Drug utilization pattern in diabetes uk,m235i chris harris,diabetes and blurred vision treatment center - For Begninners


Objectives: Patients with chronic kidney disease (CKD) suffer with multiple comorbidities and complications like secondary hyperparathyroidism and hyperphosphotemia. 5.Noordzij M, Korevaar JC, Boeschoten EW, Dekker FW, Bos WJ, Krediet RT, Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD) Study Group.
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Predictors and consequences of altered mineral metabolism: The dialysis outcomes and practice patterns study. Sevelamer hydrochloride in peritoneal dialysis patients: Results of a multicenter cross-sectional study.
KDOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease. Large variations in prescriptions of gastrointestinal medications in hemodialysis patients on three continents: The Dialysis Outcomes and Practice Patterns Study (DOPPS). Medication prescription pattern in ambulatory hemodialysis patients: Comparison of USRDS to a large not for profit dialysis provider.
Medication prescribing patterns among chronic kidney disease patients in a hospital in Malaysia. A comparative review of the efficacy and safety of established phosphate binders: Calcium, sevelamer and lanthanum carbonate.
Utilization Patterns of IV Iron and Erythropoiesis Stimulating Agents in Anemic Chronic Kidney Disease Patients: A Multihospital Study. Drug utilization studies help to identify the adherence to standard treatment guidelines and to evaluate the rational drug usage.
Evaluation of antidiabetic prescriptions, cost and adherence to treatment guidelines: A prospective, cross-sectional study at a tertiary care teaching hospital. Changing pattern of prescribing antidiabetic agents in patients suffering from diabetes mellitus. Combining insulins with oral antidiabetic agents: Effect on hyperglycemic control, markers of cardiovascular risk and disease.
Drug utilization pattern of anti-diabetic drugs in a rural area of Tamilnadu, South India - A prospective, observational study. Study of drug utilization pattern of antihyperglycemic agents in a South Indian tertiary care teaching hospital. Drug utilization pattern and effectiveness analysis in diabetes mellitus at a tertiary care centre in Eastern Nepal. Pattern of prescription of hypoglycemic drugs in Gran Canaria (Canary Islands, Spain) and estimation of the prevalence of diabetes mellitus. A study of drug prescribing pattern and cost analysis among diabetic patients in a Care Teaching Institute in North India. In patients of CKD, despite dietary phosphorus restriction, phosphate binders (PBs) are recommended to control phosphorous level.
Objective: To study prescription pattern, calculate the cost of antidiabetic drugs and to evaluate the adherence to treatment guidelines in diabetic patients attending the medicine outpatient department in a tertiary care teaching hospital.
Al-Gareeb Emergency Medicine International.
No studies about the utilization pattern of PBs in CKD patients have been reported from India.
Materials and Methods: A prospective observational study was carried out for a period of 5 months. This study analyses the current prescribing trends in the management of CKD patients undergoing tertiary care with focus on PBs. Secondary hyperparathyroidism and the associated homeostatic control of serum calcium, phosphate, and vitamin D is a critical issue in patients with CKD. Materials and Methods: This cross-sectional, observational study was conducted in nephrology department of a government super speciality hospital over 8-month period from January to August 2011. Altered mineral metabolism contributes to bone disease, cardiovascular disease, and other clinical problems in these patients. Demographic data and complete prescription details were recorded in the structured case record form. Demographic, clinical, and medication details were collected in a specially designed proforma. Indian Council for Medical research guidelines-2005 for diabetes management was used to evaluate the adherence. For this reason, one of the main goals in CKD patients is to maintain serum phosphate in the range recommended in different guidelines. The World Health Organization (WHO) defines "drug utilization" as the marketing, distribution, prescription and use of the drugs in a society considering its consequences, either medical, social, and economic. About 41.53% of the prescribed drugs were from the World Health Organization essential medicines list.
Drug utilization studies is an invaluable investigational resource to study pharmacoepidemiology, pharmacovigilance, pharmacoeconomics and pharmacogenetics.
It includes the prescribing indicators, the patient care indicators and the facility indicators. With recent concern about soft-tissue calcification, which may be worsened by calcium-based PBs, newer non calcium, nonaluminium binders, particularly sevelamer hydrochloride and lanthanum carbonate, are being used more frequently?


Glimepiride and metformin was the most frequently prescribed in 119 (76.28%) out of 156 antidiabetic drug combinations. Among PBs, calcium carbonate was the most frequently prescribed and sevelamer was the least prescribed PB.
These PBs represent a significant expense for patients and healthcare systems, and the cost of equally effective binder doses may vary by as much as 140%.
