Changes in drug therapy and disease control in a subset of diabetic patients at public primary healthcare facilities in Trinidad

ABSTRACT

OBJECTIVE: To determine changes in drug treatment over a five-year period in a subset of diabetic patients who 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 METHOD: A cross-sectional survey was conducted between June and August 2015 at 24 primary healthcare facilities across Trinidad. Demographic details, drug use, blood glucose readings and self-reported adherence to drug therapy, dietary restrictions and exercise were collected. Additionally, patients’ files were reviewed for drug changes and blood glucose readings over the previous five-year period.RESULTS: 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.