Diabetes mellitus is a metabolic disorder with a common denominator of hyperglycemia, arising from a variety of pathogenic mechanisms. The study aimed to evaluate the drug utilization pattern of anti-diabetic drugs in type 2 diabetic patients and to observe the efficacy associated with anti-diabetic therapy. A prospective observational study was carried out in diabetic patients visiting the department of general medicine in a tertiary care teaching hospital over six months. The patients diagnosed with Type 2 diabetes mellitus were identified, and all the demographic details, drug prescriptions, and clinical data of patients were collected and documented in a suitably designed case report form. Based upon the study criteria, 100 people were enrolled in the study. Among the majority of study subjects, 57% were female and 43% were males. The large numbers of diabetic patients were between the age group of 41- 60yrs. Hypertension was the most common comorbid condition. The prescription pattern showed that the majority of patients were prescribed dual therapy and about 48%, Metformin was largely prescribed anti-diabetic drug in all the prescriptions. Among combinations, metformin with glimepiride was frequently prescribed. The present study helped to find out current drug utilization patterns of oral anti-diabetic drugs with different comorbidities concerning diagnosis. Among all the anti-diabetic drugs, metformin was most commonly prescribed. In second-generation sulfonylureas, glimepiride was most commonly prescribed. The practice of metformin monotherapy is limited and it is frequently prescribed in combination with other anti-diabetic drugs. The study also highlights the need for comprehensive management of diabetic patients, including lifestyle changes, dietary control, hypoglycemic agents, cardiovascular prevention, treatment of complications, and comorbidity. Therefore, through the drug utilization patterns, attempts can be made to improve the quality and efficiency of drug therapy.
Keywords: Diabetes Mellitus, Bigunaides, HbA1C and MMAS-8
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REFERENCES
Brahmbhatt SV, Sattigeri BM, Nil AK, Parikh DP, Shah HS. A prospective study on drug utilization pattern & rationality in the treatment of type II diabetes mellitus: a population-based analysis. Int J Res Med Sci. 2014 Jul;2(3):983-7. DOI: 10.5455/2320-6012.ijrms20140852.
American Diabetes Association. Cardiovascular disease and risk management: Standards of Medical Care in Diabetes—2019. Diabetes Care. 2019 Jan;42(Suppl 1); Suppl 1:S103-23. DOI: 10.2337/dc19-S010, PMID 30559236.
Agrawal R, Rath B, Saha K, Mohapatra S. Drug utilization pattern of antidiabetic agents in a tertiary care hospital of western Odisha, India. Int J Basic Clin Pharmacol. 2016 Oct;5(5):2222-6. DOI: 10.18203/2319-2003.ijbcp20163265.
Relic G. WHO Global report on diabetes: A summary. Int J Non Communicable Dis. 2016 Apr 1;1(1):3.
Walker BR, Colledge NR. Davidson’s principles and practice of medicine e-book. Elsevier Health Sciences; 2013 Dec 6. p. 798.
Khardori R. Type 2 diabetes mellitus: new perspectives in biology and therapeutics. Adv Diabetes Novel Insights. 2016 Feb 12;148.
Walker R. Clinical pharmacy and therapeutics e-book. Elsevier Health Sciences; 2011 Oct 24.
Ralston SH, Penman I, Strachan MW, Hobson R, editors. Davidson’s principles and practice of medicine e-book. Elsevier Health Sciences; 2018 Feb 2.
Baby N, Tom C, Joseph AA, Abraham A, Nanjwade BK. Prescribing pattern of antidiabetic drugs for type 2 diabetic in a tertiary care teaching hospital. World J Pharm Pharm Sci. 2017 Jan 20;6(3):1302-15.
Khardori R. Type 2 diabetes mellitus. Medscape Diabetes Endocrinol. 2013.
American Diabetes Association, Bantle JP, Wylie-Rosett J, Albright AL, Apovian CM, Clark NG, Franz MJ, Hoogwerf BJ, Lichtenstein AH, Mayer-Davis E, Mooradian AD, Wheeler ML. Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2008 Jan;31; Suppl 1:S61-78. DOI: 10.2337/dc08-S061, PMID 18165339.
Kasper DL, Braunwald E, Hauser S, Longo D, Jameson JL. Harrison’s principles of internal medicine. 16th ed; Jul 23, 2004. p. 2152-8.
Wells BG, DiPiro CV, DiPiro JT, Schwinghammer TL. Pharmacotherapy handbook. 7th ed; 2009 by The McGraw-Hill Companies.p.210.
Available from: https://www.health.harvard.edu/a_to_z/type-1-diabetes-mellitus-a-to-z.
Kasper DL, Braunwald E, Hauser S, Longo D, Jameson JL. Harrison’s principles of internal medicine. 16th ed; Jul 23, 2004.
