Factors contributing to acute heart failure after a first acute coronary syndrome episode
DOI:
https://doi.org/10.18203/2320-6012.ijrms20252013Keywords:
Antidiabetics, Prescription patterns, Geriatrics, Diabetes, Hypertension, PolypharmacyAbstract
Background: Diabetes and hypertension are common among the elderly and significantly increase the risk of cardiovascular and renal complications. Managing type 2 diabetes mellitus (T2DM) in geriatric patients is challenging due to age-related changes, polypharmacy, and susceptibility to adverse drug reactions. This study aimed to assess prescribing patterns of antidiabetic medications in elderly patients with T2DM and coexisting hypertension at a tertiary care center in India.
Methods: A retrospective cross-sectional study was conducted at Government General Hospital, Srikakulam, Andhra Pradesh, from February 2024 to February 2025. Prescriptions of patients aged ≥60 years with both diabetes and hypertension were analyzed. Data on drug classes, dosages, and regimens were collected. Statistical analysis was done using Microsoft Excel, with categorical variables expressed as percentages.
Results: A total of 586 prescriptions were reviewed. Metformin was the most prescribed antidiabetic (49.10%), followed by sulfonylureas (30.04%), dipeptidyl peptidase-4 (DPP-4) inhibitors (6.98%), sodium-glucose co-transporter-2 (SGLT2) inhibitors (3.93%), and α-glucosidase inhibitors (3.06%). Insulin was used in 3.06% of cases. Combination therapy was common, with 69.65% on dual-drug regimens, 12.02% on triple therapy, and 0.92% on more than three drugs. Most prescriptions (99.22%) used generics, with 84.15% from the National List of Essential Medicines (NLEM) 2022 and 89.80% from the World Health Organization Essential Medicines List (WHO-EML) 2023.
Conclusions: Metformin remains the mainstay of T2DM treatment in elderly patients. A high prevalence of combination and generic prescribing was noted. Ongoing evaluation of prescribing practices is essential to optimize care, minimize polypharmacy, and enhance outcomes in this population.
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. 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. 1999;5(4):208-19. DOI: https://doi.org/10.4158/EP.5.4.208