World Journal of
Pharmaceutical and Life Sciences

( An ISO 9001:2015 Certified International Journal )

An International Peer Reviewed Journal for Pharmaceutical and Life Sciences
An Official Publication of Society for Advance Healthcare Research (Reg. No. : 01/01/01/31674/16)
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Shaimol T.*, Anilasree B. P., Nahja Rosy K.E., Minhaj Alavi, Najwa Usman Uruniyan paramban, Mohamed Sameer C. and G. Babu


Aim: Individualisation of OHA in geriatric diabetic patients. Objectives: To analyze drug prescription pattern for oral OHA in geriatric diabetic patients, To observe the prevalence of comorbidities among geriatric diabetic patients, To find any variation between the prescribed medications and individualized medications plan, Identification of glycemic control targets in consideration to individual patient characteristics. Methodology: A Retrospective observational study was conducted at PVS Hospital (P) Ltd, Calicut. From January 2021 to June 2021. Case sheet of geriatric diabetic patients from study site, Data collection form (Annexure I, II, III), Literature relevant to the study and guideline for antidiabetic agents in geriatric patients were collected.Study Procedure: Diabetic patients of age 60 and above with or without comorbid conditions were identified. The drug prescription of oral antidiabetic drugs in Type2 DM geriatric patients is analysed. The sociodemographic features of diabetic geriatric patients are identified and analyzed On-going systematic criteria-based evaluation of drug used in individual patient level. Individualized dose for the oral hypoglycaemic agents for patient is determined using guidelines and is compared with the doses given to the patient; the variation will be evaluated and assessed. Found out the prevalence of comorbidities in the patients.Analysed the variation between prescribed dose and individualised dose. Identified the glycemic control targets in individual patient. Results: The data of 100 diabetic geriatric patients were collected and analysed. The gender analysis showed that 55 patients (55%) were male and 45 patients (45%) were female. In this study, out of 100 patients who were treated with antidiabetic drugs all of them were Type 2 diabetic patients (non-insulin dependent diabetes mellitus) above age of 60 that reflect the increasing prevalence of Type 2 diabetes mellitus in our region. The average number of Oral Hypoglycemic Agents per prescription in this study was 1.46. Biguanides was the most commonly used class with 45.21% of total OHA given. In Fixed Drug Combinations Biguanide and Sulfonylureas are predominant with 28.77%. Biguanide and Sulfonylurea combination makes second most OHA utilisation after Biguanide monotherapy. Metformin was the mostly used drug in our study with a total of 45.21% among monotherapy and in all the combinations used. Metformin and Glimepiride were the mostly used combination drugs 26.71%. In case of Newer OHA DPP4 Inhibitors, its usage as a monotherapy is low (4.11%) but as combination with Biguanide it is higher (8.90%). In our study only 10.26% of the drug was in generic name, WHO Essential Medicine and NLEM was 75.55% and 73.33%. The most common comorbidity seen was hypertension with Type 2 DM in geriatric patients. Patients with diabetes without comorbidity were younger. Patients with only diabetes related comorbidity was higher in males compared to females but non diabetes related comorbidity was found to be higher in females. Metformin should be strictly discontinued in patients with eGFR <30ml/min/1.73 m2 as it causes lactic acidosis and 88% of the patients with this eGFR level were prescribed with metformin. 36.36% of the cases with eGFR 30-44ml/min/1.73 m2 were prescribed with varied dose. Similarly, 46.67% and 13.95% in varied dose was observed in eGFR level 45-59ml/min/1.73 m2and >60ml/min/1.73 m2respectively. A total of 5 Sitagliptin prescription was found in study given as monotherapy and combination therapy. 3 of them had ClCr >50 ml/min and all of them had dose given below 100mg/day. 2 patients had ClCr<30 and both were given Sitagliptin above max recommended dose. The total patients were grouped into 2 categories based on eGFR level <30-59ml/min/1.73 m2 – Of 7 prescriptions of Vildagliptin, all were contraindicated. >60ml/min/1.73 m2– Out of 4 cases prescribed with Vildagliptin, one was contraindicated. The maximum dose of Teneligliptinin geriatric patients is 20-40 mg. Out of the total cases, 3 prescriptions had Teneligliptin given as monotherapy and combination and it is given according to the guidelines. The geriatric doses of Glimepiride, Glipizide and Gliclazide is1mg – 8mg per day, 2.5-80 mg per day and 320 mg per day. Gliclazide can be given for the patients with eGFR ?30ml/min/1.73 m2. The maximum daily dose of Voglibose in geriatric patient is 0.6 mg. Of the 100 studied cases of geriatric type2 Diabetes Mellitus cases we grouped them into 3 categories based on the framework for treatment goals for diabetes in older adults. They classified the patients into healthy, intermediate/complex and very complex categories based on the patient characteristics and their HbA1C goals. Based on this categorization 21% were healthy, 45% were intermediate and 34% belonged to the very complex class. In healthy category 57.14% were from age group 60-69 years, 19% from 70-79 years and 5% from 80-89 years. In intermediate 60% were from age group 60-69 years, 28.88% from 70-79 years, 6.66% from 80-89 years, 4.44% from >90 years. In very complex 41.17% were from 60-69 years, 35.29% were from 70-79 years, 20.58% were from 8089 years and 3% were from >90 years. According to the suggested HbA1c goals given above the patients were further classified into patients with controlled (65%) and patients with uncontrolled diabetes (35%). In healthy 7(33.33%) patients had controlled and 14(66.66%) patients had uncontrolled diabetes. In intermediate 28(62.22%) patients had controlled and 17 (37.77%) had uncontrolled diabetes. In very complex 31(91.17%) patients had controlled and 3 (8.82%) had uncontrolled diabetes. Conclusion: The study conducted observed the prescribing pattern of OHA, Prevalence of comorbidities, Dose adjustment and Glycemic target in geriatric type 2 diabetes mellitus. Study showed that both men and women are at high risk of T2DM. Metformin was the mostly prescribed OHA both in monotherapy and combination therapy. Prescription trend was moving towards combination therapy especially two-drug therapy. Hypertension was the most common comorbidity. Dose adjustment is needed for most of the patients with low eGFR and more than half of the patients had controlled glycemic level. Geriatric diabetics need drug dosage adjustment.

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