Management of diabetes in Morocco: results of the International Diabetes Management Practices Study (IDMPS) – wave 5

Abstract

Objectives: The International Diabetes Mellitus Practice Study (IDMPS) is a 5-year survey documenting changes in diabetes treatment practices in developing countries. The primary objective of this survey was to assess the therapeutic management of type 2 diabetes mellitus (T2DM) in real-life medical practice. The secondary objectives were to evaluate the clinical management of type 1 diabetes mellitus (T1DM) and to assess the proportion of all diabetic patients failing to reach the glycated haemoglobin (HbA1c) <7% target. Methods: Data were analysed for 738 patients (240 with T1DM and 498 with T2DM) included in wave 5 of the IDMPS in Morocco in 2011. Results: Nearly two-thirds (61%) of T2DM patients were treated with oral glucose-lowering drugs (OGLDs) alone, 13.1% were treated with insulin alone and 23.3% were treated with OGLDs plus insulin. Insulin use was less frequent, was initiated later and involved a greater use of premixes versus basal/prandial schedules compared to other populations evaluated in the IDMPS. The majority (92.5%) of T1DM patients were treated with insulin alone and the remainder received insulin plus an OGLD. Insulin protocols included basal + prandial dosing (37.5%) and premix preparations (41.3%). The recommended target of HbA1c <7% was achieved by only 22.2% of T1DM patients and 26.8% of T2DM patients. More macrovascular but fewer microvascular complications were reported in T2DM compared to T1DM patients. Late complications increased with disease duration so that 20 years after diagnosis, 75.7% of T2DM patients were found to have at least one late complication. Conclusions:The clinical burden of diabetes is high in Morocco and the majority of patients do not achieve the recommended glycaemia target, suggesting that there is a huge gap between evidence-based diabetic management and real-life practice. Better education of patients and improved compliance with international recommendations are necessary to deliver a better quality of diabetic care.

Self-Care Activities among Patients with Type 2 Diabetes in Morocco: Prevalence and Determinants

“…The two factors associated with BST here were income and illiteracy: those with higher income reported higher testing frequency, whilst illiterate patients reported lower testing frequency. Whilst some studies that have noted the same observation have concluded this to be a consequence of low education [28], this could also be explained by the cost associated with care for diabetic patients: a recent study by Chadli et al showed that only 46.8% of patients performed this testing at home, and just 18% performed this daily, with cost being highlighted as the biggest barrier to this [10]. Given that blood sugar monitoring equipment is not covered under the scheme offered by the national health system, and with just over 42% of patients in the present study with health insurance, this could be a most prominent barrier restricting improvement of BST practices, as has been noted previously [14] [16] [29] [30].…”

“…Lower and middle income countries (LMICs) experiencing this transition, however, are often disproportionately affected by the condition, whilst simultaneously lacking sufficient resources to tackle it [2] In the Moroccan setting, there is very little evidence assessing the degree to which patients with diabetes mellitus carry out self-care activities, though published studies have reported poor health outcomes among this population [9]. In a recent study, Chadli et al reported low achievement of the international target of HbAc1 < 7%, alongside low adherence to self-monitoring of blood glucose [10]. For those reasons, assessing self-care practices and their determinants in this context represents an important area of investigation with the aim of developing effective strategies to improve diabetes self-management.…”

Coronary artery bypass surgery in type 2 diabetic patients: predictors of mortality and morbidity

“…Our study has the advantage to reflect as closely as possible the real-life situation in centers like ours and put the spotlight on the difficulties faced daily to perform CABG in "our" diabetic patients who present a high prevalence of chronic diabetic complications with microvascular lesions which were mainly due to non-compliance with diet, medications, lack of therapeutic education, and delay between the onset of diabetes and diagnosis time. Chadli et al found in an epidemiologic study that the majority of diabetic patients in our country had at least one diabetes-associated complication and did not achieve the recommended triple target of glycemic, blood pressure and lipid control, suggesting that there is a huge gap between evidence-based diabetes management and real-life practice [20]. Bos et al stipulated that most diabetic patients in northern Africa were unaware of their complications, and a high percentage of patients with severe complications had never been consulted by a specialist before [11].…”

Metabolic control targets in Sudanese adults with type 1 diabetes: A population-based study

“…[ 8 ] In Morocco, only 22.2% of type 1 diabetes can achieve the target of HbA1c of <7%. [ 9 ] Factors associated with poor diabetes control in type 1 are: (i) longer duration of diabetes (ii) lack of motivation (iii) psychological and emotional factors. [ 10 ] The complexity of management of T1DM had lead many experts in the field of diabetes to suggest special management in addition to insulin therapy.…”