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

Abstract

BackgroundInappropriate Anti-diabetic Medication Therapy (IADT) refers to a drug-related problem and includes ‘ineffective drug therapy’, ‘unnecessary drug therapy’, ‘dosage too high’, and ‘dosage too low’. This study aimed to determine the prevalence and factors associated with IADT among T2DM patients at Mbarara Regional Referral Hospital, Uganda (MRRH).MethodA prospective cross-sectional study was conducted at the medical and surgical wards of MRRH from November 2021 to January 2022. One hundred and thirty-eight adult patients aged 18 years and above, with T2DM, were recruited using consecutive sampling. Patient file reviews and interviewer-administered questionnaire was used for data collection. The data were entered into and analyzed using SPSS version 25. Descriptive analysis was employed to describe the population and determine the prevalence of IADT. Types of IADTs were identified using Cipolle’s DRP classification tool. A univariate and multivariate logistic regression analysis was used to identify factors significantly associated with IADT. The P-value of < 0.05 was considered statistically significant at 95% confidence interval.ResultsA total of 138 hospitalized T2DM patients were studied. Eighty (58.0%) were females, and 70 (50.7%) were ≥ 60 years of age. Out of a total of 138 participants, 97 experienced at least one IADT, with an estimated prevalence of 70.3%. ‘Dosage too high’ (29.2%) and ‘dosage too low’ (27.9%) were the most common type of IADTs. Age ≥ 60 years (AOR, 8.44; 95% CI, 2.09–10.90; P-value = 0.003), T2DM duration of < 1 year (AOR, 0.37; 95% CI, 0.11–0.35; P-value = 0.019), and HbA1c of < 7% (AOR, 9.97; 95% CI, 2.34–13.57; P-value = 0.002) were found to be factors significantly associated with the occurrence of IADTs.ConclusionThe overall prevalence of inappropriate anti-diabetic medication therapy among T2DM patients admitted to medical and surgical wards of MRRH was 70.3%. The most common type of IADT in this study was ‘dosage too high’, accounting for almost one-third followed by ‘dosage too low’ accounting for a quarter of total IADTs. Age greater or equal to 60 years, T2DM duration of < 1 year, and HbA1c of < 7% during the current admission were found to be factors significantly associated with the occurrence of IADTs in hospitalized T2DM patients.

Drug-related problems in hospitalized patients with type 2 diabetes mellitus: A systematic review

“… 18 cases of drug doses too low and 18 cases of drug doses too high. Hussain et al, 2019 27 India Helper Strand classification Lexicomp Micromedex Aspirin, clopidogrel, warfarin, atorvastatin and some drugs acting on the CNS- DDI Antihypertensives- ADR 99 patients (81%) experience DDI Indriani et al, 2019 28 Indonesia PCNE American Standards of Medical Care in Diabetes 2018 Drug Interaction Drug Information Handbook Indonesian Endocrinology Society – Most common DRPS is drug interactions that is 94.62% Nzayisenga et al, 2019 29 Africa PCNE Antihypertensive (270/385) Antidiabetics (267/385) Mainly drug/dose selection The prevalence of DRPs was 81.29% (313/385) Acharya et al, 2020 30 India Pharmaceutical Care Network Europe (PCNE) classification Helper Strand classification Micromedex Medscape Lexicomp Drugs.com Metformin + ciprofloxacin 2 Insulin 226 DRPs with an average of 0.91 DRP per patient Inamdar et al, 2020 31 India PCNE Metformin + Metoprolol 64 (33.16%) Metformin + Ranitidine 51 (26.42%) 278 DRPs were identified after assessing 107 study Sharma et al, 2020 32 India Beers Criteria 2019 Short-acting insulin Glimepiride PPI- PIM Clonazepam 58 (38.7%) patients were prescribed at least one PIM, 37 (24.7%) were prescribed two PIMs, and 16 (10.7%) were prescribed ≥ three PIMs Mader et al, 2022 33 Austria No reference (survey study from patient perspective) – 25% of patients already suffered at least one drug error, whereby prescribing a wrong dose seemed to be the most common type of error Nigussie et al, 2022 34 Pakistan Cipolle's DRP classification Biguanides (64) Insulin (61) The overall prevalence of inappropriate anti-diabetic medication therapy was 70.3% …”

“…, 28 India, 20 , 27 , 30. , 31 , 32 Japan, 18 and Pakistan, 34 followed by Europe (15%): Italy, 15 Poland, 19 Austria, 33 Africa (5%) 29 and North America (5%). 16 The majority of the studies were conducted in the general hospital ward with only 2 studies reported to have been conducted in the endocrinology and diabetology department.…”

“…, 32 Five studies implemented more than one method of detecting DRPs. 16 , 18 , 24 , 27 , 31 , 34 Five studies used incident reports (with/without methods combination) for adverse drug reactions and drug interactions. 15 , 16 , 18 , 23 , 24 Two studies used surveys or questionnaires as means of collecting data on DRPs from the patient.…”

“…Eight studies used one source only. 18 , 20 , 21 , 25 , 29 , 31 , 32 , 34 Seven studies used more than one source. 17 , 22 , 23 , 24 , 27 , 28 , 30 One study establishes operational definitions as its source.…”

“…Five studies examined medication errors such as potentially inappropriate medication (PIM) and dosage problems. 19 , 21 , 32 , 33 , 34 One of the studies investigated a specific drug (metformin) use in the elderly and observed 82% of 335 patients to be contraindicated with only three reported dyspepsias during hospital stay. 19 Two studies investigated PIM in the elderly population with a prevalence of 30% and 74% having at least one PIM.…”