Prescribing pattern of anti diabetic drugs in patients suffering from type 2 diabetes mellitus with co-existing hypertension in a tertiary care teaching hospital
DOI:
https://doi.org/10.18203/2319-2003.ijbcp20181183Keywords:
Anti diabetic drugs, Diabetes mellitus, Hypertension, Prescribing patternAbstract
Background: Diabetes mellitus and hypertension frequently co-exist in a patient. In such patients, the risk of complications, morbidity and mortality increases. One should be careful in management and choosing drugs. Authors undertook this study to understand the prescribing pattern of the physicians in diabetic hypertensive patients.
Methods: This cross sectional, observational study was conducted in type 2 diabetic outdoor patients with co-existing hypertension, for duration of one year. We used descriptive statistics to analyze data of 615 patients to determine prescribing pattern of drugs.
Results: 93.17% of patients were more than 40 years of age. Ratio of female to male patients was 1.30. Mean duration of diabetes was 5.81 years. Multi drug anti diabetic regimes (54.47%) were common than monotherapy (43.90%). Commonly prescribed anti diabetic drug groups were biguanides (89.27%), Sulfonylureas (43.90%) and insulin (15.28%). Metformin (89.27%), glibenclamide (29.11%) and insulin (15.28%) were commonly prescribed anti diabetic drugs. Metformin was the most common monotherapy drug and biguanide + sulfonylurea was the most common two drug combination. Commonly prescribed drugs for co-morbid conditions were enalapril (83.41%), aspirin (30.41%), amlodipine (29.76%) atorvastatin (27.32%) and famotidine (26.34%). Average number of drugs prescribed in a prescription was 4.65. Prescriptions with injections were 15.93% and with brand names were 13.15%.
Conclusions: Prescribing pattern of drugs was as per current practices and recommendations of guidelines. Still, there is room for improvement in choice of drug, prescribing drug with generic name and choosing drug from essential medicine list.
References
Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 2006;3(11):e442.
World Health Organization. Diabetes Fact sheet, 2017. Available at: http://www.who.int/mediacentre/factsheets/fs312/en/. Accessed 10 October 2017.
Kumar A, Goel MK, Jain RB, Khanna P, Chaudhary V. India towards diabetes control: Key issues. Australas Med J. 2013;6(10):524-31.
Joshi SR, Parikh RM. India - diabetes capital of the world: now heading towards hypertension. J Assoc Physicians India. 2007;55:323-4.
Venugopal K, Mohammed MZ. Prevalence of hypertension in type-2 diabetes mellitus. CHRISMED J Health Res. 2014;1(4):223-7.
Epstein M, Sowers JR. Diabetes mellitus and hypertension. Hypertension. 1992;19:403-18.
Tedesco MA, Natale F, Salvo GD, Caputo S, Capasso M, Calabró R. Effects of coexisting hypertension and type II diabetes mellitus on arterial stiffness. J Hum Hypertens. 2004;18(7):469-73.
Ministry of Health and Family Welfare Government of India. National List of Essential Medicines, 2015. Available at: http://cdsco.nic.in/WriteReadData/NLEM-2015/NLEM,%202015.pdf. Accessed 10 October 2017.
Dahal P, Maharjan L, Dahal B, Gupta K. Assessment of prescription patterns in hypertensive and diabetic patients visiting private tertiary care hospital of Dharan Municipality, Nepal. Sunsari Technical College Journal. 2015;2(1):44-7.
Kamrai D, Sachdeva P. Prescribing Trends of Antidiabetics In Diabetic Patients And Hypertensive Diabetic Patients In An Urban Secondary Care Hospital. Int J Pharm Biol Arch. 2010;1(2):249-55.
Zoungas S, Woodward M, Li Q, Cooper ME, Hamet P, Harrap S, et al. Impact of age, age at diagnosis and duration of diabetes on the risk of macrovascular and microvascular complications and death in type 2 diabetes. Diabetologia. 2014;57(12):2465-74.
Rekha MB, Rekha MS, Purushotham N. A Study of Prescribing Pattern in Type-2 Diabetics with Co-Existing Hypertension. Indian Journal of Public Health Research and Development. 2014;5(1):28-33.
Holman R. Metformin as first choice in oral diabetes treatment: the UKPDS experience. Journ Annu Diabetol Hotel Dieu. 2007:13-20.
American Diabetes Association. Approaches to glycemic treatment. Sec. 7. In Standards of Medical Care in Diabetes. Diabetes Care. 2016;39(1):S52-9.
Irons BK, Minze MG. Drug treatment of type 2 diabetes mellitus in patients for whom metformin is contraindicated. Diabetes Metab Syndr Obes. 2014;7:15-24.
Tuccori M, Filion KB, Yin H, Yu OH, Platt RW, Azoulay L, et al. Pioglitazone use and risk of bladder cancer: population based cohort study. BMJ. 2016;352:i1541.
James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. Evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507-20.
