Drug use evaluation of diabetes mellitus in hospitalized patients of a tertiary care referral hospital

Abstract

Background: Many drugs are available for the treatment of diabetes mellitus and are sometimes prescribed in combination. Irrational use of drugs is increasing expenditure and strain on health budgets. The aim of this study was to determine patient demographic characteristics, analyze prescription patterns of antidiabetic drugs, distribution of complications of diabetes, distribution of co-existing illnesses, distribution of common symptoms of diabetes and distribution of adverse drug reactions.

Methods: A study was carried out for 11 months in diabetic inpatients in the General Medicine Department. Data of 200 patients were collected and evaluated.

Results: The pattern of drug prescription in diabetes shows that insulin (80.5%) was most frequently prescribed followed by biguanides (23%), sulfonylureas (22.5%), thiazolidinediones (11%), dipeptidyl peptidase-IV (DPP-4) inhibitors (9.5%) and meglitinides (5.5%). The percentage of patients on diet control therapy was found to be 3%. Combination therapy was prescribed to 26.5% and monotherapy to 65% of patients; 47.5% of these patients were male and 52.5% were female. The most common co-existing illness was found to be hypertension (53.5%). In addition, 67% of patients had irregular blood sugar monitoring and the remaining 33% had regular (either 4 or 6 hourly) monitoring.

Conclusions: It is concluded that the prescribing trend is moving away from monotherapy with insulin and sulfonylureas and towards combination therapies. There is also a significant increase in prescriptions of newer oral antidiabetic drugs, such as DPP-4 inhibitors and insulin analogs. Most inpatients had their blood glucose checked irregularly and haphazardly by ward staff. This study strongly highlights the need for patient education or counseling on use of antidiabetic and concomitant drugs, monitoring of blood glucose and glycosylated hemoglobin (HbA_1c) levels, diet control and correction of diabetic complications.