Prescription Pattern Analysis of Anti-Diabetic Drug and Anti-Hypertensive Drug with Associated Comorbidities

HYPERTENSION

DEFINITION:

Although it is not a disease in and of itself, hypertension is a frequent condition, especially beyond middle age, and it is a significant risk factor for cardiovascular disease and death.
Blood pressure above 140 mm Hg systolic and 90 mm Hg diastolic is referred to as hypertension.^[1] According to Eight report of joint national committee on the Detection Evaluation and treatment of high blood pressure hypertension has 4 stages and it is illustrated as follows, ^[2]

Table No: 1 JNC VIII classification of Hypertension

Your blood pressure is the force of blood against the walls of your arteries. Your heart pumps blood to different parts of your body through vessels. Blood pressure naturally rises and falls during the day, but if it remains high for a long period of time, it can damage your heart and cause other health problems. Hypertension, or high blood pressure, is the term used to describe blood pressure that is higher than usual. ^[3]  Hypertension is often referred to as the silent killer. Although symptoms are usually absent, persistently elevated blood pressure is a common cause of premature mortality. Over time, it harms multiple organs and can result in stroke, chronic renal failure, and overt cardiovascular disease. It is the second most common cause of CKD, or chronic kidney disease. An estimated 1.28 billion people between the ages of 30 and 79 have hypertension worldwide; two-thirds of these people live in low- and middle-income countries. ^[4]

MEDICATION FOR HYPERTENSION

It is well recognized that cardiovascular disease is associated with obesity, diabetes, hyperlipidemia, or the metabolic syndrome, all of which coexist with hypertension. The identification and management of these risk factors is a crucial part of the overall care of people with hypertension. Because patients in these specific groups are more prone to suffer from target organ damage (TOD), clinical recommendations have set stringent goals for blood pressure (BP) regulation.^[5]

CO MORBIDITIES OF HYPERTENSIVE PATIENTS:

Comorbidities can have a big influence on how hypertension is managed. In order to enhance overall health outcomes, treatment techniques frequently need to target many illnesses at once. For instance, to treat obesity, diabetes, and hypertension all at once, medication may be advised in addition to lifestyle changes like food and exercise. ^[6,8]

EPIDEMIOLOGY:

The rising prevalence of hypertension has been attributed to a number of variables, including aging populations, growing populations, and behavioral risk factors such as poor diet, excessive alcohol use, sedentary lifestyles, obesity, and long-term stress. Every year, hypertension claims the lives of an incredible 9.4 million people globally.The global death rate from CVD dropped from 354.5 deaths per 100,000 people in 1990 to 239.9 deaths per 100,000 people in 2019. High-income countries saw the fastest decline in the death rate, albeit this decline was not consistent across all regions ^[7], Epidemiological studies show that the incidence of hypertension in India is rapidly increasing, with rates ranging from 4 to 15% in urban regions and 2 to 8% in rural areas.The numerous guidelines created worldwide for the treatment of hypertension serve as standards for clinical practitioners.^[8] Nine percent of participants in an integrated illness surveillance initiative in Tamil Nadu had a medical expert diagnose them with hypertension. 10% of the population had hypertension, with 9% of men and 11% of women affected. 8% of hypertensive individuals reside in rural areas.^[9]

SYMPTOMS OF HYPERTENSION:

High blood pressure, also referred to as hypertension, is the result of an overly high force of blood against the walls of arteries. This condition can lead to serious health issues such as heart disease or stroke. It grows slowly, often without any symptoms, even at extreme amounts. Constricted arteries and rising blood volume are two of the things that raise blood pressure. Some may experience severe spells of headaches, nosebleeds, or shortness of breath, but the majority do not exhibit any symptoms. Thankfully, it is easy to detect and treat with medical help. Regular care and monitoring can prevent long-term injury.

