DOI: http://dx.doi.org/10.26510/2394-0859.pbe.2017.32

Research Article

Study on the prescribing pattern of anti-diabetic drugs in community clinic in Uttar Pradesh state

Suresh Chandra*, Mohd. Adil Khan, Anand Mohan

Department of Pharmacy, Pranveer Singh Institute of Technology, Bhauti, Kanpur, Uttar Pradesh, India

*For correspondence

Dr. Suresh Chandra,

Department of Pharmacy, Pranveer Singh Institute of Technology, Bhauti, Kanpur, Uttar Pradesh, India.

Email: sureshcology81 @gmail.com

 

 

 

 

 

 

 

 

 

Received: 11 May 2017

Revised: 19 June 2017

Accepted: 20 June 2017

ABSTRACT

Objective: The diabetes mellitus is most common diseases. Which are spread all over the world. At they are change in modified in life style disease in this study where the prescribe drugs while using in the diagnostic and treatment of diabetes mellitus .the most commonly use drugs Sitagliptin +Metfomin in the community clinic in U.P. In the survey which are found to be the prescription pattern in Jajmau (Kanpur, U.P.) areas the most common drug which are running Sitagliptin + Metformin the survey which are randomly collect the prescription there are many variation in prescribing pattern of diabetes mellitus .the prescribing pattern is most strong tools to role of drug use in the society which are treat the DM during medication follow the proscription pattern of the drugs. There is need for appropriate safe &effective treatment and economical study to find out the pattern of drug therapy among DM.

Methods: In this study the method randomized and non randomized study design was conducted in October 2016 – November 2016 community clinic in U.P. this study found to the date which group gender in fasting blood sugar various classes of drugs analyzed them.

Results: A total of 200 patients were included in this one month's study. All the patients had Type 2 diabetes. Metformin is the drug of choice and Sitagliptin is the most preferred combination with Metformin.

Conclusions: Insulin was not preferred as mono-therapy. Despite combination therapy, the postprandial glucose levels were not in range–suggesting either poor patient compliance or inadequate dosing/inappropriate therapy. In addition to drugs, the services of a clinical pharmacist might be helpful in these patients. Metformin is the drug of choice and Sitagliptin is the most preferred combination with Metformin.

Keywords: Prescription pattern, Diabetes mellitus, Oral hypoglycemic agents, Community clinic

Introduction

Diabetes mellitus (DM) is an epidemic disease that has struck each and every corner of the world. According to the Indian council of medical research-Indian diabetes study (ICMR), a national diabetes study currently has 62.4 million people with diabetes.1 This is set to increase to over 100 million by 2030.2 The prevalence of diabetes among adults has reached approximately 20% in urban and approximately 10% in the rural population in India.3 Indian onset of diabetes is about a decade earlier than their western counterparts.4 Diabetes treatment depends on the type and severity of the diabetes. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Insulin is vital to patients with type 1 diabetes they cannot live without a source of exogenous insulin. Type 2 diabetes is first treated with weight reduction, a diabetic diet and exercise when these measures fail to control the elevated blood sugars and oral medications are used. If oral medications are still insufficient, insulin medications are considered.5 Various classes of anti-diabetic drugs including insulin and oral hypoglycemic agents (OHA) are currently used in the treatment of diabetes, which acts by different mechanisms to reduce the blood-glucose levels to maintain optimal glycemic control.6,7 Hypertension (HT) is frequently associated with diabetes mellitus (DM) and its prevalence doubles in diabetics compared to the general population. This high prevalence is associated with increased stiffness of large arteries, which often precedes macro vascular events.8 The rapidly growing number of patients with coexisting diabetes and hypertension must be intensively treated to protect them from their very high risk for premature cardiovascular morbidity and mortality.9

Recent research into the pathophysiology of type 2 DM has led to the introduction of new medications like glucagon-like peptide 1 analogues: dipeptidyl peptidase-IV inhibitors, inhibitors of the sodium-glucose co-transporter 2 and 11ß-hydroxysteroid dehydrogenate 1, insulin-releasing glucokinase activators and pancreatic-G-protein-coupled fatty-acid-receptor agonists, glucagon-receptor antagonists, metabolic inhibitors of hepatic glucose output and quick-release bromocriptine. Inhaled insulin was licensed for use in 2006 but has been withdrawn from the market because of low patronage.

Type 2 diabetes mellitus (DM) is a chronic metabolic disorder in which prevalence has been increasing steadily all over the world. As a result of this trend, it is fast becoming an epidemic in some countries of the world with the number of people affected expected to double in the next decade due to increase in ageing population.10

Diabetes mellitus is a metabolic disorder resulting from irregular secretion of insulin. The insulin deficiency causes chronic hyperglycemic disturbances which are carbohydrate protein fat metabolism.in this century the DM is a life style diseases which concerned spread in All over the world.

DM is two described which one is type one DM and type 2 DM the type 1- DM which are these are insulin dependent and type 2 are non-insulin dependent.