Greene RJ, Harris ND, Goodyer LI. Pathology and therapeutics for pharmacists: A basis for clinical pharmacy practice. London: Pharmaceutical Press; 2008.
Willens D, Cripps R, Wilson A, Wolff K, Rothman R. Interdisciplinary team care for diabetic patients by primary care physicians, advanced practice nurses, and clinical pharmacists. Clin Diabetes. 2011 Apr 1;29(2):60-8. DOI: 10.2337/diaclin.29.2.60.
Available from: https://www.mayoclinic.org/diseases-conditions/diabetes/symptoms-causes/syc-20371444.
Available from: https://my.clevelandclinic.org/health/diseases/7104-diabetes-mellitus-an-overview#diagnosis-and-tests.
Available from: https://www.mayoclinic.org/diseases-conditions/diabetes/diagnosis-treatment/drc-20371451.
Pankaj CK, Satendra SP, Dhananjay P, Kumud R, Rajmangal C, Bhanu P. A prospective study on drug utilization pattern of anti-diabetic drugs in a tertiary care teaching hospital of eastern Uttar Pradesh, India. Int J Res Med Sci| Issue3 page no 669. Mar 2019;7(3). DOI: 10.18203/2320-6012.ijrms20190915.
Shanthi M. A study of drug utilization pattern and pharmacoeconomic of the anti-diabetic drug in patients attending a teaching hospital. Int J Basic Clin Pharmacol |April. 2018 |vol 7| issue 4 page no 796-780.
Okoro RN, Nmeka C, Erah PO. Utilization study of anti-diabetes medicines at a tertiary care hospital in Nigeria. Future J Pharm Sci. 2018 Dec 1;4(2):109-15. DOI: 10.1016/j.fjps.2017.11.004.
Kavyasree A, Geetha P, Shanmugasundaram P. A Review: comparison of Efficacy of liraglutide versus sitagliptin addon-to metformin in type 2 diabetes mellitus patients. Res J Pharm Technol. 2021 Apr 1;14(4):2291-5. DOI: 10.52711/0974-360X.2021.00405.
Mahmood M, Reddy RC, Lahari JR, Fatima S, Shinde P, Reddy SA, Pranali SP. Prescription pattern analysis of antidiabetic drugs in diabetes mellitus and associated comorbidities. Clin Invest (Lond). 2017;8(1):5-12.
Verma S, Joshi Y, Singh A. Drug utilization evaluation of anti-diabetic medication through prescription monitoring. Asian J Pharm Res Dev. 2019 Jun 14;7(3):75-7. DOI: 10.22270/ajprd.v7i3.537.
Shahi SK, Kumar A, Kumar S, Singh SK, Gupta SK, Singh TB. Prevalence of diabetic foot ulcer and associated risk factors in diabetic patients from North India. The J Diabet Foot Complications. 2012;4(3):83-91.
Mandal S, Maiti T, Das AK, Das A, Mandal A, Sarkar BS, Mandal S. Drug utilization study in patients with type 2 diabetes mellitus attending diabetes clinic of a tertiary care hospital in rural Bengal. Int J Basic Clin Pharmacol. 2016 Aug;5(4):1647-54. DOI: 10.18203/2319-2003.ijbcp20162487.
Khalam A, Dilip C, Shinu C. Drug use evaluation of diabetes mellitus in hospitalized patients of a tertiary care referral hospital. J Basic Clin Physiol Pharmacol. 2012 Nov 1;23(4):173-7. DOI: 10.1515/jbcpp-2012-0012, PMID 23072848.
Acharya KG, Shah KN, Solanki ND, Rana DA. Evaluation of antidiabetic prescriptions, cost and adherence to treatment guidelines: A prospective, cross-sectional study at a tertiary care teaching hospital. J Basic Clin Pharm. 2013 Sep;4(4):82-7. DOI: 10.4103/0976-0105.121653, PMID 24808678.
Singh D, Sawlani KK, Chaudhary SC, Kumar N, Sachan AK, Nath R, Barua S, Dixit RK. Drug utilization study of drugs used in the treatment of diabetes mellitus in medicine OPD of a tertiary care hospital in northern India. IP Int J Compr Adv Pharmacol. 2019;4:120-5.
Sharma T, Sahai R, Bala S, Dhasmana DC, Kaeley N. Prescribing pattern of oral anti-diabetic agents in type 2 diabetes mellitus patients in a tertiary care hospital. Int J Basic Clin Pharmacol. 2018 May;7(5):956. DOI: 10.18203/2319-2003.ijbcp20181642.
Sultana G, Kapur P, Aqil M, Alam MS, Pillai KK. Drug utilization of oral hypoglycemic agents in a university teaching hospital in India. J Clin Pharm Ther. 2010 Jun;35(3):267-77. DOI: 10.1111/j.1365-2710.2009.01080.x, PMID 20831529.
