title: Improving management practices and clinical outcomes in type 2 diabetes study: Prevalence of complications in people with type 2 diabetes in India.
abstract: BACKGROUND
  Diabetes is the fourth leading cause of disease-related death and almost 80% of diabetes-related deaths occur in developing countries. Optimal glycemic control, in particular HbA1c level less than 7% with effective management of dyslipidemia and hypertension can reduce development of diabetes-related complications. Delay in initiating/or optimizing appropriate anti-diabetic therapy including insulin could be a possible cause of the increase in complications.
  
  
  METHODS
  Improving management practices and clinical outcomes in type 2 diabetes (IMPACT) was a prospective, open-label, 26-week, comparative, multi-center study to compare efficacy and safety of the Indian insulin guideline (IIG) group versus routine clinical practice (RCP) group in type 2 diabetes patients. A total of 20,653 subjects from 885 centers across India were enrolled.
  
  
  RESULTS
  A total of 4695 patients (22.7%) (IIG, 4113 [22.6%]; RCP, 582 [23.5%]) had macrovascular complications and 8640 patients (41.8%) (IIG, 7486 [41.2%]; RCP, 1154 [46.6%]) had microvascular complications. Of 4695 patients with macrovascular complications, 2850 patients (60.7%) had coronary heart disease followed by 1457 patients (31.0%) with peripheral vascular disease. Of all the microvascular complications recorded, 5627 patients (65.1%) had peripheral neuropathy followed by 3313 patients (38.3%) with retinopathy.
  
  
  CONCLUSIONS
  The rates of complications were high in patients with type 2 diabetes at the time of being initiated on insulin therapy in India.
authors.affiliation: Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, India.
authors.forename: Ashok Kumar
authors.initials: AK
authors.lastname: Das
authors.forename: V
authors.initials: V
authors.lastname: Seshiah
authors.forename: B K
authors.initials: BK
authors.lastname: Sahay
authors.forename: A
authors.initials: A
authors.lastname: Kumar
authors.forename: A J
authors.initials: AJ
authors.lastname: Asirvatham
authors.forename: V
authors.initials: V
authors.lastname: Balaji
authors.forename: S
authors.initials: S
authors.lastname: Kalra
authors.forename: R
authors.initials: R
authors.lastname: Channabasavaiah
authors.forename: R
authors.initials: R
authors.lastname: Shetty
authors.forename: C R A
authors.initials: CR
authors.lastname: Moses
keywords: Diabetes complications; insulin; treatment delay
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