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

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Dr Mohan Z Mani

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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."



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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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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.
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Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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"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

Original article / research
Year : 2025 | Month : January | Volume : 19 | Issue : 1 | Page : FC01 - FC04 Full Version

Pharmacoeconomics and Utilisation of Antidiabetic Medications among Type 2 Diabetes Mellitus Patients: A Longitudinal Study


Published: January 1, 2025 | DOI: https://doi.org/10.7860/JCDR/2025/75320.20527
Bikash Chandra Das, P Ansuman Abhisek, Deepak Choudhury, Suvendu Kumar Panda, Jayanti Prava Behera, Supriya Pradhan, Trupti Rekha Swain, Sasmita Mallick

1. Assistant Professor, Department of Pharmacology, SCB Medical College and Hospital, Cuttack, Odisha, India. 2. Assistant Professor, Department of Pharmacology, SCB Medical College and Hospital, Cuttack, Odisha, India. 3. Assistant Professor, Department of Ophthalmology, SCB Medical College and Hospital, Cuttack, Odisha, India. 4. Assistant Professor, Department of Pharmacology, MKCG Medical College and Hospital, Berhampur, Odisha, India. 5. Professor, Department of Pharmacology, B.B. Medical College and Hospital, Bolangir, Odisha, India. 6. Associate Professor, Department of Pharmacology, MKCG Medical College and Hospital, Berhampur, Odisha, India. 7. Professor, Department of Pharmacology, SCB Medical College and Hospital, Cuttack, Odisha, India. 8. Senior Resident, Department of Obstetrics and Gynaecology, FM Medical College and Hospital, Balasore, Odisha, India.

Correspondence Address :
Dr. Bikash Chandra Das,
Assistant Professor, Department of Pharmacology, SCB Medical College and Hospital, Cuttack-753001, Odisha, India.
E-mail: drbikashchandradas1234@gmail.com

Abstract

Introduction: Patients with Type 2 Diabetes Mellitus (T2DM) typically require long-term treatment with antidiabetic medications, resulting in a significant financial burden on both the individual and the global economy.

Aim: To assess the patterns of drug utilisation and the economic aspects of antidiabetic medications in individuals with diabetes mellitus.

Materials and Methods: The current study was a hospital-based longitudinal study conducted between October 2017 and September 2019. A total of 132 diagnosed cases of T2DM, aged 18 years and older, who had been on antidiabetic medications in the past three months, were included in the study. Pregnant women and patients in diabetic coma were excluded from the study. A predesigned, pretested, semistructured questionnaire was used to collect data from the patients or their legally accepted relatives. The subjects were followed-up at three and six months to determine any changes in the type and doses of medication. Laboratory parameters such as Fasting Blood Sugar (FBS) and Postprandial Blood Sugar (PPBS) were measured at baseline and at six months, along with a history of any complications of diabetes. The data were analysed using Statistical Package for the Social Sciences (SPSS) version 27.0.

Results: A total of 132 patients were included, of which most patients were male (65.9%), aged 60 years or above (50.8%), illiterate (79.5%), and resided in rural areas (94.7%). The Average Cost-Effectiveness Ratio (ACER) for reducing a unit of FBS was higher compared to PPBS across all forms of the drug. The ACER at three months showed a constant increase, from 24.56 for metformin only to 2709.26 for insulin with Oral Hypoglycaemic Agents (OHA) for FBS, and from 7.83 for metformin only to 907.47 for insulin with OHA for PPBS. Metformin was the most commonly prescribed medication, both as a standalone therapy and in combination therapy.

Conclusion: Present investigation showed that rational prescribing effectively reduced blood sugar readings. Metformin and Glimepiride were the predominant pharmaceuticals utilised for the treatment of diabetes. The cost-effectiveness study indicates that the financial burden of diabetes is substantial, particularly when considering the socio-economic status of individuals.

Keywords

Cost-effectiveness analysis, Metformin, Pharmaceuticals

High blood glucose levels characterise a collection of metabolic illnesses known as diabetes mellitus. T2DM is a heterogeneous disorder marked by varying levels of insulin resistance, reduced insulin secretion, and heightened glucose synthesis by the liver (1). The main cause of diabetes-related morbidity is the long-term consequences of sustained high blood sugar levels, such as microvascular and macrovascular complications. Consistent management of blood glucose levels and treatment of accompanying conditions, including hypertension and dyslipidaemia, can help alleviate these long-term consequences (2).

