Evaluation of drug usage and expenditure in a hospital diabetes clinic

Pattern of anti-diabetic drugs prescribed in a tertiary care hospital of Bangladesh

Background

Globally, diabetes mellitus is a common endocrine disorder. This study was conducted for collecting the demographic details of diabetic patients and determining the pattern of drugs prescribed among them in outpatient department of a tertiary healthcare center.

Methods

A descriptive type of cross-sectional study was carried out at the outpatient department of Endocrinology, Dhaka Medical College Hospital, Bangladesh from 1 May to 31 July, 2015. Diabetic patients receiving the management for at least 6 months were enrolled and interviewed by the researchers after getting informed written consent. Structured case record form was used for demographic data & prescription details. Data were analysed using computer in SPSS 22 and Microsoft Excel 2010.

Results

Altogether 105 patients, 40 males (38.1%) and 65 females (61.9%) were enrolled with urban predominance (69.5%) where 51 (48.6%) were in the age group 47-61 years with a mean of 53.4 (SD±10.6) years. 70 (66.7%) had diabetic history of less than 5 years and 66 (62.9%) had at least one concurrent illness. Hypertension accounted for majority (34.3%) of complications. On an average, 5.62 (SD±3.16) drugs were advised per prescription for diabetes as well as associated co-morbidities and majority (23.8%) had 4 drugs. The majority of drugs (74.3%) were from local manufacturers. Most patients (62.9%) were prescribed with oral drugs singly. Metformin alone predominated in 41% prescriptions followed by the combination of Metformin and Sitagliptin (31.4%).

Conclusions

The findings can serve as a guide to choose the formulation and combination of anti-diabetic drugs in this part of the world before developing & marketing any new drug.

Evaluation of antidiabetic prescriptions, cost and adherence to treatment guidelines: A prospective, cross-sectional study at a tertiary care teaching hospital

Introduction:

Diabetes mellitus is on alarming rise in India. Drug utilization studies help to identify the adherence to standard treatment guidelines and to evaluate the rational drug usage.

Objective:

To study prescription pattern, calculate the cost of antidiabetic drugs and to evaluate the adherence to treatment guidelines in diabetic patients attending the medicine outpatient department in a tertiary care teaching hospital.

Materials and Methods:

A prospective observational study was carried out for a period of 5 months. The diabetic patients who visited the medicine outdoor department were included. Demographic data and complete prescription details were recorded in the structured case record form. Cost of the drug therapy was calculated from the patient's bills. Indian Council for Medical research guidelines-2005 for diabetes management was used to evaluate the adherence.

Results:

A total of 250 patients were enrolled in the study with mean age 57.91 ± 9.37. Out of 250 patients 126 (50.4%) were male and rest were female. A total of 1,391 drugs were prescribed, with mean of 5.56 ± 2.52 drugs and out of which 539 drugs were antidiabetics with mean of 2.18 ± 0.96. In monotherapy, metformin was frequently 218 (40.45%) prescribed. Glimepiride and metformin was the most frequently prescribed in 119 (76.28%) out of 156 antidiabetic drug combinations. Most commonly used drugs other than antidiabetics were aspirin 146 (18.9%) and atorvastatin 119 (15.41%). Mean cost of therapy for a month for a diabetic patient was 354.60 ± 305.72 INR. Majority 209 (83.6%) of prescriptions was in accordance to guidelines.

Conclusion:

Metformin was the most frequently prescribed drug in the diabetes patient. Metformin and glimeperide being the most frequent combination used. Majority of the prescriptions followed standard guidelines.

Study of drug utilization pattern of antihyperglycemic agents in a South Indian tertiary care teaching hospital

Objective:

To determine the drug utilization pattern of antihyperglycemic agents (AHA) in a tertiary care teaching hospital.

Materials and Methods:

This was a prospective observational study. All the relevant data were collected and drug utilization pattern of AHA was determined. Direct cost associated with the use of antihyperglycemic medicines was calculated and consumption of the antihyperglycemic medicines was measured as defined daily dose (DDD)/100 bed-days. The adverse drug reactions (ADRs) related to anti-diabetic medicines were monitored.

Statistical Analysis Used:

Chi square test (χ²), mean±standard deviation.

Results:

During the study period, 350 patients diagnosed as diabetes mellitus (DM) were admitted. Insulin was prescribed as monotherapy to 81% and to 52% patients during hospital stay and discharge, respectively. Increase in utilization of insulin was recorded in majority of the patients due to presence of co-morbid conditions or resistance to oral hypoglycemic drugs. Use of insulin at the time of discharge decreased significantly (P<0.05) by 29%. Among the oral AHA, combination of glimepiride with metformin was more prevalent during hospital stay and at the time of discharge monotherapy of metformin followed by glimepiride was more prevalent. During hospital stay, cost of AHA was found to be Rs. 95.27 ± 119.03. The total antihyperglycemic drug consumption in the medicine ward during study period was 13.42 DDD/100 bed-days. Fifty ADRs were reported and descriptions of ADRs were found to be only hypoglycemia.

Conclusion:

The study exhibited a significant increase in the utilization of two drug combination therapies and monotherapy of oral AHA and decrease in the utilization of insulin at the time of discharge.

