Two‐year trends from the LANDMARC study: A 3‐year, pan‐India, prospective, longitudinal study on the management and real‐world outcome in patients with type 2 diabetes mellitus

• Published in: Endocrinology, diabetes & metabolism Vol. 6; no. 2; pp. e404 - n/a
• Main Authors: Das, Ashok K., Kalra, Sanjay, Joshi, Shashank, Mithal, Ambrish, Kumar K. M., Prasanna, Unnikrishnan, Ambika G., Thacker, Hemant, Sethi, Bipin, Chowdhury, Subhankar, Sugumaran, Amarnath, Mohanasundaram, Senthilnathan, Menon, Shalini K., Salvi, Vaibhav, Chodankar, Deepa, Thaker, Saket, Trivedi, Chirag, Wangnoo, Subhash K., Zargar, Abdul H., Rais, Nadeem
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01.03.2023; John Wiley and Sons Inc; Wiley
• Subjects: Adult; Age; Body mass index; cardiovascular diseases; Data collection; Diabetes; diabetes complications; Diabetes Mellitus, Type 2 - drug therapy; diabetic nephropathies; Disease; Ethics; Glucose; glycaemic control; Glycated Hemoglobin; Heart attacks; Heart failure; Hemoglobin; Humans; Hypertension; Hypoglycemic Agents - therapeutic use; Insulin; Laboratories; Longitudinal Studies; Overweight; Prospective Studies; Stroke; Values; India; glycaemic control; cardiovascular diseases; diabetes complications; diabetic nephropathies
• ISSN: 2398-9238; 2398-9238
• DOI: 10.1002/edm2.404

Introduction There are limited data on the real‐world management of diabetes in the Indian population. In this 2‐year analysis of the LANDMARC study, the management of type 2 diabetes mellitus (T2DM) and related complications were assessed. Method This multicenter, observational, prospective study included adults aged ≥25 to ≤60 years diagnosed with T2DM (duration ≥2 years at enrollment) and controlled/uncontrolled on ≥2 anti‐diabetic agents. This interim analysis at 2 years reports the status of glycaemic control, diabetic complications, cardiovascular (CV) risks and therapy, pan‐India including metropolitan and non‐metropolitan cities. Results Of the 6234 evaluable patients, 5318 patients completed 2 years in the study. Microvascular complications were observed in 17.6% of patients (1096/6234); macrovascular complications were observed in 3.1% of patients (195/6234). Higher number of microvascular complications were noted in patients from non‐metropolitan than in metropolitan cities (p < .0001). In 2 years, an improvement of 0.6% from baseline (8.1%) in mean glycated haemoglobin (HbA1c) was noted; 20.8% of patients met optimum glycaemic control (HbA1c < 7%). Hypertension (2679/3438, 77.9%) and dyslipidaemia (1776/3438, 51.7%) were the predominant CV risk factors in 2 years. The number of patients taking oral anti‐diabetic drugs in combination with insulin increased in 2 years (baseline: 1498/6234 [24.0%] vs. 2 years: 1917/5763 [33.3%]). While biguanides and sulfonylureas were the most commonly prescribed, there was an evident increase in the use of dipeptidyl peptidase‐IV inhibitors (baseline: 3049/6234, 48.9% vs. 2 years: 3526/5763, 61.2%). Conclusion This longitudinal study represents the control of T2DM, its management and development of complications in Indian population. Clinical Trial Registration Number CTRI/2017/05/008452. This 2‐year interim analysis of the 3‐year long LANDMARC study highlights the T2DM burden, management practices and related complications, across metropolitan and non‐metropolitan cities of India. It indicates that the burden of uncontrolled T2DM in India is high with 20.8% of participants achieving glycaemic control in 2 years (HbA1c < 7%; 53 mmol/mol); and 17.6% having microvascular and 3.1% having macrovascular complications. There is need for effective diabetes management to meet glycaemic targets and prevent CV risk and vascular complications in a developing country like India with high prevalence of T2DM.