Geriatric Diabetes Care: Prescribing Practices and Drug Utilisation at a Teaching Hospital
Sažetak
Background/Aim: Diabetes is increasingly recognised as a major health concern worldwide, affecting around 537 million adults and causing approximately 6.7 million deaths annually. In India alone, 74.9 million individuals had diabetes in 2021 and this figure could rise to 124.9 million by 2045. Older adults (aged 60 and above) are particularly affected, with 14.3 % of them living with type 2 diabetes. Managing diabetes among the elderly is complicated, as they often have other health conditions and are on multiple medications, which can lead to issues such as polypharmacy and harmful drug or food interactions. Consequently, it is crucial to examine how diabetes medications are being prescribed for this age group.
Methodology: A prospective cross-sectional study was conducted among geriatric patients (≥ 60 years) at a tertiary care teaching Hospital in Mullana, Ambala, Haryana, over six months from December 2024 to May 2025. Study samples were selected through systematic random sampling and each prescription was evaluated to analyse prescribing patterns, polypharmacy and drug interactions. Additionally, patient’s quality of life was assessed.
Results: A total of 185 patients participated in the study, including 96 males (51.9 %) and 89 females (48.1 %), with a mean age of 66.58 ± 6.26 years. Metformin was the most commonly prescribed monotherapy, followed by glimepiride, human insulin and dapagliflozin. The most frequent combination therapy was metformin with vildagliptin (17.2 %). Hypertension (22.7 %) was the most prevalent comorbidity. Polypharmacy was observed in 80 % of patients, drug-drug interactions in 84.3 % and food-drug interactions in 29.9 %. The average quality-of-life score was 67.74 ± 13.53 %, with lower scores among those aged over 80.
Conclusion: The study highlights prevalent polypharmacy, drug interactions and comorbidities among elderly diabetics, emphasising the need for rational prescribing to enhance treatment efficacy, minimise adverse effects and improve quality of life. Overall, the study underscores the importance of rational prescribing and optimised drug use in elderly diabetic patients to improve outcomes and reduce adverse effects.
Reference
Ardoino I, Mandelli S, Baviera M, Rossio R, Nobili A, Mannucci PM, et al. Antidiabetic drug prescription pattern in hospitalized older patients with diabetes. Int J Environ Res Public Health. 2023 Jan 31;20(3):2607. doi: 10.3390/ijerph20032607.
Kumar A, Gangwar R, Ahmad Zargar A, Kumar R, Sharma A. Prevalence of diabetes in India: a review of IDF Diabetes Atlas 10th edition. Curr Diabetes Rev. 2024 Jan 1;20(1):105-14. doi: 10.2174/1573399819666230413094200.
Basu S, Maheshwari V, Roy D, Saiyed M, Gokalani R. Risk assessment of diabetes using the Indian Diabetes Risk Score among older adults: secondary analysis from the Longitudinal Ageing Study in India. Diabetes Metab Syndr. 2024 May 1;18(5):103040. doi: 10.1016/j.dsx.2024.103040.
Barman P, Das M, Verma M. Epidemiology of type 2 diabetes mellitus and treatment utilization patterns among the elderly from the first wave of Longitudinal Aging Study in India (2017–18) using a Heckman selection model. BMC Public Health. 2023 Apr 14;23(1):699. doi: 10.1186/s12889-023-15661-4.
Das AK, Dutta A, Maitiy A, Sarkar DK, Nandy M, Ghosh J. Prescribing pattern of antidiabetic drugs in type 2 diabetes mellitus at a tertiary care hospital in eastern India. Int J Community Med Public Health. 2021 Feb;8(2):721-6. doi: 10.18203/2394-6040.ijcmph20210228.
Samos LF, Roos BA. Diabetes mellitus in older persons. Med Clin North Am. 1998 Jul 1;82(4):791-803. doi: 10.1016/S0025-7125(05)70024-9.
Sah KK, Gupta KK, Mehta DK, Joshi S, Das R. Prescription pattern of type-2 diabetes management in the geriatric patients. J Young Pharm. 2022 Nov 21;14(4):416-419. doi: 10.5530/jyp.2022.14.84.