DIABETES

Diabetes mellitus (DM) is a metabolic disorder that can result from a defect in the action, secretion, or both of insulin. Insulin deficiency leads to chronic hyperglycemia and anomalies in the metabolism of proteins, lipids, and carbohydrates. It is the most common endocrine condition. As diabetes progresses, tissue or vascular damage occurs, leading to major complications such as ulceration, retinopathy, neuropathy, nephropathy, and cardiovascular issues. Therefore, diabetes includes a wide range of different conditions. ⁽¹⁰⁾

Types of diabetes:

1. Type 1 Diabetes mellitus: In type-1 diabetes, formerly referred to as "juvenile onset diabetes" or "insulin dependent diabetes mellitus," the body is unable to manufacture insulin. The vital hormone insulin is produced by the pancreas, a gland located near the stomach. The primary energy source for the body, glucose, needs to be transformed into energy. In the absence of insulin, glucose stays in the blood. Excess hyperglycemia can damage the blood vessels supplying the kidney, bladder, and eyes if it is not controlled. Insulin is used everyday by people with type 1 diabetes to regulate their blood sugar levels and prevent this harm. Type 1 diabetes usually affects youngsters or people under 30 years old, while it can occur at any age.⁽¹¹⁾  
2. Type 2 Diabetes mellitus: Type 2 diabetes, formerly referred to as "adult-onset diabetes" or "non-insulin dependent," is the most common form of the condition. Over time, type 2 diabetes develops when the pancreas is unable to produce enough insulin. Similar to type 1 diabetes, glucose stays in the bloodstream and cannot be transformed into energy. During this period, the pancreas produces more insulin to overcome the resistance. The extra insulin helps cells absorb enough glucose to keep blood glucose levels from rising. Months or years may pass with no discernible symptoms⁽¹²⁾
3. Gestational Diabetes: Gestational diabetes occurs when a pregnant woman's body cannot produce enough insulin. There are typically no symptoms. Pregnant women should get tested for diabetes between weeks 24 and 28. Women who are already at risk for diabetes should be evaluated during their initial prenatal checkup. Most women need two to three times as much insulin during pregnancy because of normal hormonal changes ⁽¹³⁾

PATHOPHYSIOLOGY OF DIABETES MELLITUS:

TYPE 1 DIABETES

The autoimmune loss of pancreatic β-cells results in a shortage of insulin synthesis, which leads to the metabolic abnormalities associated with type 1 diabetes. T1DM patients exhibit increased glucagon secretion, abnormal pancreatic α-cell activity, and reduced insulin synthesis. Hyperglycemia typically reduces glucagon secretion; however, in individuals with type 1 diabetes, hyperglycemia has no effect on glucagon secretion. The resulting excessively high glucagon levels exacerbate the metabolic problems caused by insulin deficiency. Insulin insufficiency is the primary problem with type 1 diabetes, but there is also a problem with the way insulin is given.Lack of insulin prevents peripheral tissues like skeletal muscle from metabolizing glucose by causing uncontrolled lipolysis and elevated plasma levels of free fatty acids. Additionally, glucokinase in the liver and the GLUT 4 class of glucose transporters in adipose tissue are among the genes whose expression is decreased by insulin shortage and are necessary for target tissues to react to insulin appropriately. These elements clarify why the primary metabolic problems resulting from insulin shortage in type 1 diabetes are poor glucose, lipid, and protein metabolism.

TYPE 2 DIABETES

These processes malfunction in type 2 diabetes, leading to the two primary pathophysiological abnormalities: decreased insulin secretion due to pancreatic β-cell dysfunction and decreased insulin action due to insulin resistance. The mass of β-cells changes in circumstances when insulin resistance is predominant, which can boost the insulin supply and make up for the high and unusual demand. Although the plasma insulin concentration (both fasting and meal-stimulated) is often elevated in absolute terms, it is insufficient to sustain normal glucose homeostasis "relative" to the degree of insulin resistance.  Given the close connection between insulin secretion and hormone action sensitivity in the intricate regulation of glucose homeostasis, it is nearly impossible to distinguish the roles played by each in the etiopathogenesis of DM2.Impaired glucose tolerance is ultimately caused by insulin resistance and hyperinsulinemia.  The method of inheritance for type 2 diabetes mellitus is uncertain, with the exception of maturity onset diabetes of the young (MODY).  Mutations in the glucokinase gene on chromosome 7p may cause MODY, an autosomal dominant trait.  When islet cell antibodies (ICA) are negative, MODY is defined as hyperglycemia detected before the age of 25 that can be managed without insulin for more than five years.

