Effect of Antihyperglycemic Agents on Hemoglobin A1c Level in Type 2 Diabetes Mellitus Patients
Abstract
Background: Type 2 diabetes mellitus (T2DM) patients require continuous lifelong attention to pharmacotherapy to achieve and maintain optimal glucose control, which can be monitored through measuring HbA1c. This study aimed to see the comparrison of HbA1c levels before and after a minimum of two months use of antihyperglycemic agents in patients with T2DM.
Methods: This analytical cross-sectional study used medical records of patients with T2DM in the center of outpatient medical records at the Department of Clinical Pathology, Dr. Hasan Sadikin General Hospital, in 2013. Sampling was conducted using consecutive sampling technique. The data analysis used the paired t-test and Wilcoxon test for not normal data distribution.
Results: Before and after a minimum of two months use of antihyperglycemic agents, HbA1c concentration was 7.15% (6.1–12.2) and 7.3% (5.9–11.9) respectively. Statistically, the difference of HbA1c concentration of T2DM patients between those period was not significant (0.15%; p=0,812). Mean HbA1c concentration was found with greatest decrease in patients treated with sulfonylurea (2.25%), followed by insulin (0.1%). There were increases in mean HbA1c concentration in patients treated with metformin (0.05%), metformin+insulin (1.1%), sulfonylurea +metformin (0.6%), sulfonylurea+alpha-glucosidase inhibitor (1.1%), and sulfonylurea + metformin + alpha-glucosidase inhibitor (0.05%).
Conclusions: There is no significant difference of HbA1c levels before and after two months to two years use of antihyperglycemic agents in T2DM patients. This result showed the importance of comprehensiveness in T2DM therapy. The therapy should not merely consist of antihyperglycemic medication alone, but also physical exercise, lifestyle modification, and diet control.
Keywords
Full Text:
PDFReferences
Alwan A, Armstrong T, Bettcher D, Branca F, Chisholm D, Ezzati M, et al. Global status report on noncommunicable diseases 2010. Italy: WHO; 2011.
Soewondo P, Ferrario A, Tahapary DL. Challenges in diabetes management in Indonesia: a literature review. Globalization Health. 2013;9:63.
Nathan DM, Buse JB, Davidson MB, Ferrannini E, Holman RR, Sherwin R, et al. Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2009;32(1):193–203.
Kennelly PJ, Rodwell VW. Proteins: myoglobin & hemoglobin. In: Murray RK, Bender DA, Botham KM, Kennelly PJ, Rodwell VW, Weil PA, editors. Harper’s illustrated biochemistry. 28th ed. United States: The McGraw-Hill Companies, Inc; 2009.
Sikaris K. The correlation of hemoglobin A1c to blood glucose. J Diabetes Sci Technol. 2009;3(3):429–38.
Sherifali D, Nerenberg K, Pullenayegum E, Cheng JE, Gerstein HC. The Effect of Oral Antidiabetic Agents on A1C Levels: A systematic review and meta-analysis. Diabetes Care. 2010;33(8):1859–64.
Perkumpulan Endokrinologi Indonesia. Konsensus pengendalian dan pencegahan diabetes mellitus tipe 2 di Indonesia 2011. Jakarta: PB PERKENI; 2011.
Soegondo S, Prodjosudjadi W, Setiawati A. Prevalence and risk factors for microalbuminuria in a cross-sectional study of type-2 diabetic patients in Indonesia: a subset of DEMAND study. Med J Indones. 2009;18(2):124–30.
Kusniyah Y, Nursiswati, Rahayu U. Hubungan Tingkat Self Care dengan Tingkat Hba1c pada Klien Diabetes Melitus Tipe 2 di Poliklinik Endokrin RSUP Dr. Hasan Sadikin Bandung. Bandung: Universitas Padjadjaran; 2016. [cited 2018 May 15] Available from: http://repository.unpad.ac.id/8976/
Garber AJ, Arbahamson MJ, Barzilay JI, Blonde L, Bloomgarden ZT, Bush MA, et al. American Association of Clinical Endocrinologists’ comprehensive diabetes management algorithm 2013 consensus statement--executive summary. Endocr Pract. 2013;19(3):536–57.
American Diabetes Association. Standards of medical care in diabetes. Diabetes Care. 2018;41(Supplement 1):S1–2.
Shantha GP, Kumar AA, Kahan S, Cheskin LJ. Association between glycosylated hemoglobin and intentional weight loss in overweight and obese patients with type 2 diabetes mellitus: a retrospective cohort study. Diabetes Educ. 2012;38(3):417–26.
Reinehr T, Schober E, Roth CL, Wiegand S, Holl R. Type 2 diabetes in children and adolescents in a 2-year follow-up: insufficient adherence to diabetes centers. Horm Res. 2008;69(2):107–13.
Steinsbekk A, Rygg Lø, Lisulo M, Rise MB, Fretheim A. Group based diabetes self-management education compared to routine treatment for people wit type 2 diabetes melitus. A Systemic Review with Meta-analysis. BMC Health Serv Res. 2012;12:213.
Unnikrishnan R, Anjana RM, Mohan V. Drugs affecting HbA1c levels. Indian J Endocrinol Metab. 2012;16(4):528–31.
Gallagher EJ, Le Roith D, Bloomgarden Z. Review of hemoglobin A(1c) in the management of diabetes. J Diabetes. 2009;1(1):9–17.
Juarez DT, Ma C, Kumasaka A, Shimada R, Davis J. Failure to reach target glycated A1c levels among patients with diabetes who are adherent to their antidiabetic medication. Popul Health Manag. 2014;17(4):218–23.
DOI: https://doi.org/10.15850/amj.v5n2.1414
Article Metrics
Abstract view : 659 timesPDF - 312 times
This Journal indexed by
AMJ is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License
View My Stats