Nobili A, Marengoni A, Tettamanti M, Salerno F, Pasina L, Franchi C, et al. Association between clusters of diseases and polypharmacy in hospitalized elderly patients: results from the REPOSI study. Eur J Intern Med. 2011 Dec;22(6):597-602. doi: 10.1016/j.ejim.2011.08.029.
Ibrahim IA, Kang E, Dansky KH. Polypharmacy and possible drug drug interactions among diabetic patients receiving home health care services. Home Health Care Serv Q. 2005 Mar 19;24(1 2):87-99. doi: 10.1300/J027v24n01_07.
Patel PS, Rana DA, Suthar JV, Malhotra SD, Patel VJ. A study of potential adverse drug drug interactions among prescribed drugs in medicine outpatient department of a tertiary care teaching hospital. J Basic Clin Pharm. 2014 Mar;5(2):44. doi: 10.4103/0976-0105.134983.
Pourhoseingholi MA, Vahedi M, Rahimzadeh M. Sample size calculation in medical studies. Gastroenterol Hepatol Bed Bench. 2013;6(1):14. PMID: 24834239.
Pazan F, Wehling M. Polypharmacy in older adults: a narrative review of definitions, epidemiology and consequences. Eur Geriatr Med. 2021 Jun;12(3):443-452. doi: 10.1007/s41999-021-00479-3.
Chisalunda A, Ng'ambi WF, Tarimo NS, Banda NPK, Muula AS, Kumwenda J, et al. Quality of life among type 2 diabetes mellitus patients at Kamuzu Central Hospital in Lilongwe, Malawi: a mixed methods study. PLOS Glob Public Health. 2023 Oct 9;3(10):e0002367. doi: 10.1371/journal.pgph.0002367.
Mehta S, Nain P, Agrawal BK, Singh RP. Vitamin D with calcium supplementation managing glycemic control with HbA1c and improve quality of life in patients with diabetes. Turk J Pharm Sci. 2022 Apr 29;19(2):161-167. doi: 10.4274/tjps.galenos.2021.62357.
Pushpa VH, Nagesh HN, Ramesh HS. Study on prescribing pattern and rational use of antidiabetic drugs in elderly patients with type 2 diabetes mellitus in tertiary care hospital. Natl J Physiol Pharm Pharmacol. 2020 Sep 30;10(10):825. doi: 10.5455/njppp.2020.10.05138202010062020.
Kaur R, Gupta A, Mangat JS. Evaluation of drug use patterns in geriatric patients of hypertension and diabetes: a retrospective analysis. Int J Health Environ Res. 2023;1:11–8. doi: 10.1055/s-0042-1751297.
van Oort S, Rutters F, Warlé-van Herwaarden MF, Schram MT, Stehouwer CD, Tack CJ, et al. Characteristics associated with polypharmacy in people with type 2 diabetes: the Dutch Diabetes Pearl cohort. Diabet Med. 2021 Apr;38(4):e14406. doi: 10.1111/dme.14406.
Bauer S, Nauck MA. Polypharmacy in people with type 1 and type 2 diabetes is justified by current guidelines—a comprehensive assessment of drug prescriptions in patients needing inpatient treatment for diabetes associated problems. Diabet Med. 2014 Sep;31(9):1078-85. doi: 10.1111/dme.12497.
Zurita Cruz JN, Manuel Apolinar L, Arellano Flores ML, Gutierrez Gonzalez A, Najera Ahumada AG, Cisneros González N. Health and quality of life outcomes impairment of quality of life in type 2 diabetes mellitus: a cross sectional study. Health Qual Life Outcomes. 2018 May 15;16(1):94. doi: 10.1186/s12955-018-0906-y.
Inamdar SZ, Kulkarni RV. Drug related problems in elderly patients with type 2 diabetes mellitus. J Diabetol. 2016 Jan 1;7(1):1. doi: 10.4103/2078-7685.198422.
