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ANALYSIS OF ANTIDIABETIC THERAPY FOR TYPE 2 DIABETES IN PRIMARY HEALTH CARE (WESTERN KAZAKHSTAN).

Diabetes Mellitus Type 2 (T2D) represents a significant global health challenge, with increasing prevalence and the need for effective management strategies. Despite the widespread nature of the disease, there is disagreement regarding the optimal glycemic targets for patients with Type 2 diabetes. The American Diabetes Association recommends aiming for an HbA1C level of less than 7% (53 mmol/mol). About 50% of diabetes patients do not meet their glycemic targets, leading to an increased risk of chronic complications associated with diabetes. Although lifestyle modifications are crucial for prevention and management, most T2D patients eventually need pharmacotherapy to maintain control over their blood glucose levels. In Western Kazakhstan, a study was conducted to evaluate the efficacy of antidiabetic therapy in primary healthcare settings. Aim - to assess the proportion of patients with uncontrolled glycemia among adult patients with T2D, and to analyze antidiabetic therapy in the primary health care (Western Kazakhstan). The cross-sectional study involved 96 participants, divided into two groups based on their HbA1c levels: 32 patients with an HbA1c <7%; 64 patients with an HbA1c >7%. In the study 58 patients (60,6%) were female and 38 patients (39,4%) were male. Data analysis was performed using IBM SPSS 26 and GraphPad, employing Kolmogorov-Smirnov and Shapiro-Wilk tests for distribution, medians and interquartile ranges for non-normal variables, Chi-squared and Fisher's Exact tests for nominal variables, and representation of nominal data in absolute and percentage values. The study found that 66.67±5.89% of participants had unsatisfactory glycemic control at enrollment, with only 33.33±8.33% achieving the desired HbA1c level of <7% (p<=0.005; t=3.26). Statistical analysis showed a significant association between higher glucose levels and the type of therapy, with insulin therapy more common in patients with glucose levels >7 (χ²=5.500, df = 1, p <0.05) and a similar correlation with SGLT-2 inhibitors (Fisher's Exact Test, p<0.01). Analysis of the data collected from urban polyclinics in Aktobe highlighted a troubling fact: two-thirds of the participants (66.67%) had unsatisfactory glycemic control. This is considerably lower than the 45% to 60% control rates reported internationally, indicating an area for significant improvement in the regional management of T2D. The study underscores the importance of a tailored therapeutic approach, balancing drug efficacy, patient response, and individual healthcare needs. Higher variability and blood sugar peaks were observed in patients with HbA1c levels above 7%. In the Western region of Kazakhstan, metformin was the most commonly prescribed antidiabetic drug, consistent with its first-line therapy status. Patients with HbA1c >7% were more likely to receive insulin therapy and SGLT-2 inhibitors, indicating their role in more intensive treatment strategies. Less use of incretins and sulfonylureas was noted among patients with HbA1c <7%, possibly due to their efficacy, safety profiles, or availability of newer alternatives. The findings call for enhanced strategies to improve diabetes management and increase the percentage of patients achieving their glycemic targets, aiming for a more personalized, patient-centered care model in Kazakhstan and potentially similar healthcare settings.

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