Assessment of Drug Therapy Problems Among Type 2 Diabetes Patients with Hypertension Comorbidity in Indonesia

Abstract

Type 2 diabetes mellitus (T2DM) is a major chronic disease that affects a large number of people worldwide. Hypertension is a common disease comorbidity among T2DM patients, and often those patients received polypharmacy and complex treatment in long term duration. This condition may lead to an increased risk of drug therapy problems (DTPs). This study aimed to assess and determine potential drug therapy problems in type 2 diabetic patients with hypertension comorbidity. Retrospective cross-sectional design was conducted in a hospital setting, especially data sources from the prescription of ambulatory T2DM patients with hypertension. A total of 190 patients were studied. More than half of the participants were female (53.68%). The majority age range of participants was 50-59 years (46.84%). Almost all antidiabetic agents were prescribed as polypharmacy (73.16%). Metformin was the most antidiabetic agent prescribed as monotherapy and combination therapy (63.16%). Almost all antihypertensive agents were prescribed as polypharmacy (63.26%). Amlodipine was the most antihypertensive agent prescribed as monotherapy and combination therapy (34.74%). Among the study participants, 56.84% have at least one of DTPs. Adverse drug reaction was the most frequent (47.22%), followed by ineffective drug therapy (29.63%). Since the potential of DTPs in T2DM patients with hypertension comorbidity is relatively high, early identifying, resolving, and preventing drug therapy problems by the pharmacist is needed to achieve goals of treatment.

Prevalence and factors associated with inappropriate anti- diabetic medication therapy among type 2 diabetes mellitus patients at the medical and surgical wards of Mbarara Regional Referral Hospital, Uganda

“…‘Ineffective drug therapy’ which accounted for 17.0% was the least common IADT identified in our study and was attributed to the use of the ineffective drugs when a ‘more effective drug was available’. However, this proportion is lower than a study in Indonesia and Nigeria, which reported 50% and 29.6% respectively (Kisno et al, 2011) [ 54 ]. This discrepancy was due to non-adherence to guidelines and inter-patient variation in drug response in the former studies.…”

“…The proportion of ‘unnecessary drug therapy’ in our study was 25.9%, which is in agreement with a study in Eastern Ethiopia (26.7%) [ 26 ]. However, this proportion is higher than a study in Nigeria and two studies in Ethiopia, ranging from 3.6 to 17.6% [ 23 , 32 , 54 ]. This high proportion in our study site may be due to the underuse of standard diabetes treatment guidelines, initiation of insulin-based regimens without clear indications, and initiation of anti-diabetics when non-drug therapy is more appropriate.…”

Drug-Related Problems and Pharmacists’ Interventions in Hypertensive Outpatients: A Multicenter Prospective Study in 3 Vietnamese Hospitals

“…7 -12 Several studies in some Southeast Asian countries such as Malaysia and Indonesia about DRPs in hypertensive patients reported more than 56% of the patients had at least 1 DRP. 11,13,14…”

“…[7][8][9][10][11][12] Several studies in some Southeast Asian countries such as Malaysia and Indonesia about DRPs in hypertensive patients reported more than 56% of the patients had at least 1 DRP. 11,13,14 DRPs may lead to elevating morbidity, mortality, treatment costs, poor adherence, and longer hospitalization. 11,15 To prevent or minimize the DRP, an effective intervention strategy is required.…”

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“…'Ineffective drug therapy' which accounted for 17.0% was the least common IADT identified in our study and was attributed to the use of the ineffective drugs when a 'more effective drug was available'. However, this proportion is lower than a study in Indonesia and Nigeria, which reported 50% and 29.6% respectively (Kisno et al, 2011) [54]. This discrepancy was due to non-adherence to guidelines and interpatient variation in drug response in the former studies.…”