Trends in the use of oral antidiabetic drugs by outpatients in Taiwan: 1997-2003

OBJECTIVE

To define the prescribing patterns of oral antidiabetic drugs (OADs) in Taiwan over a 7-year period (1997-2003) and to critically comment on changes observed.

METHODS

A cross-sectional study design was implemented using data from Taiwan's National Health Insurance Research Database between January 1997 and December 2003. Outpatients who were 18 years or older and had at least an OAD claim during the study period were identified. The unit of analysis was each OAD prescription for diabetic outpatient visits. The prescribing trends were described in terms of annual changes in prescribing rates and patterns.

RESULTS

The numbers of OAD prescriptions rose 1.23-fold. The sulfonylurea (SU) class was the most commonly used OAD, but the prescribing rates for this class declined over time. The biguanide (BG) class was the second most frequently prescribed OAD class and its prescribing rate initially increased, peaked in 2000, and then substantially decreased. The largest increase in prescribing was for acarbose use. The prescribing rates of two new classes of OAD, meglitinide (MG) and thiazolidinedione (TZD), also significantly increased within a short period of time. A trend towards combination therapy was observed away from monotherapy. The SU class was the most commonly prescribed as monotherapy. SU plus BG was the most commonly prescribed dual therapy. Triple oral therapy showed a significant ninefold increase.

CONCLUSION

The prescribing rates of OADs are shifting from the older OADs (i.e. SUs) to newer OADs [i.e. alpha-glucosidase inhibitor (AGI), MGs, and TZDs]. The prescribing patterns of OADs are moving toward combination therapy, especially triple oral therapy.

Using a pharmacoepidemiological approach to estimate diabetes type 2 prevalence in Portugal

PURPOSE

To estimate the prevalence of drug-treated diabetes type 2 in Portugal using drug consumption data and accounting for the proportion of patients treated with combinations of oral hypoglycaemic agents (OHAs).

METHODS

The prevalence of diabetes treated by OHAs was calculated on the basis of: IMS-Health data for Portugal (2003) and two measures of daily drug intake-defined daily dose (DDD) and prescribed daily dose (PDD), after correcting for the proportion of patients treated with two or more OHAs. The PDD and proportion of patients in combination therapies have been obtained in a descriptive, cross-sectional national survey, conducted in 2003, by inquiry of 1,046 type 2 diabetics country wide distributed.

RESULTS

Drug use study: We have studied 1046 type 2 diabetics (539 women, 501 men, 6 sex unknown), with a mean age of 64.5 (SD=11) years. OHAs were prescribed as monotherapy in 46.8% (489/1,046) of the patients and the remaining 557 (53.2%) received from 2 to 4 OHAs concomitantly.Diabetes prevalence: Using DDD as the mean daily intake consumption unit, the prevalence of drug-treated type 2 diabetes was 4.15%, which dropped to 2.52% when the proportion of OHAs associations was taken into account. Using PDD these values were 4.48% and 2.72%, respectively.

CONCLUSIONS

Since a high proportion of patients are treated with combination of OHAs in clinical practice, it is imperative to account for that confounder in order to improve the accuracy of estimate from drug consumption data. The use of this methodology provided a slight under-estimation of diabetes prevalence, compared with the National Health Authorities values (3%-5%). Nevertheless we consider this as an efficient tool to estimate drug-treated diabetes prevalence that should be implemented in a regular way for longitudinal observations, in order to generate signals.

How does the prognosis of diabetes compare with that of established vascular disease? Insights from the Canadian Vascular Protection (VP) Registry

BACKGROUND

Diabetes mellitus is a major risk factor for atherosclerotic cardiovascular disease. In a large, prospective, practice-based registry (the Vascular Protection Registry), we enrolled patients with vascular disease and/or diabetes, and compared the following features between diabetic and non-diabetic participants: (1) risk factor profiles, (2) utilization of cardioprotective medications, and (3) cardiovascular outcomes in short-term follow-up.

METHODS

Patients were enrolled by participating physicians practicing in family medicine or specialty practices across Canada. The primary outcome was a composite of the first occurrence of any of the following vascular events: myocardial infarction, unstable angina, coronary revascularization, stroke, transient ischemic attack, or death. Patients were stratified according to the presence or absence of cardiovascular disease and diabetes.

RESULTS

In all, 3297 patients were available for analysis (972 [30%] with diabetes but no cardiovascular disease; 899 [27%] with both diabetes and cardiovascular disease; and 1425 [43%] with cardiovascular disease but no diabetes). Most of the measured risk factors were worse for patients with diabetes. Compared to non-diabetic patients, diabetes was associated with substantial undertreatment with cardioprotective medications, including antiplatelet agents, beta blockers, and statins. During a mean follow-up of 10 (SD 3.3) months, patients with both diabetes and cardiovascular disease had the worst prognosis, with the primary outcome occurring at a rate of 16.3 per 100 person-years of follow-up.

CONCLUSIONS

Patient registries provide a powerful tool for examining treatment patterns, risk factors, and outcomes. Patients with both cardiovascular disease and diabetes had the highest rates of adverse vascular outcomes. Possible reasons include relatively worse risk factor profiles and undertreatment with proven cardiovascular medications.