For most adults without significant hypoglycemia, maintaining an HbA1c level below 7% is recommended. Despite guidelines and advancements in diabetes treatment, approximately half of the global diabetic population fails to meet glycemic targets. While lifestyle changes are crucial for the prevention and management of Type 2 Diabetes (T2D), most patients ultimately require pharmacotherapy to achieve effective blood glucose control.

Purpose. This study aims to explore the key barriers preventing patients from achieving optimal glycemic levels by examining therapy structures in an outpatient setting.

Methods. We evaluated a dataset of adult T2D patients (n=66) from general practice clinic No.1 in Aktobe, Kazakhstan. Measures included laboratory data, prescriptions, and patient and practice variables. The proportion of patients meeting clinical targets as of November 2023 was calculated, along with the proportion of T2D patients initiating monotherapy and polytherapy, and any changes in HbA1c levels.

Results. The study found that 66.67% of patients did not achieve target treatment levels, with only one-third of participants demonstrating satisfactory diabetes control. Data analysis revealed a significant relationship between blood glucose levels and insulin therapy (χ2 = 5.500, df = 1, p ˂ 0.05), indicating that patients with glucose levels above 7 mmol/L are more likely to receive insulin. A notable correlation was also observed between glucose levels and the use of SGLT-2 inhibitors (Fisher's Exact Test, p ˂ 0.01), with higher glucose patients more frequently prescribed these drugs. Additionally, there was a substantial association between glucose levels and the chosen therapy structure (χ2 = 13.050, df = 2, p ˂ 0.001), suggesting that monotherapy is common in patients with glucose levels ≤7 mmol/L, whereas those with higher levels often require multi-drug treatment. Furthermore, a significant relationship was identified between elevated blood glucose levels (˃7 mmol/L) and the presence of endocrine diseases (Fisher's Exact Test, p = 0.004), indicating a higher incidence of these diseases among patients with elevated glucose levels.

Conclusion. The study highlights the critical relationship between blood glucose levels and treatment strategies, emphasizing the need for personalized diabetes management. It points to the broader use of insulin and SGLT-2 inhibitors among patients with higher glucose levels and underscores the importance of individualized treatment planning. This approach to diabetes care necessitates a nuanced understanding of each patient's condition, advocating for tailored treatment regimens to effectively enhance patient outcomes.

Keywords: Type 2 diabetes, glycemic control, antidiabetic therapy, treatment effectiveness