COMPLICATIONS IN DIABETES MELLITUS:

Retinal vascular disease: Diabetic retinal degeneration, a capillary disorder that can impact the macula, peripheral retina, or both, is one of the primary causes of blindness and visual loss in diabetics. Complete or significant visual loss may result from vitreous hemorrhage or retinal objectivity. It can be divided into two groups under the previous arrangement: "benign diabetic retina" (NPDR) and "expanding diabetic retina" (PDR). The primary features of NPDR include increased microaneurysm and liquid leakage, capillary divider insufficiency, and more prominent leukocyte and monocyte endothelial adhesion. Diabetic retinopathy is characterized by endothelial cell and pericyte retinal capillary degeneration caused by the prevalence of ischemia and microaneurysm.⁽¹⁴⁾

Neuropathy: Diabetic polyneuropathy is the most common kind of neuropathy and one of the most common long-term effects of diabetes in the developed world. Among the various neuropathic conditions it encompasses, diabetic peripheral neuropathy (DPN), also known as chronic distal symmetrical polyneuropathy, is the most common. DPN is associated with an increased risk of death and cardiovascular disease. Significant morbidity is also brought on by it, including amputations, foot ulcers, and neuropathic pain. Risk factors for DPN include poor glucose management and markers of macrovascular disease, such as hypertension. There is now strong evidence that nerve ischemia is the reason. Painful DPN affects 15–26% of diabetics and can seriously impact their quality of life⁽¹⁵⁾

Nephropathy: Diabetic nephropathy affects around 40% of adults with type 1 and type 2 diabetes and is the most common cause of kidney damage among those starting renal replacement therapy. It is characterized by elevated urine albumin discharge in the absence of other renal disorders, increases the risk of death, and primarily results from cardiovascular reasons. Microalbuminuria (UAE >20 μg/min and ≤199 μg/min) and macroalbuminuria (UAE ≥200 μg/min) are the two stages of diabetic nephropathy. The three main risk factors for the development of diabetic nephropathy are hyperglycemia, high blood pressure, and genetic susceptibility. Additionally, smoking, high blood cholesterol, and the type and amount of protein taken seem to be risk factors. Annual screening for type 1 diabetes must start five years after the diagnosis, or earlier if puberty had already occurred. High blood cholesterol, smoking, and the amount and type of protein consumed in the diet all appear to be risk factors. Type 1 diabetes should be monitored annually for about five years following diagnosis, or sooner if puberty or poor metabolic control are noticeable. After receiving a type 2 diabetes diagnosis, people should be checked often after that. It is critical to check for the presence of related conditions, particularly retinopathy and macrovascular disease, in individuals with both micro- and macroalbuminuria.⁽¹⁶⁾

Cerebrovascular diseases: Cerebrovascular disease is the main cause of diabetes-related illness and mortality. Individuals with diabetes have a lower functional outcome, an earlier onset of symptoms, and a stroke risk that is at least double that of those without the condition. About 20% of people with diabetes die from stroke, making it one of the leading causes of death in this population. Effective primary and secondary stroke prevention strategies have been developed from research cohorts that include individuals with and without diabetes. However, when it comes to preventing diabetes, there are a few specific aspects to consider. In this article, we have collated the data to aid in the diagnosis and treatment of stroke in people with diabetes ⁽¹⁷⁾

DIAGNOSIS: Those who are at risk (so that lifestyle changes and other preventative measures can be implemented) and those who have early disease (so that treatment can begin) can be identified through early identification and monitoring. A glycated hemoglobin level of 6.5% or higher, or a fasting plasma glucose level of 126 mg per deciliter (7.0 mmol per liter) or higher, is the diagnostic cutoff point for diabetes; the diagnosis needs to be verified by the same test or another one. The American Diabetes Association recommends a range of 5.7 to 6.4% for glycated hemoglobin levels that are diagnostic of prediabetes, while there is disagreement over this range. Prediabetes is defined as a fasting glucose level between 100 and 125 mg/dL (5.6 and 6.9 mmol/L). For certain ambient glucose levels, there have been reports of racial and ethnic differences in glycated hemoglobin levels; hemoglobinopathies and conditions involving reduced red-cell turnover can result in inaccurate glycated hemoglobin readings. Both glycated hemoglobin and fasting plasma glucose tests identify patients at similar risk for adverse outcomes, although they appear to identify different patient groups with prediabetes and diabetes ⁽¹⁸⁾

