A PROSPECTIVE STUDY OF PRESCRIBING PATTERN OF INSULIN IN PATIENTS WITH TYPE 2 DIABETES MELLITUS ADMITTED IN MEDICINE WARDS

SHRUTI VIHANG BRAHMBHATT; RUSHI DEWANG DAVE; HITANSHI BHARATBHAI PATEL

doi:10.22159/ajpcr.2025v18i5.54035

Authors

SHRUTI VIHANG BRAHMBHATT Department of Pharmacology, Shrimati Bhikhiben Kanjibhai Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, India https://orcid.org/0000-0002-3549-1132
RUSHI DEWANG DAVE Department of Pharmacology, Shrimati Bhikhiben Kanjibhai Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, India
HITANSHI BHARATBHAI PATEL Department of Pharmacology, Shrimati Bhikhiben Kanjibhai Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, India. https://orcid.org/0009-0008-9911-1697

DOI:

https://doi.org/10.22159/ajpcr.2025v18i5.54035

Keywords:

Human actrapid, Oral hypoglycemic agents, Adherence, Type 2 Diabetes mellitus, Sliding scale

Abstract

Objective: The prevalence of Diabetes Mellitus is increasing exponentially. The present research is mainly focusing on study the prescription pattern and rationality of insulin prescribed in patients with type 2 Diabetes. It also reviews acceptance to the insulin therapy in type 2 diabetes patients. This research focuses on events of adverse drug reaction and also reviews adherence with the latest American Diabetic Association (ADA) guidelines.

Methodology: A study was conducted in 50 diabetic patients admitted in medicine wards. Patients were included in the study only after obtaining written informed consent form. Fasting blood sugar and post prandial blood sugar level was noted on the day of admission and on the day of discharge.

Result: Out of 50 patients, human actrapid (HAI) according to sliding scale was the most commonly prescribed (66%) insulin followed by HAI + Lantus (30%) and mixtard (4%). In addition to insulin, 23 patients (46%) were given oral hypoglycemic agents out of which majority (60.8%) were on combination therapy with metformin, sulfonylureas and DPP-4 inhibitors. Total 28% of patients had shown adherence and acceptability with the therapy. About 86% of prescriptions in present study were adherent to guidelines of American Diabetes association.

Conclusion: Study shows that HAI therapy according to sliding scale remains the first choice of treatment in type 2 diabetes patients in rural area where data is insufficient. Poor adherence was observed among the patients towards insulin therapy which may be due to lack of awareness.

Downloads

Download data is not yet available.

References

Katzung BG, Trevor AJ (Eds): Basic and Clinical Pharmacology: 13th ed: Lange Medical Book, McGraw-Hill Education (India), New Delhi, 2015; p.753-755.

Baruah MP, Kalra S, Bose S, Deka Tripathi KD. Essentials of medical pharmacology. 8th ed.: Jaypee Brothers Medical Publishers (P) Ltd: New Delhi, 2021. p.280.

International Diabetes Federation. IDF diabetes Atlas 2019 and 2021. Available at: https:// www. https://diabetesatlas.org/. Accessed on January 31, 2022

World Health Organization. The top 10 causes of death. [Last accessed on 2023 May 22). Available from: http://www.who.int/en/news-room/fact-sheets/detail/the-top-10-causes- of-death

J. An audit of insulin usage and insulin injection practices in a large Indian cohort. Indian J Endoer Metab 2017; 21:443-52.

Mathew P, Thoppil D. Hypoglycemia. 2022 Dec 26. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan PMID: 30521262.

Tandon N, Kalra S, Balhara YP, Baruah MP, Chadha M, Chandalia HB, et al. Forum for injection technique (FIT), India: The Indian recommendations 2.0, for best practice in insulin injection technique, 2015. Indian J Endocrinol Metab 2015;19:317-31.

Thakur S. Thakur, R. Unequal burden of equal risk factors of diabetes between different gender in India: a cross-sectional analysis. Sci Rep 11, 22653 (2021)

Singla R, Bindra J, Singla A, Gupta Y, Kalra S. Drug prescription patterns and cost analysis of diabetes therapy in India: Audit of an endocrine practice. Indian J Endocrinol Metab 2019:23:40-5.

Kesavadev J, Murthy LS, Chaudhury T, Yalamanchi SR, Giri J, Gupta S. Phatak S, Modi KD, Chatterjee S, Manjunath A, Revanna M, Bhattacharya A. One-year safety and effectiveness of insulin degludec in patients with diabetes mellitus in routine clinical practice in India-TRUST (Tresiba real-world use study). Metabol Open. 2022 Apr 18:14:100184.

