Clinical Outcome Evaluation of Glycaemic Control in a Metformin-based Therapy of Type 2 Diabetes Mellitus Patients Managed Under Ambulatory Care Settings
John David Ohieku *
Department of Clinical Pharmacy and Pharmacy Administration, University of Maiduguri, PMB 1069, Maiduguri, Borno State, Nigeria.
Joy Bitrus Musa
Department of Clinical Pharmacy and Pharmacy Administration, University of Maiduguri, PMB 1069, Maiduguri, Borno State, Nigeria.
Onoja Ameh
Department of Clinical Pharmacy and Pharmacy Administration, University of Maiduguri, PMB 1069, Maiduguri, Borno State, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Background: Short term clinical outcomes evaluation of glycaemic goals or its control are desirable to monitor response to therapy in individual patients and to identify compliance or other problem areas.
Aim and Objectives: The objectives of this study are to determine the levels of glycaemic control between clinic visits, determine changes in diabetes status during consecutive clinic visits and to evaluate the degree of decrease or otherwise in fasting blood sugar of patients.
Results: The fasting blood sugar (FBS) during consecutive clinic visits showed hypoglycaemia increased from 1.0% during the first visit to 3.3% during the fifth visit. Normal glycaemic levels increased from 15.0% during first clinic visits to 23.3% at fifth visits. About 18.2% of the FBS were maintained at impaired glucose concentration range. The proportion of patients whose FBS was in the diabetic range decrease progressively (P<0.05) from 72.0% during the first visit to 50.0% at the fifth visit. The distributions in glycaemic levels during the entire periods are hypoglycaemia (1.4%), normal range (19.4%), impaired glucose concentration (18.2%) and diabetic range (61.4%). In 98 (24.0%) cases, the changes which occurred was from higher diabetic range to lower diabetic range with mean change of 14.12±4.84 to 10.28±3.13 mMol/L. Other changes are from diabetic range to impaired glucose concentration range with mean change of 10.47±3.07 to 6.55±2.98 mMol/L(P<0.01); diabetic range to normal range (mean change from 9.98±3.10 to 4.96±0.61 mMol/L; P<0.01) and from impaired glucose concentration to normal range (mean FBS change from 6.31±0.43 to 4.75±0.74 mMol/L; P<0.01). Changes involving increase in FBS occurs from normal range to diabetic range (4.60±0.66 to 10.76±3.71 mMol/L; P<0.01), impaired glucose concentration to diabetic range (6.43±0.36 to 9.87±2.95 mMol/L; P<0.01) and diabetic range to higher diabetic value (11.66±3.73 to 14.66±5.03 mMol/L; P<0.01).
Conclusion: Most patients recorded decrease in FBS over values recorded in their previous clinic visits but these changes do not translate to good glycaemic control. Several patients experiences poor glycaemic control probably as a result of non-compliance. Multiple clinic visits also do not translate to the desired glycaemic control.
Keywords: Type 2 diabetes mellitus, glycaemic control, fasting blood sugar (FBS), compliance, clinic visits