Suboptimal glycemic control among subjects with diabetes mellitus in India: a subset analysis of cross-sectional wave-7 (2016) data from the International Diabetes Management Practices Study (IDMPS)

Abstract

Objective: To assess the real-world management practices of subjects with type 2 diabetes mellitus (T2DM) and type 1 diabetes mellitus (T1DM) in India. Methods: This cross-sectional study was conducted between 7 March 2016 and 15 May 2016 in India as part of the seventh wave (2016) of the International Diabetes Management Practices Study (IDMPS). Adult subjects with T1DM or T2DM visiting physicians during a 2-week recruitment period were included. Results: A total of 55 physicians included 539 subjects who met eligibility criteria. Of 495 subjects with T2DM, 303 were treated with oral glucose lowering drugs (OGLDs) only, 158 were treated with OGLD + insulin, and 27 received insulin only. Among 44 subjects with T1DM receiving insulin, 13 (29.5%) were also treated with OGLD therapy. The most commonly used insulin regimens were basal alone (69/184; 37.5%) and premixed alone (63/184; 34.2%) in subjects with T2DM, and basal + prandial insulin (24/44; 54.5%) in subjects with T1DM. Proportions of subjects achieving glycemic targets were low [glycated haemoglobin (HbA1c) <7%: T1DM = 7.3% (3/44), T2DM = 25.2% (106/495); as targeted by the treating physician: T1DM = 31.8% (14/44), T2DM = 32.1% (59/185); global target: T1DM = 4.8% (2/42) and T2DM = 1.7% (8/482)]. In subjects with T2DM, HbA1c <7% was noted in 11/22 subjects receiving insulin only and 76/260 receiving only OGLDs. Lack of experience in self-managing insulin dosing, poor diabetes education and failure to titrate insulin dosages were the main reasons for non-achievement of glycemic targets. Conclusion: Timely insulinization, education and empowerment of people with diabetes may help improve glycemic control in India.

LIVE INDIA: Effectiveness of Gla-100 in a Post hoc Pooled Analysis of FINE ASIA and GOAL Registries

“…These observations comprehensively portray a real-world picture of low glycemic control among participants with T2DM from India. These observations are in concordance with the previous evidence from India wherein uncontrolled glycemia was highlighted as a key feature of people with T2DM in India [ 32 – 34 ]. These results are further substantiated by a real-world cross-sectional study by Ramachandran et al wherein only 25.2% of participants with T2DM achieved glycemic control (HbA1c < 7%).…”

Baseline characteristics of participants in the LANDMARC trial: A 3‐year, pan‐india, prospective, longitudinal study to assess management and real‐world outcomes of diabetes mellitus

“…This result is similar to that of the TIGHT (The Investigation of Glycosylated Haemoglobin on Therapy in Indian diabetics) study (23.4%) 15 and the International Diabetes Management Practices Study (IDMPS): wave-5 (2011)(2012)26.0% of participants from India had HbA1c < 53 mmol/mol or <7%) 16 and wave-7 (2016, 25.2% of participants had HbA1c 53 mmol/mol or <7%). 17 This result is also similar to that of a report from North Kerala (28.3%, HbA1c < 53 mmol/mol or <7%) 18 and to that of a recent national diabetes registry program conducted across 200 diabetes clinics/centers in India (23.4%). 19 Further, the 1st phase of the multicentric Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study conducted in 480 participants with selfdeclared diabetes reports a slightly higher (31.0%) proportion of participants with glycemic control.…”

“…At baseline, only 25.1% of the study population had optimal glycemic control (HbA1c < 53 mmol/mol; <7%). This result is similar to that of the TIGHT (The Investigation of Glycosylated Haemoglobin on Therapy in Indian diabetics) study (23.4%) 15 and the International Diabetes Management Practices Study (IDMPS): wave‐5 (2011–2012, 26.0% of participants from India had HbA1c < 53 mmol/mol or <7%) 16 and wave‐7 (2016, 25.2% of participants had HbA1c 53 mmol/mol or <7%) 17 . This result is also similar to that of a report from North Kerala (28.3%, HbA1c < 53 mmol/mol or <7%) 18 and to that of a recent national diabetes registry program conducted across 200 diabetes clinics/centers in India (23.4%) 19 .…”

Evaluating Glycemic Control in Patients of South Asian Origin With Type 2 Diabetes Using a Digital Therapeutic Platform: Analysis of Real-World Data

“…Many studies have reported poor glycemic control in patients with T2D in South Asian countries. [3][4][5]. In India, the management of T2D is limited by the high burden and early onset of the disease [6].…”