REGIMEN COMPLEXITY, CLINICAL RESPONSE AND DIRECT MEDICATION COSTS IN TYPE 2 DIABETES: A RETROSPECTIVE REAL-WORLD COHORT STUDY FROM PRIMARY CARE IN KAZAKHSTAN

Received: 01.07.2026

Accepted: 20.10.2026

Published online: 30.10.2026

UDC: 615.03:616.379-008.64-085-07

SRSTI: 76.31.29, 76.29.37

DOI: 10.53511/pharmkaz.2026.5.4

Article type: Original research article

 

REGIMEN COMPLEXITY, CLINICAL RESPONSE AND DIRECT MEDICATION COSTS IN TYPE 2 DIABETES: A RETROSPECTIVE REAL-WORLD COHORT STUDY FROM PRIMARY CARE IN KAZAKHSTAN

 

I.B. Kaibagarova¹, G.A. Smagulova¹, A. Sh. Sartayeva², N.M. Mavlyudova¹,
L.M. Zhamaliyeva², A. K. Ovsiannikova^3
1Department of Pharmacology, Clinical Pharmacology, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan

²Department of General Medical Practice N 2, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan

³ Institute of Internal and Preventive Medicine – a branch of a federal publicly funded scientific institution, the federal research center Institute of Cytology and Genetics, the Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia

 

Introduction. The increasing prevalence of type 2 diabetes mellitus (T2DM) is accompanied by growing demand for long-term glucose-lowering therapy and a substantial economic burden on both patients and healthcare systems. In routine clinical practice, treatment decisions are influenced not only by clinical effectiveness but also by medication availability, prescribing patterns, and treatment costs. Therefore, pharmacoepidemiological and pharmacoeconomic evaluation of glucose-lowering therapy may provide valuable information for optimizing diabetes management in primary healthcare settings.

Objective. To perform a pharmacoepidemiological and pharmacoeconomic analysis of oral glucose-lowering therapy among patients with type 2 diabetes mellitus receiving primary healthcare in Aktobe, Kazakhstan.

Methods. A retrospective study of medical records of patients with T2DM receiving routine follow-up between April 2024 and April 2025 was conducted. After applying the inclusion and exclusion criteria, 232 patients were included in the analysis. Treatment patterns, clinical and demographic characteristics, achievement of the predefined HbA1c research threshold, clinical response to therapy, and direct medication costs were evaluated. Logistic and linear regression analyses were used to identify factors associated with treatment response and therapy costs. A pharmacoeconomic analysis of direct medication costs was performed, including calculation of the cost per responder (CER).

Results. Dual oral therapy was the most common treatment strategy (50.9%), followed by monotherapy (34.5%) and triple therapy (14.7%). Metformin was included in 84.5% of treatment regimens. The predefined HbA1c research threshold of <7% was achieved by 28.4% of patients. Clinical response, defined as a reduction in HbA1c from baseline to follow-up, was observed in 37.9% of patients (88/232). Response rates were 36.3%, 38.1%, and 41.2% for monotherapy, dual therapy, and triple therapy, respectively; the difference was not statistically significant (χ² = 0.250, p = 0.882). Annual medication costs were 51,434 KZT, 119,931 KZT, and 332,591 KZT, respectively. Discussion. The findings indicate that dual oral therapy predominated in primary care, while the annual direct medication cost increased markedly with the number of agents in the regimen. Nevertheless, clinical response rates did not differ significantly among monotherapy, dual therapy, and triple therapy (p = 0.882). As the groups differed in baseline HbA1c and diabetes duration, unadjusted comparisons cannot establish the comparative effectiveness of treatment regimens. The study-specific definition of response as any HbA1c reduction and the exploratory nature of the ROC analysis warrant cautious interpretation of the observed associations.

Conclusions. Combination oral glucose-lowering therapy represents the predominant treatment strategy in routine primary healthcare practice. Greater regimen complexity was associated with substantially higher annual medication costs, whereas differences in clinical response between treatment groups were not statistically significant; because the groups were not comparable at baseline, these findings are descriptive. Baseline HbA1c was the only variable independently associated with clinical response (any reduction in HbA1c); this association may partly reflect regression to the mean, and the exploratory ROC threshold requires external validation.

Keywords: type 2 diabetes mellitus; glucose-lowering therapy; pharmacoeconomics; cost per responder; primary healthcare; HbA1c.

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