The Efficacy of Pharmacological Intervention in a Subset of Hyperglycemic Pakistani Population

Treatment of type II diabetes with oral anti-hyperglycemic drugs is initially successful, but the inclusion of insulin in the treatment regime is eventually inevitable under poor control. This paper aims to provide an overview of anti-hyperglycemic drugs and their use in Pakistan population coupled with their efficacy in treatment of diabetes type II. Literature search identified 140 clinical trials and 26 observational studies that compared mono or combination therapies. Further a retrospective review of 1518 patients which were undergoing treatment for type II diabetes mellitus in outpatient department (OPD) of endocrinology unit of Aga Khan University Hospital during 2007-2010 was done. The inclusion criteria for study subjects favored of age between 35-65 years with duration of diabetes between 5-35 years. The data was collected from hospital record department and was analyzed for efficacy of the medications using SPSS. V16. Prescribed oral anti-hyperglycemic drugs were independent of diabetes duration. Insulin, Biguanides, Sulfonylureas, Thiazolidinediones and Alpha-glycosidase were preferred to use singly or in combination. Overall insulin usage with other combination was in 56 % of patients while overall Biguanides and sulfonylureas usage was in 61 % and 45 % of patients respectively. In response to therapy, the achieved FBS level, below 110 mg/dl, was in 21 % of patients, levels as greater than110 to 126 mg/dl (CI 95 %, OR 2.74, p=0.0006). Insulin and Biguanides were found efficacious in only 34 % of selected population to bring the glycemic levels at normal limits when employed singly or in combination. Poorly controlled glycemic levels in 66 % of population indicate co-morbidities and future complications of diabetes. All the current anti-hyperglycemic medications existing in global market were not being used in Pakistani population. Further genetic variation affecting drug metabolism may be the cause of decreased efficacy of drugs. The results can aid diabetologists, physicians and patients in making informed choices for better management of type II diabetes.