STUDY ON PRESCRIBING PATTERN OF ANTI-DIABETIC DRUGS AMONG TYPE 2 DIABETES PATIENTS WITH COMPLICATION IN SOUTH INDIAN TEACHING HOSPITAL

ABSTRACTObjective: To evaluate the drug utilization pattern of anti-diabetic agents with respect to glycosylated hemoglobin A1c (HbA1c) level in a Type 2diabetes patient with complication.Methods: This retrospective observational study was conducted as per the protocol approved by the Institutional Ethics Committee. The patientsdiagnosed with Type 2 diabetes mellitus with complication were identified, and those who had measured HbA1c level during previous follow upswere included in the study. All demographic, drug prescriptions, and clinical data of patients were collected and documented in a suitably designedcase report form. Descriptive analyses were performed using Statistical Package for the Social Sciences Version 20.Results: Based on the study criteria, 644 patients were selected and enrolled for the study. The majority of study subjects 494 (76.7%) were male and415 (64.4%) were belonged to the age group 45-64 years. 252 (39.1%) of the patient, had normal weight followed by 234 (36.3%) were overweight,and 142 (22.1%) patients were obese. The prescription pattern showed the majority of patients 509 (79%) patients had 1-2 anti-diabetic medicationfollowed 133 (20.7%) patient prescribed with 3-4 anti-diabetic drug. An insulin was prescribed in 507 (63.4%) patients and among oral anti-diabeticdrugs, metformin 283 (43.9%), glimepiride 140 (21.7%), and voglibose 88 (13.7%) was most commonly prescribed.Conclusion: Among all the anti-diabetic drugs, the insulin was highly preferred over oral hypoglycemic agents (OHAs) to control the glycemic level,and metformin accounted for the most commonly prescribed OHAs. In the second generation of sulfonylureas class, glimepiride and glipizide weremost prescribed.Keywords: Anti-diabetic agents, Diabetes mellitus, Prescription pattern

CORRELATION OF GLYCOSYLATED HEMOGLOBIN LEVELS WITH FASTING AND POSTPRANDIAL GLUCOSE IN SOUTH INDIAN TYPE 2 DIABETIC PATIENTS

Objective: To assess the correlation of glycosylated hemoglobin levels with fasting and postprandial glucose in South Indian type 2 diabetic patients.Methods: This retrospective observational study was carried out as per the protocol approved by the institutional ethics committee (IEC) and case records of patients (≥ 40 y old) diagnosed with type 2 diabetes mellitus (T2DM) and complications, that fasting blood sugar (FBS), postprandial blood sugar (PPBS) and HbA1c measured during previous follow-ups were included in the study. Statistical analyses were carried out using SPSS Ver.20 and p ≤ 0.05 were considered statistically significant. Results: Based on the study criteria, 633 case profiles were selected and enrolled in the study. Most of the patients were males 488 (77.1%) and the mean age of patients was 59.7 y (SD=9.6). The mean fasting glucose and postprandial glucose were 9.42 mmol/l (SD=4.2), 13.39 mmol/l (SD=5.2) respectively. Patients were suffering from different type of diabetes complications, and most of them had poor glycemic control as the mean HbA1c was found to be 8.7 % (SD=2.2). The FBS and PPBS were plotted against HbA1c values showed moderate correlation and the sensitivity, specificity, positive predictive value and negative predictive value of postprandial glucose level was better than the fasting blood glucose level.Conclusion: This present study showed that there is the significant correlation between PPBS and HbA1c values. Since PPBS is performed routinely, its interpretation in terms of long term glycemic control will help clinicians to tailor their therapeutic strategies

Preparation, validation and user-testing of pictogram-based patient information leaflets for hemodialysis patients

