Pattern of Antidiabetic Drugs used in Outpatient and Hospitalized Patients in a Tertiary Health Institute of Central India

Dashputra, AV; Badwaik, Rupesh T; Borkar, AS; Date, AP; Kalnawat, NR

doi:10.18049/jcmad/239a10

Cited by 8 publications

(11 citation statements)

References 14 publications

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“…These findings were similar to several other studies and also in the study by Dutta S et al 15,18,20,23,25,26 The American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD) guidelines also endorses metformin as first line drug for treatment of T2DM, as metformin is associated with very low risk of hypoglycemia, does not cause weight gain rather may promote weight loss, has beneficial effects on lipid profile, and has low cost. 27,28 Thiazolidinedione's (Pioglitazone) were the least prescribed, probably because of more adverse effects of weight gain, higher risk of edema, fractures and heart failure.…”

Section: Drug Utilizationsupporting

confidence: 93%

“…However, the average number of drugs per prescription was much better than other similar studies (3-5 drugs per prescription). 16,18,23 In a similar study done earlier in the same institute, the number of drugs per prescription was 3.99, much more than in present study. 20 This change could be the impact of the earlier study in the same institute that would have helped identify the problems and irrational use of drugs.…”

Section: Drug Utilizationsupporting

confidence: 60%

“…Prevalence of diabetes was seen to be more in males (54.21%) than females (45.79%), as seen in a number of other studies and in a study done earlier in the same institute by Dutta S et al [15][16][17][18][19][20] As per WHO, average number of drugs per prescription should be in the range of 1.6 to 1.8 drugs. 21 Present study states 2.95 drugs per prescription, more than that recommended by WHO and more than in a similar study by Sutharson L et al (1.95).…”

Section: Drug Utilizationmentioning

confidence: 88%

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A drug utilization and pharmacoeconomic study of anti-diabetic drugs prescribed to type 2 diabetes mellitus patients visiting the medicine out-patient department of a tertiary care hospital of north India

Singh

Dutta

Varma

et al. 2016

Int J Basic Clin Pharmacol

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INTRODUCTIONType 2 diabetes mellitus (T2DM) is the commonest form of diabetes (responsible for >90% cases of diabetes) affecting around 422 million people in the world, and more than 80% of diabetes deaths occur in low-and middle-income countries.1 The treatment of patients with T2DM involves diet, exercise and lifestyle modifications. Those not controlled are put on oral anti-diabetic (OAD) agents, the most commonly used being sulfonylurea's and ABSTRACT Background: Type 2 diabetes mellitus (T2DM) patients require anti-diabetic drugs on chronic basis, frequent monitoring of blood glucose levels and a number of laboratory investigations, all of which result in significant economic burden on the diabetes patients and the world economies. The purpose of this study was to analyse the prescribing pattern to highlight the current approaches to the rational use of anti-diabetic drugs in T2DM patients visiting the medicine out-patient department, and to calculate the economic burden of different antidiabetic therapies prescribed to patients with T2DM in a tertiary care hospital of north India. Methods: This prospective study included T2DM patients visiting the outpatient department of medicine of a tertiary care hospital of Uttarakhand, India. Prescriptions of patients diagnosed as cases of T2DM were analysed as per the WHO drug use indicators. For pharmacoeconomic evaluation, the cost variation of different anti-diabetic therapies was compared using the cost-effectiveness analysis method. Results: 273 prescriptions from 148 men and 125 women were analysed. 805 drugs were prescribed to the patients with an average of 2.95 per encounter: 494 anti-diabetic drugs with an average of 1.81 drugs per patient, and 311 for comorbid conditions. Of the 494 anti-diabetic drugs, 75.1% were oral anti-diabetic (OAD) agents and 24.9% were insulin's. Metformin (209) and insulin aspart (42) were the most prescribed OAD and insulin, respectively. The pharmacoeconomic analysis included 138 patients. The cost per unit (1 mg/dl) reduction in fasting blood glucose was lowest with glipizide and metformin combination (INR 10.46) and highest with insulin degludec and insulin aspart combination (INR 217.38). The average total direct cost of therapy for two months was INR 2244.39 ± 2745. 86.63% of the average total direct cost of therapy was attributed to anti-diabetic agents. Conclusions: Metformin was the most common OAD agent and insulin aspart was the most common injectable anti-diabetic drug prescribed in patients with T2DM. The newer anti-diabetic drugs sitagliptin and newer insulin analogues were also prescribed to a great extent. Overall, the prescribing trend was rational to a great extent and had improved since the earlier study in the same institute. The most cost-effective anti-diabetic therapy was combination therapy of glipizide and metformin. The cost of diabetes management is high, especially for insulin therapy.