The type 1 DM changes of life style modification such as fasting regular exercise and taken insulin normally and the other hand the type two DM are not treat with the changes of life style modification. The type two DM are treat with oral hypoglycemic drugs sulfonylurea. Bigunides thiazolidine alpha glycosidase inhibitor which are used. The type 2 DM glucose level cannot control by diet and weight loss and regular exercise.in the population where 80% are here in DM type 2. The complication of DM which are 70-80% death among.

Type 1(1a,1b)- ß-cell destruction with little or no

  • Endogenous
  • Insulin secretory capacity
  • Autoimmune
  • Idiopathic

Type 2 Ranges From Relative Insulin

  • Deficiency to disorders of insulin
  • Secretion and insulin resistance

Other specific types genetic defects of ß-cell function

  • Genetic defects in insulin
  • Secretion
  • Diseases of the exocrine pancreas
  • Endocrinopathies
  • Drug-induced or chemical induced
  • Infections (congenital rubella,
  • Cytomegalovirus and others)
  • Uncommon forms of immune mediated
  • Diabetes
  • Other genetic syndromes
  • Sometimes associated with
  • Diabetes
  • Gestational diabetes.

Materials and Methods

Inclusion criteria

Inclusion criteria was any type-II Diabetic patient (male/female).

Exclusion criteria

Exclusion criteria were patient with sever medication history; Comorbid patient should be excluded; pregnant/Lactating women.

Work conducted in October 2016 –November 2016 community clinic in U.P. The intended work was divided into the following steps.

Primary stage

In the first step which collect the prescription of pattern diagnose with diabetes mellitus.

Secondary stage

In the second step to separate the prescriptions prescribing Anti Diabetic Drugs and the ones without anti diabetic drugs.

Territory stage

To divide the prescriptions into various groups according to the following: Age and sex of patient and diseases associated with DM.

Quaternary stage

To statistically analyze the prescriptions on the following aspects

  • Demographic characters of patients.
  • Showing incidence of DM according to sex.
  • Showing incidence of DM according to different age groups.
  • Analysis of Prescription in DM with respect to dosage forms.
  • Analysis of prescription showing incidence with other diseases.
  • Patterns of utilization of major Pharmacological drug classes.

Penta stage

To analyze the frequency of diseases associated with DM statistically and the drugs according to their pharmacological categories.

Hexa stage

In the last step we are collect all over the prescription and taken to separate accordingly over the patients.

Location The study was conducted in the Community Clinic, Jajmau, Kanpur Nagar, U.P. State.

Study design

It was a retrospective randomized non interventional study

Study period data were collected from September 2016 to November 2016 in between 9 am to 10 pm in the Nasir Khan Hospital Jajmau.

Out of 200 patients, most of the patients 600 were in the age group of 55-65 years while, 25 were in the age group of 30-40 years, followed by 22 were in age group of 45-50 years and 12 were in age group of 65-70 years. These demographic characteristics related to age and gender were shown in the table 1. A total of 6 drugs were used during the time of study, in which Sitagliptin+metformin was the most preferred drug combination followed by glimepiride+metformin. The former was used in 60 prescriptions while latter was used in 45 of them. The less commonly used anti-diabetic drugs were human insulin and isophane insulin. They were used in only.

Results and Discussion

A total of 200 patients were included in this two months study. All the patients had Type 2 diabetes, the patients were on treatment for Type 2 Diabetes. The mean fasting Blood sugar was 118±40.34 mg/dl, while the mean post-pyramidal blood sugar was 245.75±67.35 mg/dl. The average number of OHAs per prescription was 1.99±0.54. About 22% of the patients were on mono-therapy with Metformin, while all the other patients received a combination of oral hypoglycemic agents. Insulin was used in 2.75% of the patients. Among combinations, the most commonly used combination was Sitagliptin +metformin 30% number of prescription.

Table 1: Classification of diabetes.

Name of the drug Dosage form Number of prescription % of prescribe drug
Sitagliption+metformin 50 mg+500 mg 60 60
Metformin 250 mg - 500 mg 45 40
Glibencilamide+metformin 300 mg+500 mg 49 50.6
Glimpride+metformin 300 mg+500 mg 46 45.6

 

In the study we perfumed in U.P state area and the drugs are prescribed mostly sitagliption+metformin the sitagliptin +metformin was prescribed above 60 prescription per day and almost many other drugs like metformin and glimpride are much better as well prescribed but not more then 46 patients. Out of 200 patients, most of the patients 50 were in the age group of 55-65 years while, 25 were in the age group of 30-40 years, followed by 22 were in age group of 41-50 years and 12 were in age group of 61-70 years. These demographic characteristics related to age and gender were shown in the Table 1. A total of 6 drugs were used during the time of study, in which sitagliptin+metformin was the most preferred drug combination followed by glimepiride+ metformin. The former was used in 30% prescriptions while latter was used in 23% of them. The less commonly used anti-diabetic drugs were human insulin and isophane insulin.

Conclusions

The study of randomized and non randomized controlled which are not prefers in insulin because of most of the patient are type 2 DM whereas the using medication on oral hypoglycemic agent such as Sitagliptin and Metformin. On the other hand there is some glimepiride and metformin are rarely use in the practices of physician bust mostly physician are use in the treatment of DM, Sitagliptin and metformin.

Funding: No funding sources

Conflict of interest: None declared

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