative evaluation of biphasic insulin with metformin and triple oral hypoglycemic agents (OHA) in type 2 diabetes patients

Introduction

The prevalence of secondary failure to oral hypoglycemic agents among type 2 diabetes mellitus (T2DM) patients ranges from 30 to 60%. The alternative approaches to overcome this issue are either switching to triple oral hypoglycemic agents (OHA) or intensifying the regimen by adding insulin.

Objective

To compare the glycemic control achieved with biphasic insulin plus metformin and triple OHA in T2DM patients who were not adequately controlled with two OHA regimen.

Methods

A qualitative prospective study was conducted at Asir diabetes center, Abha, KSA. Poorly controlled T2DM patients with two OHA for at least 1 year with glycated hemoglobin (HbA1c) >7.0% were included. Subjects were divided into group I (a third OHA was added to the existing two OHA regimen) and group II (switched over to Biphasic insulin and metformin). At baseline and 3-month intervals, level of HbA1C, Fasting Plasma Glucose (FPG), Postprandial Plasma Glucose (PPG), Blood Pressure (BP), lipid profile and hypoglycemic episodes were obtained and evaluated for one year.

Results

41.1% of patients were in group I and 58.9% were in group II. At the end of the study, there was a significant reduction in HbA1c in group II subjects comparing to group I (8.18 ± 1.32 vs 8.79 ± 1.81, p = 0.0238). FPG and PPG were improved also in group II. The mean body weight increased from baseline in group II is +4.48 kg and decreased from baseline in group I (−0.46 kg). 11.3% from group I and 23.7% from group II reported hypoglycaemic incidences.

Conclusion

Biphasic insulin and metformin regimen could be an appropriate therapeutic option for achieving good glycemic control compared with triple OHA in patients with two OHA failure.

Prevalence and control of cardiovascular risk factors among type 2 diabetes mellitus patients in southern region of Saudi Arabia

BACKGROUND/AIM

Dyslipidemia is a significant predictor of cardiovascular events and mortality in diabetes patients. The aim of this study is to estimate the prevalence rates, characteristics of dyslipidemia and their control in outpatient population in a Diabetic Centre.

METHODS

A cross sectional prospective study design was used to collect data from 255 patients which included patient characteristics, past medical history of CVD, medications and parameters related to DM and cardiovascular risk factor control. Blood pressure and laboratory measurements for glycosylated hemoglobin and lipoprotein panel were recorded.

RESULTS

Body mass index (BMI) of the dyslipidemic diabetic patients was significantly higher for females. In terms of age, duration of diabetes, family history, diabetes treatment offered did not differed significantly among genders. Clinical characteristics of HDL values were significantly higher for female in comparison to men (P = 0.02) whereas glycosylated hemoglobin and blood pressure appeared not to differ significantly. Among the three factors studied BMI, duration of diabetes mellitus and drug therapy on lipoprotein levels of diabetes patients, except for the influence of drug therapy which influenced significantly the total cholesterol level (P = 0.02). Number of females with normolipid were more than males (P = 0.009) and number of males with abnormal cholesterol and triglyceride patients were significantly more than females (0.0002).

CONCLUSION

Dyslipidemia among males were higher than females which could be a significant risk factor for causing low glycemic control culminating in cardiovascular events. Control of hyperglycaemia and other CVD risk factor appears to be suboptimal in Saudi Arabia. Addressing health system components such as providing medical staff training, incentive to health professionals and better patient education may improve quality of DM care.