Polypragmasia and Drug Load Depending on the State of Kidney Function of Patients Suffering From Diabetes Mellitus

Abstract

Type 2 diabetes mellitus is often combined with other diseases, which increases the likelihood of polypragmasia. For the correct dosage regimen of drugs, it is necessary to take into account the state of kidney function, the change of which may be associated with diabetic nephropathy. The aim of the study was to determine the structure of comorbid pathology in patients with type 2 diabetes mellitus and to evaluate the dosage regimen of hypoglycemic drugs taking into account the state of the kidneys. A retrospective analysis of 100 medical records of patients hospitalized in the endocrinology department of the Russian Railways Medicine Clinical Hospital from January to April 2022 was carried out. Patients were divided into groups depending on the presence or absence of CRD (chronic renal disease). Hypoglycemic therapy was evaluated by calculating the drug burden index (DBI) in DDD units for 10 days of pharmacotherapy with oral hypoglycemic and insulin drugs.
 It was found that arterial hypertension (85%), dyslipidemia (67%), obesity (62%) prevailed in the structure of comorbid pathology in patients with diabetes mellitus. Polypragmasia was detected in 87% of patients. Decrease of glomerular filtration rate (GFR40 ml/min) was found in 61% of patients.
 The study showed that while maintaining kidney function (GFR 60 ml/min) in the selected cohort of patients, the average DBI value for oral drugs reached 34 DDD units for 10 days of pharmacotherapy, for insulin preparations - 13 DDD units for 10 days of pharmacotherapy. In patients with reduced GFR40 ml/min, the average DBI value for oral medications was significantly lower, reaching 8.6 DDD units for 10 days of pharmacotherapy, for insulin preparations 7.6 DDD units for 10 days of pharmacotherapy, indicating a decrease in the number of drug prescriptions.