Pattern of Antidiabetic Drugs Use in a Diabetic Outpatient Clinic of a Tertiary Health Institution in Sokoto, North-western Nigeria

Combination Therapy in Diabetes Mellitus Patients Attending Outpatient Department in a Tertiary Care Centre: A Descriptive Cross-sectional Study

Introduction

Assessing anti-diabetic drug use patterns in hospitals is an important activity which helps to promote the rational use of drugs and may suggest measures to change prescribing habits for the better. This study aimed to find the use of combination therapy in diabetes mellitus patients attending the outpatient department of a tertiary care centre.

Methods

A descriptive cross-sectional study was conducted among 201 diabetes mellitus patients in the internal medicine department from 2 March 2022 to 30 June 2022 for a duration of four months after approval from the Institutional Review Committee (Protocol No: IRC-LMC-01/R-022). Diabetic patients prescribed at least one anti-diabetic drug in prescription forms were included. Socio-demographic profiles, clinical characteristics and anti-diabetic drug use pattern-related data were collected. Convenience sampling was used. Point estimate and 95% Confidence Interval were calculated.

Results

Among 201 patients, 134 (66.66%) (60.14-73.18, 95% Confidence Interval) patients were given combination therapy. The most common combination therapy was metformin 500 mg and sitagliptin 50 mg. A total of 324 anti-diabetic drugs were used. The average number of drugs prescribed per patient was 1.6±0.7. The number of anti-diabetic drugs prescribed by generic name and from the national essential drugs list was 74 (22.83%) and 188 (58.02%) respectively. Biguanides were used in 176 (87.56%) patients.

Conclusions

These findings were similar to some other studies conducted in similar settings. In most patients, combination drug therapy was more prevalent. Among combination therapy, two drug combinations were more prevalent.

Keywords

diabetes mellitus; drug combinations; outpatients; teaching hospital.

Drug Utilization Study of Antidiabetic Drugs in Patients Attending Geriatric Outpatient Department at a Tertiary Care Hospital

Introduction Diabetes has increased in prevalence from 108 million individuals in 1980 to 463 million individuals in 2021. As people's life expectancies have risen, it's become increasingly necessary to be worried about diseases that affect the elderly. To focus and manage these diseases effectively, the illumination of current knowledge about the pattern of anti-diabetic drug utilization in the elderly is important. As a result, it is necessary to evaluate the pattern of anti-diabetic medication use among diabetes patients of the geriatric age group and determine if there is room for improvement in light of current knowledge. With this information, we intend to provide feedback and suggestions for the health care providers. This research aimed to study and analyze the drug utilization of antidiabetic medications in patients attending the geriatric outpatient department. Methods The data of 600 patients visiting the geriatric outpatient department from January 1, 2016 to September 30, 2017 were collected from the electronic medical record (EMR) database. The protocol was designed using Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Subjects were grouped according to gender, age, drug combination use, and underlying co-morbidities. Indicators of drug usage and the total number of drugs prescribed and prescription patterns were analyzed. Then, the recorded data were classified according to the anatomical therapeutic chemical (ATC) - daily defined dose (DDD) classification. Prescribed daily dose (PDD) values and PDD/DDD ratio of antidiabetic drugs prescribed to a sample of patients (n=600) were calculated. Cost analysis of the prescribed drugs was analyzed and the cost index for each drug is described. Results A total of 600 diabetic patients (286 males) were recruited in the study. In the study, the average age of participants was 69.30±11.34 years. The most common comorbidity associated with diabetes mellitus (DM) was hypertension followed by hypertension along with chronic heart disease. Glibenclamide and pioglitazone (thiazolidenediones) had PDD/DDD ratio equal to 1. The ratios for glimepiride (sulfonylurea), metformin (biguanides), sitagliptin (sodium-glucose cotransporter 2 inhibitor), insulin glargine, insulin lispro, insulin aspart, were 1.85, 1.29, 1.66, 1.63, 1.42, and 1.21, respectively, whereas the premixed insulin had a ratio of 0.83. The average cost per prescription was USD 3.36 and around 87.72% of the cost per prescription was due to the prescribed antidiabetics. Metformin + glibenclamide was the most commonly prescribed combination followed by metformin + glimepiride. Conclusion On the whole, the principles of rational prescription were followed in accordance with the different WHO drug usage indicators. Many of the drugs prescribed by generic name were supplied from hospital pharmacy thus reducing the burden to some extent.

