Evaluation of the Therapeutic Approach and Outcome of Type 2 Diabetes Mellitus Management Strategies in Cameroon

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.