Publication:

Assessment of prescribing pattern, adverse drug reactions and drug information sources in middle aged diabetic hypertensives at a tertiary care hospital in central India: a prospective observational study

Background Prescription pattern studies are powerful exploratory tools to ascertain the role of drugs in society. Aim of this study is to analyze the prescription pattern and adverse drug reactions (ADRs) of type-2 diabetes mellitus (T2DM) with co-existing hypertension in a tertiary care hospital and fulfill the drug information needs of the physician and give feedback to the prescribers to improve quality of healthcare.

Methods An observational cross-sectional study is conducted in general medicine OPD at tertiary care hospital in central India after approval of IEC for a period of 1 year and 6 months. The data of prescriptions of patients having T2DM with co-existing hypertension and patient specific queries on drug information were collected and interpreted using WHO Core drug use prescribing indicators, JNC 8 and American diabetes association 2021 guidelines for hypertensive diabetic patients. Suspected ADRs reporting forms were analyzed by ADR causality and severity assessment scales.

Results Study population included 160 patients with T2DM and co-existing hypertension. Most common antidiabetic class of drugs prescribed was biguanides (79.4%) followed by sulfonylureas (76.3%). Insulin was prescribed to 25% of the study population. Calcium channel blockers (CCB) (41.3%) were the most prescribed antihypertensive class of drugs followed by ACE inhibitors (37.5%). Polypharmacy was seen in 29.4% of the study population. In the study population, number of patients with drug information queries were 56 (35%), commonest queries being adverse effects and dosage of drugs. ADRs reported were only 12 (7.5%) of 160 patients, hypoglycemia (3.75%) being most common under study, indicating under reporting.

Conclusions In this study, monotherapy was more often prescribed than the combination drug therapy. biguanides (metformin) and CCBs (amlodipine) were the most frequently prescribed agents among oral hypoglycemics and antihypertensive. Diabetes and hypertension when coexist multiply the risk of many hazardous complications which can kept in check by rational prescribing using WHO drug use indicators and adhering to recent standard treatment guidelines. Pharmacovigilance awareness at every level of health care system regarding ADR reporting is of utmost importance.