Nikbin A, Bayani M, Jenabian N, Khafri S, Motallebnejad M. Oral health related quality of life in diabetic patients: comparison of the Persian version of Geriatric Oral Health Assessment Index and Oral Health Impact Profile: a descriptive analytic study. J Diabetes Metab Disord. 2014 Feb 4;13(1):32. doi: 10.1186/2251-6581-13-32.
Al-Musawe L, Torre C, Guerreiro JP, Rodrigues AT, Raposo JF, Mota-Filipe H, et al. Polypharmacy, potentially serious clinically relevant drug drug interactions, and inappropriate medicines in elderly people with type 2 diabetes and their impact on quality of life. Pharmacol Res Perspect. 2020 Aug;8(4):e00621. doi: 10.1002/prp2.621.
McGuire H, Longson D, Adler A, Farmer A, Lewin I. Management of type 2 diabetes in adults: summary of updated NICE guidance. BMJ. 2016 Apr 6;353:i1575. doi: 10.1136/bmj.i1575.
Home P, Mant J, Diaz J, Turner C. Management of type 2 diabetes: summary of updated NICE guidance. BMJ. 2008 Jun 7;336(7656):1306-8. doi: 10.1136/bmj.39560.442095.AD.
Pal AD, Baig S, Rao SV. Study of the prescription pattern of antidiabetics in hypertension with diabetes patients in geriatric population at tertiary care centre: a retrospective observational study. Int J Res Med Sci. 2025 Mar;13(3):1051-8. doi: 10.18203/2320-6012.ijrms20250666.
Nadukkandiyil N, Al HH, Kunnummal NK, Ramadan MB, Al OM, Saleh H. A retrospective study of medication utilization pattern and clinical outcome in middle aged and older patients with type 2 diabetes mellitus in Qatar. J Diabetes Metab. 2018 Dec 1;9(815):2. doi: 10.4172/2155-6156.1000815.
Dashputra A, Badwaik RT, Borkar A, Date AP, Kalnawat NR. Pattern of antidiabetic drugs used in outpatient and hospitalized patients in a tertiary health institute of central India. J Contemp Med Dent. 2014;2(3):48–54. doi: 10.18049/jcmad/239a10.
Ramadhani P, Fauziah F, Kurnia NM. Polypharmacy and drug interactions in geriatric patients with type 2 diabetes mellitus at the internal medicine inpatient installation at RSUP Dr. M. Djamil Padang. Int J Pharmaceut Sci Med. 2023;8(5):1–6. doi: 10.47760/ijpsm.2023.v08i05.001.
Dookeeram D, Bidaisee S, Paul JF, Nunes P, Robertson P, Maharaj VR, et al. Polypharmacy and potential drug drug interactions in emergency department patients in the Caribbean. Int J Clin Pharm. 2017 Oct;39(5):1119-27. doi: 10.1007/s11096-017-0520-9.
Alhumaidi RM, Bamagous GA, Alsanosi SM, Alqashqari HS, Qadhi RS, Alhindi YZ, et al. Risk of polypharmacy and its outcome in terms of drug interaction in an elderly population: a retrospective cross sectional study. J Clin Med. 2023 Jun 10;12(12):3960. doi: 10.3390/jcm12123960.
Dobrică EC, Găman MA, Cozma MA, Bratu OG, Stoian AP, Diaconu CC. Polypharmacy in type 2 diabetes mellitus: insights from an internal medicine department. Medicina (Kaunas). 2019 Aug 3;55(8):436. doi: 10.3390/medicina55080436.
Bojuwoye AO, Suleman F, Perumal Pillay VA. Polypharmacy and the occurrence of potential drug–drug interactions among geriatric patients at the outpatient pharmacy department of a regional hospital in Durban, South Africa. J Pharm Policy Pract. 2022 Jan 4;15(1):1-12. doi: 10.1186/s40545-021-00401-z.
Hermann M, Carstens N, Kvinge L, Fjell A, Wennersberg M, Folleso K, et al. Polypharmacy and potential drug drug interactions in home dwelling older people - a cross sectional study. J Multidiscip Healthc. 2021 Mar 9;14:589-97. doi: 10.2147/JMDH.S297423.
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