Achievement of ABC Goals in Type 2 Diabetes in Real-life

Introduction: This real-life observational study from a diabetes centre in Western India reports the status of A1C (glycated hemoglobin), blood pressure, and cholesterol levels (ABC goals) currently achieved in type 2 diabetic patients. Research design and methods: A cohort of 497 patients of type 2 diabetes first seen at the Diabetes Endocrine Nutrition Management and Research Centre from the years 2014 to 2017 were followed for a median [interquartile range (IQR)] duration of 21.5 (7, 33) months. A minimum of two follow-up clinical evaluations and investigations were analyzed. Results: Hemoglobin A1C (HbA1c) dropped significantly in the whole cohort (HbA1c, Percent: initial 9.0 ± 1.98, follow-up 7.66 ± 1.73; p < 0.0001). Increasing duration of diabetes showed a significantly poorer achievement of HbA1c targets on follow-up (HbA1c 0-5 years vs 5.1-10 years and >10 years, p < 0.001). Pretreatment HbA1c of <6, 6.1-7, 7.1-7.5, 7.6-8, 8.1-9, and >9% was seen in 2, 15, 11, 8, 20, and 44%, respectively. The corresponding HbA1c values on follow-up were 5, 30, 14, 11, 17, and 23%, respectively. Sodium-glucose transport protein 2 inhibitor (SGLT2i) group was in poorer control (HbA1c 8.20 ± 1.71) at follow-up than non-SGLT2i group (HbA1c 7.55 ± 1.72), p < 0.001) probably due to significantly greater use of sulphonylurea as background therapy in SGLT2i group (SGLT2i group 72.2%, non-SGLT2i group 58.7%, p < 0.02). Initial ABC targets were at goal for HbA1c, high blood pressure, and low-density lipoprotein (LDL) cholesterol in 17, 40, and 33% of patients, respectively. On follow-up, percent of patients at goal were HbA1c 35%, hypertension 95.77%, and LDL cholesterol 75.85%. Conclusion: The study brings out the difficulties in achieving HbA1c goals as compared to blood pressure and LDL cholesterol goals. Additionally, it brings out the efficacy of sulphonylureas as a treatment modality. Longer duration of diabetes resulted in lower achievement of glycemic targets.