Adverse Effects of Oral Hypoglycemic Agents and Adherence to them among Patients with Type 2 Diabetes Mellitus in Nepal

Abstract

ABSTRACT:Introduction: Oral hypoglycemic agents (OHAs) are the most common drugs used in Type 2 Diabetes Mellitus. There are various established adverse effects related to their use including hypoglycemia, weight gain, gastrointestinal disturbance, lactic acidosis, and fluid retention. However, the pattern of adverse effects related to OHAs in Nepalese patients still needs to be explored. Our study aims to determine the pattern of adverse effects resulting from the use of OHAs among Type 2 Diabetes mellitus patients and their adherence to the medication. Methods: All diabetic patients who met the inclusion criteria were enrolled in the study. After informed consent, patients were interviewed and evaluated as per the designed proforma. They were mainly studied for common drug used, adverse effects of the drugs, occurrence of hypoglycemia, and adherence to treatment. Results: The study comprised of 183 patients with mean age of 58.73 years (SD = 12.95). Fifty-six (30.6%) patients said that they developed adverse effects of drugs but only 21 (11.5%) of them reported to their treating physician. Most common adverse effect were related to central nervous system such as tingling sensation of hands and feet, dizziness, drowsiness, etc. Though 91 (49.7%) patients had developed symptoms suggestive of hypoglycemia, only 31 (16.9%) knew that it was due to hypoglycemia. Majority of the patients (n = 143, 78.1%) administered the drugs as prescribed by the physician. Among the defaulters, the most important reasons for failure to properly administer the drugs was forgetfulness in 82.5% (n = 33, N = 40) of cases. Among the study variables family history of chronic illness (p = 0.046) and information about adverse effects from physician (p = 0.001) had a significant relationship with incidence of adverse effects. Whereas none of them had a significant relationship with adherence to hypoglycemic medication. Conclusion: The incidence of adverse effects was high with hypoglycemia occurring in 49.7% of the cases, though only one-third of them recognized it to be due to hypoglycemia, in the patients with Type 2 Diabetes Mellitus. Family history of chronic illness and information about adverse effects from the physician had significant relationship with the incidence of adverse effects of hypoglycemic treatment.

Analysis of Prescribing Pattern, Efficacy and Adverse Drug Reactions of Anti-diabetic Agents in Type-2 Diabetic Patients at a Tertiary Care Teaching Hospital

“…Though these are very likely to improve compliance in the patient and therefore may be used once the dose adjustment in a particular patient has been achieved. Our findings correlate with the observation of previous studies where mean drugs per prescription was 2.03 17 , metformin alone was used in 49.7% 7 , combination therapy was prescribed to 60% of all prescriptions 9 and metformin was the commonly prescribed medicine and sulphonylureas were the second most commonly prescribed drug 6 .…”

“…Evaluation of ADRs is important for the assessment of risk factors to ensure maximum benefits of drug therapy, compliance and also confirms the rational usage of drugs. Our results for ADRs were quite satisfactory and encouraging as several other studies conducted on ADDs reported ADRs about 40%, 18,19 and nearly 30% 7 and thus combination therapy was used in these study to prevent adverse reaction such as lactic acidosis caused due to metformin 20 .…”

“…Studies evaluating drug utilization pattern for Diabetes Mellitus in past have shown metformin as the most prescribed drug followed by sulphonylureas 6 . A study evaluating adherence to ADD in Nepal has shown that metformin alone is most frequently prescribed, 7 whereas use of metformin in fixed dose combinations was roughly 20% from a study in India, 8 the use of metformin in combination with other medications has been reported to nearly 60% from a Taiwanese study 9 . Such prescription audits for chronic disorders such as DM offer us clue for drug utilization and allow us to use corrective steps for rational use of drugs.…”

In Vivo Antidiabetic Efficacy, Mineral Element Composition, and Qualitative Phytochemistry of the Aqueous Leaf Extracts of Pentas zanzibarica (Klotzsch.) Vatke and Olea europaea subspecies africana (Mill.)

“…Furthermore, persistent hyperglycaemia damages blood vessels, nerves, kidneys, eyes, among other organs and machinery of the body, resulting in devastating sequelae [48]. The currently available anti-diabetic therapies, including insulin and synthetic oral hypoglycaemic drugs such as biguanides, sulfonylureas, and glinides [12], are inaccessible, unaffordable, palliative, and cause serious side effects [48,[50][51][52]. Consequently, the search for potent, curative, safer, accessible, and affordable alternative antidiabetics is warranted.…”

Assessment of safety of Saxagliptin in patients of type 2 diabetes mellitus who were previously on metformin monotherapy with uncontrolled diabetes

“…There are various established adverse effects related to the use of OHA (oral hypoglycemic agents) including hypoglycemia, weight gain, gastrointestinal disturbance, lactic acidosis, and fluid retention. 2 Adverse drug reactions may reduce the patient compliance (poor patient adherence towards the therapy). From a clinical/economic viewpoint, patient's poor-adherence towards OHA is associated with reduced treatment benefits and significant financial burden, Also it can cause prolonged uncontrolled diabetes with microvascular and macrovascular complications.…”