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Patterns of drug therapy, glycemic control, and predictors of escalation – non-escalation of treatment among diabetes outpatients at a tertiary care center

  • Shubham Atal , Rajnish Joshi , Saurav Misra ORCID logo EMAIL logo , Zeenat Fatima , Swati Sharma , Sadashivam Balakrishnan and Pooja Singh
Published/Copyright: August 27, 2021
Journal of Basic and Clinical Physiology and Pharmacology
From the journal Journal of Basic and Clinical Physiology and Pharmacology Volume 33 Issue 6

Abstract

Objectives

The study was conducted to assess patterns of prescribed drug therapy and clinical predictors of need for therapy escalation in outpatients with diabetes mellitus (DM).

Methods

This was a prospective cohort study, conducted at an apex tertiary care teaching hospital in central India for a period of 18 months. The demographic, clinical, and treatment details on the baseline and follow up visits were collected from the patients’ prescription charts. Glycemic control, adherence, pill burdens along with pattern of antidiabetic therapy escalation, and deescalations were analyzed.

Results

A total of 1,711 prescriptions of 925 patients of diabetes with a mean age of 53.81 ± 10.42 years and duration of disease of 9.15 ± 6.3 years were analyzed. Approximately half of the patients (n=450) came for ≥1 follow up visits. Hypertension (59.35%) was the most common comorbidity followed by dyslipidemia and hypothyroidism. The mean total daily drugs and pills per prescription were 4.03 ± 1.71 and 4.17 ± 1.38, respectively. Metformin (30.42%) followed by sulphonylureas (SUs) (21.39%) constituted majority of the AHA’s and dual and triple drug therapy regimens were most commonly prescribed. There were improvements in HbA1c, fasting/postprandial/random blood sugar (FBS/PPBS/RBS) as well as adherence to medication, diet, and exercise in the follow up visits. Among patients with follow ups, therapy escalations were found in 31.11% patients, among whom dose was increased in 12.44% and drug was added in 17.28%. Apart from Hb1Ac, FBS, and PPBS levels (p<0.001), characteristics such as age, BMI, duration of diagnosed diabetes, presence of hypertension and dyslipidemia, and daily pill burdens were found to be significantly higher in the therapy escalation group (p<0.05). Inadequate medication adherence increased the relative risk (RR) of therapy escalation by almost two times.

Conclusions

Disease and therapy patterns are reflective of diabetes care as expected at a tertiary care center. Higher BMI, age, pill burden, duration of diabetes, presence of comorbidities, and poor medication adherence may be the predictors of therapy escalation independent of glycemic control and such patients should be more closely monitored.

Keywords: diabetes mellitus; predictors; therapy escalation
Corresponding author: Dr. Saurav Misra, MBBS, MD, Senior Resident, Department of Pharmacology, AIIMS Bhopal, Bhopal, India, E-mail:

Acknowledgments

The authors would like to acknowledge the help of tutors posted in the Department of Pharmacology, AIIMS Bhopal for their contribution in data collection, and Dr. Manu Gupta for his help in developing the app for data collection.

  1. Research funding: No funding was required (Not applicable).

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission. Dr Shubham Atal: Conceptualization, Methodology, Data curation, Supervision, Writing – review & editing; Dr Rajnish Joshi: Conceptualization, Methodology, Data curation, Supervision, Writing – review & editing; Dr Saurav Misra: Data curation, analysis, Writing – review & editing; Dr. Zeenat Fatima: Data collection, analysis; Dr Swati Sharma: Data collection, analysis; Dr Balakrishnan S: Conceptualization, Methodology, Data curation; Dr Pooja Singh: Data collection, analysis.

  3. Competing interests: There was no conflict of interest with any authors.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: The local Institutional Review Board approved this study.

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Received: 2021-06-22
Accepted: 2021-08-02
Published Online: 2021-08-27

© 2021 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/jbcpp-2021-0189
Keywords for this article
diabetes mellitus; predictors; therapy escalation

Articles in the same Issue

  1. Frontmatter
  2. Minireview
  3. The effect of endurance, resistance training, and supplements on mitochondria and bioenergetics of muscle cells
  4. Reviews
  5. Cellular cross talk between epicardial fat and cardiovascular risk
  6. The physiological insight of Coenzyme-Q10 administration in preventing the incidence of reperfusion arrhythmia among patients undergoing coronary artery bypass grafting surgery
  7. Is it possible to treat nonalcoholic liver disease using a flavanol-based nutraceutical approach? Basic and clinical data
  8. An overview of post COVID sequelae
  9. Clinical implications of anti-idiotype antibodies in COVID-19
  10. Original Articles
  11. Monocyte chemoattractant protein-1 levels are associated with major depressive disorder
  12. Detection of soluble suppression of tumorigenicity 2 and N-terminal B-type natriuretic peptide in a rat model of aortic regurgitation: differential responses to omecamtiv mecarbil
  13. Preoperative monocyte-to-lymphocyte ratio as a potential predictor of bladder cancer
  14. AICAR promotes endothelium-independent vasorelaxation by activating AMP-activated protein kinase via increased ZMP and decreased ATP/ADP ratio in aortic smooth muscle
  15. Moderate-intensity exercise decreases the circulating level of betatrophin and its correlation among markers of obesity in women
  16. Impact of muscle mass on blood glucose level
  17. Behavioral alterations, brain oxidative stress, and elevated levels of corticosterone associated with a pressure injury model in male mice
  18. Patterns of drug therapy, glycemic control, and predictors of escalation – non-escalation of treatment among diabetes outpatients at a tertiary care center
  19. Pattern, severity, and outcome of adverse drug reactions in a tertiary care hospital: an evidence from a cross-sectional study
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