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Drug use evaluation in diabetic patients at out patient department Gorakhpur.

Drug utilization studies are powerful exploratory tools to ascertain the rational usage of drugs in society [1]. Drug utilization review is "the evaluation of drug use in given health care against predetermined criteria and standards to assess the appropriateness of drug therapy" [2]. These studies create a sound sociomedical and health economic basis for healthcare decision making. According to World Health Organization (WHO) drug utilization studies are the important indicators to assess the clinical and inappropriate drug use over the time. It is also used as a supervisory tool in health facilities and to measure the effect of an intervention [3]. Various guidelines are available that recommended for different classes of drug to treat diabetes.

Diabetes Mellitus (DM) is characterized by abnormalities in the normal carbohydrate, fat, and protein metabolism. On the basis of the body response to insulin DM is mainly divided in two type's i.e Type-I DM and Type-II DM. Type-I is insulin dependent diabetes mellitus which involves damage of pancreatic 3 cells, while Type-II is non-insulin dependent diabetes mellitus which progress with the resistance to insulin. It is estimated that in India there are around 50.8 million in registered till year 2010 and this number may raise to 87.0 million by 2030 [4]. Current estimates revealed that there are at least 150 million people living with diabetes worldwide of which two-third is from developing countries [5]. The total number of diabetic patients is predicted to rise approx. 300 million by 2025 [6]. Due to high blood sugar levels DM patients are more susceptible to a wide range of infectious bacterial and fungal infections [7]. Diabetes treatment depends upon type and severity of diabetes. Treatment decisions are influenced by the age, life expectancy, comorbid conditions and severity of vascular complications.

The present study was conducted to establish the current prescribing pattern of antidiabetic drug in the area of Gorakhpur. Two hundred diabetic patients were the part of this study, of whom 125 (62.5%) were males and 75 (37.5%) females. Majority 44.5% of the patients were from the age group 40-50 years, followed by the age group 50-60 years (26.50%). About 53 (26.5 %) patients had no co-existing illness, while 47 (31.97%) patients had hypertension. Antidiabetic agents prescribed were second generation sulfonylurea, biguanides, thiazolidinediones and insulin. It was seen that 75 (37.5%) were on monotherapy and 125 (62.5%) were on polytherapy for diabetes. Out of 125 patients on polytherapy 89 (44.5%) were on a two drug combination, 35 (17.5%) on a three drug combination and 1 (0.5%) on four drug combination. In monotherapy insulin 31 (15.5%) was found maximum prescribed followed by thiazolidinediones 13 (6.5%), sulfonylurea 11 (5.5%), herbal 8 (4%), biguanides 7 (3.5%) and acarbose 5 (2.5%). Among antidiabetic drugs sulfonylurea (65%) and biguanides (65%) were most frequently prescribed followed by thiazolidinediones (23%) and alpha glucosidase inhibitors (3%).

The treatment pattern observed in this study were found in following order Biguanides= Sulfonylurea > Thiazolidinediones > Insulin > Herbal > Acarbose. Among the sulfonylurea category prescription was found to be maximum for glipizide followed by gliperamide. Among Biguanides only prescribed drug was metformin. Among thiazolidinediones category pioglitazone was maximum prescribed followed by rosiglitazone. There is a need to encourage physicians to follow the guidelines while treating diabetes. Overall there was no implementation of the clinical and therapeutic guideline for the management of DM which may be one of the potential reason for the current prescription pattern for the diabetic patients. Health regulatory authorities should take some initiatives to ensure the implementation of the therapeutic guidelines in all the health care settings through out India. Such initiatives will not only result in rational and quality use of medicine but also help in reducing the drug related problems with a higher therapeutic outcomes and better control for the conditions like diabetes mellitus.

Conflict of Interest

All the authors have no conflict of interest

Funding

Not Any

Manuscript History:

Article Received on: 19th Nov, 2010

Revised on: 27th Nov, 2010

Approved for Publication: 9th Dec, 2010

Reference

[1.] Bakassas I, Lunde PK. (1986). National Drug Policies: The need for drug utilization studies. Trends Pharmacol Sci;7:331-4.

[2.] Knapp DA. (1991). Development of criteria for drug utilization review. Clin Pharm Ther;50:600-5.

[3.] WHO, (1993). How to investigate drug use in health facilities: Selected drug use indicators. Geneva: World Health Organization;.WHO/DAP1993:1:1-87.

[4.] IDF Diabetes Atlas, (2009). 4th edition. International Diabetes Federation,

[5.] Wild S, Roglic G, Green A, Sicree R, King H. (2004). Global prevalence of diabetes: Estimate for the year 2000 and projections for 2030. iabetic Care;27:1047 53.

[6.] Sicree R, Shaw J, Zimmet P. (2006). Diabetes and impaired glucose tolerance. In:Gan D, editor. Diabetes Atlas. International Diabetes Federation. 3rd ed. International Diabetes Federation; Belgium: 15-103.

[7.] Daud A, Syed AS & Muttalif RA. To Assess The Co relation of Diabetes Mellitus and Co-Morbid Tuberculosis on the leukocyte and platelet counts. Archives of Pharmacy Practice. 2010;1(1):12-14

Tripathi Poonam, Pandey Awanish, Pandey Rishabh, Goswamy Shambaditya & Srivatava Rashmi

(1) Institute of Technology and Management, Gorakhpur, India

Corresponding Author:

Tripathi Poonam

Institute of Technology and Management, AL-1 Sector-7 GIDA

Gorakhpur U.P 273209, India

Phone No: 09897696504,09670470766

Email: poonam tripathi20@yahoo.co.in
TABLE 1: Anti-diabetic Drug Utilization
(Individual\Combination)

Anti-diabetic         Mono-    Combination     Total
drugs                Therapy

Sulfonylurea           11          119       130 (65%)
Biguanide               7          123       130 (65%)
Thiazolidinediones     13          43         56 (28%)
Acarbose                5           1          6 (3%)
Insulin                31          --        31 (15.5%)
Herbal                  8          --          8 (4%)
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Article Details
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Title Annotation:Short Communication
Author:Poonam, Tripathi; Awanish, Pandey; Rishabh, Pandey; Shambaditya, Goswamy; Rashmi, Srivatava
Publication:Archives of Pharmacy Practice
Geographic Code:9INDI
Date:Jul 1, 2010
Words:926
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