T2DM is a significant factor in the increasing prevalence of non communicable diseases in both industrialised and developing countries. The International Diabetes Federation Atlas (2017) projects that diabetes affects approximately 451 million individuals aged 18 years and over worldwide, with a projected increase to 693 million by 2045 (3). Diabetes prevalence in India currently stands at 32.7 million. Projections indicate that this figure will rapidly increase to 124.9 million by 2045 (4). In 2017, approximately 4.0 million people died worldwide due to diabetes and its complications. The cost of managing diabetes increased from 237 billion USD in 2007 to 727 billion USD in 2017 (3).

Patients with T2DM typically require long-term treatment with antidiabetic medications, resulting in a significant financial burden on both the individual and the global economy. The elderly face health economic challenges and social assistance issues (4). Older diabetics frequently have co-morbidities that necessitate the use of multiple medications. Moreover, physiological differences in elderly individuals can lead to variations in the absorption, distribution, metabolism, and elimination of medications, as well as their effects on the body. As a result, the elderly often experience inappropriate medicine use, illogical prescribing, Adverse Drug Reactions (ADRs), and non compliance due to economic and health concerns (4). Therefore, it is essential to address these issues and develop strategies for prescription medication for the elderly.

Rational prescribing ensures that pharmaceuticals are suitable for their specific clinical indications, at the appropriate dosage, for a sufficient duration, and at the most cost-effective price for both the patient and the community. Drug utilisation studies support this. According to the World Health Organisation (WHO), drug utilisation encompasses various aspects of drug management in society, including prescription, dispensing, ingestion, marketing, distribution and usage. It primarily focuses on the subsequent health, societal and economic outcomes. These studies are essential because they encourage us to think critically about new drugs that come to the market, the wide range of prescription and usage patterns for drugs, concerns about delayed ADRs, and how the costs of drugs and therapies are increasing (5),(6).

Pharmacoeconomics is a recently developed field of health economics that compares multiple medications, instruments/products, or therapies. It calculates expenses and outcomes related to effectiveness and quality of life. These investigations ensure the scientific and competent utilisation of scarce resources to enhance the effectiveness of healthcare facilities in underdeveloped nations (7),(8). Implementing a cost-effective treatment for diabetes mellitus will not only encourage patients to follow the appropriate prescriptions but also improve patient adherence, resulting in fewer individuals discontinuing treatment due to financial considerations. This, in turn, will lead to reduced diabetes complications and an improved quality of life, thereby enhancing the effectiveness of therapy.

In a study conducted in northern India, the cost per unit reduction in fasting glucose was as low as INR 10.46 for oral antidiabetic medications and as high as INR 217.38 for injectables (9). Another study from southern India found that the most economical combination therapy was glimepiride and metformin, reporting a percentage cost variation of 5.88% for three-drug combinations and 177.57% for two-drug combinations (10). The cost variation was highest among the different formulations and combinations of injectable antidiabetics (10),(11). Given the large variation in the study findings, which differ across various geographies within India, present study was designed as a drug utilisation study in diabetic patients who visit our hospital. The primary objective of this study was to assess the patterns of drug utilisation and the economic aspects of antidiabetic medications in individuals with diabetes mellitus.

Material and Methods

The current study was a longitudinal study conducted between October 2017 and September 2019 (24 months) in the Department of Endocrinology at Maharaja Krushna Chandra Gajapati Medical College and Hospital, Berhampur, Odisha, India. The Institutional Ethics Committee (IEC) approved the study, as documented in letter No. 588/Chairman-IEC, M.K.C.G Medical College, Brahmapur-4. Written informed consent was obtained from each eligible subject before enrollment in the study.

Inclusion criteria: Diagnosed cases of T2DM aged 18 years and older, who had been on antidiabetic medications in the past three months, were included in the study.

Exclusion criteria: Pregnant women and patients in diabetic coma were excluded from the study.

