Metabolic control of type 2 diabetic patients commonly treated with sulphonylureas in a developing country

Abstract

Background: Previous reports suggest that currently available drugs used in the treatment of type 2 diabetes do not sustain glycaemic control. Objective: To assess metabolic control in type 2 diabetic patients predominantly treated with sulphonylurea drugs at primary care clinics in a developing country. Design: Descriptive. Setting: Two primary care clinics in Trinidad, West Indies. Subjects: One hundred and seventy nine (117 females and 62 males), randomly selected, type 2 diabetic patients. Protocol: Body weight, height, blood pressure (BP), waist and hip circumferences were measured and fasting blood samples taken for glycated haemoglobin (HbA lc , glucose, insulin and lipids determinations. Fasting insulin and glucose concentrations were used to assess insulin resistance and sensitivity (%S) using Homeostasis model assessment (HOMA) method. Results: Of the 179 patients studied, 87% of male and 92% of female patients were treated with sulphonylurea drugs whereas 13% and 9% of male and female patients respectively were managed on diet and/or exercise. Female patients had significantly higher prevalence of obesity than males, and despite similar fasting glucose and HbA lc , levels, the females and patients of East Indian ethnic group had significantly higher prevalence rates of insulin resistance, hypercholesterolaemia, hypertriglyceridaemia and reduced HDL-cholesterol than the males and patients of African origin respectively. Conclusion: Consistent with previous reports, the results showed indications of poor metabolic control among the patients particularly females and patients of East Indian ethnic group.

Anaemia and kidney dysfunction in Caribbean Type 2 diabetic patients

“…For diabetic patients, it is well documented that reducing blood glucose levels and targeting acceptable glycated haemoglobin (HbA1c) levels have been the focus so as to prevent the risk of micro- and macro-vascular complications [ 19 , 27 , 28 ]. Even then, the reality is that most patients with type 2 diabetes in developed and developing countries have glycated haemoglobin levels above the recommended target levels and are prone to macro-vascular complications [ 2 , 3 ]. Inadequate or absence of laboratory facilities at the primary care settings in many developing countries is a major limitation in routine laboratory assessment of diabetic patients.…”

Serum adiponectin levels and enzyme markers of liver dysfunction in diabetic and non-diabetic Caribbean subjects

“…However, the use of drug combination protocols notwithstanding, there are several reports of poor long-term glycaemic control in diabetic patients in developing countries. [2][3][4][5][6] Previous reports suggest that the identification of molecules that would potentially sensitise the insulin signalling pathways in liver or muscle could be helpful in long-term glucose control in diabetic patients. Thus, the adipocyte-derived protein adiponectin, which has been shown to be an insulin sensitiser, 7,8 might play a role.…”

Self-monitoring of blood glucose improved glycemic control and the 10-year coronary heart disease risk profile of female type 2 diabetes patients in Trinidad and Tobago

“…[18] . Previous studies from other developing countries [25,26] and our laboratory [27,[11][12][13][14] have reported a poor glycemic control among type 2 diabetic patients. Similarly, a report from the United States has identified ethnic-related difficulties in glycemic control among type 2 diabetic patients of African origin.…”