Persistent poor glycaemic control in individuals with type 2 diabetes in developing countries: 12 years of real-world evidence of the International Diabetes Management Practices Study (IDMPS)

Abstract

Aims/hypothesis: We evaluated the secular trend of glycaemic control in individuals with type 2 diabetes in developing countries, where data are limited.

Methods: The International Diabetes Management Practices Study provides real-world evidence of patient profiles and diabetes care practices in developing countries in seven cross-sectional waves (2005-2017). At each wave, each physician collected data from ten consecutive participants with type 2 diabetes during a 2 week period. The primary objective of this analysis was to evaluate trends of glycaemic control over time.

Results: A total of 66,088 individuals with type 2 diabetes were recruited by 6099 physicians from 49 countries. The proportion of participants with HbA_1c <53 mmol/mol (<7%) decreased from 36% in wave 1 (2005) to 30.1% in wave 7 (2017) (p < 0.0001). Compared with wave 1, the adjusted ORs of attaining HbA_1c ≤64 mmol/mol (≤8%) decreased significantly in waves 2, 5, 6 and 7 (p < 0.05). Over 80% of participants received oral glucose-lowering drugs, with declining use of sulfonylureas. Insulin use increased from 32.8% (wave 1) to 41.2% (wave 7) (p < 0.0001). The corresponding time to insulin initiation (mean ± SD) changed from 8.4 ± 6.9 in wave 1 to 8.3 ± 6.6 years in wave 7, while daily insulin dosage ranged from 0.39 ± 0.21 U/kg (wave 1) to 0.33 ± 0.19 U/kg (wave 7) for basal regimen and 0.70 ± 0.34 U/kg (wave 1) to 0.77 ± 0.33 (wave 7) U/kg for basal-bolus regimen. An increasing proportion of participants had ≥2 HbA_1c measurements within 12 months of enrolment (from 61.8% to 92.9%), and the proportion of participants receiving diabetes education (mainly delivered by physicians) also increased from 59.0% to 78.3%.

Conclusions: In developing countries, glycaemic control in individuals with type 2 diabetes remained suboptimal over a 12 year period, indicating a need for system changes and better organisation of care to improve self-management and attainment of treatment goals.

Keywords: Clinical diabetes; Education; Epidemiology; Healthcare delivery; Insulin therapy; Prediction and prevention of type 2 diabetes.

Fig. 1

The proportion of participants attaining HbA_1c goal defined as: (a) <53 mmol/mol or <7%; and (b) <64 mmol/mol or <8%, between 2005 and 2017. The p values show test of significance for trend in HbA_1c goal achievement in the overall population: (a) over all waves; or (b) waves 2–7 vs reference wave 1. **p < 0.01, ***p < 0.001. A two-sided Cochran–Armitage test was used to investigate the relationship between study waves and the variables of interest, assuming a no-trend null hypothesis: (a) p < 0.0001 for trend over all waves; (b) p = 0.0036 for wave 2 vs wave 1, p = 0.2991 for wave 3 vs wave 1, p = 0.0514 for wave 4 vs wave 1, p = 0.0011 for wave 5 vs wave 1, p = 0.0006 for wave 6 vs wave 1 and p = 0.0017 for wave 7 vs wave 1. HbA_1c goal achievement data were missing for 3893 participants in wave 1, 5084 participants in wave 2, 3150 participants in wave 3, 961 participants in wave 4, 1256 participants in wave 5, 548 participants in wave 6 and 608 participants in wave 7

Fig. 2

Changes in use of insulin regimens in type 2 diabetes between 2005 and 2017

Fig. 3

Distribution of sources of education in participants who received diabetes-related education. Data on the provider of diabetes education were not captured in waves 1–3