Abstract

PRESCRIBING PATTERNS OF ANTIDIABETIC DRUGS IN PATIENTS WITH CARDIOVASCULAR AND KIDNEY DISEASE IN A TERTIARY CARE TEACHING HOSPITAL

Ananda Krishnan, Anjum K., Anugraha Biju, Archa S., Dr. Manasa T.*, Prof. J. S. Venkatesh

Abstract

Background: Diabetes mellitus (DM) is a major global health concern, frequently associated with cardiovascular disease (CVD) and chronic kidney disease (CKD). The coexistence of these comorbidities poses unique therapeutic challenges, necessitating the rational selection of antidiabetic agents. Recent advancements, such as sodium-glucose co-transporter-2 (SGLT2) inhibitors and Dipeptidyl Peptidase-4 inhibitors (DPP-4), provide additional renal and cardiovascular protection. However, real-world prescribing trends require evaluation to ensure adherence to evidence-based guidelines. Objective: To analyse the prescribing pattern of antidiabetic drugs among patients with cardiovascular and kidney diseases in a tertiary care teaching hospital, and to assess their rationality in comparison with national and international essential medicine lists. Methodology: A prospective observational study was conducted over six months at a tertiary care teaching hospital. A total of 220 inpatients aged >40 years with DM and associated CVD and/or CKD were included. Data on demographics, comorbidities, prescription patterns, and drug formulations were collected, analysed, and compared with the NLEM (2022) and WHO EML (2023) standards. Results: Among the 220 patients, males (61.36%) predominated, with the largest age group being 60–69 years (31.82%). Hypertension was the most common comorbidity (36.36%), often coexisting with CVD (31.82%) and CKD (16.82%). Drug utilization revealed that 40.46% received monotherapy, 50.45% dual therapy, and 9.09% triple therapy. Human Actrapid was the most frequently prescribed monotherapy (83.15%), while metformin + glimepiride was the most common dual therapy (38.74%). In triple therapy, metformin + glimepiride + human actrapid was predominant (55%). Overall, injectable formulations (50.30%) were slightly more common than oral agents (49.70%). Metformin (35.97%) and its combinations remained the most frequently prescribed oral hypoglycaemic agents. Importantly, 87.63% of prescriptions adhered to NLEM and 80.9% to WHO EML. Co-prescription of antihypertensives (43.15%) and statins (24.62%) was frequent, reflecting the burden of comorbidities. Diabetic foot (43.3%) and nephropathy (20%) were the most observed complications. Conclusion: The prescribing trend in this study emphasizes predominant use of insulin preparations, particularly Human Actrapid, followed by metformin and sulfonylurea combinations. Although most prescriptions aligned with essential medicine guidelines, use of newer agents such as SGLT2 inhibitors and DPP-4 was limited. These findings highlight the need to strengthen evidence-based prescribing practices, optimize therapeutic outcomes, and promote the integration of newer cardio-protective and Reno protective agents in managing diabetes with CVD and CKD.

Keywords: Diabetes mellitus; Cardiovascular disease; Chronic kidney disease; Prescription pattern; Antidiabetic drugs; WHO model of Essential Medicines List; National List of Essential Medicines.