CARDIOVASCULAR RISK PROFILES OF MONOTHERAPY VS. COMBINATION THERAPY IN TYPE 2 DIABETES

Abstract

Background: The most serious complications of type 2 diabetes mellitus are cardiovascular diseases which account for morbidity and mortality. It is crucial for the management of patients and the disease burden in Pakistan to understand how different antidiabetic therapies impact cardiovascular outcomes. Objective: To assess the association between various antidiabetic treatment patterns and cardiovascular outcomes among patients with T2DM. Methods: This cross-sectional study encompasses 350 subjects diagnosed with T2DM who visited a Tertiary Care Hospital for the period spanning from January 2024 to July 2025. Information encompassing socio-demographics, clinical characteristics, treatment modalities, and cardiovascular complications was accrued via record surveys and direct structured questionnaires. Cardiovascular complications, consisting of myocardial infarctions, strokes, anginas, heart failure, and certain overlapping complications together, were evaluated among subjects receiving mono and combination therapies, and the chi-square test was employed for analysis of p-values, with p < 0.05 considered as statistical significance for the study. Results: Participants were predominantly aged between 40 and 50 years, and 62.9% were men. 50% of the subjects were morbidly obese, and 50.3% were hypertensive. Metformin as monotherapy was most common (75.1%), as was insulin (24.9%). In 13.1% of patients, metformin and insulin were used in combination. The prevalence of myocardial infarction and stroke was 25.7% and 21.7%, respectively; in addition, 40.3% of patients also reported angina, and 11.7% heart failure. There were no significant differences in cardiovascular outcomes between the monotherapy and combination therapy groups (p > 0.05). Conclusion: Within this group of Pakistani patients with T2DM, cardiovascular complications were prevalent; however, no significant relationship was observed between treatment type and cardiovascular outcomes. These results highlight the need for integrated cardiovascular risk management, especially in patients with diabetes, as controlling glucose alone will not be sufficient.