To determine changes in drugtreatment over a five-year period in a subset of diabetic patientswho were either uncontrolled on monotherapy or required polypharmacy with or without insulin. These changes were assessed in their ability to be able to achieve glycaemic control.SUBJECTS AND
A total of 236 patients were enrolled and 49% had random blood glucose greater than 180 mg/dL (uncontrolled). Most patients (91%) were prescribed metformin or gliclazide (67.5%) either singly or in combination; 92 patients (39%) were prescribed insulin. Over the five-year period, monotherapy declined from 26.9% to 8.4%; conversely, polypharmacy increased from 68.2% to 82.4%. Additionally, doses of all antidiabetic drugs increased. However, despite these changes, only modest decreases in random blood glucose were observed, ranging from 18 mg/dL to 43 mg/dL for the various drug combinations. On average, none of these combinations produced blood glucose levels below 180 mg/dL to achieve glycaemic control.
CONCLUSION:
Over the five-year period, there was a shift from monotherapy to polypharmacy, with increasing doses of individual drugs and further addition of insulin. Despitethese therapeutic changes, accompanied by moderate decreases in random blood glucose, they were insufficient to achieve glycaemic control in a significant number of patients.