Assessment of Prevalence, Determinants and Management of Potential Antidiabetic Drug Interactions Altering Glycemic Control in Patients with Type II Diabetes Mellitus- A Cross-Sectional Analysis.
Abstract
Patients diagnosed with type II diabetes mellitus are often prescribed multiple medications to achieve glycemic target and to treat the co-morbidities. In these patients, polypharmacy eventually leads to potential drug-drug interactions (pDDI) and adverse outcomes. The study aimed to assess the prevalence of pDDIs altering glycemic control, its determinants, and its management. A cross-sectional investigation was carried out using the medical records of individuals diagnosed with type II diabetes mellitus. Demographic characteristics, medical history, and medications prescribed were obtained from the patient records. The Lexi-Interact® online database was utilised to identify the pDDI. Out of the 101 diabetic patients included, 68% of patients had at least 1 pDDI. A total of 375 drug-drug interactions and 107 pairs of interacting drugs altering the glycemic control were identified. 71.9% drug-drug interaction could lead to hypoglycemic episodes, and 28% drug-drug interaction could cause hyperglycemia-like symptoms. Most of the interactions were moderate interactions (89%) belonging to category C, followed by minor interactions (11%). The antidiabetic drug with the maximum number of interactions was metformin (51%). Female patients, presence of co-morbidities, duration of hospitalisation, and medication count per patient were found to have significant associations with the occurrence of pDDI. Screening of prescriptions by a clinical pharmacist can guide the physicians on avoiding drug combinations causing adverse outcomes in diabetic patients.
Keywords:
antidiabetic drugs, diabetes mellitus, glycemic control, potential drug-drug interactions
Downloads
Download data is not yet available.
References
American Diabetes Association. (2021). 6. Glycemic targets: Standards of medical care in diabetes—2021. Diabetes Care, 44(Supplement 1), S73–S84.
American Diabetes Association. (2023). Hyperglycemia (High Blood Glucose). https://diabetes.org/healthy-living/medication-treatments/blood-glucose-testing-and-control/hyperglycemia. Accessed February 3, 2023.
Anjana, R. M., Unnikrishnan, R., Deepa, M., Pradeepa, R., Tandon, N., Das, A. K., ... & Ghosh, S. (2023). Metabolic non-communicable disease health report of India: the ICMR-INDIAB national cross-sectional study (ICMR-INDIAB-17). The Lancet Diabetes & Endocrinology, 11(7), 474-489.
Arow, M., Waldman, M., Yadin, D., Nudelman, V., Shainberg, A., Abraham, N. G., ... & Arad, M. (2020). Sodium–glucose cotransporter 2 inhibitor Dapagliflozin attenuates diabetic cardiomyopathy. Cardiovascular diabetology, 19, 1-12. https://doi.org/10.1186/s12933-019-0980-4
Dagnew, E. M., Ergena, A. E., Wondm, S. A., & Sendekie, A. K. (2022). Potential drug-drug interactions and associated factors among admitted patients with psychiatric disorders at selected hospitals in Northwest Ethiopia. BMC Pharmacology and Toxicology, 23(1), 88. https://doi.org/10.1186/s40360-022-00630-1
Good, C. B. (2002). Polypharmacy in elderly patients with diabetes. Diabetes Spectrum, 15(4), 240-248.
Hamadouk, R. M., Alshareif, E. M., Hamad, H. M., & Yousef, B. A. (2023). The Prevalence and Severity of Potential Drug–Drug Interactions in Internal Medicine Ward at Soba Teaching Hospital. Drug, Healthcare and Patient Safety, 149-157.
Hammad, M. A., Tangiisuran, B., Kharshid, A. M., Abdul-Aziz, N., Hassan, Y., Aziz, N. A., & Elsayed, T. M. (2017). Drug-drug interaction-related uncontrolled glycemia. Journal of Pharmacy and Bioallied Sciences, 9(4), 221-228. https://doi.org/10.4103/jpbs.JPBS_26_17
Ikäheimo, I., Karjalainen, M., Tiihonen, M., Haanpää, M., Kautiainen, H., Saltevo, J., & