Study of the prescription pattern of antidiabetics in hypertension with diabetes patients in geriatric population at tertiary care centre: a retrospective observational study
DOI:
https://doi.org/10.18203/2320-6012.ijrms20250666Keywords:
Antidiabetics, Prescription patterns, Drug utilization studies, WHO-DUS indicators, Geriatric patientsAbstract
Background: In India, the elderly population is particularly affected with diabetes and hypertension which is prevalent in this population, leading to complex health challenges, necessitating effective treatment strategies. This study aimed to analyze the prescription patterns of antidiabetic drugs in geriatric patients with type 2 diabetes (T2DM) and hypertension at a tertiary care center.
Methods: A retrospective, cross-sectional study was conducted at the government medical college, Chhatrapati Sambhaji Nagar, from March 2023 to March 2024. Prescriptions of patients aged 60 years and above, diagnosed with both diabetes and hypertension, were analyzed.
Results: A total of 649 prescriptions were reviewed, with 58.71% of patients being male and 41.29% female. The majority (72.73%) were in the 60-70 age group. Metformin was the most prescribed drug (49.10%), followed by sulfonylureas, particularly glimepiride (30.04%). Combination therapy was the most common treatment approach, with 69.65% of patients receiving two-drug regimens, and 12.02% on three-drug regimens. The most frequent combination was metformin + glimepiride (79.42%). A small proportion (0.92%) received more than three drugs. Generic prescriptions dominated (99.22%), and nearly 89.80% drugs were from the WHO-EML 2023. The average number of drugs per prescription was 1.96.
Conclusions: The study highlights metformin as the predominant treatment for elderly patients with diabetes and hypertension, with a strong preference for generic medications and combination therapies. These findings underscore the importance of ongoing evaluation of prescribing patterns to optimize treatment strategies for geriatric patients.
Metrics
References
Ogurtsova K, da Rocha Fernandes JD, Huang Y, Linnenkamp U, Guariguata L, Cho NH, et al. IDF Diabetes Atlas: Global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Res Clin Pract. 2017;128:40-50. DOI: https://doi.org/10.1016/j.diabres.2017.03.024
Singh U. Prevalence of diabetes and other health related problems across India and worldwide: An overview. J Appl Nat Sci. 2016;8(1):500-5. DOI: https://doi.org/10.31018/jans.v8i1.825
Gupta M, Singh R, Lehl SS. Diabetes in India: a long way to go. Int J Sci Rep. 2015;1(1):1-2. DOI: https://doi.org/10.18203/issn.2454-2156.IntJSciRep20150194
Magliano D, Boyko EJ. IDF diabetes atlas. 10th edition. Brussels: International Diabetes Federation; 2021;37.
Schutta MH. Diabetes and Hypertension: Epidemiology of the Relationship and Pathophysiology of Factors Associated with These Comorbid Conditions. J Cardiometab Syndr. 2007;2(2):124-30. DOI: https://doi.org/10.1111/j.1559-4564.2007.06368.x
Chen G, McAlister FA, Walker RL, Hemmelgarn BR, Campbell NRC. Cardiovascular Outcomes in Framingham Participants with Diabetes. Hypertension. 2011;57(5):891-7. DOI: https://doi.org/10.1161/HYPERTENSIONAHA.110.162446
Pedelty L, Gorelick PB. Management of Hypertension and Cerebrovascular Disease in the Elderly. Am J Med. 2008;121(8):S23-31. DOI: https://doi.org/10.1016/j.amjmed.2008.05.019
Mehanna A. Antidiabetic agents: past, present and future. Future Med Chem. 2013;5(4):411-30. DOI: https://doi.org/10.4155/fmc.13.13
Mohan V, Cooper ME, Matthews DR, Khunti K. The Standard of Care in Type 2 Diabetes: Re-evaluating the Treatment Paradigm. Diabetes Ther. 2019;10(1):1-13. DOI: https://doi.org/10.1007/s13300-019-0573-y
Dalal J, Chandra P, Chawla R, Kumar V, Abdullakutty J, Natarajan V, et al. Clinical and Demographic Characteristics of Patients with Coexistent Hypertension, Type 2 Diabetes Mellitus, and Dyslipidemia: A Retrospective Study from India. Drugs-Real World Outcomes. 2023;11(1):167-76. DOI: https://doi.org/10.1007/s40801-023-00400-3
Daivasikamani P, Perumal K, Pandurangan T, Thamilselvam P, Diwakar A, Sawrirajan R. Does Diabetes and Hypertension have Common Pathophysiology-A Study. Diabetes Obes Int J. 2020;5(4):1-8. DOI: https://doi.org/10.23880/doij-16000233
David PO, Timothy A. Socio-Demographic Profiling of Patients with Hypertension and Diabetes in Public Hospitals In Nigeria: A Study of University of Benin Teaching Hospital (UBTH) Edo State Nigeria (2018-2023). Int J Sci Res Publ. 2024;14(4):122-33. DOI: https://doi.org/10.29322/IJSRP.14.04.2023.p14815
Barret-Connor E, Criqui MH, Klauber MR, Holdbrook M. Diabetes and hypertension in a community of older adults. Am J Epidemiol. 1981;113(3):276-84. DOI: https://doi.org/10.1093/oxfordjournals.aje.a113097
