Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Short Communication
Year : 2022 | Month : May | Volume : 16 | Issue : 5 | Page : OM01 - OM06 Full Version

Analysis of Burden and Outcomes of Oral Hypoglycaemic Agent Induced Adverse Drug Effects at a Tertiary Care Centre


Published: May 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/55130.16401
Kavita S Joshi, Arnav H Tongaonkar, Alhad AMulkalwar

1. Associate Professor, Department of Medicine, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India. 2. Resident, Department of Medicine, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India. 3. Intern, Department of Medicine, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India.

Correspondence Address :
Dr. Alhad Ajay Mulkalwar,
Intern, Department of Medicine, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India.
E-mail: alhad.mulkalwar@gmail.com

Abstract

Introduction: Recent studies, both globally as well as in India, have depicted an alarming rise in the prevalence of Diabetes Mellitus (DM). Oral Hypoglycaemic Agents (OHAs) are the most common drugs used in the treatment of type 2 diabetes mellitus. There are numerous established Adverse Drug Reactions (ADR) associated with their use, such as, hypoglycaemia, weight gain, gastrointestinal disturbance, lactic acidosis and fluid retention.

Aim: To assess the incidence of ADRs, clinical profile, severity and causality among the admitted patients, taking OHAs, in a tertiary care hospital.

Materials and Methods: This was a hospital-based, prospective, observational, non interventional cohort study undertaken at the General Medicine Wards of a public teaching hospital, Seth GSMC and KEMH, Mumbai, Maharashtra, India. The present study was conducted in the Department of Medicine from June 2017 to December 2018. The patient’s data was recorded using a structured ADR reporting form. The baseline parameters, medical history and underlying diseases, clinical data, characteristics of ADRs and details of medication responsible for ADRs as well as medication for treatment of ADRs were recorded. The data was analysed using descriptive statistics with the Statistical Packages for the Social Sciences (SPSS) version 26.0 software.

Results: Out of 164 patients admitted due to ADRs, within the study period, 48 (29.3%) patients had developed ADRs due to OHAs (sulfonylureas). The severity of ADRs of five patients fell under the moderate category (three males in the age group of 61-80 years and two females in the age group of 21-40 years), all of whom successfully recovered. The remaining 43 (89.6%) were associated with severe ADRs. Four patients had succumbed to the ADR while one reported further sequelae, and the rest of the patients recovered (one was still recovering at the time of data analysis).

Conclusion: Sulfonylurea-induced hypoglycaemia is the most common ADR seen in patients on treatment of type 2 diabetes mellitus. Presence of systemic co-morbidities and polypharmacy are significant risk factors associated with OHA-induced ADRs.

Keywords

Adverse drug reactions, Polypharmacy, Sulfonylurea drugs

The World Health Organisation (WHO) defined an Adverse Drug Reaction (ADR) as “a noxious, unintended, and undesirable effect that occurs as a result of dose normally used in man for diagnosis, prophylaxis, and treatment of disease or modification of physiological function. Response in this context means that a causal relationship between a medicinal product and an adverse event is at least a reasonable possibility (1). ADRs are a major public health problem. They are considered a leading cause of morbidity and mortality (2). Estimated 2.9-5% hospital admissions are due to ADRs and approximately 35% of hospitalised patients experience an ADR during their hospital stay (3). Adverse drug events can range from mild to life threatening reactions resulting in inconvenience or serious morbidity and mortality besides being a financial burden on the society (4).

Diabetes Mellitus (DM) is a chronic metabolic disorder characterised by hypoglycaemia and associated with a high risk of numerous complications (5). The prevalence of type 2 DM is rising throughout the world, in developed as well as developing countries (6),(7). At present, a total of 415 million people are affected by diabetes globally and this number is set to rise beyond 642 million by 2040 (8). In India, over 65.1 million individuals have been diagnosed with the disease and the estimates suggest that roughly 89 million patients may develop by 2030 (9),(10). Patients with type 2 DM require pharmacotherapy throughout life; they also need to have a proper and regular diet along with physical activity so as to maintain the blood sugar levels within normal levels (11). Diabetes mellitus is affecting India badly leading to increased morbidity with increasing treatment cost. The current pharmacotherapy of diabetes mellitus includes treatment with drugs such as insulin and oral hypoglycaemic agents. With increase in the number of medication, the chances of ADRs also increase, contributing to morbidity and loss of productivity (12).

Oral Hypoglycaemic Agents (OHAs) are the most common drugs used in type 2 DM. There are numerous established ADRs associated with their use such as hypoglycaemia, weight gain, gastrointestinal disturbance, lactic acidosis and fluid retention (13). Adequate counselling about ADRs and early reporting of the same to physician is essential to avoid such predictable ADRs (12). Pharmacovigilance of anti-diabetic drugs can play an important role in identifying ADRs and providing valuable feedback to physicians. However, the Pharmacovigilance Programme of India is still in its budding stage (14).

