Comparison of Insulin, Sulfonylurea and Sulfonylureas-Metformin Combination on HbA1c and eGFR Level on Age-, Sex- and BMI-Matched Groups of Indonesian Type 2 DM Patients

Objective: This study aimed to evaluate efficacy of insulin, sulfonylurea, and sulfonylureas-metformin combination in reducing the HbA1c level and preventing renal function decline in type 2 diabetes mellitus (DM) patients in Indonesia. Methods: A cross-sectional study was conducted at Dr. Sitanala Hospital involving 105 patients who were taking: insulin (30), sulfonylureas (30) and sulfonylureas-metformin combination (45). The subjects were classified into age-, sex- and BMI-matched groups. We measured their HbA1c level and serum creatinine to calculate eGFR level. Results: There were no differences among the three groups in term of age, sex, BMI, occupation and exercise habit. However, diet and family history of DM were different between the three groups. The average of HbA1c levels in the sulfonylureas-metformin group was 7.46±1.81 and showed a significant difference compared to the insulin group (8.27±1.74) with p=0.042. No significant difference existed in eGFR in the three groups (p=0.476). Subjects with obesity or BMI >30 kg/m2 had 3.268 times probability (p= 0.001) of having HbA1c >7 relative to underweight (BMI <18.5 kg/ m2), after adjustment for comorbidity, diet and exercise habit. Subjects with diabetic family history had 1.616 times relative risk to have HbA1c level >7%, compared to those without diabetic family history (p = 0.002). Conclusion: We found in this study site that sulfonylureas-metformin combination was more efficient in decreasing HbA1c level in type 2 DM patients compared to insulin or sulfonylureas monotherapy. Family history of DM and overweight had considerable effect on uncontrolled HbA1c. Meanwhile, there was no significant difference among the three groups in preventing the decline of eGFR.