ABSTRACT
Background: The Covid-19 lockdown imposed all across the nation substantially disturbed the lifestyle and dietary habits among Indians, and this can be particular concern among individuals with diabetes. Objective(s): To understand the impact of lockdown on glycemic control in patients with type 2 diabetes, and to evaluate the healthcare practitioner (HCP) treatment preferences. Method(s): This systematic survey was done among 126 HCPs in whom a structured objective questionnaire was administered. The survey collected data related to the proportion of patients with poor glycemic control, its causes, and treatment preferences. Result(s): For the pre lockdown scenario, 37% and 48% of HCPs respectively, opined that 10-20% and 20-40% of their patients had HbA1c >8.5%. Only 10.3% HCPs reported 40-60% patients presented with high HbA1c respectively. However, for the post lockdown scenario, 8.7% and 42% of HCPs respectively, reported that 10-20% and 20-40% of their patients had HbA1c >8.5%. A notable 42% of HCPs admitted that after the lockdown 40-60% of their patients presented with HbA1c >8.5%. While 4% of HCPs reported uncontrolled glycemia in >60% of their patients before lockdown this proportion considerably increased to 7% for post lockdown scenario. HCPs perceived excess carbohydrate consumption and the lack of physical activity as the main causes of uncontrolled glycemia followed by poor medication adherence and stress. Of all the respondents, 53% agreed that they will prefer triple-drug therapy in more than 30% of their patients with HbA1c values above 8.5%. More than half of the HCPs mentioned that they would choose triple-drug therapy (Glimepiride+ metformin+ voglibose fixeddose combination) over other antidiabetics to manage the uncontrolled glycemia in their patients. Conclusion(s): The survey findings indicated an increase in the proportion of patients with HbA1c >8.5% after the lockdown as compared to the pre-lockdown phase. The altered nutritional behavior and reduced physical activity during lockdown are believed to be the major contributors to such an alarming rise in the proportion of patients with uncontrolled diabetes. Clinically, the triple-drug FDC (Glimepiride+ metformin+ voglibose) is perceived as the choice of therapy to achieve optimal glycemic control by a majority of HCPs.
ABSTRACT
Introduction: Background: Optimum glycemic control is pivotal to prevent complications and premature mortality, and improve quality of life in patients with type 2 diabetes mellitus (T2DM). Patients uncontrolled on mono- or dual- antidiabetic therapy require triple drug therapy (TDT) to achieve optimal glycemic control. Objectives: Objective: This survey was carried out to understand the clinical utilization of TDT in attaining durable glycemic control in patients with T2DM. Methods: Methods: A structured objective questionnaire was used for the survey and responses were sought from 270 Healthcare practitioners (HCPs) across India during May 15 to May 30, 2020 via Google forms. The questionnaire consisted of questions related to proportion of patients with uncontrolled glycemia, role and choice of TDT in achieving durable glycemic control, importance of cost of therapy, etc. The responses were analyzed descriptively. Results: Results: The respondent HCP pool comprised consulting physicians (47%), diabetologists (30%), endocrinologists (16%), and family physicians (7%). More than 45% of HCPs agreed that 30-50% of their diabetes patients have HbA1c >8.5%, and uncontrolled fasting and postprandial blood glucose levels while 21% mentioned such uncontrolled glycemia in more than 50% of their patients. Approx. 52% of the HCPs think that 50-70% of their patients can be brought under control with TDT, while a quarter of HCPs believe that more than 70% of their patients can be effectively managed with TDT. 72% of respondents aligned in their views that the cost of anti-diabetic therapy is an important parameter during Covid-19 pandemic. In uncontrolled T2DM patients taking a combination of modern sulphonylurea and metformin, HCPs rated DPP-4 inhibitor, pioglitazone and voglibose as third line options for achieving durable glycemic control. 60% of the HCPs opined that triple drug therapy can delay the initiation of insulin therapy in patients with T2DM. Almost two-thirds of the HCPs agreed that double and triple fixed dose OAD combinations have better pharmacy availability than insulin, enabling better patient accessibility. Conclusion: Conclusion: A high proportion of patients have a suboptimal glycemic control during covid-19 pandemic, and TDT can control a majority of these patients. The survey also highlights the HCPs' opinion that the triple drug therapy has multiple patient-centric benefits like cost effectiveness, accessibility, delaying insulin usage.