Assessment of Drug Utilization Pattern, Prescription Appropriateness and Glycaemic Control Among Patients with Type 2 Diabetes Mellitus in a Tertiary Care Teaching Hospital: A Prospective Observational

Abstract

Background: Type 2 diabetes mellitus (T2DM) is a chronic progressive disorder that requires long-term, multi-drug therapy. Periodic evaluation of prescribing patterns and their appropriateness is essential to promote rational drug use and achieve optimal glycaemic control.

Objectives: To evaluate the drug utilization pattern, assess the appropriateness of prescriptions and determine the glycaemic control among patients with T2DM attending a tertiary care teaching hospital.

Materials and Methods: A prospective observational study was conducted for 12 months in the medicine outpatient and inpatient departments of a tertiary care teaching hospital. Three hundred adult patients with T2DM were enrolled and followed for six months. Prescriptions were analysed using the WHO prescribing indicators, the Anatomical Therapeutic Chemical (ATC) classification and a guideline-based appropriateness checklist (ADA 2021, RSSDI 2018 and ICMR 2018). Glycaemic control was assessed by fasting blood sugar (FBS), post-prandial blood sugar (PPBS) and glycated haemoglobin (HbA1c) at baseline, 3 months and 6 months. Data were analysed with SPSS version 26; p < 0.05 was considered significant.

Results: The mean age was 56.4 ± 11.2 years and 56.0% were men. A total of 1,842 drugs were prescribed (6.14 per prescription), of which 848 (2.83 per patient) were antidiabetic agents. Metformin was the most frequently prescribed drug (82.3% of patients), followed by sulfonylureas (66.0%) and DPP-4 inhibitors (48.3%). Fixed-dose combinations were used in 47.3% of patients and only 33.2% of drugs were prescribed by generic name. Overall, 211 prescriptions (70.3%) were appropriate, while 89 (29.7%) had at least one inappropriate element; the commonest were non-use of an indicated SGLT2 inhibitor/GLP-1 receptor agonist (7.3%) and omission of metformin without contraindication (9.7%). Potential drug-drug interactions were seen in 44.7% of patients. Among 268 patients who completed follow-up, mean HbA1c fell from 8.38 ± 1.68% to 7.46 ± 1.44% (p < 0.001), and the proportion achieving HbA1c < 7% rose from 16.0% to 36.6%. Target attainment was higher with appropriate prescriptions (43.2% vs 20.5%; p = 0.001). Adverse drug events occurred in 31.3% of patients; hypoglycaemia (12.7%) was the commonest serious event.

Conclusion: Prescribing in this hospital was largely guideline-concordant with metformin-based therapy as the cornerstone; however, low generic prescribing, polypharmacy, under-use of cardio-renal protective agents and suboptimal glycaemic control highlight areas for intervention through prescriber education, clinical pharmacist involvement and periodic prescription audit.