The present study aimed to assess the incidence of ADRs among the admitted patients in a tertiary care hospital taking OHAs. It also assessed the clinical profile of patients with OHA associated ADRs, along with the severity, causality and preventability of these ADRs.

Material and Methods

This was a hospital-based, prospective, observational, non interventional cohort study undertaken at Seth GSMC and KEMH, Mumbai, Maharashtra, India. It was conducted in the General Medicine Wards. The study spanned in the Department of Medicine from June 2017 till December 2018, the study was initiated after obtaining approval from the Departmental Review Board and the Institutional Ethics Committee (IEC/167/2017).

Inclusion criteria: All consenting patients, of age >21 years, either admitted in the Medical Wards of the hospital for ADR following use of OHAs or those who developed OHA-induced ADRs while admitted in the medical wards were included in the study.

Exclusion criteria: Patients on insulin therapy, those with intentional or accidental poisoning, drug abuse (except alcohol) and non compliance to the prescribed medications were excluded from the study.

Study Procedure

The patient’s data was recorded using a structured ADR reporting form. The baseline parameters were assessed to obtain relevant data on demographics, clinical condition, co-morbidities, relevant laboratory data and medications used. The medical history and underlying diseases, clinical data, characteristics of ADRs and details of medication responsible for ADRs (suspected drug, dosage, route of administration, indication, date of beginning and stopping therapy, concomitant drugs) as well as medication for treatment of ADRs were obtained from the clinical notes, medication charts, clinical examination, interviews with patient or his/her relatives or caregivers or ward staff, the treatment sheets, drug administration charts, dispensing records and pill/injection count validation. All patients were followed-up till discharge from the hospital or till death. The ADRs were recorded in detail in a descriptive format. The onset, duration and progress as well as the systems affected, the drugs and the class of drugs causing the ADRs, the severity as well as the seriousness of the reactions and the treatment given for the same were recorded. Data pertaining to the adverse event was collected- the likely causative drug/class of drug, causality (WHO-UMC scale) (15), severity (Hartwig and Siegel scale) (16), avoidability (Halla’s criteria) (17) and outcome.

Statistical Analysis

The data was analysed using descriptive statistics with the Statistical Packages for the Social Sciences (SPSS) version 26.0 software.

Results

Out of the 164 patients admitted due to ADRs within the study period, 48 (29.3%) developed ADRs due to OHAs (26 males and 22 females). All the patients were on OHAs of the class sulfonylurea-glimepiride (n=38), glibenclamide (n=7), and glicazide (n=3).The age and gender distribution of the subjects is given in (Table/Fig 1).

The mean duration of stay was 3.9±2.034 days. Most of the patients (n=43) had co-morbidities. the recovered patients had a mean hospital stay of 2.2 days (extended hospital stay after diagnosis of the ADR). The causality of all subjects (n=48) was found to be probable (WHO-UMC scale). Almost 90% of the patients (n=43) suffered from severe ADRs; 87.5% of the patients (n=42) showed complete recovery as depicted in (Table/Fig 2). The severity of ADRs of five patients fell under the moderate category (three males in the age group of 61-80 years and two females in the age group of 21-40 years), all of whom successfully recovered. The remaining 43 (89.6%) were associated with severe ADRs.

All the subjects who succumbed to the OHA-induced adverse were elderly (age >60 years) males with significant co-morbidities. All oral hypoglycaemic related ADRs in the study were metabolic in nature, manifesting as hypoglycaemia. Of these, 11 patients had missed meals while some had insufficient blood sugar monitoring at the community level. Co-morbidities were seen in 90% of the patients (n=43). Polypharmacy was another frequent risk factor in the study population, seen in 54% of the patients (n=26). Four cases of OHA- induced hypoglycaemia were fatal. As per the Halla criteria, maximum patients (n=43) had developed ADRs which were ‘possibly avoidable’. The patient details are presented as a supplement table.

Discussion

Sulfonylureas are the most commonly prescribed class of drugs to treat Type 2 Diabetes Mellitus and hypoglycaemia remains its most common ADR (18). In accordance with the same, all OHA related ADRs in the present study were found to be due to sulfonylureas, and all of them were metabolic in nature, manifesting as hypoglycaemia. Hypoglycaemia is most likely to occur after a missed meal, (18) which was also reported in 11 of the study patients. In this study, out of 48 ADRs assessed, 45 (93.75%) could have been avoided by more than usual effort by the physician or patient. Studies have reported that only few patients started on OHAs are informed about the adverse effects by their physicians in pre-medication stage and this factor has a significant association with incidence of adverse effects (19). Physicians should inform patients about the possible ADRs, which might help them cope with unpleasant adverse effects and also enhance adherence to the pharmacotherapy (20). It is a well-established fact that as the number of medications increase, the chances of developing ADRs also increase (21). Polypharmacy (higher drug count) and higher co-morbidity scores have been consistently reported as risk factors for ADRs, especially amongst geriatric patients (22). The present study was no different; with two of the major risk factors in the patients being presence of significant co-morbidities (N=43) and polypharmacy (N=26), both of which were also present in the four elderly males who succumbed to the ADR. It should be noted that in the present study, for those with OHA induced hypoglycaemia, diabetes was not considered a risk factor, since, it was the reason for treatment.

