Glucose Lowering Treatment Patterns in Type 2 Diabetes Mellitus (T2DM) Management: A Real World Study from the Rural-Urban Fringe Zone of Suzhou City, Jiangsu Province

Objective: To manage type 2 diabetes mellitus (T2DM) using glucose lowering regents(GLRs) effectively, the patterns of treatment were studied based on real world data from a rural-urban fringe zone of Suzhou city, Jiangsu Province. Methods: A cross-sectional study was carried out using data from T2DM management as basic public health service during August 2018 to January 2021 in the urban-rural fringe zone in Suzhou city, Jiangsu Province, China. HbA1c and detail information of the diabetic treating histories were collected when registered for T2DM management. HbA1c<7.0% was considered as T2DM controlled (i.e., HbA1c≥7.0% as the uncontrolled), and glucose lowering treatments patterns for medicine and insulin usages were described. Results: Among GLRs in this rural-urban fringe zone, sulfonylurea (SU), metformin (MET) and alpha glucosidase inhibitor (AGI) were the most frequently used oral antidiabetic drugs(OADs), and 12% (150/1207) patients used short-term insulin(STI). More than 60% (764/1207) T2DM patients were managed with regent combinations. SU and MET were the most commonly observed combination for glucose lowering which accounted for 41%(489/1207) of patients under management and three quarters (371/489) were two-drug combinations. SU combined with AGI was observed as the second with proportion of 11% (127/1207). More regent numbers with less control rates for T2DM management was observed. Single SU with control rate (95% CI) of 51.4% (108/210, 95% CI 44.5%-58.4%), nearly twenty percentage higher than that of then combination therapy (32.9%,189/386, 95% CI 29.0%-36.9%)(χ2=22.526, P<0.001). Among two-combinations of SU+MET, SU+AGI, AGI+MET and STI+MET, HbAc control rates were listed as 33% ( 95%CI 29%-37%), 35% (95%CI 26%-44%), 28% (95%CI 19%-38%) and 21%(95%CI 11%-33%), respectively. Using SU as example, combinations had lower levels of HOMA-β scores which meant lower function of islets. Conclusions: Antidiabetic drugs treatment patterns followed the national recommendation in the rural-urban fringe zone, however, the effects were not as expected, i.e., more glucose lowering regents would not raise the controlled rates and recently discovered regents should be included in the future managements.