Utilization of Some Newer Oral Antidiabetic Agents in a Tertiary Care Hospital

Background: Type 2 diabetes mellitus (DM), a common metabolic disorder, prevalence of which is predicted to rise in virtually every country with the greatest increase expected in developing countries. Modification in diet and life style are usually insufficient to provide good, long-term metabolic control of type 2 DM; pharmacological adjuvants are required in majority of patients. As there is no recommended regimen, it is difficult to choose an antidiabetic agent from the available groups which become even more complex by rapidly introducing newer agents. Aims & Objective: To evaluate prescribing pattern of newer oral antidiabetic agents in a tertiary care hospital. Materials and Methods: Prospective observational study was conducted for one year in the diabetic out patient department (OPD) at Civil Hospital, Ahmedabad. A total 290 randomly selected patients of all age groups and either sex of type 2 diabetes mellitus were observed and details were recorded in a predesigned case record form. FBS level of 120mg% and PPBS level of 150 mg% was considered for achieving satisfactory blood sugar control. Results: Among the patients who had undergone blood sugar analysis at the time of study, FBS level was 120 mg% in 48 (22.42%) patients while PPBS level was 150mg% in 21 patients (9.81%) only. Oral antidiabetic drugs alone were prescribed in 242 (83.45%) patients while insulin was added along with oral antidiabetic agents in rest of patients. Among patients receiving oral antidiabetic drugs, monotherapy was prescribed in only 43 (14.83%) patients while in the rest of the patients combination therapy was prescribed. Among oral antidiabetic combination, glipizide along with metformin is the most commonly prescribed combination in 112 (38.42%) patients. Among newer agents, pioglitazone was the most commonly prescribed agent but only in combination with other oral antidiabetic agents. Pioglitazone was prescribed with glipizide and metformin in 44 (15.17%) patients while along with metformin and glimepiride in 10 (3.45%) patients. Patients who had diabetes for five years or less could be managed with single oral agent while two or three agents were required in patients having diabetes for more than this period. Conclusion: Adequate management of diabetes mellitus is difficult to be achieved with a single oral agent. Most of the patients require two or more drugs to achieve glycemic control. Newer antidiabetic agents have been prescribed in combination only. Pioglitazone has been the most frequently prescribed medication in combination with glipizide and metformin. Even with all these medications a tight glycemic control is achieved in very few patients which needs an attention.