TREATMENT OF TYPE 2 DIABETES MELLITUS WITH GLIMEPIRIDE AND METFORMIN BITHERAPY IN REAL CLINICAL PRACTICE IN THE GULF REGION: PATTERNS OF USE AND GLYCAEMIC CONTROL.

Patients with type 2 diabetes mellitus (T2DM) require regular monitoring and treatment adjustment to ensure sustained glycaemic control. The objective of this naturalistic study was to evaluate the effectiveness of bitherapy with glimepiride and metformin in T2DM patients inadequately controlled by monotherapy in everyday medical practice in the Gulf region, which has one of the highest prevalence rates of T2DM worldwide. This was a prospective, observational study in four Gulf countries (Kuwait, Qatar, Oman and UAE). General practitioners enrolled adult patients with T2DM inadequately controlled (HB1Ac >7%) on metformin or glimepiride monotherapy who were switched to bitherapy with glimepiride and metformin. Data were collected on HbA1c, weight, treatment and hypoglycaemia. The study duration was six months and the primary outcome variable was change in HbA1c (%) over six months following initiation of bitherapy. 697 eligible patients were enrolled; 579 completed the six-month follow-up and were available for analysis and 292 patients (50.4%) received bitherapy as a fixed-dose combination alone. During the study, mean HbA1c fell from 8.92% to 7.08% (mean change: 1.84%; p = 0.03). 46.1% of patients achieved their HbA1c target of <7%. No significant changes in weight were documented. The number of patients with symptomatic hypoglycaemia rose from 8 (1.1%) in the three months before switching to bitherapy to 35 (6.0%) in the three months following switch. Two patients discontinued glimepiride due to hypoglycaemia. At the last study visit, 57 patients (9.8%) changed their dosing regimen and 35 (6.0%) switched to another treatment, principally a gliptin. Around half of patients who responded inadequately to monotherapy achieve glycaemic control targets within six months of switching to bitherapy with metformin and glimepiride. However, patients failing to achieve targets are infrequently moved to more intense treatment, suggesting that physician education on treat-to-target therapeutic strategies would be beneficial.