Optimizing Diabetes Management: Insights from a Prospective Study

Introduction: According to the results of a large international observational study, IDMPS (The International Diabetes Management Practices Study), the achievement of therapeutic objectives in terms of glycemic control (HbA1c < 7%]), LDL cholesterol (LDLc < 2.6 mmol/l) and blood pressure (BP < 130/80 mmHg) among diabetics remains sub-optimal. The main objective of this study was to assess the quality of care provided to type II and type I diabetics, in terms of glycemic control and the management of the various associated cardiovascular risk factors, in our department. Secondly, this study aimed to identify predictive factors for achieving optimal metabolic control, with the ultimate goal of improving the management and outcomes of diabetic patients. Materials and Methods: This prospective, descriptive, and analytical study was performed at the Endocrinology Department of Hassan II University Hospital, Fez, from January 2020 to December 2022, and included patients with type 1 and type 2 diabetes receiving follow-up in a specialized diabetology consultation. The primary endpoint was glycemic control, assessed using patient-level mean HbA1c over the two-year follow-up, while the secondary endpoints included weight loss, blood pressure control, and lipid control, represented by the averages of BMI, blood pressure, and LDL-C levels collected during patient follow-up. Results: After two years of follow-up, good metabolic control—defined as the simultaneous achievement of the three therapeutic targets (glycemic control, blood pressure control, and lipid control)—was attained by 42.8% of patients with Type 2 Diabetes (T2DM) and 39.8% of those with Type 1 Diabetes (T1DM). Achieving good metabolic control was significantly associated with a reduction in cardiovascular events (p = 0.013; OR = 0.22; 95% CI [0.19 - 0.28]) and microvascular complications (p = 0.001; OR = 0.31; 95% CI [0.26 - 0.43]). In multivariate logistic regression analysis, several factors were independently associated with the achievement of optimal metabolic control. These included High socioeconomic status (OR = 0.72, 95% CI [0.35 - 0.97]), weight loss of 5- 10% from baseline body weight (OR = 0.76, 95% CI [0.54 - 0.83]), number of education sessions > 6 (OR = 0.59, 95% CI [0.26 - 0.97]), therapeutic adherence (OR = 0.79, 95% CI [0.46 - 0.98]), and self-monitoring of blood glucose > 4/day (OR = 0.41, 95% CI [0.11 - 0.83]). Conclusion: Good metabolic control is the cornerstone of any strategy aimed at reducing the risk of