Attainment of Best Practice Recommendations and Late Complications of Patients with Type 1 and Type 2 Diabetes Mellitus

Background: There is a need for information on the current practices of diabetes management to take some actions and improve the attainment of therapeutic goals. Objective. We aimed to describe the attainment of therapeutic targets and late complications of patients with type 1 (T1D) and type 2 (T2D) diabetes mellitus. Material and Methods. In the fourth wave of the International Diabetes Management Practices Study, 1,966 Mexican patients were analyzed (T1D: n=157, 8%; T2D: n=1809, 92%). The cross-sectional phase regarding metabolic profile, current complications, and management are analyzed. Results. Out of T1D patients, 77.6% received insulin alone, and 27.4% had insulin and oral glucose-lowering drugs (OGLD, mostly metformin). Out of T2D patients, 63% received OGLD exclusively (mostly metformin), 4.3% insulin alone, 30.4% OGLD, and insulin, and 2% were on a diet and exercise exclusively. Only 19.7% T1D and 35.9% T2D patients had HbA1c <7% (p=0.01), and only 5.0% of T1D and 3.9% of T2D met the combined therapeutic target of HbA1c <7% + BP <130/80 mmHg + LDL <100 mg/dl. Late diabetes-related complications occurred in 42.7% of T1D and 52.8% of T2D patients, mostly microvascular disease. Macrovascular complications were more frequent in patients with T2D, as compared with T1D (36.8% vs. 16.4%, p<0.001). The number of late complications increased steadily with disease duration, more pronounced in patients with T2D. Conclusions. This study evidences substantial lags in the attainment of clinical goals of patients with diabetes mellitus. There are noticeable differences in the achievement of current therapeutic targets between patients with T1D and T2D in a sample of the Mexican practice.