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Section: Drug Utilizationsupporting

confidence: 93%

Section: Drug Utilizationsupporting

confidence: 60%

Section: Drug Utilizationmentioning

confidence: 88%

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A drug utilization and pharmacoeconomic study of anti-diabetic drugs prescribed to type 2 diabetes mellitus patients visiting the medicine out-patient department of a tertiary care hospital of north India

Singh

Dutta

Varma

et al. 2016

Int J Basic Clin Pharmacol

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“…In one study, it was used in combination with metformin, sulphonylurea and dipeptidyl peptidase-IV inhibitor at 15 mg/day dose 11 . In five studies patients from only inpatient departments were included 12 13 14 15 16 , one study included patients from both inpatient and outpatient departments 17 while 25 studies included patients from outpatient departments only 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 . Pioglitazone was prescribed to 6.5-11 per cent of T2DM patients in inpatient departments 12 13 14 15 16 .…”

Section: Resultsmentioning

confidence: 99%

Pioglitazone utilization, efficacy & safety in Indian type 2 diabetic patients: A systematic review & comparison with European Medicines Agency Assessment Report

Pai

Kshirsagar

2016

Indian J Med Res

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Background & objectives:With pioglitazone ban and subsequent revoking in India along with varying regulatory decisions in other countries, it was decided to carry out a systematic review on its safety, efficacy and drug utilization in patients with type 2 diabetes mellitus (T2DM) in India and compare with the data from the European Medicines Agency Assessment Report (EMA-AR).Methods:Systematic review was performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searching Medline/PubMed, Google Scholar and Science Direct databases using ‘pioglitazone AND India AND human’ and ‘pioglitazone AND India AND human AND patient’ and compared with EMA-AR. Spontaneous reports in World Health Organization VigiBase from India were compared with VigiBase data from other countries.Results:Sixty six publications, 26 (efficacy), 32 (drug utilization) and eight (safety), were retrieved. In India, pioglitazone was used at 15-30 mg/day mostly with metformin and sulphonylurea, being prescribed to 26.7 and 8.4 per cent patients in north and south, respectively. The efficacy in clinical trials (CTs) was similar to those in EMA-AR. Incidence of bladder cancer in pioglitazone exposed and non-exposed patients was not significantly different in an Indian retrospective cohort study. There were two cases and a series of eight cases of bladder cancer published but none reported in VigiBase.Interpretation & conclusions:In India, probably due to lower dose, lower background incidence of bladder cancer and smaller sample size in epidemiological studies, association of bladder cancer with pioglitazone was not found to be significant. Reporting of CTs and adverse drug reactions to Clinical Trials Registry of India and Pharmacovigilance Programme of India, respectively, along with compliance studies with warning given in package insert and epidemiological studies with larger sample size are needed.

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“…This study shows the drug use pattern among diabetic patients and analyzes the prescriptions according to WHO core drug prescribing indicators. [1][2][3][4][5][6] The irrational use of drugs is an another problem and it can be managed with WHO guidelines and it helps to promote the rational drug use. Irrational prescribing may cause failure in treatment and leads to make burden, distress, anxiety and increased costs.…”

Section: Introductionmentioning

confidence: 99%

Drug Use Pattern Among Diabetic Hospitalized Patients Managed With Oral Hypoglycemic Drugs, Insulin, Both Oral Hypoglycemic Drugs and Insulin in Tertiary Care Teaching Hospital

Sriram¹,

Dhanapal²

2018

J. Pharm. Sci. Innov.

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To observe and document the drug use pattern in hospitalized diabetic patients. To determine the choice of therapy based on age, gender, complications, duration of the disease. To find out the commonly occurring adverse drug reactions associated with antidiabetics. The present study involves prospective observational study for patients with diabetes. The methodology involves collection and documentation of patients medical and medication history, blood glucose levels, and duration, choice of therapy with diabetes. During the period of study, a total of 143 cases were collected and reviewed, among that 91% cases were type 2 diabetes mellitus and 9 % cases were type 1 diabetes mellitus. In this study females were higher in range than males. Most of the patients were with the age group of 41 to 60 followed by the age group 61 to 70 was affected by diabetes mellitus. The overall study shows Insulin was used more in most of the prescriptions for both single as well as doublet therapy. Next, to that Metformin was used as first line agent all type2 diabetes patients. Sulfonylureas such as Glimepiride Glibenclamide were used as second line agent. Oral anti-diabetic drugs still dominate the drug prescribing pattern, but there was a little change in the study towards the use of Insulin preparations in the management of Type 2 diabetes mellitus because of the severe diabetic level and insulin deficiency. Insulin preparations were found to be more effective than oral antidiabetics for hospitalized patients.

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Pattern of Antidiabetic Drugs used in Outpatient and Hospitalized Patients in a Tertiary Health Institute of Central India

Cited by 8 publications

References 14 publications

A drug utilization and pharmacoeconomic study of anti-diabetic drugs prescribed to type 2 diabetes mellitus patients visiting the medicine out-patient department of a tertiary care hospital of north India

A drug utilization and pharmacoeconomic study of anti-diabetic drugs prescribed to type 2 diabetes mellitus patients visiting the medicine out-patient department of a tertiary care hospital of north India

Pioglitazone utilization, efficacy & safety in Indian type 2 diabetic patients: A systematic review & comparison with European Medicines Agency Assessment Report

Drug Use Pattern Among Diabetic Hospitalized Patients Managed With Oral Hypoglycemic Drugs, Insulin, Both Oral Hypoglycemic Drugs and Insulin in Tertiary Care Teaching Hospital

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