So the cost of antidiabetic drug is the major deciding factor for the patients' compliance. Selection of oral antidiabetic drugs as first-line drug or combined therapy should be based on both the pharmacological properties of the compounds like efficacy, safety profile and also on the clinical characteristics of the patient like stage of disease, body weight, BMI etc., There exists a wide range of variation in the prices of drugs marketed in India and other countries of the world.
Although sevelamer hydrochloride has less side effects as compared to calcium salts, it was less prescribed since it is costlier. Percentage cost variation is an effective tool to find out the difference between the various brands prescribed by prescriber in the same setting. The study of prescribing patterns is a component of medical audit that monitors and evaluates prescribing practices, and recommends necessary modifications to achieve rational drug use.
There are many studies carried out on drug utilization in diabetic patients but a limited number of studies had focus on analyses of cost and adherence to treatment guidelines.So, we planned to carry out this study drug utilization studies in diabetic patient with focus on cost analyses and adherence to standard treatment guideline. Objectives To study prescription pattern, calculate cost of antidiabetic agents and to evaluate the adherence to treatment guidelines in diabetic patients attending the medicine outpatient department in a tertiary care teaching hospital. Study was approved by institutional ethics committee and written informed consent was obtained from each patient before enrolment. All the demographic data and complete prescriptions were collected on predesigned case record form. All CKD patients diagnosed by consultant nephrologists, undergoing treatment in the nephrology unit were included and their prescriptions analyzed. All the diabetic patients attending the medicine outdoor department were enrolled in the study after explaining the aim of the study. Demographic details, necessary clinical data, and medication details were collected in a specially designed proforma. Drugs were classified into different groups based on Anatomic Therapeutic Chemical (ATC) classification.
Prior approval of Institutional ethics committee, hospital superintendent and from the head of the medicine department was obtained. World Health Organization (WHO) recommends this classification system developed by European Association for Pharmaceutical Market and International group.
Patients receiving any of the anti-diabetic drugs were included in the study irrespective of their gender and those patients who were pregnant and having insufficient data or records were excluded from the study.
For those prescriptions whose generic name of the drugs and price were not mentioned in the prescription, they were obtained from CIMS (current index of medical specialty) [12] and Indian drug review (IDR) [2012 issues]. When enquired, all patients stated that they were strictly adherent to dietary modification as advised by nephrologists. The difference in the maximum and minimum price of the same drug manufactured by different pharmaceutical companies was calculated. The drugs being manufactured by only one company or being manufactured by different companies however, in different strengths were excluded. For calculation of adherence to standard diabetes guidelines we used Indian Council of Medical Research Guidelines, 2005. We used unpaired t-test and Fischer's exact test to evaluate the difference between two groups. A total of 539 antidiabetic drugs were used as shown in [Table 2] and [Figure 1] (Range 1-6). Practice of polypharmacy is a common finding in similar studies in CKD patients with average number of drugs per prescription varying from 8 [13] to 12.3.
Most commonly used drug combination was of Glimepiride and Metformin in 119 (76.28%) patients.
This further increases the chances of drug interactions and ADRs.In our study, no drug was prescribed by its generic name, showing that prescribing by brand name is the norm, which needs to be discouraged. Encouraging prescription of drugs by generic names is always recommended by various national and international bodies to promote rational use of medicines.
But implementation of this practice is never satisfactory and requires motivation of prescribers and strong regulatory interventions. Drug utilization research study will help for improvement in drug usage, more focused generic brand prescribing pattern. Selecting proper cost effective brand will help in quality of the drug usage, cost reduction, proper dose selection and better health outcome.Diabetes is a chronic disease requiring a lifelong treatment.
Majority of the patients attending these facilities cannot afford to purchase these drugs from private pharmacies.
Although lifestyle modifications play an important role in diabetes management, drugs become unavoidable in many patients. This study was focusing on the prescription pattern in diabetic patients attending the outpatient departments in a hospital.Two hundred and fifty patients were participated in our study. These findings are similar to most of the earlier reported studies where calcium carbonate, multivitamin, folic acid, and ferrous sulphate were the most commonly prescribed drugs for CKD patients.
However in earlier study male predominance was seen in the study population which is not in agreement with the results of our study. Among PBs, calcium carbonate was the most frequently prescribed and sevelamer was the least prescribed.
These findings are similar to those reported in an earlier study using data from contributors to the European practice database.


Majority of 90 (36%) of the patients were found in 51-60 years of age group and among 43 (17.2%) newly diagnosed patients with Type-II DM, 30% were of the age group of 41-50 years indicating that the risk of type-II DM increases after the age of 40 years, this result was similar to study of Roy V et al (1998). Similarly a study from Brazil also reported a large percentage of prescriptions of sevelamer among patients on maintenance hemodialysis despite the high cost of the medication and absence of contraindications for PB with calcium salts. Sevelamer hydrochloride is an ion exchange resin, nonabsorbable, and the first PB that is not a source of aluminium or calcium. Sevelamer, besides its effect on phosphate, has been associated with reduction of coronary and aortic calcification. Advantages and drawbacks of using sevelamer hydrochloride and lanthanum carbonate, as first choice of PB yet remains debatable.