Limitation(s)

The study evaluated the patients admitted to the internal medicine wards only. The study did not calculate the costs based on duration of hospitalisation alone. The patients were brought to the hospital after a prolonged period of uncorrected hypoglycaemia and had sustained hypoglycaemic brain damage. The assessment of whether an ADR has increased the length of stay or caused death, and in particular whether it is due to the underlying disease or due to an ADR, can be extremely difficult.

Conclusion

Patients being treated with sulfonylurea drugs are susceptible to hypoglycaemia, especially after missed meals. Presence of systemic co-morbidities and polypharmacy are significant risk factors associated with the same. Polypharmacy is a risk factor that is liable to increase since life expectancy is increasing, and co-morbidities are likely to increase with age. Thus, with the increasing prevalence of polypharmacy, one should be more watchful for ADR and review all ongoing prescriptions for unnecessary medications, especially in geriatric patients.

References

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WHO. International Drug Monitoring: The Role of Hospital. (Technical Report Series No. 425). Geneva, Switzerland: World Health Organization; 1969.
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Ditto AM. Drug allergy: In:(Grammer, LC and Greenberger, PA) Eds. Patterson’s allergic diseases. 8th Edition. Wolter Kluwer. 2018.
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Murphy BM and Frigo LC. Development, Implementation and Results of a Successful Multidisciplinary Adverse Drug Reaction Reporting Program in a University Teaching Hospital. Hosp Pharm. 1993;28(12):1199-204.
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Raut A, Diwan A, Patel C, Patel P, Pawar A. Incidence, Severity and Financial Burden Associated With Adverse Drug Reactions in Medicine Inpatients: Asian. J Pharm Clin. Res. 2011;4(2):103-11.
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International Diabetes Federation. IDF Diabetes Atlas, 10th edn. Brussels,Belgium: 2021. Available at: https://www.diabetesatlas.org.
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Misra A, Ramachandran A, Zargar AH. Prediabetes. In: Zargar AH, editor. ECAB clinical update: Diabetology. 1st ed. New Delhi, India: Elsevier; 2008. pp. 2-95.
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Magalhães ME, Cavalcanti BA, Cavalcanti S. Could prediabetes be considered a clinical condition? Opinions from an endocrinologist and a cardiologist. Diabetol Metab Syndr. 2010;2:2. [crossref] [PubMed]
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Ramachandran A. Know the signs and symptoms of diabetes. Indian J Med Res. 2014;140(5):579-81.
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Indian Diabetes Market Report and outlook for 2010-2015. Press Release.http://www.mynewsdesk.com/in/pressreleases/indian-diabetes-marketreport-outlook-for2010-2015 bharatbookcom-586410, accessed on November 26, 2015.
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Graffigna G, Barello S, Libreri C, Bosio CA. How to engage type-2 diabetic patients in their own health management: Implications for clinical practice. BMC Public Health. 2014;14:648. [crossref] [PubMed]
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Singh S, Nigam N, Gupta S, Kumar S. Adverse drug reactions monitoring of newer oral hypoglycemic drugs in a tertiary care hospital of North India: A prospective study. Int J Basic Clin Pharmacol. 2017;6:2434-40. [crossref]
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Shrestha JTM, Shrestha H, Prajapati M, Karkee A, Maharjan A. Adverse Effects of Oral Hypoglycemic Agents and Adherence to them among Patients with Type 2 Diabetes Mellitus in Nepal. Journal of Lumbini Medical College. 2017;5(1):34-40. [crossref]
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Faich GA. US adverse drug reaction surveillance 1989-1994. Pharmacoepidemiol Drug Saf. 1996;5(6):393-98. 3.0.CO;2-H>[crossref]
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DOI and Others

DOI: 10.7860/JCDR/2022/55130.16401

Date of Submission: Jan 21, 2022
Date of Peer Review: Feb 25, 2022
Date of Acceptance: Apr 12, 2022
Date of Publishing: May 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jan 24, 2022
• Manual Googling: Apr 11, 2022
• iThenticate Software: Apr 23, 2022 (17%)

ETYMOLOGY: Author Origin

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