Glycemic control and its determinants in insulin-initiated type 2 diabetic patients previously on oral antidiabetic medications at the outpatient clinic of the University of Gondar Comprehensive Specialized Hospital

Abstract

Abstract Background: Diabetes mellitus is a chronic disease characterized by elevated blood glucose levels. Progression of diabetes leads to macrovascular and microvascular complications ad premature death. The American Diabetes Association recommends glycemic targets of glycosylated hemoglobin values <7% or/and fasting plasma glucose levels of 70 to 130 mg/dl. Objective: This study aimed to assess glycemic control and its determinants after insulin initiation in type 2 diabetes mellitus patients, initially on oral antidiabetics’ medications at the chronic outpatient clinic of the University of Gondar Comprehensive Specialized Hospital Methods: A retrospective follow-up study was conducted at the outpatient clinic of the University of Gondar Comprehensive Specialized Hospital from May to July 2020, on T2DM patients who were attending their diabetic follow-up from 2014-2019. Study subjects were selected from the list of the eligible diabetic population using simple random sampling technique by lottery method. A nonparametric Wilcoxon rank test used to assess the median FPG difference before and after insulin initiation while a Kruskal-Wallis test was used to examine the median FPG difference between the treatment groups after insulin initiation. The Logistic regression model was used to identify determinants of glycemic control after insulin initiation. Results: Of 424 patient medical records, 54.7% were males, mean ± SD age 59.3±9.3 and duration of diabetics was 13.4±4 years. The median VII rd month of insulin initiation month of insulin initiation. Higher FPG and SBP during insulin initiation were slightly associated with poor glycemic control with AOR 1.016( rd month of insulin initiation. Having dyslipidemia, renal problems and macrovascular complications before insulin initiation with AOR 0.485( th month of post-insulin initiation. Conclusion: The initiation of insulin to the therapeutic regimen of T2DM patients, who failed to achieve the glycemic target by OADs alone, brought a significant glycemic change and declining trend of FPG over one year. Being on atorvastatin, higher levels of FPG and SBP during insulin initiation were determinants of poor glycemic control at 3 rd month of insulin initiation while having dyslipidemia, renal problems and macrovascular complication in pre-period of insulin initiation were inversely associated with poor glycemic control at 12 th month of insulin initiation. Hence, appropriate management focusing on predictors of glycemic control and other associated factors would be of a great benefit to achieve glycemic control of insulin-initiated patients. Key words: Glycemic control, Fasting plasma glucose, Insulin initiation, Type 2 diabetes mellitus