Sample size calculation: According to a previous study by Gnanasegaran S et al., the proportion of patients receiving combination oral antidiabetics was 85.3%. Taking this effect size with an error of 7%, a power of 80%, and an alpha value of 0.05, the sample size was calculated to be 110 (10). Considering a dropout and missing data rate of 20%, the final sample size was increased to 132. The sample size was calculated using OpenEpi.

The study subjects were recruited and enrolled from the Outpatient Department (OPD) of Endocrinology of the institute. A predesigned, pretested, semistructured questionnaire was used to collect data from the patients or their legally accepted relatives. Five subject experts assessed the content validity of the questionnaire. It was pretested on 15 subjects (10% of the total sample), and necessary modifications were made. The subjects included in the pretesting were excluded from the final analysis. Demographic data, such as age, sex, education, residence, lifestyle and monthly family income, were collected. Information regarding diabetes history, including the duration of the disease, and drug utilisation data, such as type of drug (single/combinations), dose, and routes of administration, were also recorded. Detailed treatment history, including the initiation of antidiabetics and any changes in treatment during the course, was documented. Subjects were followed-up at three and six months to assess changes in the type and doses of medication.

Laboratory parameters, including FBS and PPBS, were measured at baseline and at six months, along with a history of any complications related to diabetes. Drug utilisation data for current therapy were noted according to the WHO-ATC/DDD (World Health Organisation- Anatomic Therapeutic Chemical (ATC) and Defined Daily Dose (DDD) tool (12). The cost of antidiabetics was calculated using the Odisha State Medical Corporation Limited Drug Procurement List (OSMCL) (13). The economics of antidiabetics was measured by the ACER, calculated as the ratio of the cost of antidiabetic medications to the unit decrease in FBS and PPBS.

Statistical Analysis

The data were analysed using SPSS version 27.0. Frequencies and percentages were used to describe categorical variables, while mean and Standard Deviation (SD) were used for continuous variables. The comparison of the median of continuous variables at more than two different time points was calculated using the Friedman test, as the distribution of continuous variables was not normally distributed, as assessed by the Shapiro-Wilk test. A p-value <0.05 was considered statistically significant.

Results

A total of 132 diabetic patients were included in the final analysis. Most patients were male (65.9%) and aged 60 years or above (50.8%). The majority of patients were illiterate (79.5%) and resided in rural areas (94.7%). Most had some form of income (96.9%) and engaged in moderate housework (74.2%). The average monthly income of the patients was Rs. 2545.45±1412.13. Co-morbidities were present in 65.9% of the patients, and 48.5% had a duration of diabetes exceeding 18 months (Table/Fig 1).

Laboratory parameters for diabetes, such as FBS, PPBS, and glycosylated haemoglobin (HbA1c), significantly decreased from baseline measurements to those taken at three months and six months (p-value <0.001) (Table/Fig 2).

The dose modification was highest at baseline (96.2%), primarily involving an increase in the concurrent medication dose. At the three-month follow-up, the dose modification was 37.9%, which decreased to 9.8% at six months. All dose modifications made at the three- and six-month follow-ups involved increasing the doses of concurrent medications (Table/Fig 3).

At baseline, 36 (27.3%) of the patients were prescribed only one Oral Hypoglycaemic Agent (OHA), which was metformin; 76 (57.6%) were prescribed metformin with one additional OHA; 17 (12.9%) had insulin with an OHA; and the remaining 3 (2.3%) were prescribed only insulin. The number of patients prescribed two OHAs was highest at the three-month follow-up, at 96 (72.7%), while the proportion slightly decreased to 78 (59.1%) at six months. Eight (6.1%) patients were given three OHAs, which increased to 28 (21.2%) at six months. All subjects who were prescribed only insulin at baseline (3, or 2.3%) were changed to insulin with an OHA at three months (20, or 15.2%) and remained unchanged at six months (Table/Fig 4).

The ACER for reducing a unit of FBS was higher compared to PPBS for all forms of the drug. The ACER at three months showed a constant increase from 24.56 for metformin only to 2709.26 for insulin with OHA for FBS, and from 7.83 for metformin only to 907.47 for insulin with OHA for PPBS. At the six-month mark, metformin only had a better ACER, followed by combinations of three OHAs and two OHAs per unit decrease in FBS and PPBS. Meanwhile, the ACER for insulin with OHA was considerably higher than that of other regimens at six months (Table/Fig 5).

