Impact of metformin dose titration and self care practices on glycemic control of type 2 diabetes mellitus patients at Felege Hiwot Referral Hospital, Northwest Ethiopia

Abstract

Recent targets for glycemic management in patients with type 2 diabetes mellitus (T2DM) require optimization of dosing strategies for oral antidiabetics. Metformin is the first choice in the absence of contraindications with dose-related antihyperglycemic efficacy that extends to daily doses of 2000 mg/day. So metformin dose titration with appropriate self care practice is the cornerstone to see the intended antihyperglycemic efficacy of metformin in T2DM. Objective: To assess the impact of metformin dose titration and self care practices on glycemic control of T2DM patients at Felege Hiwot Referral Hospital (FRH). Methods and Participants: A retrospective-general cohort study was conducted. All T2DM patients who had started metformin from March 01, 2010 to March 31, 2012, and came for follow up at the diabetes mellitus (DM) clinic during the study period were included. Data were collected by face-to-face interview and medical chart review. Data were analyzed by SPSS version 20.0. Logistic regression, Repeated Measures ANOVA, and Kaplan Meier survival analysis were used. Results: Nineteen (23.7%) of patients were on the metformin dose of 1500 mg and above, whereas 61 (76.3%) of patients were on metformin dose of less than 1500 mg. Twenty four (30.0%), and twenty three (28.7 %) of the patients had attained the desired fasting plasma glucose (FPG) level of below 130 mg/dl in the first two, and six months of metformin therapy respectively. The mean FPG in the first two, and six months of therapy was 190 mg/dl (standard deviation (SD) = 70.9), and 179.9 mg/dl (SD=57.7) respectively. Titrated form of metformin in the first two months of therapy had a 70.2%, 66.1% and 70.2% control of FPG than the untitrated metformin at the two, six and twelve month period respectively. Conclusion: More than two-third of the participants had suboptimal dose titration where less than one-third of them had FPG level below130 mg/dl. So practitioners should practice the titration of metformin during the first two months of therapy depending on the FPG level of the patients