Tiwari K, Bisht M, Kant R, Handu SS. Prescribing pattern of anti-diabetic drugs and adherence to the American Diabetes Association's (ADA) 2021 treatment guidelines among patients of type 2 diabetes mellitus: A cross-sectional study. J Family Med Prim Care 2022:11:6159-64

Dhananjay K, Sree JD. A study of drug utilization pattern of antihyperglycemic agents in diabetes mellitus cases of a rural Telangana population. Med Pulse Int J Pharmacol 2019:11:1-5.

Padhi S, Nayak AK, Behera A. Type II diabetes mellitus: a review on recent drug based therapeutics. Biomed Pharmacother. 2020 Nov; 131:110708.

Silver B, Ramaiya K, Andrew SB, Fredrick O, Bajaj S, Kalra S, Charlotte BM, Claudine K. Makhoba A. EADSG Guidelines: Insulin Therapy in Diabetes. Diabetes Ther. 2018 Apr;9(2):449-492.

Kumar S, Mittal A, Babu D, Mittal A. Herbal Medicines for Diabetes Management and its Secondary Complications. Curr Diabetes Rev. 2021: 17(4):437-456.

Baruah MP. Kalra S, Bose S, Deka J. An audit of insulin usage and insulin injection practices in a large Indian cohort. Indian J Endocr Metab 2017:21:443-52

Kovil R et al. Consensus on Insulin Dose and Titration Algorithms in Ambulatory Care of Type 2 Diabetes in India. JAPI 2017; 65:17-30.

Acharya KG, Shah KN, Solanki ND, Rana DA. Evaluation of antidiabetic prescriptions, cost and adherence to treatment guidelines: A prospective, cross-sectional study at a tertiary care teaching hospital. J Basic Clin Pharm. 2013;4:82-7

Modi KD et al. Adoption of Gla-100 in India and its Impact on Insulin Usage Patterns. Journal of The Association of Physicians of India December 2020, 25-30

Singla R. Bindra J. Singla A, Gupta Y, Kalra S. Drug prescription patterns and cost analysis of diabetes therapy in India: Audit of an endocrine practice. Indian J Endocr Metab 2019:23:40-5

Agarwal AA, Jadhav PR, Deshmukh YA. Prescribing pattern and efficacy of anti-diabetic drugs in maintaining optimal glycemic levels in diabetic patients. J Basic Clin Physiol Pharmacol 2014; 5:79-83.6.

Patel B, Oza B, Patel K, Malhotra S, Patel V. Pattern of antidiabetic drugs use in type-2

diabetic patients in a medicine outpatient clinic of a tertiary care teaching hospital. Int J Basic Clin Pharmacol 2013; 2:485.

Yacoub T. Impact of improving postprandial glycemic control with intensifying insulin therapy in type 2 diabetes. Postgrad Med. 2017 Nov;129(8):791-800.

Migdal AL., Fortin-Leung C, Pasquel F, Wang H, Peng L, Umpierrez GE. Inpatient Glycemic Control With Sliding Scale Insulin in Noncritical Patients With Type 2 Diabetes:Who Can Slide? J Hosp Med. 2021 Aug;16(8):462-468.

Aronoff SL. Rationale for treatment options for mealtime glucose control in patients with type 2 diabetes. Postgrad Med. 2017 Mar, 129(2):231-241.

Kakade A, Mohanty IR, Rai S, Kakade A, Mohanty IR, Rai S. Assessment of prescription pattern of antidiabetic drugs in the outpatient department of a tertiary care hospital. Int J Clin Endocrinol Metab 2017; 3:1-7.

Ardoino I, Mandelli S, Baviera M, Rossio R, Nobili A, Mannucci PM, Franchi C, On Behalf Of Reposi Investigator. Antidiabetic Drug Prescription Pattern in Hospitalized Older Patients with Diabetes, Int J Environ Res Public Health. 2023 Jan 31:20(3):2607.

Khan PA et al. Prescription Pattern of Anti Diabetics in Diabetic Patients. American J

Pharmacy and health research. January 2016;4(7):122.

Lee KA, Jin HY, Kim YJ, Im Y-J, Kim E-Y, Park TS. Treatment patterns of type 2 diabetes assessed using a common data model based on electronic health records of 2000- 2019. J Korean Med Sci 2021:36:e230.