Table No: 2 Drug Classifications: ⁽¹⁹⁾

REVIEW OF LITERATURE

Pankaj Kumar Jain  et al, The purpose of the study is to ascertain the trend of antihypertensive medication prescriptions among a group of patients at a tertiary care facility in the East Nimar region of Central India. A total of 86 patients' clinical and demographic information was gathered, and the prescriptions of these hypertensive patients were examined. The largest proportion of hypertensive patients (of the 86 total patients), both male and female, were between the ages of 60 and 70. Amlodipine and calcium channel blockers were the most prescribed drug classes since the majority of patients were older, followed by metoprolol and telmisartan. Of the 35 patients (40.69%) who received combination therapy, 25 patients (20.06%) frequently received two drug combinations. With 16 patients (18.60%), ARBs + CCBs dominated the scenario. This was followed by CCBs + Beta Blockers (5 patients, 5.81%). Our results demonstrated that among older individuals with hypertension, CCBs dominated the monotherapy scenario, followed by CCB and ARB combination therapy. Since the majority of patients were elderly, the use of antihypertensive medications generally complies with the guidelines; nonetheless, there is still much space for improvement in terms of sensible prescribing.^[20]

Bipin panda et al , Behavior The purpose of the study was to determine the trend in anti-hypertensive medication prescriptions among hypertensives and diabetic hypertensives in Odisha. A two-month prospective study was carried out at Sambalpur's Veer Surendra Sai Medical College and Hospital. Prescriptions for antihypertensives were gathered from patients who were seen in the general medicine outpatient department. Of the 422 prescriptions that were tracked, 285 were written by men and 137 by women. The patients' ages range from 35 to 75 years old. Of the 422 prescriptions, 304 were for diabetic hypertensives and 118 were for hypertensives. Antihypertensive medication combinations were used to treat 48% of hypertensive patients, while single antihypertensive medications were used to treat 52% of patients. Just 17% of people have secondary hypertension (HTN), compared to 83% who have primary hypertension (HTN). Both combination therapy and monotherapy were used to treat hypertension. Primary hypertension (HTN) affects 83% of persons, while secondary hypertension (HTN) affects just 17%. Hypertension was treated with both solo and combination medication.^[21]

Tom Cyril  et al, Investigate how antihypertensive medications are prescribed and evaluate the risk factors linked to hypertension. Males over 60 years old were the most impacted by hypertension out of the 31 cases. According to the JNC 7 classification, the majority of study participants (41.9%) had Stage II hypertension. Age was the primary risk factor for hypertension (41.9%), followed by drunkenness (12.9%) based on environmental risk factors and diabetes (64.5%) based on disease. According to the study, Type II DM was comorbid in the majority of patients, or 19 (61.3%), with CKD, followed by 15 (48.4%). The majority of patients, or 74.2%, received triple therapy, while 25.8% received monotherapy. Furosemide (diuretics) 18 was the most often given medication (58.1%).^[22]

Taklo Simeneh Yazie  et al, Examining prescription trends for hypertension and blood pressure (BP) control at randomly chosen South Gondar Zone hospitals was the aim of the current study. Data analysis includes all 423 patients who were recruited. On average, 93.5% of prescriptions for hypertension were found to comply with WHO guidelines. Monotherapies accounted for almost 53% of prescriptions for hypertension. Diuretics were the most frequently prescribed drug in monotherapy and in combination with calcium channel blockers (CCBs) as dual therapy. On average, more than 90% of prescription was in accordance with WHO guideline and around one-third of participants experienced at least one moderate or major drug-drug interaction. Monotherapy and patient-level low medication regimen complexity were favorably correlated with blood pressure control, but non-adherence, poor drug selection^[23]

Dinesh Prasad Sinha et al, Behavior The purpose of the study was to examine the present practice of prescribing antihypertensive medications in an Indian tertiary care hospital. Prescriptions written for patients with essential hypertension who visited the outpatient department of Patna Medical College in Patna, Bihar, between December 2023 and March 2024 were examined cross-sectionally. A total of 1000 prescriptions for hypertensive patients were gathered over the course of the trial; 500 of these were disqualified based on the exclusion criteria. Uncomplicated hypertension affected the remaining 500 people (62.07% of whom were men and 39.29% of whom were women). This study offers baseline data and depicts the current prescribing trends for antihypertensive medications.For comparable research in the future, given the constantly shifting trends in the prescription of antihypertensive medications.^[24]

