Endocrine Abstracts

OBJECTIVE: There are reports suggesting that currently available drugs used in the management of Type 2 diabetes do not sustain metabolic control on long term basis. We therefore assessed metabolic control and insulin resistance indices in Type 2 diabetic patients commonly treated with sulphonylurea drugs at primary care setting.

METHOD: One hundred and seventy-nine (117 females, 62 males) randomly selected Type 2 diabetic patients attending primary care clinics between January 1 and April 30, 2000 were studied after an overnight fast. Anthropometric indices (weight, height, waist and hip circumferences) and blood pressure (BP) were measured and blood samples were taken for glycated hemoglobin (HbA1c), glucose, insulin and lipids (triglyceride, total cholesterol, LDL-cholesterol, HDL-cholesterol) determinations. Fasting insulin and glucose concentrations were used to assess insulin resistance and sensitivity using Homeostasis model assessment (HOMA) method.

RESULTS: Eighty-seven percent of male and 92% of female patients were treated with sulphonylurea drugs (p > 0.05) whereas 13% and 9% of men and women respectively were managed on diet and exercise (p > 0.05). Female patients had significantly higher mean body mass index (p < 0.01). Despite similar fasting glucose and HbA1c levels, the female patients had significantly higher mean levels of serum triglyceride, t-cholesterol, insulin and insulin-to-glucose ratios (p < 0.05) and lower percent insulin sensitivity than the male patients (p < 0.01). Male patients of East Indian origin had significantly higher systolic BP, insulin levels and lower percent insulin sensitivity compared with patients of African descent (p < 0.05).

CONCLUSION: Patients with Type 2 diabetes attending primary care clinics in Trinidad had poor metabolic control attributable to increased insulin resistance and body mass index. Women and patients of East Indian ethnic group are at greater risk of metabolic syndrome X than men and patients of African descent.