Glycemic Control, Medication Use and Obesity among Patients with Type 2 Diabetes Mellitus Presenting to an Endocrinology Clinic during the War in Yemen. A Three-Year Retrospective Study

Background and Aims: The war in Yemen caused the already weak health system in the country to decline. We conducted a 3-year retrospective chart review on patients with type 2 Diabetes Mellitus (DM) attending an endocrinology center for the first time during the war, most of the patients were treated by internists and in government hospitals prior to presentation and only a small amount had seen a specialist prior to presentation. Patients and methods: A total of 4261 charts (2005 males and 2256 females) were reviewed on all patients with type 2 DM attending an endocrinology center for the first time from Jan 2017-Dec 2019. The age, age at onset of diabetes, BMI, medications at presentation were documented in all patients. The HBA1c was documented in only 4031 of the patients' charts. Results: The mean age of the patients was 51.2 (SD 12.4) and the mean age at diagnosis was 44.6 years (SD 11.5). The mean duration of diabetes was 6.6 (SD 6.6) years. The mean HBA1c was 9.7 (SD 2.7) In 58.4% of the patients the HBA1c was > 9% and only 14.4% had an HBA1c <7%. The mean BMI in females was 28.3 (SD 5.4) in comparison to males 25.8 (SD 4.4). Obesity was higher in females (33.9%) than in males (15.6%) OR 2.78 (p-value <0.001). The most common medications used were metformin+sulfonylurea (met+sulf) combination in 31.4% of the patients followed by sulfonylureas (sulf) in 13.2%, metformin (met) 13% and insulin 12.8%, 18.8% weren't on any medications and only 11.1% were on any other combination of medications. The patients on met and on 4 oral agents showed a significantly lower HBA1c than those not on medications whereas patients on other medications did not have significant lowering of the HBA1c when compared with those not on medications. When compared to a previous study done in the same center 2007-2011 there was a significant increase in obesity among males. Conclusion: Patients with type 2 DM presenting to an endocrinology clinic during the war in Yemen showed poor control, little use of newer available medications and less obesity among males when compared to females.