AbstractBackground: Patient information leaflets are universally-accepted resources to educate the patients/users about their medications, disease and lifestyle modification. Objectives: The objective of the study was to prepare, validate and perform user-testing of pictogram-based patient information leaflets (P-PILs) among hemodialysis (HD) patients. Methods: The P-PILs are prepared by referring to the primary, secondary and tertiary resources. The content and pictograms of the leaflet have been validated by an expert committee consisting of three nephrologists and two academic pharmacists. The Baker Able Leaflet Design has been applied to develop the layout and design of the P-PILs. Results: Quasi-experimental pre- and post-test design without control group was conducted on 81 HD patients for user-testing of P-PILs. The mean Baker Able Leaflet Design assessment score for English version of the leaflet was 28, and 26 for Kannada version. The overall user-testing knowledge assessment mean scores were observed to have significantly improved from 44.25 to 69.62 with p value <0.001. Conclusion: The overall user opinion of content and legibility of the leaflets was good. Pictogram-based patient information leaflets can be considered an effective educational tool for HD patients

Predictors of warfarin-induced bleeding in a South Indian cardiology unit

Objectives: Warfarin-induced bleedingresults in increased morbidity and mortality and higher cost of healthcare. The objective of the study is to identify the predictors of warfarin-induced bleeding in the Cardiology Unit of a teaching hospital. Materials and Methods: A cross-sectional study was carried out for a period of six months in a tertiary care teaching hospital. A total of 235 patients were enrolled in the study, to identify the predictors of warfarin-induced bleeding. Only prescriptions with warfarin were selected for the study. The chi square test was used to find the association between demography and risk factors. Results: Out of 235 patients, 61 (25.95%) had developed warfarin-induced bleeding and the majority were in the age group of 41 - 61 years (60.65%), and it was also found to be higher in women (62.29%). The length of stay was > 14 days (65.57%) and the number of drugs prescribed was in the range of 6 - 12 (52.45%). Aspirin (40.98%), Heparin (36.06%), Clopidogrel (22.95%), and Streptokinase (14.75%) were the most common drugs involved, and other comorbid conditions like diabetes (37.70%), hypertension (32.78%), smoking (57.37%), and alcohol (32.78%) were found to be major predictors of warfarin-induced bleeding in this study. The severity of warfarin-induced most of the bleeding reactions were moderate (44.26%) and the most common site of bleeding was gastrointestinal system (34.42%). Conclusion: Predictors of warfarin-induced bleeding were found to be female gender, length of stay, number of medications, drugs like aspirin, heparin, and clopidogrel, and other comorbidities like smoking, alcohol, and hypertension

Factors Influencing Pharmacokinetics of Tamoxifen in Breast Cancer Patients: A Systematic Review of Population Pharmacokinetic Models

Background: Tamoxifen is useful in managing breast cancer and it is reported to have significant variability in its pharmacokinetics. This review aimed to summarize reported population pharmacokinetics studies of tamoxifen and to identify the factors affecting the pharmacokinetics of tamoxifen in adult breast cancer patients. Method: A systematic search was undertaken in Scopus, Web of Science, and PubMed for papers published in the English language from inception to 20 August 2022. Studies were included in the review if the population pharmacokinetic modeling was based on non-linear mixed-effects modeling with a parametric approach for tamoxifen in breast cancer patients. Results: After initial selection, 671 records were taken for screening. A total of five studies were selected from Scopus, Web of Science, PubMed, and by manual searching. The majority of the studies were two-compartment models with first-order absorption and elimination to describe tamoxifen and its metabolites’ disposition. The CYP2D6 phenotype and CYP3A4 genotype were the main covariates that affected the metabolism of tamoxifen and its metabolites. Other factors influencing the drug’s pharmacokinetics included age, co-medication, BMI, medication adherence, CYP2B6, and CYP2C19 genotype. Conclusion: The disposition of tamoxifen and its metabolites varies primarily due to the CYP2D6 phenotype and CYP3A4 genotype. However, other factors, such as anthropometric characteristics and menopausal status, should also be addressed when accounting for this variability. All these studies should be externally evaluated to assess their applicability in different populations and to use model-informed dosing in the clinical setting