OBJECTIVES: The study was conducted to assess patterns of prescribed drug therapy and clinical predictors of need for therapy escalation in outpatients with diabetes mellitus (DM).

METHODS: This was a prospective cohort study, conducted at an apex tertiary care teaching hospital in central India for a period of 18 months. The demographic, clinical, and treatment details on the baseline and follow up visits were collected from the patients' prescription charts. Glycemic control, adherence, pill burdens along with pattern of antidiabetic therapy escalation, and deescalations were analyzed.

RESULTS: A total of 1,711 prescriptions of 925 patients of diabetes with a mean age of 53.81 ± 10.42 years and duration of disease of 9.15 ± 6.3 years were analyzed. Approximately half of the patients (n=450) came for ≥1 follow up visits. Hypertension (59.35%) was the most common comorbidity followed by dyslipidemia and hypothyroidism. The mean total daily drugs and pills per prescription were 4.03 ± 1.71 and 4.17 ± 1.38, respectively. Metformin (30.42%) followed by sulphonylureas (SUs) (21.39%) constituted majority of the AHA's and dual and triple drug therapy regimens were most commonly prescribed. There were improvements in HbA1c, fasting/postprandial/random blood sugar (FBS/PPBS/RBS) as well as adherence to medication, diet, and exercise in the follow up visits. Among patients with follow ups, therapy escalations were found in 31.11% patients, among whom dose was increased in 12.44% and drug was added in 17.28%. Apart from Hb1Ac, FBS, and PPBS levels (p<0.001), characteristics such as age, BMI, duration of diagnosed diabetes, presence of hypertension and dyslipidemia, and daily pill burdens were found to be significantly higher in the therapy escalation group (p<0.05). Inadequate medication adherence increased the relative risk (RR) of therapy escalation by almost two times.

CONCLUSIONS: Disease and therapy patterns are reflective of diabetes care as expected at a tertiary care center. Higher BMI, age, pill burden, duration of diabetes, presence of comorbidities, and poor medication adherence may be the predictors of therapy escalation independent of glycemic control and such patients should be more closely monitored.