Yunus SZ. Binti Musa NS, Sapian RA, Azahar A, Binti Zainuddin NA. Anti-diabetic drugs utilization pattern and its cost in managing Type 2 Diabetes patients in hospitals in Selangor, Malaysia. Informatics in Medicine Unlocked. 2018 Jan 1;13:21-5.
Ponnachan R, Babu B, Yesodhar S, Utangi S. Drug utilization evaluation of anti-diabetics in type 2 diabetes mellitus patients with or without comorbidities in a tertiary care teaching hospital. J Young Pharm. 2021 Jul 1;13(3):267-9. DOI: 10.5530/jyp.2021.13.54.
K V, Mohammed MZ. Prevalence of hypertension in type-2 diabetes mellitus. CHRISM J Health Res. 2014 Oct 1;1(4):223. DOI: 10.4103/2348-3334.142981.
Ramachandran A, Jali MV, Mohan V, Snehalatha C, Viswanathan M. High prevalence of diabetes in an urban population in south India. Br Med J. 1988 Sep 3;297(6648):587-90. DOI: 10.1136/BMJ.297.6648.587, PMID 3139221.
Sankar UV, Lipska K, Mini GK, Sarma PS, Thankappan KR. The adherence to medications in diabetic patients in rural Kerala, India. Asia Pac J Public Health. 2015 Mar;27(2): NP513-23. DOI: 10.1177/1010539513475651, PMID 23417905.
Al-Saeed AH, Constantino MI, Molyneaux L, D'Souza M, Limacher-Gisler F, Luo C, Wu T, Twigg SM, Yue DK, Wong J. An inverse relationship between age of type 2 diabetes onset and complication risk and mortality: the impact of youth-onset type 2 diabetes. Diabetes Care. 2016 May 1;39(5):823-9. DOI: 10.2337/dc15-0991, PMID 27006511.
Alkhatib A, Tsang C, Tiss A, Bahorun T, Arefanian H, Barake R, Khadir A, Tuomilehto J. Functional foods and lifestyle approaches for diabetes prevention and management. Nutrients. 2017 Dec;9(12):1310. DOI: 10.3390/nu9121310, PMID 29194424.
Davidson MB, Schriger DL. Effect of age and race/ethnicity on HbA1c levels in people without known diabetes mellitus: implications for the diagnosis of diabetes. Diabetes Res Clin Pract. 2010 Mar 1;87(3):415-21. DOI: 10.1016/j.diabres.2009.12.013, PMID 20061043.
Booth GL, Kapral MK, Fung K, Tu JV. Relation between age and cardiovascular disease in men and women with diabetes compared with non-diabetic people: a population-based retrospective cohort study. Lancet. 2006 Jul 1;368(9529):29-36. DOI: 10.1016/S0140-6736(06)68967-8, PMID 16815377.
Bianco A, Pomara F, Thomas E, Paoli A, Battaglia G, Petrucci M, Proia P, Bellafiore M, Palma A. Type 2 diabetes family histories, body composition and fasting glucose levels: a cross-section analysis in healthy sedentary male and female. Iran J Public Health. 2013;42(7):681-90. PMID 24427747.
Sawicki PT, Didjurgeit U, Mühlhauser I, Bender R, Heinemann L, Berger M. Smoking is associated with progression of diabetic nephropathy. Diabetes Care. 1994 Feb 1;17(2):126-31. DOI: 10.2337/diacare.17.2.126, PMID 8137682.
van de Wiel A. Diabetes mellitus and alcohol. Diabetes Metab Res Rev. 2004 Jul;20(4):263-7. DOI: 10.1002/dmrr.492, PMID 15250029.
Struijs JN, Baan CA, Schellevis FG, Westert GP, Van Den Bos GA. Comorbidity in patients with diabetes mellitus: impact on medical health care utilization. BMC Health Serv Res. 2006 Dec;6(1):84. DOI: 10.1186/1472-6963-6-84, PMID 16820048.
Maruthur NM, Tseng E, Hutfless S, Wilson LM, Suarez-Cuervo C, Berger Z, Chu Y, Iyoha E, Segal JB, Bolen S. Diabetes medications as monotherapy or metformin-based combination therapy for type 2 diabetes: a systematic review and meta-analysis. Ann Intern Med. 2016 Jun 7;164(11):740-51. DOI: 10.7326/M15-2650, PMID 27088241.
Mannucci E, Monami M, Masotti G, Marchionni N. All?cause mortality in diabetic patients treated with combinations of sulfonylureas and biguanides. Diabetes Metab Res Rev. 2004 Jan;20(1):44-7. DOI: 10.1002/dmrr.411, PMID 14737744.