Supriya Selvakumar Suseela et al, A tertiary care hospital's prescribing practices for hypertension patients will be evaluated through a research based on JNC 8 standards. All patients gave their informed consent after 100 hypertensive prescriptions were screened for the trial. The selection of antihypertensive medications complies with the JNC 8 criteria for the management of hypertension in a reasonable manner, indicating that practitioners are generally in conformity with the standards. According to this study, diuretics are the first-choice medication for hypertension in monotherapy, triple treatment, and quadruple therapy. The majority of patients with a hypertensive diagnosis were men. To raise the BP control rate in this institution, however, better patient education regarding medication adherence and more focus from physicians on lifestyle modification issues are required.^[25] 

Dinesh Prasad Sinha et al, Finding out how anti-diabetic drugs are now prescribed and how well they maintain proper glycemic control in diabetic patients receiving treatment at a teaching hospital in Patna, Bihar, was the aim of this study. This cross-sessional, prospective, observational study was conducted with 150 patients in accordance with the World Health Organization's handbook to assess drug use in specific facilities. wherein 100 (n = 150) patients with Type 2 diabetes were evaluated and 140 anti-diabetic prescription items were prescribed. With 54% of participants being male (n = 81) and 46% being female (n = 69), the sample's mean age was 58.12 (±10.5) years. Of the 140 anti-diabetic drug items prescribed, 84 (56.4%) and 66 (43.6%) were OHA and insulin, respectively. OHAs were therefore the most frequently suggested class of anti-diabetic drugs in our investigation. The most often prescribed class of OHA was sulfonylureas (35.14%), followed by biguanides (32.65%), and their fixed dose combination (FDC) accounted for 21.25%. The most often administered individual OHA was biguanide, also known as metformin (32.6%), followed by glimepiride (sulfonylurea) (21.25%) and the FDC of glimepiride and metformin (12.40%). The data indicates that OHAs continue to dominate the prescribing pattern, even in the face of a shift toward the use of insulin preparations in the treatment of Type 2 diabetes mellitus. Since anti-diabetic drugs were only 41% successful in preserving appropriate glycemic control, it is necessary to strengthen current drug treatment and develop multiple drug interventions with lifestyle changes.⁽²⁶⁾  

 Mohd Mahmood et al, The main objective of this study was to highlight current prescribing practices for people with diabetes mellitus who also have other co-morbid conditions. A prospective observational study was conducted on inpatients admitted to various wards in a tertiary care hospital over a six-month period, from October 2016 to March 2017. A carefully designed questionnaire is used to collect prescriptions from patients, and relevant information is recorded and reviewed. The study looked at the prescription habits of 235 patients, 62.97% of whom were men and 37.02% of whom were women. Patients between the ages of 41 and 60 made up the majority. Hypertension was the most common co-morbid condition. Rapid-acting insulin was typically prescribed while the patient was hospitalized. Metformin was the most often prescribed oral hypoglycemic drug, followed by glimepride. Adverse drug reactions can be decreased by replacing current medications with new ones, such as glucagon-like peptide agonists, dipeptidyl peptidase inhibitors, and sodium-glucose transport inhibitors. Medication interactions should be managed using clinical significance and correlation.⁽²⁷⁾

P. Bhavana et al, Research on drug use helps identify clinical drug usage in the public and its impact on the healthcare system, as well as evaluate rational drug use. to look into prescription trends and evaluate treatment compliance in diabetes patients who come to the medical outpatient department of a teaching hospital. Drug consumption research helps identify clinical drug use in the population and its impact on the healthcare system. must decide to give some drugs to people with diabetes mellitus primarily through the cautious use of medications. Patients with diabetes in the General Medicine Department took part in a cross-sectional retrospective study for six months. Data from 280 patients were collected and analyzed. In all, 280 patients with diabetes mellitus were admitted. In our analysis, polypharmacy was found in almost all of the prescriptions. Insulin was the most often prescribed drug for diabetes mellitus (22.14%), followed by metformin (8.21%) and glimepiride (16.78%). Sulfonylureas are used in monotherapy in 50.7% of cases, two-drug combinations in 21%, and three-drug combinations in 2.14% of cases. Of the patients, 45.71% were female and 54.28% were male; 44.41% were prescribed combination therapy and 52.48% were prescribed monotherapy. Insulin and glimepiride are the most often prescribed medications; however, they must be assessed using the proper criteria before being prescribed to patients. To put it another way, strict commitment to responsible drug use is necessary.⁽²⁸⁾

