Sustained Glycemic Control and Improved Well-being on Early Induction of Triple Drug Therapy in Newly Diagnosed Type 2 Diabetes Mellitus Patients with HbA1c ≥9%: A Prospective, Cross-sectional, and Observational Study.

Introduction: To study outcomes of the triple-drug therapy in newly diagnosed type 2 diabetes mellitus (T2DM) [glycated hemoglobin (HbA1c) ≥9%] with respect to change in HbA1c, low-density lipoprotein (LDL) levels, weight, waist circumference, variation in drug dosages, hypoglycemic events, patient response of well-being, and corresponding result satisfaction.

Materials And Methods: It was a prospective, observational study conducted from 1st June 2018 to 31st May 2019 at Indira Gandhi Medical College and Hospital, Shimla, a tertiary care hospital in Himachal Pradesh. During the initial 3 months, patients were treated with triple-drug [oral hypoglycemic agents (OHAs)] therapy and then switched over to dual or single therapy (OHAs) depending on the HbA1c levels and were followed up for 1 year.

Observations: A total of 137 participants completed the study period. At baseline, the mean values of fasting plasma glucose (FPG), postprandial plasma glucose (PPPG), HbA1c, and LDL were 218.4 ± 36 mg/dL, 343.94 ± 60 mg/dL, 10.5 ± 1.42%, and 120.34 ± 30.99 mg/dL, respectively. At the end of 12 weeks, the mean values of FPG, PPPG, HbA1c, and LDL were reduced to 123 ± 16 mg/dL, 164 ± 30 mg/dL, 8.14 ± 0.97%, and 109.04 ± 28.28 mg/dL, respectively. The differences were highly significant statistically when compared with the baseline observations. At the end of the study (52 weeks), the mean values of FPG, PPPG, HbA1c, and LDL were 96 ± 10 mg/dL, 146 ± 16 mg/dL, 6.14 ± 0.43%, and 90.55 ± 28.14 mg/dL. Reductions in values were statistically significant when compared with both the baseline and 12-week values.

Conclusion: Early induction of combination therapy with glimepiride, metformin, and pioglitazone results in more desirable outcomes in terms of greater reduction in HbA1c level and lower incidence of hypoglycemia as compared to the conventional add-on therapy.