Background. Chronic hyperglycemia has been linked to the development of acute and chronic complications, so one of the primary interventions is to maintain appropriate glycemic control for each patient. Despite this, information on the matter continues to be limited.
Objective. To describe glycemic control in patients with diabetes mellitus and explore their behavior based on other clinical variables.
Methodology. Evaluation of a cohort of patients with diabetes from an endocrinology practice, assessed from January 2014 to December 2018. A descriptive analysis of sociodemographic and clinical variables was made. Data was collected from medical records, and characteristics were analyzed using frequencies and averages.
Results. Of the 661 patients, 27% of DM1 (type 1 diabetes mellitus) and 47.7% of DM2 (type 2 diabetes mellitus) had adequate glycemic control; when assessing the duration of the disease, the highest percentage of DM1 with adequate glycemic control (42%) had a recent diagnosis (less than five years) as in DM2 (41%). In terms of microvascular complications, the most frequent event was peripheral neuropathy in both groups of patients with diabetes with good glycemic control (8% of DM1 and 12% of DM2). Of the macrovascular complications there was only 1 case of PAD in DM1 in the group with inadequate glycemic control while in DM2 9.7% of patients with adequate glycemic control had a record of CAD (coronary artery disease). Finally, when considering hypoglycemic treatment, basal/bolus insulin therapy was the most used in DM1 in both glycemic control groups; and DM2 with good glycemic control, the most used therapies were metformin (6.4%) and metformin/IDPP4 in 8%.
Conclusions. Less than half of the study population had adequate glycemic control, being those with a recent diagnosis the largest group under this classification. There was a low frequency of microvascular and macrovascular complications, even in the group with inadequate glycemic control. Both groups of patients with diabetes with inadequate glycemic control recorded a higher frequency of hypoglycaemias, showing that an HbA1c measurement is insufficient to define glycemic control.
Federación Internacional de diabetes. ATLAS de la DIABETES de la FID. 8th. Bruselas, Bélgica: Federación Internacional de Diabetes; 2017.
Aschner M, P., Muñoz V, O., Girón, D., Milena García, O., Fernández-Ávila, D., Casas, L., et al. Guía de práctica clínica para la prevención, diagnóstico, tratamiento y seguimiento de la diabetes mellitus tipo 2 en la población mayor de 18 años. Colombia Médica, 2016. 47 (2), 109-131.
Escobedo J, Buitrón LV, Velasco MF, Ramírez JC, Hernández R, Macchia A, Pellegrini F, Schargrodsky H, Boissonnet C, Champagne BM. High prevalence of diabetes and impaired fasting glucose in urban Latin America: the CARMELA Study. Diabet Med. 2009 Sep;26(9): 864-71.
Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Medical Care in Diabetes-2019. Diabetes Care. 2019 Jan;42(Suppl 1): S34-S45.
Microvascular Complications and Foot Care: Standards of Medical Care in Diabetes-2019. Diabetes Care. 2019 Jan; 42(Suppl 1): S124-S138.
Thomas MC, Brownlee M, Susztak K, Sharma K, Jandeleit - Dahm KA, Zoungas S, Rosing P, Groop PH, Cooper ME. Diabetic kidney disease. Nat Rev Dis Primers. 2015 Jul30; 1:15018.
Pop-Busui R, Boulton AJ, Feldman EL, Bril V, Freeman R, Malik RA, Sosenko JM, Ziegler D. Diabetic Neuropathy: A Position Statement by the American Diabetes Association. Diabetes Care. 2017 Jan;40(1):136–154.
Cefalu WT. Glycemic targets and cardiovascular disease. N Engl J Med 2008; 358: 2633–35.
Alayón N. Control metabólico y factores biopsicolo?gicos y socioeconómicos de adherencia al tratamiento en pacientes diabéticos, usuarios de Coomeva, sede manga, Cartagena, Colombia, 2006. Uni Norte. 2007.
Villegas Perrasse A, Abad SB, Faciolince S, Hernández N, Maya C, Parra L, et al. El control de la diabetes mellitus y sus complicaciones en Medellín, Colombia, 2001–2003. Rev Panam Salud Publica. 2006;20(6):393–402.
Glycemic Targets: Standards of Medical Care in Diabetes - 2019. Diabetes Care. 2019 Jan;42(Suppl 1): S61-S70.
Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Research Group, Nathan DM, Zinman B, et al. Modern-day clinical course of type 1 diabetes mellitus after 30 years' duration: the diabetes control and complications trial/epidemiology of diabetes interventions and complications and Pittsburgh epidemiology of diabetes complications experience (1983-2005). Arch Intern Med 2009; 169:1307.
Currie CJ, Peters JR, Tynan A, et al. Survival as a function of HbA (1c) in people with type 2 diabetes: a retrospective cohort study. Lancet 2010; 375:481.
Holman RR, Paul SK, Bethel MA, et al. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 2008; 359:1577.
Ceriello A, Monnier L, Owens D. Glycaemic variability in diabetes: clinical and therapeutic implications. Lancet Diabetes Endocrinol. 2019 Mar; 7(3):221-230.
Gorst C, Kwok CS, Aslam S, Buchan I, Kontopantelis E, Myint PK, Heatlie G, Loke Y, Rutter MK, Mamas MA. Long-term Glycemic Variability and Risk of Adverse Outcomes: A Systematic Review and Meta-analysis. Diabetes Care. 2015 Dec; 38(12):2354-69.
Zinman B, Marso SP, Poulter NR, Emerson SS, Pieber TR, Pratley RE, et al. Day-to-day fasting glycaemic variability in DEVOTE: associations with severe hypoglycaemia and cardiovascular outcomes (DEVOTE 2). Diabetología 2018; 61:48-57.
Tseng JY, Chen HH, Huang KC, Hsu SP, Chen CC. Effect of mean HbA1c on the association of HbA1c variability and all-cause mortality in patients with type 2 diabetes mellitus. Diabetes Obes Metab. 2020 Jan 5.
Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes-2020. Diabetes Care. 2020 Jan;43(Suppl 1): S98-S110.
DeGeeter M, Williamson B. Alternative Agents in Type 1 Diabetes in Addition to Insulin Therapy: Metformin, Alpha-Glucosidase Inhibitors, Pioglitazone, GLP-1 Agonists, DPP-IV Inhibitors, and SGLT-2 Inhibitors. J Pharm Pract. 2016 Apr;29(2):144-59.
Alba LH, Bastidas C, Vivas JM, Gil F. Prevalencia de control glucémico y factores relacionados en pacientes con diabetes mellitus tipo 2 del Hospital Universitario de San Ignacio, Bogotá, Colombia. Gac Méd Méx. Vol 145 Nº 6, 2009: 469 – 474.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.