Even guidelines recommend that no single binder is effective and acceptable to every patient and a combination of binders needs to be considered for many patients so as tominimize the potential adverse effects of any specific binder. Similar result was obtained by the study conducted by Rataboli P et al., (2007) stated that among all diabetic complications, cardiovascular complications (hypertension) pose a major threat. In chronic renal failure or end stage renal disease, hyperkalemia is more likely to develop when Angiotensin converting enzyme (ACE) inhibitors or Angiotensin receptor blockers (ARBs) are prescribed. So the choice of CCBs and diuretics seems to be logical.Out of 34 patients suffering with diabetes mellitus, antidiabetics were prescribed in only 19 patients with preference for insulin (12) over oral hypoglycaemic drugs (7).
In diabetic patients, rigorous glycaemic control decreases the rate and progression of micro-albuminuria. However, during the phase of deteriorating renal function, insulin requirement falls because the kidney is a site of insulin degradation and this might be reason for the remarkable number of patients not receiving any antidiabetic agent, similar to previous study.
This suggests the gradual takeover of metformin as a first-line agent for type-2 DM in a decade.
Among sulfonylureas, selection of glimepiride and glipizide has been recommended by Texas Diabetes Council because these agents have lower incidence of hypoglycemia. Underutilization of erythropoietin in the present study is surprising despite recommendations for its use. The high cost of erythropoietin may be the reason for its underuse since most patients visiting this government hospital are economically backward. The low prescription rate of erythropoietin indicates lacunae of current treatment practices and signals an opportunity for improvement in prescribing practices in CKD patients. Obtaining details about the contents of these preparations was, however, beyond the scope of our study.There are several limitations to this study.
Most commonly used drug combination was of glimepiride and metformin which was a common finding seen with earlier study of V. First, the sample size may not be adequate to reflect the exact picture of prescribing patterns in general and PB in particular. Similarly, data from multiple centres need to be collected to get a broader yet more comprehensive idea of use of PB and to analyze the reasons for underuse of these drugs. Another shortcoming of the study is the point prevalence nature of the medication-related data. It cannot be assumed that the prescription characteristics of a particular medication for a given patient remains unchanged over the course of follow-up of these patients. In spite of these lacunae, this study certainly provides an insight into the problems associated with the use of drugs in CKD patients.To conclude, this study identified a wide variety of drug classes prescribed in a cohort of CKD patients indicative of prevailing morbidity. It provides a framework for continuous prescription audit in a hospital setting and suggests possible improvement in prescription practices in patients suffering from CKD. More and more amount of drugs should be prescribed by generic names as it increases uniformity and decreases cost of drug therapy. In earlier study essential drugs were prescribed to a large extent but in our study nearly half numbers of drugs were prescribed from essential drug list which suggest a trend of using newer drugs in prescribing and also suggest the influence of pharmaceutical companies in prescribing.A very less amount of drugs was given in injections as compared to earlier study. This finding can be explained as we collected only outpatient prescriptions and insulin was the most frequently prescribed drug by injection route which is a cornerstone of type 1 DM and also this also suggest better knowledge of the doctors about the risks and high cost of these injections. Only few antibiotics (0.79%) were prescribed out of all drugs it was an expected finding as patient in outpatient department arrives only for refilling of prescription and present mostly without infection.
The percentage of generics and drug use from essential drug list are higher when compared to those from a study reported in Delhi by Kumar R et al (2013).
The cost of prescription can be reduced by choosing most economic drugs without changing its quality. In our study therapy cost for a diabetic patient ranged from 15 to 2501 INR and most of the patients fall in the cost range of 100-400 INR per month.
Glimepiride, Metformin and Pioglitazone combination had the least percentage cost variation i.e.
181.81, this finding suggest availability of more brands in Glimepiride as compared to other drugs and total cost of treatment can be reduced drastically by using the cheapest brand of Glimepiride and prescriber should avoid writing the costliest brand of glimepiride in order to curtail the total cost of drug therapy. In our study majority (15.6%) of the non-adherence was due to prescribing of other drugs in place of metformin in the patients having BMI more than 25. Prescribing drugs other than metformin in inappropriate as literature showed that using in obese patient metformin should be preferred.
Oral dosage form was the most commonly used to increase the patient compliance in type 2 DM. The cost of prescription can be reduced by choosing the most economic drugs (generic) without changing its quality.
The pattern of prescription for diabetic patients should be more rational as per our study and compliant with current evidence and clinical guidelines.



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