Comparative Evaluation of Glycemic Control, Drug Safety, Quality of Life, and Medication Adherence in Patients with Type 2 Diabetes Mellitus Receiving Monotherapy, Dual Therapy, and Triple Therapy: A Prospective Study at Dharashiv Civil Hospital

Abstract

Diabetes mellitus is a chronic metabolic disorder characterized by persistent hyperglycemia resulting from abnormalities in insulin secretion, insulin action, or both. Among the various forms of diabetes, Type 2 Diabetes Mellitus (T2DM) represents the most prevalent type, accounting for more than 90% of global cases. The increasing prevalence of T2DM has become a major global health concern, driven by demographic transitions, urbanization, sedentary lifestyles, and unhealthy dietary patterns. Current global estimates indicate that hundreds of millions of adults are living with diabetes, and this number is expected to rise substantially in the coming decades. India is among the countries most affected by this epidemic, with a rapidly growing population of individuals diagnosed with T2DM, thereby placing a considerable burden on healthcare systems.

The development of T2DM is multifactorial and results from a complex interaction between genetic predisposition, environmental exposures, and lifestyle-related factors. The principal pathophysiological mechanisms underlying the disease include insulin resistance in peripheral tissues such as skeletal muscle, liver, and adipose tissue, along with progressive dysfunction of pancreatic β-cells. These alterations lead to impaired glucose utilization, excessive hepatic glucose production, and sustained hyperglycaemia. Chronic hyperglycaemia contributes to the development of several long-term complications affecting multiple organ systems. These complications include microvascular disorders such as diabetic retinopathy, nephropathy, and neuropathy, as well as macrovascular complications including cardiovascular disease, cerebrovascular disease, and peripheral vascular disease.

Clinical manifestations of T2DM may vary widely. Many individuals remain asymptomatic during the early stages of the disease, and diagnosis often occurs during routine medical screening. When present, common symptoms include polyuria, polydipsia, polyphagia, fatigue, blurred vision, and increased susceptibility to infections. Laboratory investigations play a crucial role in the diagnosis and monitoring of T2DM. Common diagnostic methods include glycated haemoglobin (HbA1c) measurement, fasting plasma glucose testing, random blood glucose assessment, and the oral glucose tolerance test. These investigations provide valuable information regarding long-term and short-term glycaemic control.

Effective management of T2DM requires a comprehensive and multidisciplinary approach that combines lifestyle modification with pharmacological therapy. Non-pharmacological interventions constitute the cornerstone of diabetes management and include dietary regulation, weight reduction, regular physical activity, behavioural counselling, and diabetes self-management education. These strategies significantly improve glycaemic control and reduce the risk of cardiovascular complications. In addition to lifestyle measures, pharmacological therapy is frequently required to achieve optimal glycaemic targets. Several classes of antidiabetic medications are currently available, including biguanides, sulfonylureas, DPP-4 inhibitors, SGLT2 inhibitors, GLP-1 receptor agonists, and insulin preparations. These agents act through different mechanisms to improve insulin sensitivity, enhance insulin secretion, or reduce glucose production and absorption.

In conclusion, the rising global burden of T2DM highlights the need for early detection, effective preventive strategies, and appropriate therapeutic interventions. Strengthening healthcare infrastructure, improving public awareness, and promoting healthy lifestyle practices are essential components in reducing the long-term impact of diabetes and its associated complications.