RESEARCH ARTICLE SA JOURNAL OF DIABETES & VASCULAR DISEASE 26 VOLUME 21 NUMBER 1 • November 2024 MDD group were admitted for macrovascular events (22.8%, p = 0.012). Fewer patients with T2DM + MDD (3.3%) were admitted for depressive episodes compared to the patients from the MDD control group (15.5%, p = 0.003). More patients with T2DM + MDD (12%) had repeated macrovascular admissions versus those with T2DM – MDD (2.9%, p = 0.005). Discussion While over 70% of patients in all three groups achieved the target SBP of ≤ 140 mmHg, the findings indicated inadequate glycaemic and lipid control among the T2DM patients managed in a private healthcare organisation, despite the high rate of claims for hypoglycaemic and lipid-lowering medications. Both study groups had a median target HbA1c closer to 7%, although the group with a diagnosis of co-morbid MDD had a higher HbA1c of 7.4% compared with the T2DM – MDD group. Findings of this study are similar to studies by Akpalu et al.18 and Kaulgud et al.38 that reported no association between poor glycaemic control and MDD. The successful management of diabetes care is reduction of CV risk biomarkers HbA1c, BP and LDL-C. Each individual biomarker goal achieved has proven to be associated with a reduction in micro- and macrovascular complications.15,39,40 The composite attainment of the three goals simultaneously is known as the ABCs of diabetes,9 which are considered individually in the clinical management of patients with T2DM, evidenced in South African studies whereby separate measures are reported as opposed to the combined triad of ABC control. In this study, the participants’ glucose control in isolation showed better rates of glycaemic control [T2DM + MDD (56%) and T2DM – MDD (45%)], in comparison with the 22% seen across three public healthcare centres in rural Africa.41 The privately managed healthcare environment is well resourced and the study population may be more aware of their diabetes status and have access to newer hypoglycaemic agents and health technology assessment devices, including diabetes management programmes via a capitated risk-sharing model to improve patient outcomes and reduce healthcare costs.42 Therefore, one would expect better clinical (glycaemic, lipid control and macrovascular complications) outcomes of patients with T2DM. SGLT2i, a newer class of hypoglycaemic agents, had just been introduced to the healthcare system and a small number of patients with T2DM in both groups claimed SGLT2i during this period of analysis. SGLT2i, in addition to lowering blood glucose levels, has been shown to reduce BP with an average reduction of 3.6/1.7 mmHg (systolic/ diastolic) in 24-hour ambulatory BP,43 and may have influenced those patients claiming SGL2i in achieving BP goals. As the number of patients were too small to analyse, future studies will look at the CV risk reduction of SGLT2i in this sub-group when there is a much higher utilisation of this class of drugs. Of concern, only 24% of patients in the T2DM groups in this study achieved LDL-C control of < 1.8 mmol/l. The number of patients with T2DM achieving LDL-C targets would have been far fewer if the latest 2023 European Society of Cardiology (ESC) Table 4. Stepwise multivariate logistic regression of LDL-C control in T2DM + MDD and T2DM – MDD groups Variables OR* 95% CI p-value Age 1.03 1.01–1.04 < 0.0001 Statins claimed 2.51 1.50–4.21 0.001 *Adjusted for claims for antihypertensive agents, metformin and gender. Table 5. Hospitalisations of patients with T2DM + MDD, T2DM – MDD and MDD T2DM+MDD T2DM–MDD MDD control (n = 223) (n = 656) (n = 332) Characteristics n (%) n (%) n (%) p-value Total number of hospital admissions 200/223 (89.7) 493/656 (75.2) 290/332 (87.3) < 0.0001 Total number of patients admitted 92/223 (41.3) 236/656 (36) 161/332 (48.5) 0.0007 Admissions per patient 200/92 (2.2) 493/236 (2.1) 290/161 (1.8) – Patients admitted for macrovascular events 21/92 (22.8) 31/236 (13.1) 16/161 (9.9) 0.012 Patients admitted for repeated macrovascular admissions 11/92 (12) 7/236 (2.9) 8/161 (5.6) 0.005 Patients admitted for depressive episodes 3/92 (3.3) – 25/161 (15.5) 0.003 MDD, major depressive disorder; T2DM, type 2 diabetes mellitus. Fig. 2. Percentage of patients with T2DM + MDD on antidepressants (SSRIs vs non-SSRIs) achieving HbA1c target. HbA1c, glycated haemoglobin; MDD, major depressive disorder; MA, melatonergic agonist; NaSSA, noradrenergic and specific serotonergic antidepressant; NDRI, norepinephrine dopamine reuptake inhibitor; SSRIs, selective serotonin reuptake inhibitors; SNRI, serotonin norepinephrine reuptake inhibitor; SARIs, serotonin receptor antagonists and reuptake inhibitors; SA, serotonergic antidepressant); T2DM, type 2 diabetes mellitus.
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