Pattern of Disease and Therapy for Diabetes along with Impact of Generic Prescribing on Cost of Treatment among Outpatients at a Tertiary Care Facility

Background:

India has become the diabetes capital of the world. Analyzing trends in drug prescribing helps in judging rationality of prescriptions in different settings. This study aimed to assess disease and prescribing trends with a special emphasis on evaluating use of metformin, insulin, fixed dose combinations (FDCs), concomitant medications, pill burden, and costs of drug therapy in diabetes.

Materials and Methods:

This was a cross-sectional study in which patients of either sex who attended the diabetes clinic at a tertiary care center over 9 months were included consecutively. Basic demographic profile, clinical, and treatment details on the day of visit were collected from the prescription charts. Drug costs for prescriptions were calculated using generic and median brand prices of formulations using a recognized commercial drug directory and generic price list of the government, respectively. Data were analyzed by using Microsoft Excel and Open Epi online software to compare results with published studies.

Results:

Average age of diabetics was 53.9 ± 11.8 years and disease duration was 8.13 ± 7.78 years in 336 prescriptions analyzed. Dual drug regimens were seen in 32.7% prescriptions, most commonly metformin and sulfonylureas, followed by triple drug regimens (25%) with inhibition of dipeptidyl peptidase IV (DPP IV) inhibitor. Metformin was prescribed in 95% prescriptions (mean dose 1511 ± 559.87 mg) and insulin in 22.6% prescriptions. Angiotensin receptor blocker (ARBs) and statins were the most commonly prescribed concomitant drugs. One FDC per prescription (median) each for diabetes and comorbidities were prescribed. Daily pill burden was 4.59 ± 2.65 pills. The median monthly cost of drug therapy with branded prescribing was INR 870.43 and INR 393.72 with the use of generics. Inferences drawn by comparison with published data showed variable results for different parameters analyzed.

Conclusion:

Disease pattern was as expected for the region and trends of therapy showed concurrence with rational prescribing. Pill burden and cost of therapy remain high with a significant contribution of comorbidities.

Impact of generic substitution practice on care of diabetic patients

BACKGROUND

Patients with chronic diseases like type II diabetes mellitus often have their prescriptions substituted with generic medicines in the course of care to save costs of medicines and to improve access. There is need to assess impact of this practice on patient care.

OBJECTIVE

To assess patient's knowledge of generic substitution practice and its impact on patient care.

SETTING

An outpatient diabetic clinic of a tertiary hospital in Nigeria.

METHOD

The study is a cross sectional survey of patients attending a diabetic clinic. A structured questionnaire was used to interview willing patients. A total of 120 patients were enrolled for the study, but only 102 responded (85 % overall response rate).

MAIN OUTCOME MEASURES

Patients' knowledge of generic substitution practice, patients' report of abstaining from drug use, experiences of more side effects and patients' confusion.

RESULTS

Over half (57.8 %) of surveyed patients (n = 59) had noticed brand switches, out of which, 30.5 % experienced brand switches more than 3 times within a year. More than a third of the respondents (38.6 %) did not know when pharmacists actually substituted their medicines. About one in five (19.6 %) patients did not use their medicines after substitution because they were not sure of the brand supplied but 35.6 % have rejected substitution at one time and insisted on doctors' prescription. Respondents (14.9 %) agreed that brand substitution resulted in confusion while 24 % reported receiving brands that resulted in more side effects. More respondents (58.6 %) indicated that they never had a discussion with their pharmacists about the reasons for generic substitution and switches.

CONCLUSION

Generic substitution without adequate information resulted in confusion and subsequent lack of adherence. There is the vital need for appropriate policy and guidelines for generic substitution in Nigeria.