Pattern of anti-diabetic drugs prescribed for type 2 diabetes mellitus patients in a tertiary care hospital of India: an observational study
Keywords:Diabetes mellitus type 2, Drug utilization, Prescription study
Background: Type 2 diabetes mellitus (T2DM) is a leading cause of significant morbidity and mortality in developing countries. Evaluation of anti-diabetic drug use pattern guides the healthcare professionals to identify early signals of irrational prescribing and to plan interventions to optimize the benefits of pharmacotherapy.
Methods: Observational descriptive study was conducted on 500 prescriptions of T2DM patients collected from Outpatient department of a tertiary care hospital. Prescriptions were analysed for type, number, generic/brand names, fixed dose combinations (FDCs) of anti-diabetic drugs and anti-diabetic drugs prescribed from within National List of Essential Medicines (NLEM) 2015.
Results: Average number of anti-diabetic drugs per prescription was 2.5. Of these 49% were from within NLEM and only 39% were prescribed by their generic names. Among all the anti-diabetic groups of drugs used, biguanide (32.85%) was the most frequently prescribed followed by insulins (25.4%) and DPP-4 inhibitors (13.75%). Combined drug therapy was more prevalent than monotherapy (70% versus 30%). Metformin+sitagliptin and metformin+linagliptin were most commonly prescribed fixed dose combinations.Conclusions: Recent trend of anti-diabetic drug use included newer anti-diabetic drugs in combination with metformin to achieve better euglycemia and to minimize complications of T2DM.
Klein R. Hyperglycemia and microvascular and macrovascular disease in diabetes. Diabetes Care. 1995 Feb;18(2):258-68.
Pradeepa R, Deepa R, Mohan V. Epidemiology of diabetes in India-current perspective and future projections. J Indian Med Assoc. 2002 Mar;100(3):144-8.
Venkataraman K, Kannan AT, Mohan V. Challenges in diabetes management with particular reference to India. Int J Diabetes Dev Ctries. 2009;29(3):103-9.
World Health Organization (WHO). Introduction to drug utilization research. WHO International Working Group for Drug Statistics Methodology, WHO Collaborating Centre for Drug Statistics Methodology, WHO collaborating centre for Drug Utilization Research and Clinical Pharmacological services. Geneva: WHO press, World Health Organization. 2003. Available at: http://apps.who.int/medicinedocs/pdf/s4876e/s4876e.pdf
Lewis JD, Schinnar R, Bilker WB, Wang X, Strom BL. Validation studies of the health improvement network (THIN) database for pharmacoepidemiology research. Pharmacoepidemiol Drug Saf. 2007;16(4):393-401.
Sultana G, Kapur P, Aqil M, Alam SM, Pillai KK. Drug utilization of oral hypoglycaemic agents in a university teaching hospital in India. J Clin Pharm Ther. 2010;35(3):267-77.
Joshi H, Mary R, Padil GM, Shastry CS, Pathak R. Investigation of In-Patient Prescribing Patterns of Oral Antidiabetic Drugs in a Tertiary Care Teaching Hospital. Afr J Pharmacol Ther. 2013;2(2):54-8.
Guidoni CM, Borges AP, Freitas Od, Pereira LR. Prescription patterns for diabetes mellitus and therapeutic implications: a population-based analysis. Arq Bras Endocrinol Metab. 2012;56(2):120-7.
Yurgin N, Secnik K, Lage MJ. Antidiabetic prescriptions and glycemic control in german patients with type 2 diabetes mellitus: a retrospective database study. Clin Ther. 2007;29(2):316-25.
National List of Essential Medicines of India, NLEM 2015. Available at: http://cdsco.nic.in/WriteReadData/NLEM-2015/NLEM,%202015.pdf. Accessed 8 October 2018.
Gafar A, Jimoh O, Sabir AA, Chika A, Sani Z. Pattern of Antidiabetic Drugs Use in a Diabetic Outpatient Clinic of a Tertiary Health Institution in Sokoto, North-western Nigeria. J Med Sci. 2011;11(5):241-5.
Bocuzzi JS, Wogen J, Fox J. Utilization of oral hypoglycaemic agents in drug-insured US population. Diabetes Care. 2001;24(8):1411-5.
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;4(4):82-7.
Agarwal AA, Jadhav PR, Deshmukh YA. Prescribing pattern and efficacy of anti‑diabetic drugs in maintaining optimal glycemic levels in diabetic patients. J Basic Clin Pharm. 2014;5(3):79-83.
Alex SM, Sreelekshmi BS, Smitha S, Jiji KN, Menon AS, Devi U. Drug utilization pattern of anti-diabetic drugs among diabetic outpatients in a tertiary care hospital. Asian J Pharm Clin Res. 2015;8(2):144-6.
Burgmann K, Fatio S, Jordi B, Rutishauser J. Medical care of type 2 diabetes mellitus in light of international and national recommendations: a retrospective analysis. Swiss Med Wkly. 2013;143:w13871.
Riaz H, Krasuski RA. Should Physicians be Encouraged to use Generic Names and to Prescribe Generic Drugs? Am J Cardiol. 2016;117(11):1851-2.
Brian O, Charles E. Drug use indicators in patients with type 2 diabetes in a tertiary healthcare facility in nigeria. Int J Pharm Pharm. 2014;6(11):493-5.
Johnson JA, Majumdar SR, Simpson SH, Toth EL. Decreased Mortality Associated with the Use of Metformin Compared With Sulfonylurea Monotherapy in Type 2 Diabetes. Diabetes Care. 2002;25(12):2244-8.
Boland CL, Degeeter M, Nuzum DS, Tzefos M. Evaluating second-line treatment options for type 2 diabetes: focus on secondary effects of GLP-1 agonists and DPP-4 inhibitors. Ann Pharmacother. 2013;47(4):490-505.
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;23(4):173-7.
Rafaniello C, Arcoraci V, Ferrajolo C, Sportiello L, Sullo MG, Giorgianni F, et al. Trends in the prescription of antidiabetic medications from 2009 to 2012 in a general practice of Southern Italy: a population-based study. Diabetes Res Clin Pract. 2015;108(1):157-63.
Kim YG, Hahn S, Oh TJ, Kwak SH, Park KS, Cho YM. Differences in the glucose-lowering efficacy of dipeptidyl peptidase-4 inhibitors between Asians and non-Asians: a systematic review and meta-analysis. Diabetologia. 2013;56(4):696-708.
Sivasankari V, Manivannan E, Priyadarsini SP. Drug utilization pattern of anti-diabetic drugs in a rural area of Tamilnadu, South India-A prospective, observational study. Int J Pharm Bio Sci. 2013;4(1):514-9.
Indian Council of Medical Research. Guidelines for Management of type 2 Diabetes. New Delhi: 2005. Available at: icmr.nic.in/guidelines_diabetes/guide_diabetes.htm. Accessed 28 April 2015.
IDF Clinical Guidelines Task Force. International Diabetes Federation Global Guideline for Type 2 Diabetes: recommendations for standard, comprehensive, and minimal care. Diabet Med. Diabet Med. 2006;23(6):579-93.