Discussion

According to the findings of the current study, metformin was the most commonly prescribed medication, both as a standalone treatment and in combination therapy. This finding was consistent with multiple previous research studies (14),(15),(16). The guidelines from the European Association for the Study of Diabetes (EASD) and the American Diabetes Association (ADA) also support the use of metformin as the initial medication for treating T2DM. Metformin is favoured due to its minimal potential for hypoglycaemia, lower chance of weight gain, potential for weight reduction, improved cholesterol levels, and cost-effectiveness (17),(18).

The primary approach to treating diabetes in present study (76; 57.6%) and other investigations was combination therapy (19),(20),(21). In contrast to previous studies where monotherapy was used as the primary treatment, the current study demonstrated a different approach (16). A Fixed Drug Combination (FDC) enhances adherence to treatment protocols and potentially reduces treatment expenses. However, it may also increase the likelihood of experiencing negative medication responses and interactions (22). The present analysis revealed that the combination of glimepiride and metformin was the most frequently prescribed, which aligns with the most preferred combinations in earlier studies (23),(24).

Present study analysis showed a lower prescription rate (15%) for insulins, particularly newer insulins. Similar findings were observed in research conducted by Mathew OJ and Nduka SO and Sutharson L et al., where the prevalence rate was around 10% (25),(26). This was corroborated by the recent ADA guidelines, which advocate for the initiation of insulin therapy (with or without supplementary medications) in individuals newly diagnosed with Type 2 Diabetes (T2D) who have significant symptoms and/or elevated blood glucose levels or HbA1c, or if individuals with T2D are not achieving their desired glycaemic targets with Oral Antidiabetic Drugs (OADs) (18).

Cost-Effectiveness Analysis (CEA) is a widely used method of economic evaluation in medication therapy. It helps identify the cost discrepancies between treatments with comparable outcomes in a specific therapeutic domain. India, known as the global epicenter of diabetes, combined with the chronic nature of the disease, results in a substantial financial burden. The high cost of pharmaceuticals can affect patients’ adherence and lead to a decline in their medical wellbeing and overall quality of life. Reducing the expenses associated with diabetes treatment for patients would significantly impact healthcare expenditures in India.

The primary objective of pharmacoeconomic evaluation is not to directly influence the therapeutic choices made by physicians but rather to assist physicians, pharmacists and policymakers in making well-informed decisions regarding whether the cost and additional benefits of a new drug are significant within the allocated budget (5),(6).

This study observed the highest average decrease in blood glucose parameters for PPBS compared to FBS. The findings of present investigation were corroborated by several studies conducted in India (20),(27),(28). There was a significant variance in the average cost per unit reduction in FBS (ACER) of recommended antidiabetes medication regimens, ranging from 38.61 to 385.92. This variation was consistent with the findings of a previous study by Acharya KG et al., (20). In present study, using a single drug called biguanide and a combination of two drugs called sulfonylurea and biguanide were the most cost-effective approaches in reducing FBS and PPBS. These findings align with previous studies (21),(28). The study by Acharya KG et al., found that the combination of sulfonylurea and biguanides was the most cost-effective (20). Insulin monotherapy is more cost-effective than combining it with OHA, as demonstrated in a study conducted by Abdulganiyu G and Fola T (27).

Limitation(s)

Present study had a few limitations, as the research was carried out in a single-centre, tertiary care set-up, and the results may be applicable only to tertiary care settings. A multicentre study involving all types of healthcare centres may provide a broader perspective.

Conclusion

Present investigation showed that rational prescribing effectively reduces blood sugar levels. Metformin and sulfonylureas were the predominant pharmaceuticals used for the treatment of diabetes. The cost-effectiveness study indicates that the financial burden of diabetes is substantial, especially when considering the socioeconomic status of individuals.

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DOI and Others

DOI: 10.7860/JCDR/2025/75320.20527

Date of Submission: Sep 18, 2024
Date of Peer Review: Nov 05, 2024
Date of Acceptance: Dec 30, 2024
Date of Publishing: Jan 01, 2025

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: Sep 19, 2024
• Manual Googling: Dec 11, 2024
• iThenticate Software: Dec 26, 2024 (12%)

ETYMOLOGY: Author Origin

EMENDATIONS: 7

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