Temesgen Sidamo Summoro et al, Rational prescribing is one of the first steps in ensuring responsible drug use. Inappropriate prescriptions for half of the drugs are common, and because people don't take them as recommended, half of them are even abused. The purpose of this study was to investigate the drug-prescribing procedures of four hospitals in southern Ethiopia. Using World Health Organization (WHO) prescribing indicators, a retrospective cross-sectional study was conducted from May 15 to June 25, 2014, to evaluate drug-prescribing trends. The four hospitals' outpatient departments' prescription records from the previous year were reviewed in compliance with WHO guidelines. Additionally, a review of hospital prescriptions revealed the most often prescribed drugs. All statistical analyses were performed using SPSS® version 20.0. The average number of drugs per prescription varied from 1.82±0.90 to 2.28±0.90, while the rates of use for injectables and antibiotics ranged from 15 to 61.7 and 46.7 to 85, respectively. The essential medicines list and generic names accounted for 94.1 and 95.8, respectively, of the average percentages of prescription medications.
Analgesics and anti-infectives are the drugs that are most frequently administered. The prescribing practices deviated somewhat from the WHO's guidelines for permissible polypharmacy. Prescriptions from the essential medicine list and under generic names were almost perfect. In the other two hospitals, however, injectables were used within the allowed range.⁽²⁹⁾

Akshay A. Agarwal et al, Examining how anti-diabetic drugs are provided and how well they maintain optimal glycemic levels in diabetic patients receiving treatment at a tertiary care teaching hospital in Navi Mumbai was the aim of the study. To assess their prescription habits for anti-diabetic medications, one hundred patients with diabetes mellitus who were examined in the diabetes outpatient and medicine outpatient departments took part in a prospective, cross-sectional, observational study. To evaluate the patients' glycemic management, blood glucose levels were measured using the Accu-Chek Active glucometer. During the trial, 1.4 anti-diabetic drugs were prescribed on average, with one to four anti-diabetic pharmaceutical items prescribed. Out of the 140 anti-diabetic drugs prescribed, 61 (43.6%) were insulin and 79 (56.4%) were OHA. Accordingly, in our analysis, OHAs were the most frequently suggested class of anti-diabetic drugs. Sulfonylureas (34.14%) and biguanides (31.6%) were the most frequently prescribed classes of OHA, with their fixed dose combination (FDC) accounting for 20.25%. Metformin (biguanide) was the most frequently prescribed individual OHA. Glimepiride (sulfonylurea) came in second at 20.25%, while the FDC of glimepiride and metformin was 11.40%. Alpha glucosidase inhibitors (3.8%), thiazolidinediones (6.33%), and dipeptidyl peptidase 4 inhibitors (DPP 4 inhibitors) were among the other OHA classes that were assigned. The most often used kind of insulin preparation, accounting for 43.6% of all anti-diabetic drugs, was short-acting insulin preparation^.(30)

Asha Pathak et al, To urge patients in rural areas to take pharmaceuticals responsibly, it is essential to assess drug usage patterns using WHO prescription indicators. Evaluating drug prescription patterns among patients hospitalized to the Medicine department at UPRIMS&R was the aim of this study. A prospective observational study was conducted from January to June 2015. The data was collected, analyzed, and presented using descriptive statistics in compliance with WHO prescription indicators. A total of 626 prescriptions were selected, of which 3205 were written. 24.64% of all prescriptions were for antibiotics, with the next most common categories being anti-diabetic drugs (12.38%), analgesics (12.23%), cardiovascular drugs (11.82%), and GIT drugs (9.01%). On average, 5.11 medicines were prescribed^.(31)

AIM:

To study prescription pattern, to evaluate the adherence to treatment guidelines in diabetic and Antihypertensive patients attending the medical In patient department in a tertiary care teaching hospital.

OBJECTIVE:

• To examine demographic information of the enrolled patients.
• To describe the patterns of use of major pharmaceutical drug classes given for diabetes and Hypertensive
• To know about the current use of Anti-Diabetics drug And Anti-Hypertensive Drug
• To examine the prescriptions with polypharmacy.
• To evaluate the glycemic control patients receiving different treatment regimens

METHODOLOGY

Sample size:

Diabetes Patients

The sample size is calculated using the Rao soft online sample size calculator. For a random sampling of a population of 200 persons with a confidence interval of 95%, the sample size is found to be 70 with a 5% margin of error. The following formula is used to calculate the size of the required sample N= Z² x p (1- p)/ d²

Where; N= sample size

Z= reliability co-efficient with 95% confidence level =1.96

P= population variance available from previous data = 0.089

D= degree of precision or margin of error = 0.05

N = (1.96)² x 0.058 (1- 0.089) / (0.05)²

N = 70

SAMPLE SIZE (n) = 70patients.

