Germanyuk T & Ivko T, National Pirogov Memorial Medical University, Ukraine
Title : Combination therapy of patients with diabetes in Ukraine: quality of life
Diabetes mellitus is a chronic disease that reduces the quality of life of patients significantly. For economic evaluation to assess the value for money of medical service used indicator of quality of life (QOL). The aim of the study was research of the level of QOL of the patients with type 2 diabetes mellitus (T2DM) before and after treatment with combination therapy.
Methodology: 300 questionnaires to determine the quality of life of patients with T2DM. In-patients were treated in specialized endocrinology clinics of Podolsky region of Ukraine. The quality of life of patients was determined by visual analogue scale adapted European questionnaire of quality of life. We performed retrospective analysis of 1792 in-patient's medical histories, their treatment sheets and frequency analysis of the treatment regimens. Frequency analysis of the used pharmacotherapy regimens for patients with T2DM showed that the leaders among the prescribed regimens of combination therapy were metformin+glimepiride (45% of the prescriptions), metformin+gliclazide (15%) and metformin+glibenclamide (6%). That is why, these schemes were chosen for further study. The patients were examined on the following parameters: age, sex, duration of T2DM, body mass index, the average fasting plasma glucose, level of QOL before prescribing treatment and after treatment prescribed therapy. All patients were treated with oral antidiabetic drugs only. The patient’s QOL was determined by visual analogue scale adapted European questionnaire EuroQol-5D. Results. It was found that age of patients ranged from 20 to 67 years: 20-30 – 6 % (18 patients), 30-40 – 11% (33 patients), 40-50 – 26% (78 patients), 50-60 – 37% (111 patients), 60-67 – 20% (60 patients). Among the patients women accounted for 52% (156 patients), men – 48% (144 patients). It has been found that the age of patients with metformin+glimepiride therapy was 56,86±0,62 years, duration of T2DM of these patients – 6,87±0,34 years, body mass index of them was – 32,97±0,47, their average fasting plasma glucose before treatment was – 10,71±0,19 mmol/l; level of QOL of these patients before treatment was 0,61±0,11, after treatment – 0,69±0,08. The age of patients with metformin+gliclazide therapy was 57,68±1,16 years, duration of T2DM of these patients – 7,81±0,75 years, their body mass index was – 31,07±0,65, the average fasting plasma glucose before treatment – 10,32±0,34 mmol/l; level of QOL of these patients before treatment was 0,55±0,16, after treatment – 0,65±0,07. The age of patients with metformin+ glibenclamide therapy was 59,33±1,81 years, duration of T2DM of these patients – 9,43±1,35 years, their body mass index – 32,03±1,18, the average fasting plasma glucose before treatment – 11,11±0,57 mmol/l; level of QOL of these patients before treatment was 0,46±0,04, after treatment – 0,58±0,13. As a result of the survey by questionnaire it has been found that level of QOL in patients with metformin+glimepiride therapy before treatment was 0,61±0,11, after treatment – 0,69±0,08 (? < 0.05); with metformin+ gliclazide therapy before treatment was 0,55±0,16, after treatment – 0,65±0,07 (? < 0.05); with metformin+glibenclamide therapy was 0,46±0,04, after treatment – 0,58±0,13 (? < 0.05). Also it was determined that the patients with metformin+ glibenclamide regime were significantly older, with the largest T2DM duration, with the highest body mass index and highest levels of fasting plasma glucose. In comparing patients with metformin+gliclazide and metformin+glimepiride treatment regimes it was found no other significant differences (? > 0.05).
Conclusions.: According to the results of this study it has been shown that the greatest value of QOL was in patients with metformin+glimepiride therapy, the lowest – with metformin+gliclazide and metformin+glimepiride therapy. It has been found improving patient’s QOL after treatment by all including in the study regimes.