[Untagged]
━ Included
━ ━ Human
━ ━ ━ Pregnant women
━ ━ ━ ━ Case-control
━ ━ ━ ━ Cohort
━ ━ ━ ━ Cross-sectional
━ ━ ━ Infants
━ ━ ━ ━ Case-control
━ ━ ━ ━ Cohort
━ ━ ━ ━ Cross-sectional
━ ━ ━ Children
━ ━ ━ ━ Case-control
━ ━ ━ ━ Cohort
━ ━ ━ ━ Cross-sectional
━ ━ ━ General population
━ ━ ━ ━ Case-control
━ ━ ━ ━ Cohort
━ ━ ━ ━ Cross-sectional
━ ━ ━ Occupational
━ ━ ━ ━ Case-control
━ ━ ━ ━ Cohort
━ ━ ━ ━ Cross-sectional
━ ━ Animal
━ ━ ━ Acute
━ ━ ━ Short-term
━ ━ ━ Subchronic
━ ━ ━ Chronic
━ ━ ━ Developmental
━ ━ ━ Multigenerational
━ Excluded
━ ━ Manually excluded in SWIFT-Review
━ ━ Automatically excluded via ML in SWIFT-Active Screener
━ ━ Manually excluded in Distiller (TIAB)
━ ━ Manually excluded in Distiller (full-text)
━ ━ ━ No data provided
━ ━ ━ No relevant exposure
━ ━ ━ Unable to obtain full-text
━ ━ ━ Wildlife study
━ Supplemental
━ ━ Mechanistic (in vitro/ex vivo/in silico)
━ ━ ADME
━ ━ PK/PBPK
━ ━ Non-mammalian model
━ ━ Transgenic mammalian model
━ ━ Non-oral or non-inhalation route
━ ━ ━ Exposure duration
━ ━ ━ ━ Acute
━ ━ ━ ━ Short-term
━ ━ ━ ━ Subchronic
━ ━ ━ ━ Chronic
━ ━ ━ ━ Developmental
━ ━ ━ ━ Other/unclear
━ ━ ━ Route of exposure
━ ━ ━ ━ Oral (gavage)
━ ━ ━ ━ Dermal
━ ━ ━ ━ Injection
━ ━ ━ ━ Intravenous
━ ━ ━ ━ Other/unclear
━ ━ Exposure only
━ ━ Mixture
━ ━ Case reports/series (n≤3)
━ ━ No original data
━ ━ Conference abstract
━ ━ ECHA read-across
━ ━ Presumed duplicate
━ ━ Other supplemental
━ Chemicals
━ ━ Not specified
━ ━ 1-Butanesulfonic acid, 1,1,2,2,3,3,4,4,4-nonafluoro-, salt with sulfonium, dimethylphenyl- (1:1)
━ ━ 1-Hexene, 3,3,4,4,5,5,6,6,6-nonafluoro-, polymer with ethene and 1,1,2,2-tetrafluoroethene
━ ━ 1H,1H,2H-Perfluorocyclopentane
━ ━ 1H,1H,5H-Perfluoropentanol
━ ━ 2-Chloro-1,1,1,2-tetrafluoroethane
━ ━ 2H,2H,3H,3H-Perfluorooctanoic acid
━ ━ 3-Methoxyperfluoro(2-methylpentane)
━ ━ 3-Perfluoroheptylpropanoic acid
━ ━ 3,3,4,4,5,5,6,6,6-Nonafluorohexene
━ ━ 4:2 Fluorotelomer alcohol
━ ━ 6:2 Fluorotelomer alcohol
━ ━ 6:2 Fluorotelomer methacrylate
━ ━ 6:2 Fluorotelomer sulfonic acid
━ ━ 8:2 Fluorotelomer alcohol
━ ━ 8:2 Fluorotelomer sulfonic acid
━ ━ Bis(2-hydroxyethyl)ammonium perfluorobutanesulfonate
━ ━ Dodecafluoroheptanol
━ ━ (Heptafluorobutanoyl)pivaloylmethane
━ ━ Heptafluorobutanol
━ ━ Methyl perfluoro(3-(1-ethenyloxypropan-2-yloxy)propanoate)
━ ━ Nafion
━ ━ ━ Included
━ ━ ━ ━ Animal
━ ━ ━ ━ ━ Short-term
━ ━ ━ ━ Human
━ ━ ━ ━ ━ Occupational
━ ━ ━ ━ ━ ━ Cross-sectional
━ ━ ━ Excluded
━ ━ ━ ━ Manually excluded in Distiller (TIAB)
━ ━ ━ ━ Manually excluded in Distiller (full-text)
━ ━ ━ Supplemental
━ ━ ━ ━ ADME
━ ━ ━ ━ Exposure only
━ ━ ━ ━ Mechanistic (in vitro/ex vivo/in silico)
━ ━ ━ ━ Non-mammalian model
━ ━ ━ ━ Non-oral or non-inhalation route
━ ━ ━ ━ ━ Exposure duration
━ ━ ━ ━ ━ ━ Chronic
━ ━ ━ ━ ━ ━ Short-term
━ ━ ━ ━ ━ ━ Subchronic
━ ━ ━ ━ ━ Route of exposure
━ ━ ━ ━ ━ ━ Injection
━ ━ ━ ━ ━ ━ Intravenous
━ ━ ━ ━ ━ ━ Other/unclear
━ ━ ━ ━ Other supplemental
━ ━ ━ Chemicals
━ ━ ━ ━ Nafion
━ ━ N-Ethyl-N-(2-hydroxyethyl)perfluorooctanesulfonamide
━ ━ N-Ethylperfluorooctanesulfonamide
━ ━ N-Methyl-N-(2-hydroxyethyl)perfluorooctanesulfonamide
━ ━ N-Methylperfluorooctanesulfonamide
━ ━ Pentafluoropropanoic anhydride
━ ━ Perfluamine
━ ━ Perfluoro-1,3-dimethylcyclohexane
━ ━ Perfluoro-1-iodohexane
━ ━ Perfluoro-2,5-dimethyl-3,6-dioxanonanoic acid
━ ━ Perfluoro-2-methyl-3-oxahexanoic acid
━ ━ Perfluoro-3-(1H-perfluoroethoxy)propane
━ ━ Perfluoro-3,6-dioxaheptanoic acid
━ ━ Perfluoro(N-methylmorpholine)
━ ━ Perfluoro(propyl vinyl ether)
━ ━ Perfluorobutanesulfonyl fluoride
━ ━ Perfluorocyclohexanecarbonyl fluoride
━ ━ Perfluoroheptanesulfonate
━ ━ Perfluoroheptanesulfonic acid
━ ━ Perfluoroheptanoic acid
━ ━ Perfluoroisobutyl methyl ether
━ ━ Perfluoromethylcyclopentane
━ ━ Perfluorooctanesulfonamide
━ ━ Perfluorooctanesulfonyl fluoride
━ ━ Perfluoropentanoic acid
━ ━ Perfluoropropanoic acid
━ ━ Perfluorotetradecanoic acid
━ ━ Perfluorotridecanoic acid
━ ━ Perfluoroundecanoic acid
━ ━ Propanoic acid, 3-[1-[difluoro[(trifluoroethenyl)oxy]methyl]-1,2,2,2-tetrafluoroethoxy]...
━ ━ Sodium perfluorodecanesulfonate
━ ━ Tetrabutylphosphonium perfluorobutanesulfonate
━ ━ Tetraethylammonium perfluorooctanesulfonate
━ ━ Trichloro((perfluorohexyl)ethyl)silane
━ ━ Triethoxy((perfluorohexyl)ethyl)silane
━ ━ Trifluoroacetic acid
━ ━ Trifluoromethanesulfonic acid
━ ━ 3:3 Fluorotelomer carboxylic acid
━ ━ 4:2 Fluorotelomer sulfonic acid
━ ━ Perfluoro(2-methyl-3-oxahexanoyl) fluoride
━ ━ Propane, 1,1,1,2,2,3,3-heptafluoro-3-[(trifluoroethenyl)oxy]-, polymer with tetrafluoroethene
━ ━ Perfluoro-3-methoxypropanoic acid
━ ━ Perfluoro(4-methoxybutanoic) acid

References (17373 found)