Achievement of 3B goals among T2DM patients: An experience from Central Nepal

Background:Management of type 2 diabetes mellitus (T2DM) requires comprehensive control of three metabolic parameters: blood glucose, blood pressure (BP), and blood lipid commonly known as 3B. We studied the prevalence of patients reaching the 3B goals in Nepalese context.

Materials and Methods:Patients aged 30 years or above who presented in Dhulikhel Hospital outpatient clinic of internal medicine department of Dhulikhel Hospital with a diagnosis of T2DM diagnosed at least for 6 months were enrolled in this cross-sectional, observational study. Patients with any major illness, surgery, or diabetic ketoacidosis in last 6 months, use of glucocorticoids, post-transplant diabetes, and gestational diabetes were excluded. The study was conducted during the period between January 2015 and June 2015. Chi-square test was used to compare qualitative variables. The nonparametric test (2 independent sample tests) was used for quantitative variables.

Results:One hundred and fifty study participants had a mean age of 56 ± 11.88 years, body mass index of 23.97 4.72kg/m ², and an HbA1c of 8.02 ± 1.78%. The proportion of patients with good glycemic control (HbA1c >7%) was 30%. Only 26% patients had achieved targets for both systolic and diastolic BP (>130/80) and 35% patients had achieved the target of LDL less than 100. In this study, 32 (21.33%) patients had control of blood glucose and blood lipid, whereas 26 (17.33%) patients had control of blood glucose and BP. Likewise, only 19 (12.67%) patients met the target of blood glucose, BP, and blood lipid control.

Conclusion:Our data showed that only 13% of patients achieved the 3B goals. Our study highlights the urgent unmet need, to improve the quality of diabetes care in our center which may be a representative of the country.

Keywords

3B goals - HbA1c goal - Nepal - T2DM

• References

• 1 Gaede P, Vedel P, Parving HH, Pedersen O. Intensified multifactorial intervention in patients with type 2 diabetes mellitus and microalbuminuria: The steno type 2 randomised study. Lancet 1999; 353: 617-622
• 2 American Diabetes Association. Standards of medical care in diabetes-2014. Diabetes Care 2014; 6 (Suppl. 01) S14-S80
• 3 Jenssen TG, Tonstad S, Claudi T, Midthjell K, Cooper J. The gap between guidelines and practice in the treatment of type 2 diabetes A nationwide survey in norway. Diabetes Res Clin Pract 2008; 80: 314-320
• 4 Cheung BM, Ong KL, Cherny SS, Sham PC, Tso AW, Lam KS. Diabetes prevalence and therapeutic target achievement in the united states, 1999 to 2006. Am J Med 2009; 122: 443-453
• 5 Braga M, Casanova A, Teoh H, Dawson KC, Gerstein HC, Fitchett DH. et al. Diabetes Registry to Improve Vascular Events (DRIVE) Investigators. Treatment gaps in the management of cardiovascular risk factors in patients with type 2 diabetes in canada. Can J Cardiol 2010; 26: 297-302
• 6 Ji L, Hu D, Pan C, Weng J, Huo Y, Ma C. et al. CCMR Advisory Board; CCMR-3B STUDY Investigators. Primacy of the 3B approach to control risk factors for cardiovascular disease in type 2 diabetes patients. Am J Med 2013; 126 (925) e11-e22
• 7 Group UPDS. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 1998; 317: 703
• 8 Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA. et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): Prospective observational study. BMJ 2000; 321: 405-412
• 9 Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 2008; 359: 1577-1589
• 10 Gakidou E, Mallinger L, Abbott-Klafter J, Guerrero R, Villalpando S, Ridaura RL. et al. Management of diabetes and associated cardiovascular risk factors in seven countries: A comparison of data from national health examination surveys. Bull World Health Organ 2011; 89: 172-183
• 11 Mendes AB, Fittipaldi JA, Neves RC, Chacra AR, Moreira Jr ED. Prevalence and correlates of inadequate glycaemic control: Results from a nationwide survey in 6,671 adults with diabetes in Brazil. Acta Diabetol 2010; 47: 137-145
• 12 Chuang LM, Tsai ST, Huang BY, Tai TY. Diabcare-Asia 1998 Study Group. The status of diabetes control in asia–a cross-sectional survey of 24 317 patients with diabetes mellitus in 1998. Diabet Med 2002; 19: 978-985
• 13 Bi Y, Yan JH, Liao ZH, Li YB, Zeng LY, Tang KX. et al. Inadequate glycaemic control and antidiabetic therapy among inpatients with type 2 diabetes in guangdong province of china. Chin Med J (Engl) 2008; 121: 677-681
• 14 Kumar KH, Modi KD. A1c, blood pressure and cholesterol goal achievement in patients of Type 2 diabetes. Med J DY Patil Univ 2016; 9: 195-199
• 15 Hoerger TJ, Segel JE, Gregg EW, Saaddine JB. Is glycemic control improving in U.S. Adults?. Diabetes Care 2008; 31: 81-86
• 16 Pan C, Yang W, Jia W, Weng J, Tian H. Management of chinese patients with type 2 diabetes, 1998-2006: The diabcare-china surveys. Curr Med Res Opin 2009; 25: 39-45
• 17 VinodMahato R, Gyawali P, Raut PP, Regmi P, Singh KP, Pandeya DR. et al. Association between glycaemic control and serum lipid profile in type 2 diabetic patients: Glycated haemoglobin as a dual biomarker. Biol Res 2011; 22: 375-380
• 18 IDF Clinical Guidelines Task Force. Global Guideline for Type 2 Diabetes: Recommendations for standard, comprehensive, and minimal care. Diabet Med 2006; 23: 579-593
• 19 Charpentier G, Genès N, Vaur L, Amar J, Clerson P, Cambou JP. et al. ESPOIR Diabetes Study Investigators. Control of diabetes and cardiovascular risk factors in patients with type 2 diabetes: A nationwide french survey. Diabetes Metab 2003; 29: 152-158
• 20 Stark Casagrande S, Fradkin JE, Saydah SH, Rust KF, Cowie CC. The Prevalence of Meeting A1C, Blood Pressure, and LDL Goals Among People With Diabetes, 1988–2010. Diabetes Care 2013; 36: 2271-2279
• 21 Gaede P, Lund-Andersen H, Parving HH, Pedersen O. Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med 2008; 358: 580-591
• 22 Comaschi M, Coscelli C, Cucinotta D, Malini P, Manzato E, Nicolucci A. SFIDA Study Group–Italian Association of Diabetologists (AMD). Cardiovascular risk factors and metabolic control in type 2 diabetic subjects attending outpatient clinics in italy: The SFIDA (survey of risk factors in italian diabetic subjects by AMD) study. Nutr Metab Cardiovasc Dis 2005; 15: 204-211
• 23 Cummings DM, Doherty L, Howard G, Howard VJ, Safford MM, Prince V. et al. Blood pressure control in diabetes: Temporal progress yet persistent racial disparities: National results from the reasons for geographic and racial differences in stroke (REGARDS) study. Diabetes Care 2010; 33: 798-803
• 24 Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of The National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult treatment panel III). JAMA 2001; 285: 2486-2497
• 25 Sainsbury E, Colagiuri S, Magnusson R. An audit of food and beverage advertising on the sydney metropolitan train network: Regulation and policy implications. BMC Public Health 2017; 17: 490
• 26 Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med 2003; 348: 383-393
• 27 Detournay B, Cros S, Charbonnel B, Grimaldi A, Liard F, Cogneau J. et al. Managing type 2 diabetes in france: The ECODIA survey. Diabetes Metab 2000; 26: 363-369