Study of Prescription Pattern of Oral Hypoglycemic Agents in Relation to Gfr Appropriateness in Diabetes Mellitus with Nephropathy

Amreen Abdul Hameed, A Snigdha

Abstract

Aim: The decline in the renal function impairs the clearance and metabolism of the anti-diabetic agents and insulin, resulting in the frequent requirement of the prescription reassessment. Objective:The objective is to sort out the inappropriateness in the prescription pattern of oral hypoglycemic agents in diabetes mellitus with nephropathy. Method:The prescriptions were randomly selected for the study, after they fulfilled the necessary inclusion, exclusion criteria. After obtaining the informed consent form, the socio demographic data, details of anti-diabetic therapy, required laboratory investigations (serum creatinine, BUN, BUN:Se.cr ratio, CUE, HbA1C), hypoglycemic episodes (if any) are recorded. Another required parameter GFR is calculated using CKD-EPI equation. Fischer exact test is used to test the significance of hypoglycemic episodes among CKD 1-2 and CKD 3-5. Results:Metformin+Glimepiride combination is the most commonly prescribed medication (34.6%), followed by metformin alone (23.07%). The drugs which are found to be least prescribed are Glipizide (1.92%), Sitagliptin (1.92%), Pioglitazone (0.96%). Inappropriately prescribed drug which is highly responsible for hypoglycemic episodes is Metformin+Glimepiride (22.22%). Conclusion:Biguanides and sulphonylureas have been found to dominate the prescription pattern of DM-II, despite of the presence of the comorbidity such as nephropathy.