Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic disorder characterized by insulin resistance and impaired insulin secretion, leading to hyperglycemia and associated microvascular and macrovascular complications (1). It accounts for more than 90% of all diabetes cases globally and represents a major contributor to morbidity and mortality in both developed and developing countries (2). The International Diabetes Federation (IDF) estimated that approximately 537 million adults were living with diabetes in 2021, with projections reaching 643 million by 2030 and 783 million by 2045, largely driven by T2DM (3).

In countries like India, the burden of T2DM is rising rapidly, with a significant proportion of patients remaining undiagnosed or inadequately managed at the primary care level (4). This is further complicated by limited healthcare resources, poor patient education, and a lack of continuity in care delivery. As primary healthcare is often the first point of contact for patients, it plays a critical role in early diagnosis, lifestyle intervention, pharmacologic therapy initiation, and monitoring of complications (5).

Despite the growing emphasis on diabetes control, there remains a gap in understanding the clinical characteristics and outcomes of T2DM patients managed in primary care settings. Identifying the demographic and clinical profiles of these patients, along with their response to treatment interventions, can aid in optimizing care strategies, customizing education, and enhancing glycemic outcomes. This study was designed to evaluate the clinical features and treatment outcomes of individuals with T2DM managed in primary healthcare clinics, with the goal of generating evidence to support improved disease control at the grassroots level.

The study population included adult patients (aged ≥30 years) previously diagnosed with Type 2 Diabetes Mellitus (T2DM) and registered for follow-up care at these centers.

Inclusion Criteria:

Patients aged 30 years and above, with a diagnosis of T2DM for at least 6 months, and receiving regular treatment in the selected primary care centers were included. Only those who provided informed written consent were enrolled.

Exclusion Criteria:

Patients with Type 1 diabetes, gestational diabetes, secondary diabetes (due to medications or pancreatic disease), critically ill patients, and those unwilling to participate were excluded.

Data Collection:

A structured proforma was used to collect demographic data (age, gender, occupation), clinical history (duration of diabetes, comorbidities), and lifestyle habits (diet, exercise, tobacco and alcohol use). Anthropometric measurements (height, weight, BMI) and blood pressure were recorded using standardized procedures.

Biochemical Analysis:

Fasting blood glucose (FBG), postprandial blood glucose (PPBG), and glycated hemoglobin (HbA1c) levels were obtained from recent laboratory reports (within the last two weeks). Lipid profiles and renal function tests were also recorded where available.

Treatment and Follow-up:

All patients received standard care including oral hypoglycemic agents or insulin as indicated, along with lifestyle modification counseling. After three months of follow-up, repeat measurements of FBG, PPBG, and HbA1c were recorded. Medication adherence was assessed using a self-reported questionnaire based on the Morisky Medication Adherence Scale (MMAS-8).

Statistical Analysis:

Data were entered into Microsoft Excel and analyzed using SPSS version 25.0. Descriptive statistics were used for demographic and clinical variables. Paired t-test was applied to compare pre- and post-intervention HbA1c values. A p-value of less than 0.05 was considered statistically significant.

A total of 200 patients with Type 2 Diabetes Mellitus were included in the study. The mean age of the participants was 54.6 ± 9.8 years, with a slight male predominance (male:female ratio of 1.2:1).

Demographic and Clinical Profile

Table 1 summarizes the baseline demographic and clinical characteristics. A majority of participants (58%) were in the 50–60 age group. The mean duration of diabetes was 6.4 ± 3.2 years. Comorbid conditions were common, with hypertension present in 52% and dyslipidemia in 41% of the cases.

Table 1: Baseline Demographic and Clinical Characteristics of Study Participants (n = 200)

Glycemic Parameters Before and After Follow-up

At baseline, 68% of patients had poor glycemic control (HbA1c > 7%). Following three months of management, 43% of participants achieved target HbA1c levels. Statistically significant improvements were observed in fasting blood glucose, postprandial glucose, and HbA1c values (p < 0.05) (Table 2).

Table 2: Comparison of Glycemic Parameters at Baseline and After 3-Month Follow-up (n = 200)

Lifestyle Modification and Medication Adherence

Lifestyle adherence improved significantly over the study period, with 59% reporting regular exercise at follow-up compared to 28% at baseline. Medication adherence was categorized based on MMAS-8 scores: 38% high adherence, 42% moderate, and 20% low. Patients with high adherence demonstrated significantly greater reductions in HbA1c (Table 3).

Table 3: Association Between Medication Adherence and Change in HbA1c

The findings of this study highlight the crucial role of primary care settings in managing Type 2 Diabetes Mellitus (T2DM), particularly in resource-limited areas. The mean age of participants was 54.6 years, consistent with previous Indian and global studies that report peak T2DM onset in the fifth and sixth decades of life (1,2). The slight male predominance observed aligns with national epidemiological trends, although global data suggest a relatively balanced gender distribution (3).

Comorbid conditions, especially hypertension and dyslipidemia, were highly prevalent in our cohort, observed in over 50% of patients. These findings reinforce the evidence that cardiovascular risk factors are commonly clustered in individuals with T2DM (4,5). Early identification and integrated management of such comorbidities are essential for reducing the burden of complications (6).

The baseline HbA1c levels in our study revealed suboptimal glycemic control in a significant proportion of patients, with 68% having values above 7%. This is consistent with reports from community-based studies in India and Southeast Asia, where poor glycemic control persists due to delayed diagnosis, inadequate follow-up, and low adherence to lifestyle modifications (7,8).

However, following a structured intervention strategy involving pharmacotherapy, dietary advice, and exercise counseling, 43% of participants achieved target glycemic levels within three months. This underscores the potential effectiveness of even short-term interventions when properly implemented (9,10).

Importantly, medication adherence significantly influenced glycemic outcomes. Patients with high adherence showed a mean HbA1c reduction of 1.5%, which is in line with global evidence suggesting that improved adherence can lead to clinically meaningful improvements in metabolic parameters (11,12). Despite this, a notable 20% of participants demonstrated low adherence, highlighting the need for continuous patient education and follow-up reinforcement (13).

Lifestyle changes, especially increased physical activity, were also associated with better outcomes in this study. At follow-up, 59% of patients reported engaging in regular physical activity compared to 28% at baseline. Such findings support the established role of lifestyle interventions in primary care as foundational to long-term diabetes control (14,15).

This study’s strength lies in its real-world setting and its focus on patients in primary healthcare, providing valuable insight into the practical challenges and opportunities in managing T2DM at the grassroots level. However, limitations include the short follow-up duration and reliance on self-reported adherence and behavior data, which may introduce recall bias.

Future studies with larger sample sizes, longer follow-up periods, and inclusion of additional variables such as psychosocial determinants, quality of life, and complications would help in building a comprehensive understanding of diabetes management in primary care.

In conclusion, primary care interventions can result in significant short-term improvements in glycemic control when supported by structured treatment plans, patient education, and regular monitoring. These findings reinforce the need to strengthen primary health infrastructure and adopt patient-centered models to address the growing T2DM burden effectively.

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