Geldsetzer P, Manne-Goehler J, Theilmann M, Davies JI, Awasthi A, Vollmer S, et al. Diabetes and Hypertension in India: A Nationally Representative Study of 1.3 million Adults. JAMA Intern Med. 2018;178(3):363-72. DOI: https://doi.org/10.1001/jamainternmed.2017.8094
Gaviria-Mendoza A, Sánchez-Duque JA, Medina-Morales DA, Machado-Alba JE. Prescription patterns and costs of antidiabetic medications in a large group of patients. Prim Care Diabetes. 2018;12(2):184-91. DOI: https://doi.org/10.1016/j.pcd.2017.11.002
Overbeek JA, Heintjes EM, Prieto-Alhambra D, Blin P, Lassalle R, Hall GC, et al. Type 2 Diabetes Mellitus Treatment Patterns Across Europe: A Population-based Multi-database Study. Clin Ther. 2017;39(4):759-70. DOI: https://doi.org/10.1016/j.clinthera.2017.02.008
Bosi E. Metformin-the gold standard in type 2 diabetes: what does the evidence tell us? Diabetes Obes Metab. 2009;11(2):3-8. DOI: https://doi.org/10.1111/j.1463-1326.2008.01031.x
Allyhiani M, Kurdi A, Abdulaziz A, Faqeh S, Alhajjaji A, Alansari S, et al. Prescribing patterns of antidiabetics in type 2 diabetes and factors affecting them. Saudi Pharm J SPJ Off Publ Saudi Pharm Soc. 2022;30(2):112-9. DOI: https://doi.org/10.1016/j.jsps.2021.12.019
Dashputra A, Badwaik RT, Borkar A, Date A, Kalnawat N. Pattern of Antidiabetic Drugs used in Outpatient and Hospitalized Patients in a Tertiary Health Institute of Central India. J Contemp Med Dent. 2014;2(3):48-54. DOI: https://doi.org/10.18049/jcmad/239a10
Hao R, Myroniuk T, McGuckin T, Manca D, Campbell-Scherer D, Lau D, et al. Underuse of cardiorenal protective agents in high-risk diabetes patients in primary care: a cross-sectional study. BMC Prim Care. 2022;23(1):124. DOI: https://doi.org/10.1186/s12875-022-01731-w
Scheen AJ. Efficacy / safety balance of DPP-4 inhibitors versus SGLT2 inhibitors in elderly patients with type 2 diabetes. Diabetes Metab. 2021;47(6):101275. DOI: https://doi.org/10.1016/j.diabet.2021.101275
Lamprea-Montealegre JA, Madden E, Tummalapalli SL, Chu CD, Peralta CA, Du Y, et al. Prescription Patterns of Cardiovascular- and Kidney-Protective Therapies Among Patients with Type 2 Diabetes and Chronic Kidney Disease. Diabetes Care. 2022;45(12):2900-6. DOI: https://doi.org/10.2337/dc22-0614
Karki N, Kandel K, Shah K, Prasad P, Khanal J. Combination Therapy in Diabetes Mellitus Patients Attending Outpatient Department in a Tertiary Care Centre: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc. 2022;60(256):1016-20. DOI: https://doi.org/10.31729/jnma.7642
Rani J, Reddy S. Prescribing pattern of antidiabetic drugs in urban population of Hyderabad. Natl J Physiol Pharm Pharmacol. 2015;5(1):5. DOI: https://doi.org/10.5455/njppp.2015.5.190620141
Mandal S, Maiti T, Das A, Das A, Mandal A, Sarkar B, et al. 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;1647-54. DOI: https://doi.org/10.18203/2319-2003.ijbcp20162487
Mudaliar S, Henry RR. Combination therapy for type 2 diabetes. Endocr Pract Off J Am Coll Endocrinol Am Assoc Clin Endocrinol. 1999;5(4):208-19. DOI: https://doi.org/10.4158/EP.5.4.208
Downes MJ, Bettington EK, Gunton JE, Turkstra E. Triple therapy in type 2 diabetes; a systematic review and network meta-analysis. PeerJ. 2015;3:e1461. DOI: https://doi.org/10.7717/peerj.1461
Khan SZ. A Study of Polypharmacy in Patients with Co-Existing Diabetes Mellitus Type II and Hypertension in a Tertiary Care Center. Biomed Pharmacol J. 2021;14(4):1831-9. DOI: https://doi.org/10.13005/bpj/2282
Naser AY, Wong ICK, Whittlesea C, Beykloo MY, Man KKC, Lau WCY, et al. Use of multiple antidiabetic medications in patients with diabetes and its association with hypoglycaemic events: a case-crossover study in Jordan. BMJ Open. 2018;8(11):e024909. DOI: https://doi.org/10.1136/bmjopen-2018-024909
Chen HY, Chang HR, Lang HC. Effects of hospital generic drug substitution on diabetes therapy. Patient Prefer Adherence. 2014;8:127-33. DOI: https://doi.org/10.2147/PPA.S54917
Malani R, Tiwari V, Vishwe A, Nyati P. An observational study of drug utilization pattern in patients with diabetes mellitus in tertiary care hospital. Natl J Physiol Pharm Pharmacol. 2024;14(8):1. DOI: https://doi.org/10.5455/njppp.2024.14.05212202411072024
Singla R, Bindra J, Singla A, Gupta Y, Kalra S. Drug Prescription Patterns and Cost Analysis of Diabetes Therapy in India: Audit of an Endocrine Practice. Indian J Endocrinol Metab. 2019;23(1):40-5. DOI: https://doi.org/10.4103/ijem.IJEM_646_18
WHO Model List of Essential Medicines-23rd list, 2023. Available at: https://www.who.int/publications/i/item/WHO-MHP-HPS-EML-2023.02. Accessed on 15 December 2024.
Central Drugs Standard Control Organization. National List of Essential Medicines (NLEM) 2022. Available at: https://cdsco.gov.in/opencms/opencms/en/consumer/Essential-Medicines/. Accessed on 15 December 2024.
Downloads
Published
How to Cite
Issue
Section
