Abstract
Background
Despite the clinical advances in the management of type 2 diabetes mellitus (T2DM) over the past decades, in the US, nearly 48% of patients do not achieve the ADA recommended glycemic goal of glycated hemoglobin (HbA1c) below 7.0%1. The Brazilian Guidelines for the Treatment of T2DM has established the same goal of HbA1c below 7.0%2, but the data for the rate of glycemic goal achievement in Brazil is lacking. The aim of this study was to determine the rate of HbA1c goal achievement among Brazilian patients receiving antidiabetic therapy and investigate its relation to other clinical and demographic covariates.
Methods
Using a cross-sectional database analysis from a group of private clinics in São Paulo, Brazil, this Real Word Evidence study evaluated 1034 patients with T2DM, which were being treated with at least one antidiabetic agent for a minimum of three months and had a basal level of Glycated Hemoglobin (HbA1c) above 7.0%. The number of patients that did not achieve the therapeutic target of HbA1c below 7% was calculated. Demographic and clinical characteristics were collected and a correlation analysis with the treatment target achievement was performed.
Results
The average age of the population was 60.5 years and gender were equally distributed. A total of 60.3% of the patients did not achieve the target of HbA1c below 7% after a minimum of three months treatment with one or more antidiabetic agents. The average time between HbA1c basal to final was 9.9 months. The average basal level of HbA1c was 9.9% ± 2.2 and the final level was 7.8% ± 1.9. In the univariate analysis a statistically significant difference was observed in the following clinical variables: age, total cholesterol level, LDL level, basal and final HbA1c, time to HbA1c final measure, treatment time, and number of antidiabetic agents.
Conclusion
In this retrospective real-world study, only 40% of patients achieved the glycemic target of HbA1c below 7% after at least 3 months of treatment with one or more antidiabetic agent. The average initial HbA1c was 9.9% and the final level was 7.8%. Patients not at goal were older and had more comorbidities, which highlight the challenge that represents the management of diabetes in Brazil. This study confirms previous published data that T2DM glycemic targets are difficult to achieve and the reasons for this are complex and multifactorial