Introduction & Objective: Insulin therapy in patients with type 2 diabetes mellitus (T2DM) with A1c ≥9% as recommended by some guidelines is not always possible due to different psychological and social factors. Our work compares this strategy with the intensified and combined use of oral hypoglycemic agents (OHAs) in patients with uncontrolled T2DM.

Methods: This was a descriptive and longitudinal study with 426 T2DM patients and A1c ≥9% divided in 2 groups: Group A consisted of OHAs-only therapy (n=188) and Group B of insulin plus OHAs (n=238). We considered the glycemic goal of A1c ≤7%. Cohorts at 3, 6 and 12 months were evaluated using the chi-square test with a significance level of p=≤ 0.05.

Results: Initial Group A vs Group B: age 53.1 ±12.3 vs 56.1 ±12.4 (p= 0.695), weight 77.8 ±15.6 vs 74.3 ±18.1 (p= 0.202), BMI 29.7 ±5.5 vs 29.1±6.0 (p= 0.202); years since T2DM diagnosis 8.6 ±7.6 vs 13.5 ±8.8 (p= 0.000); FPG 223.4 ±69.6 vs 253.6 ±82.8 (p= 0.299); A1c 10.8 ±1.5 vs 11.4 ±1.6 (p= 0.128); At 3 months Group A vs Group B: monotherapy 5 (2.7%) vs 19 (8.0%) p=0.018, dual therapy 53 (28.2%) vs 117 (49.2%) p= 0.000, triple therapy 83 (44.1%) vs 77 (32.4%) p=0.013, quadruple therapy 42 (22.3%) vs 9 (3.8%) p= 0.000; at 6 months: monotherapy 4 (4.3%) vs 13 (11.4%) p=0.064, dual therapy 18 (19.4%) vs 61 (53.5%) p= 0.000, triple therapy 43 (46.2%) vs 37 (32.5%) p= 0.043, quadruple therapy 23 (24.7%) vs 3 (2.6%) p= 0.000; at 12 months: monotherapy 1 (6.8%) vs 8 (10.0%) p= 0.054, dual therapy 16 (27.1%) vs 6 (57.5%) p= 0.000, triple therapy 26 (44.1%) vs 26 (32.5%) p= 0.164. A1c glycemic target achievement at 3 months Group A vs Group B; 46.3% vs 25.2% p=0.000; at 6 months 63.4% vs 37.7% p=0.000; at 12 months 74.6% vs 32.5% p=0.000.

Conclusion: The combined use of OHAs was more effective than insulin therapy plus OHAs in T2DM patients with A1c ≥9.0%, this new approach may be an alternative in patients who do not choose to use insulin or doctors without sufficient knowledge of insulinization.

Disclosure

R. Violante Ortiz: None. N. Fernandez Ordoñez: None. A. Tavera Tapia: None. E. Reyna-Beltrán: None. J. Perez Perez: None. I. Castro Chong: None. V. Vázquez Garcia: None. I. Badillo Grijalva: None. J. Bautista Sánchez: None. K. Wong De León: None. A. Olvera Escobedo: None. C. Ramos Gomez: None. A. Avila Silva: None.

© 2024 by the American Diabetes Association
2024
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