Hypertensive Patients

The sample size is calculated using the Rao soft online sample size calculator. For a random sampling of a population of 100 persons with a confidence interval of 95%, the sample size is found to be 80 with a 5% margin of error. The following formula is used to calculate the size of the required sample N= Z² x p (1- p)/ d²

Where; N= sample size

Z= reliability co-efficient with 95% confidence level =1.96 P= population variance available from previous data = 0.058

D= degree of precision or margin of error = 0.05

N = (1.96)² x 0.058 (1- 0.058) / (0.05)²

N = 80

SAMPLE SIZE (n) = 80 patients. Study design: A prospective observational study is conducted in the inpatients admitted to various words.

Study duration: Six months

STUDY SITE: St Isabel Hospital, Mylapore, Chennai-600004

Source of data:

All relevant and necessary data for the study was collected from the patients profile forms and from the patients medication chart.

Study procedure:

The study teams visits the study site on a regular basis and selects the patients according to the study criteria, the necessary data is collected from the patient in the patient profile form and the medication chart in a designed data collection form.

Data collection instrument:

To collect data, I used data collection form. The observational study includes the following informations.

SECTION:1

• Demographical Data:
• Gender, Age

SECTION:2

• Investigations:
• Range of HbA1c levels in patients and blood glucose level.

SECTION:3

• Prescription pattern of anti-diabetics drug:
• Oral hypoglycemic therapy, insulin and combinations per prescription

SECTION:4

• Prescription pattern of anti-hypertensive drug:
• Clinical Characteristics of Hypertensive Patients, Drugs of Monotherapy, Two Drug Combinations, Three Drug Combinations.

WHO PRESCRIBIMG GUIDELINES:

1. Average number of medications per counter: This figure is determined by dividing the total number of prescriptions for various drug items by the number of encounters that were survived. Whether the patient actually received the medications is irrelevant.
2. Prescription medication percentage by generic name: This percentage is determined by dividing the number of prescription pharmaceuticals prescribed by generic name by the total number of prescription drugs, then multiplying the result by 100.
3. The proportion of interactions where an antibiotic is prescribed: Divide the number of patient interactions during which an antibiotic is provided by the total number of encounters survived, then multiply the result by 100 to get the percentage.
4. The proportion of interactions where an injection is prescribed: The percentage is determined by dividing the number of patients seen during an injection visit by the total number of encounters that were survived, then multiplying the result by 100.
5. Percentage of medications prescribed from the formulary's list of essential drugs: The percentage is determined by dividing the number of prescribed goods that are either on the local formulary or the essential medications list (or that are identical to pharmaceuticals on the list).

RESULTS

Fig1.Sex wise distribution of Hypertensive Patients

Fig.2 Age wise Distribution of Hypertensive Patients:

Tabe No: 3. Clinical Characteristics of Hypertensive Patients

Table No: 4 Prescription pattern of Anti-Hypertensive Drugs:

Fig :3 Percentage of Antihypertensive patient  Mono-therapy along with drugs prescribed

Fig :4 Percentage of Antihypertensive patient  Two Drug Combination along with drugs prescribed

RESULTS FOR DIABETES

Fig:  Sex wise distribution of diabetes patients

This study was conducted with 80 diabetic patients, under which 66% of them are male and 34% of them are female.

Fig: 6 Age wise distribution of diabetes patients

In this study, 5 patients were in the 40-50 age group, 19 were in the 50-60 age group, 20 were in the 60-70 age group, 16 were in the 70-80 age group, 7 were in the 80-90 age group, and 3 were in the 90-100 age group.

Fig: 7 Use of antidiabetic drug along with diabetic drug vs only diabetic drugs

During this study, 66% of patients consumed only diabetic drug and 34% of patients took both diabetic and antibiotic drugs.

Fig: 8 Range of diabetes

In this study, patients are taken from various ranges of diabetes and the ranges are mentioned above.

Table No:5 Most common diabetes drugs prescribed in this study

Fig 9: Amount of drugs that has been prescribed

Fig 10: Amount of combinational drug prescribed

Table 6: Most commonly prescribed antibiotic drug

Table 7: Most commonly prescribed Insulin

Table 8: Result of study of drug through WHO prescribing guidelines (n=70)