Introduction

Diabetes mellitus is one of the oldest diseases known to man ,which was the first reported in Egyptian literature about 3000 years ago [1]. Diabetes Mellitus is a chronic disorder defined as metabolic cum vascular syndrome of multiple aetiology characterised by chronic hyperglycaemia with disturbances of carbohydrate fat and protein metabolism resulting from defects in insulin secretion , insulin action or both leading to changes in both small blood vessels (microangiopathy) and large blood vessels macroangiopathy) [2].

Diabetes results from the failure of the pancreas to produce a sufficient amount of insulin. Pancreas produce a sufficient amount of insulin, but if the insulin is blocked from the body cells and cannot be used (insulin resistance). This causes the patients to have abnormally high amounts of sugar in their urine and blood [3]. The two types of DM observed are Type 1(insulin dependent) and Type 2 (noninsulin dependent). Insulin is vital to patients with type 1 DM. Type 2 DM is first treated with weight reduction, plans a diabetic diet and exercise. When these measures fail, oral medications are used [4].

DM is associated with a higher prevalence of risk factors such a hypertension and dyslipidemia which in turn leads to major vascular complications. These complications are debilitating to the patient, and also associated with significant economic burden to the patient, family members and the nation’s health care budget [5]. There has been a gradual and continuous increase in rural- urban migration. With this migration comes an apparent shift in life style from a relatively healthy traditional pattern, to the urban scenario of increased quantity and reduced quality of food, physical inactivity, smoking and increased alcohol indulgence. These are all risk factors for development of DM [6].

The statistical report in the year 2000 precisely reported that India topped the world with the highest number of people with DM, followed by China [7]. According to international diabetes federation 537million people in the world live with diabetes as of 2021. According to WHO around 77 million Indians are affected by Diabetes by and it is estimated that it may increase to 134million by 2045 [8]. This could place considerable burden on the health budgets of this country [9]. Various classes of ANTIDIABETIC DRUGS including insulin and oral hypoglycaemic agents are currently used in the treatment of diabetes, which acts by different mechanisms to reduce blood glucose levels to maintain optimal glycaemic control [10].

ANTIDIABETICS: INSULIN

Objectives:

1. Identifying prescription pattern using WHO core indicators.
2. Pharmacoeconomic evaluation to check adherence.
3. To check for rationality in the prescribed therapy.
4. To study the most utilized anti-hypertensive and anti-diabetic drug.

(STUDY DESIGN)

Prospective observational study

STUDY SITE

Mahaveer tertiary care hospital

STUDY DURATION

3months (August – November)

INCLUSION CRITERIA

1. All the inpatients and out patients diagnosed with diabetes alone and also with co-morbidities were included.
2. Patients who are willing to participate in the study.
3. Type 2 DM patients irrespective of age and sex who were prescribed with at least one Oral Hypoglycemic Agents.

EXCLUSION CRITERIA

1. Patients who are critically ill and admitted in ICU.
2. Prescriptions containing incomplete information.
3. Gestational Diabetes Mellitus

Methodology

A suitable data collection form was designed to collect and document the data. Data collection form included the provision for the collection of information related to

• Demographic details of the patient
• Past medical history
• Duration of diabetes mellitus
• Medication list
• Dose.
• Dosage form
• Frequency
• Total number of injectable and oral drugs
• Pharmacoeconomic evaluation

The number of anti-diabetic drugs prescribed was evaluated. The prescribing patterns of anti–diabetic drugs were assessed.

All the data collected as per proforma were analysed by WHO prescribing indicators. which include the following parameters;

1. Percentage of drugs prescribed by generic name.
2. Percentage of prescriptions with an anti-biotic.
3. Percentage of drugs with an injectable prescribed.
4. Percentage of drugs prescribed from Essential Medical List.
5. Average drug cost.
6. Cost minimization analysis was done to predict that amount of money that can be saved if prescriber have prescribed the cheaper brand in market, which in turn improves adherence to prescribed drug use as well as rationality. Results were depicted in tabular columns.

Results

A Prescription based study is considered as one of the most effective methods to assess and to evaluate the prescribing pattern of medications. This study analyzed the prescription patterns in Type 2 Diabetes mellitus. A Drug Utilization Study was considered to be one of the most effective methods to assess and to evaluate the prescribing attitude of the physician and helps to promote the rational use of the drugs. Individuals with Type 2 Diabetes is considered on high priority as they are potential candidates for rapid evaluation to prevent and halt the progression of many complications.

The study included 150 patients within an age range of 30 to >65 years. A total of 134 drugs were prescribed in the study population. The Demographic data of the study subjects are presented in table 1. The number of subjects diagnosed with diabetes mellitus alone are discussed in table 2. The gender distribution of the subjects are studied in pie diagram. The Drug Utilization pattern for the prescribed antidiabetics (monotherapy, dual drug therapy and triple drug therapy) were included in table 3.

Table 1: Demographic Details.

Table 2: Gender Distribution.

Table 3: Antidiabetics Prescribed.

The utilization pattern of antidiabetic drug therapy (monotherapy) were included in table 4. The utilization pattern of antidiabetic drug therapy (dual therapy) were included in table 5. Table 6 shows the utilization pattern of antidiabetic drug therapy (triple therapy). Number of Antidiabetic injectables encountered are 47 and are briefly described in table 7. Classes of drugs prescribed by generics were included in table.

Table 4: Drug Utilisation Pattern of Antidiabetic Therapy (Monotherapy).

Table 5: Drug Utilisation Pattern of Antidiabetic Therapy (Dual Therapy).

Table 6: Drug Utilisation Pattern of Antidiabetic Therapy (Triple Therapy).

Table 7: Number of Antidiabetic Injectables.

Table 8-10 depicts the number of prescribed classes of drugs as per EML. Table discusses the summary of prescription evaluation as per WHO prescribing core indicators.

Table 8: Prescribed Classes of Drugs Not As Per Eml.

Table 9: Who Prescribing Core Indicators.

Table 10: Pharmacoeconomic Evaluation of the Prescribed Drugs.