English abstract
Background: Type 2 diabetes mellitus (T2DM) is a progressive and complex disorder and Oman ranks among top 10 countries worldwide with the highest prevalence. The goals of management are: symptomatic treatment, improvement of quality of life, screening for complications, and preventive therapy to reduce the risk of complications. Pharmacotherapy is initiated with metformin and often progresses to combination therapy with other oral antidiabetic drugs. Lifestyle changes, weight loss, control of glycemic and non-glycemic parameters leads to successful management. Objectives: To provide a descriptive report of the glycemic parameter glycosylated hemoglobin (Hb A1C) and non-glycemic parameters blood pressure (BP), body mass index (BMI), lipid profile, urine albumin creatinine ratio (UACR) and glomerular filtration rate (GFR) in T2DM patients at Sultan Qaboos University Hospital. To determine the predictors (oral antidiabetic drugs, body mass index, age, sex, diabetes duration) of good glycemic control in these patients and to determine the predictors (sex, age, Hb A1C, hypertension, log serum creatinine, diabetes duration, and BMI) of microalbuminuria. Methodology: A retrospective observational study using electronic medical records was conducted. All T2DM outpatients on one or more oral antidiabetic drugs aged > 20 years who attended and were followed up in the diabetes and other clinics of the Outpatient Department (OPD) from January 2009 to December 2009 were included. Also all T2DM outpatients who attended the Family Medicine & Public Health (FMPH) Clinic were included. Demographic information, and glycemic and non-glycemic parameters were recorded in a customized data collection form. Results: 376 type 2 diabetic patients were included in the study of which 295(78.5%) were Omanis and 81(21.5%) were non-Omanis.The mean age of the cohort was 54.7 years, and male to female ratio was 194(51,6%):182(48.4%). The mean of disease duration for 268 participants was 8.0 years and 332(88.3%) of the study cohort received metformin therapy. OPD to FMPH ratio of the participants was 212; 164. By using multi-variable logistic regression mode and after adjusting for other factors in the model there was a significant association between good glycemic control (Hb A1C57%) and oral aritidiabetic drugs, metformin plus sulfonylureas, metformin and sulfonylureas plus rosiglitazone, other combinations (OR 2.5, p-value 0.011, OR 7, p-value 0.004, OR 3, p-value 0.039 respectively). Of the study cohort 131 (35.3%) patients had good glycemic control (Hb AICS 7%), 119(31.8%) had good BP control <130/80 mmHg), 62(19.8%) patients had normal BMI (< 24.9 kg/m,), 46(15.3%) had optimal lipid profile control. Nineteen (6.64%) participants achieved the targets of Hb A1C, BP and LDL-C. By using adjusted multi variable logistic regression model, microalbuminuria correlated significantly with Hb A1C, diabetes duration, and BMI (OR 1.3, p-value 0.01, OR 1, p-value 0.014, OR 0.92, p-value 0.029 respectively). Conclusions: Good glycemic control was associated with utilization of oral antidiabetic drugs, but not with age, sex, BMI, and diabetes duration. Also, appropriate utilization of metformin was observed as initial antidiabetic therapy. The significant predictors of microalbuminuria were Hb AIC, DM duration, and BMI, while age, sex, hypertension and log serum creatinine were not associated. Control of glycemic and non-glycemic parameters was comparable to the results reported in other Arab countries but was dissimilar to international studies. Key words: Glycemic control, nonglycemic control, type 2 diabetes mellitus, SQUH