CROSS-SECTIONAL REAL-WORLD EVALUATION OF GLYCEMIC CONTROL, HYPERTENSION, LIFESTYLE FACTORS, AND DRUG UTILIZATION PATTERNS AMONG 500 PATIENTS WITH TYPE 2 DIABETES MELLITUS IN INDIA
Author(s)
SWATHY GOVINDASWAMY, PhD1, HEMPRASATH SHANMUGAVEL, PharmD2, Sk Suresh, PharmD3, giftson I. Jeyraj, PharmD4, Thanu V. RS, PharmD5;
1Sri Ramachandra Institute of Higher Education and Research, ASSISTANT PROFESSOR, CHENNAI, India, 2Sri Ramachandra Institute of Higher Education and research,porur, KANCHIPURAM, India, 3Sri Ramachandra Institute of Higher Education and research,porur, Chennai, India, 4SRIHER(du), Chennai, India, 5Sri Ramachandra Institute of Higher Education and Research, Chennai, India
1Sri Ramachandra Institute of Higher Education and Research, ASSISTANT PROFESSOR, CHENNAI, India, 2Sri Ramachandra Institute of Higher Education and research,porur, KANCHIPURAM, India, 3Sri Ramachandra Institute of Higher Education and research,porur, Chennai, India, 4SRIHER(du), Chennai, India, 5Sri Ramachandra Institute of Higher Education and Research, Chennai, India
OBJECTIVES: To estimate prevalence ratios for hypertension by glycemic control status and assess comparative effectiveness of insulin versus DPP4i+metformin regimens on dual cardiometabolic control using propensity score matching in a large South Indian cross-sectional study.
METHODS: A cross-sectional observational study was conducted at a single time point among 500 adults with confirmed T2DM from the inpatient and outpatient departments of a Tamil Nadu tertiary hospital. All variables (HbA1c, BP, medications, and lifestyle factors) were measured simultaneously. Primary exposure: glycemic control (HbA1c <7% vs ≥7%). Outcomes: hypertension prevalence and dual cardiometabolic control (HbA1c <7% AND BP <140/90 mmHg). Propensity score matching (1:1 nearest neighbor, caliper 0.2) created balanced groups of insulin users (n=310) versus DPP4i+metformin users (n=190) according to age, sex, smoking, alcohol, and hypertension status, with balance confirmed across covariates. Multivariable log-binomial regression estimated adjusted prevalence ratios (aPR).
RESULTS: The mean age was 58.4 years (SD 9.2), and 52% were men. The prevalence of hypertension was 55% (n=275). Poor glycemic control strongly associated with hypertension (aPR 2.8, 95% CI: 2.1-3.7). prevalence of dual control was 28% (95% CI: 24-32%). After propensity score matching achieved balance across characteristics, insulin regimens demonstrated inferior dual control versus DPP4i+metformin (18% vs. 42%, aPR 0.43, 95% CI: 0.31-0.60, p<0.001). Smoking (15%) and alcohol use (18%) showed synergistic effects with poor glycemic control on hypertension (interaction aPR 3.4).
CONCLUSIONS: The study revealed that poor glycemic control is associated with a nearly three-fold increase in hypertension prevalence among Indian T2DM patients. Propensity score-matched analysis demonstrated the superiority of DPP4i + metformin over insulin for dual control. While these findings provide preliminary insights, the cross-sectional nature of our study limits causal inference, and further longitudinal research is needed to fully support the integration of these findings into precision prescribing algorithms and integrated diabetes-hypertension protocols for the NPCDCS program in India.
METHODS: A cross-sectional observational study was conducted at a single time point among 500 adults with confirmed T2DM from the inpatient and outpatient departments of a Tamil Nadu tertiary hospital. All variables (HbA1c, BP, medications, and lifestyle factors) were measured simultaneously. Primary exposure: glycemic control (HbA1c <7% vs ≥7%). Outcomes: hypertension prevalence and dual cardiometabolic control (HbA1c <7% AND BP <140/90 mmHg). Propensity score matching (1:1 nearest neighbor, caliper 0.2) created balanced groups of insulin users (n=310) versus DPP4i+metformin users (n=190) according to age, sex, smoking, alcohol, and hypertension status, with balance confirmed across covariates. Multivariable log-binomial regression estimated adjusted prevalence ratios (aPR).
RESULTS: The mean age was 58.4 years (SD 9.2), and 52% were men. The prevalence of hypertension was 55% (n=275). Poor glycemic control strongly associated with hypertension (aPR 2.8, 95% CI: 2.1-3.7). prevalence of dual control was 28% (95% CI: 24-32%). After propensity score matching achieved balance across characteristics, insulin regimens demonstrated inferior dual control versus DPP4i+metformin (18% vs. 42%, aPR 0.43, 95% CI: 0.31-0.60, p<0.001). Smoking (15%) and alcohol use (18%) showed synergistic effects with poor glycemic control on hypertension (interaction aPR 3.4).
CONCLUSIONS: The study revealed that poor glycemic control is associated with a nearly three-fold increase in hypertension prevalence among Indian T2DM patients. Propensity score-matched analysis demonstrated the superiority of DPP4i + metformin over insulin for dual control. While these findings provide preliminary insights, the cross-sectional nature of our study limits causal inference, and further longitudinal research is needed to fully support the integration of these findings into precision prescribing algorithms and integrated diabetes-hypertension protocols for the NPCDCS program in India.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EPH96
Topic
Epidemiology & Public Health
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory), SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity)