Evaluating HbA1c reduction with protocol-driven drug therapy in early type 2 diabetes: a prospective analysis
DOI:
https://doi.org/10.18203/2320-6012.ijrms20253147Keywords:
Type 2 diabetes mellitus, HbA1c, Glycemic control, Treatment intensification, Drug tapering, Antidiabetic therapyAbstract
Background: Effective blood sugar control is critical to preventing complications in type 2 diabetes. While intensive drug therapy can improve glycemic outcomes, the long-term benefit of starting with aggressive regimens tailored to disease severity remains under investigation.
Methods: This study categorized patients with type 2 diabetes into three groups based on initial HbA1c levels: Group 1 (mild, 7–9%), Group 2 (moderate, 9–11%), and Group 3 (severe, >11%). Treatment was escalated accordingly: triple therapy for Group 1, quadruple therapy for Group 2, and quintuple therapy for Group 3. The medication regimen included pioglitazone, metformin, dapagliflozin, teneligliptin, and gliclazide. HbA1c levels were tracked to assess glycemic improvement and therapy simplification over time.
Results: All groups achieved significant reductions in HbA1c. Group 1 saw a 24.4% reduction, Group 2 a 29.0% reduction, and Group 3 a 51.7% reduction (p=0.001). Notably, many patients in Group 3 were able to simplify their medication regimens during follow-up, transitioning from five drugs to fewer agents while maintaining glycemic control (p<0.05).
Conclusions: Tailored intensive therapy based on initial glycemic severity leads to significant HbA1c improvement. Starting with robust combination therapy and later reducing drug burden may be an effective, sustainable strategy in managing type 2 diabetes.
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References
Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, et al. IDF diabetes atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022;183:109-19. DOI: https://doi.org/10.1016/j.diabres.2021.109119
Chehregosha H, Khamseh ME, Malek M, Hosseinpanah F, Ismail-Beigi F. A view beyond HbA1c: Role of continuous glucose monitoring. Diabetes Ther. 2019;10:853–63. DOI: https://doi.org/10.1007/s13300-019-0619-1
Kaiafa G, Veneti S, Polychronopoulos G, Pilalas D, Daios S, Kanellos I, et al. Is HbA1c an ideal biomarker of well-controlled diabetes? Postgrad Med J. 2021;97:380–3. DOI: https://doi.org/10.1136/postgradmedj-2020-138756
Qaseem A, Wilt TJ, Kansagara D, Horwitch C, Barry MJ, Forciea MA, et al. Hemoglobin A1c targets for glycemic control with pharmacologic therapy for nonpregnant adults with type 2 diabetes mellitus: A guidance statement update from the American College of Physicians. Ann Intern Med. 2018;168:569–76. DOI: https://doi.org/10.7326/M17-0939
American Diabetes Association Professional Practice Committee. Summary of revisions: Standards of care in diabetes–2025. Diabetes Care. 2025;48(Suppl 1):S6–13.
Dehghani Zahedani A, Shariat Torbaghan S, Rahili S, Karlin K, Scilley D, Thakkar R, et al. Improvement in glucose regulation using a digital tracker and continuous glucose monitoring in healthy adults and those with type 2 diabetes. Diabetes Ther. 2021;12:1871–86. DOI: https://doi.org/10.1007/s13300-021-01081-3
Mostafa SA, Mena SC, Antza C, Balanos G, Nirantharakumar K, Tahrani AA. Sleep behaviours and associated habits and the progression of pre-diabetes to type 2 diabetes mellitus in adults: A systematic review and meta-analysis. Diab Vasc Dis Res. 2022;19:14791641221088824. DOI: https://doi.org/10.1177/14791641221088824
American Diabetes Association. 6. Glycemic targets: Standards of medical care in diabetes–2021. Diabetes Care. 2021;44(Suppl 1):S73–84. DOI: https://doi.org/10.2337/dc21-S006
Shayeghian Z, Hassanabadi H, Aguilar-Vafaie ME, Amiri P, Besharat MA. A randomized controlled trial of acceptance and commitment therapy for type 2 diabetes management: The moderating role of coping styles. PLoS One. 2016;11:e0166599. DOI: https://doi.org/10.1371/journal.pone.0166599
Laiteerapong N, Ham SA, Gao Y, Moffet HH, Liu JY, Huang ES, et al. The legacy effect in type 2 diabetes: Impact of early glycemic control on future complications (the diabetes & aging study). Diabetes Care. 2019;42:416–26. DOI: https://doi.org/10.2337/dc17-1144
UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352(9131):837–53. DOI: https://doi.org/10.1016/S0140-6736(98)07019-6
Prattichizzo F, Ceriello A. Is time ready for combination therapy at diagnosis of type 2 diabetes? Diabetes Metab Res Rev. 2021;37(5):e3460. DOI: https://doi.org/10.1002/dmrr.3460
Xie X, Wu C, Hao Y, Wang T, Yang Y, Cai P, et al. Benefits and risks of drug combination therapy for diabetes mellitus and its complications: a comprehensive review. Front Endocrinol (Lausanne). 2023;14:1301093. DOI: https://doi.org/10.3389/fendo.2023.1301093
Chaudhury A, Duvoor C, Reddy Dendi VS, Kraleti S, Chada A, Ravilla R, et al. Clinical review of antidiabetic drugs: Implications for type 2 diabetes mellitus management. Front Endocrinol (Lausanne). 2017;8:6. DOI: https://doi.org/10.3389/fendo.2017.00006
Singla R, Bindra J, Singla A, Gupta Y, Kalra S. Drug prescription patterns and cost analysis of diabetes therapy in India: Audit of an endocrine practice. Indian J Endocrinol Metab. 2019;23(1):40–5. DOI: https://doi.org/10.4103/ijem.IJEM_646_18
Zhang J. The diabetes market in China. PharmExec. 2018. Available at: https://www.pharmexec.com/view/diabetes-market-china. Accessed on 20 June 2025.
Miller BR, Nguyen H, Hu CJ, Lin C, Nguyen QT. New and emerging drugs and targets for type 2 diabetes: Reviewing the evidence. Am Health Drug Benefits. 2014;7(8):452–63.
Kulzer B, Daenschel W, Daenschel I, Schramm W, Messinger D, Weissmann J, et al. Integrated personalized diabetes management improves glycemic control in patients with insulin-treated type 2 diabetes: Results of the PDM-ProValue study program. Diabetes Res Clin Pract. 2018;144:200–12. DOI: https://doi.org/10.1016/j.diabres.2018.09.002
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