RESUMO
Background@#Worldwide, diabetes mellitus (DM) is a serious health issue with a global prevalence of 9.8% in 2021. According to the latest 2018 Expanded National Health and Nutrition survey done by the DOST-FNRI, the prevalence of diabetes in the Philippines have more than doubled from 3.4% in 2003 to 7.9% in 2018. The latest research conducted regarding diabetes care in the Philippines was in 2008 which showed that 85% of patients with diabetes failed to achieve the HbA1c general target of <7%.@*Objectives@#A population-based cross-sectional study to update the current status of diabetes care in the Philippines, specifically to determine glycemic control, trends in DM management, prevalence of complications and lastly their clinico-socio demographic profile.@*Methods@#340 patients with diabetes were included from the clinics of the Institute for Studies on Diabetes Foundation, Inc. physicians. The following data were collected: clinico-socio demographic profile, HbA1C-based glycemic control, trend in the use of glucose lowering agents, and prevalence of diabetes complications.@*Results@#The mean age of the 340 patients with diabetes in this study was 62 years old. Almost sixty-seven percent (66.8%) were females. The mean body mass index was 26 kg/m2. The mean duration of diabetes was 12.63 years. Close to sixty- eight percent (67.6%) had tertiary education, 58.8% were unemployed and 65% had above minimum income. The most commonly used single oral agent was biguanide (72.9%), followed by dipeptidyl peptidase-4 inhibitors (64.3%). The most common dual therapy combinations were biguanide plus dipeptidyl peptidase-4 inhibitors (43.2%), biguanide plus sulfonylureas (27.2%), and biguanide plus sodium-glucose co-transporter-2 inhibitors (11.1%). Basal insulin was the most commonly used injectable agent. The present study showed that 47.4% of patients achieved an HbA1c of <7%. For the microvascular complication group alone, most had neuropathy (30.4%) followed by nephropathy (17.3%) and by retinopathy (5.4%). For the macrovascular complication group, the most common was coronary artery disease (82%) followed by peripheral artery disease and DM foot (27%). Overall, the most frequent DM complication identified was neuropathy (30.4%) , nephropathy (17.3%) and coronary heart disease (16.1%).@*Discussion@#Compared to the 2008 study, oral glucose lowering agents’ usage shifted from sulfonylureas to more use of dipeptidyl peptidase-4 inhibitors. There was a decline in the use of thiazolidinediones, α-glucosidase inhibitors and non-use of meglitinides. For insulin use, there was a shift from the use of premixed insulin to more basal insulin usage. There was marked improvement in the diabetes care situation in the Philippines from the 2008 study to the 2020 study. Glycemic control defined as HbA1c level of <7.0 increased from 15% to 47.4%. Coronary artery disease was the most common macrovascular complication while neuropathy was the most common overall and microvascular complication.
Assuntos
Complicações do Diabetes , Controle GlicêmicoRESUMO
Objective@#To present the results from the Philippine cohort of the A1chieve study receiving insulin detemir (IDet) ± oral antidiabetic drugs. @*Methodology@#A1chieve is a multinational, 6-month, observational study of 66,726 people with type 2 diabetes mellitus (T2DM), both insulin users and non-insulin users, started on IDet, insulin aspart or biphasic insulin aspart in 28 countries across four continents. This subgroup analysis evaluates the safety and effectiveness of IDet in 988 subjects from the Philippines. @*Results@#At baseline the mean age, duration of diabetes and mean BMI were found to be 57±11.9 yrs, 6.9±5.3 yrs and 26±4.8 kg/m2 respectively. Majority of subjects were insulin-naive (84.3%) and glycemic control was poor in all the groups at baseline. At the end of 24 weeks, there were significant improvements following IDet initiation with a 2.1% reduction in mean HbA1c. The HbA1c target of <7% was achieved by 46.8% subjects at the study end. Although not statistically significant, there was a modest decrease in body weight in all the groups. There was no increase in the incidence of hypoglycemia among baseline insulin-naive subjects, while a significant reduction in hypoglycemia was seen among prior insulin users. @*Conclusions@#IDet appears to be an effective and safe option for individuals with T2DM in the Philippines. HbA1C was lowered to target, and there was no increase in incidence of hypoglycemia and body weight with IDet.