Thailand Diabetes Registry Project: Glycemic Control in Thai Type 2 Diabetes and Its Relation to Hypoglycemic Agent Usage
Natapong Kosachunhanun MD*, Yupin Benjasuratwong MD**, Sirima Mongkolsomlit BS***, Petch Rawdaree MD***, Nattachet Plengvidhya MD****, Rattana Leelawatana MD*****, Pongamorn Bunnag MD******, Thongchai Pratipanawatr MD*******, Sirinate Krittiyawong MD********, Sompongse Suwanwalaikorn MD*********, Chaicharn Deerochanawong MD**********, Thanya Chetthakul MD***********, Chardpraorn Ngarmukos MD******, Chulaluk Komoltri Ph D************
Affiliation : * Faculty of Medicine Chiang Mai University, ** Department of Internal Medicine, Phramongkutklao Hospital *** BMA Medical College and Vajira Hospital **** Department of Medicine, Faculty of Medicine, Siriraj Hospital Mahidol University ***** Department of Medicine, Faculty of Medicine, Prince of Songkla University ****** Department of Medicine, Faculty of Medicine, Ramathibodi Hospital Mahidol University ******* Department of Medicine, Faculty of Medicine, Khon Kaen University ******** Theptarin General Hospital ********* Department of Medicine, Faculty of Medicine, Chulalongkorn University ********** Rajavithi Hospital, Department of Medicine *********** Department of Medicine, Maharat Nakhon Ratchasima Hospital ************ TDR research coordinator, Division of Research and Development, Siriraj Hospital, Mahidol University
Objective : To determine the pattern of hyperglycemic agent usage in Thai type 2 diabetics (T2 DM) who attended the diabetes
clinic in university and tertiary-care hospitals. The achievement of target glycemic control by various modalities of treatment
was also analyzed.
Materials and Methods : A cross-sectional, hospital-based diabetes registry of 8,913 type 2 diabetic patients in 11 tertiary care
hospitals and medical schools was carried out from April to December 2003. Demographic data, usage of hypoglycemic
agents and level of glycemic control were collected to determine the pattern of use, associated factors, and achievement of
glycemic control.
Results : Overall, 2,342(26.3%) of T2 DM achieved HbA1C less than 7%. The percentage of patients treated with metformin
was 70.8%, sulfonylureas (SU) was 68.7% and insulin was 25.3%. Only 7.0% of patients received alpha-Glucosidase
Inhibitor (AGI), 5.7% received ThaiZoliDinediones (TZD), 1.1% received repaglinide, and 3.2% was on diet control alone.
Target glycemic control was achieved in 57.6%, 37.1%, 52%, 16.7%, 62.5%, 52% and 16.9% of patients who were on diet
control only, monotherapy with SU,metformin, TZD, AGI, repaglinide and insulin,respectively. Sulfonylureas were the most
commonly used drug for monotherapy. Metformin with sulfonylurea was the most common combination therapy and was
used in 39.5% of patients. More than 60% of the patients treated with metformin monotherapy had body mass index (BMI) of
more than 25 kg/m2, as compare to less than half of patient treated with other monotherapy agent. Mean duration of diabetes
in the patients treated with metformin alone was 5.9 + 5.5 years, less than that in the SU- treated patients (8.3 +7.1 years) and
also in the insulin-treated patients (14.8 + 9.0 years). TDZ were commonly prescribed in combination with sulfonylureas and
metformin in subjects with relatively longer duration of diabetes.
Conclusion : Better treatment strategies for glucose control of diabetic patients on medical treatments should be encouraged
to improve glycemic control and reduce long term complications.
Keywords : Diabetes registry, Diabetes, Glycemic control, Hypoglycemic agents
