Evaluation of the Therapeutic Approach and Outcome of Type 2 Diabetes Mellitus Management Strategies in Cameroon
Lukong Marie Chantal Suinyuy
Department of Pharmacotoxicology and Pharmacokinetics, University of Yaoundé, Cameroon.
Tembe Estella Fokunang
Department of Pharmacotoxicology and Pharmacokinetics, University of Yaoundé, Cameroon.
Dehayen Mesmin
Department of Internal Medicine and Specialties, University of Yaoundé 1, Cameroon.
Ngo Valery Ngo
Department of Global Health, Sahlgrenska Institute of Medicine, The University of Gothenburg, Sweden.
Charles Ntungwen Fokunang *
Department of Pharmacotoxicology and Pharmacokinetics, University of Yaoundé, Cameroon.
*Author to whom correspondence should be addressed.
Abstract
Introduction: Type 2 diabetes mellitus (T2DM) is a metabolic syndrome that is characterized by chronic hyperglycaemia, and can lead to chronic long-term complications. The prevalence of diabetes mellitus in Cameroon has been reported at 5.9% in 2017. Studies conducted in 2011, showed that only 41% of patients had a good glycaemic control which was, HbA1c < 6.5.
The aim of this study was therefore to evaluate the treatment intensification with time in T2DM patients in the Yaoundé diabetic Centre in Cameroon.
Methods: The study was a cross-sectional analytical study. In a group of T2DM patients followed up at the National Obesity Centre (NOC) with poorly controlled blood sugar (HbA1c ≥ 7%). The treatment intensification and outcome were evaluated between the periods January 2016 to April 2018. The data was collected from patients’ medical booklet and through a face-to-face interviewer-administered questionnaire.
Results: One hundred and eleven patients (31 males, 27.9% and 80 females, 72.1%) were recruited. The mean age was between 59 ± 10 years and the mean duration of diabetes 8.6 ± 7.0 years. The patients’ treatment consisted: 1) oral anti-diabetic (OAD) agents, monotherapy (24.3%), bitherapy (28.8%), tritherapy 2.7%, 2) insulin only, 19.8% and 3) insulin mixture, 24.3%. The mean baseline HbA1c was 9.3 ± 2.0%. Within the given follow-up time of 16 [11-21] months, only 40 out of the 111 patients had their treatment intensified and 71 had no intensification (therapeutic inertia) despite poor HbA1c levels. Among the 40 with intensification, 5 had immediate intensification and the proportions according to intensification delay ≤3 months, 3-6 months, 6-12 months and >12 months .
Conclusion: Therapeutic inertia affected two third of our population. Despite the high level of inertia, both patients with intensified treatment and non-intensified treatment reached treatment targets.
Keywords: Type 2 diabetes mellitus, glycated haemoglobin, treatment intensification, therapeutic inertia.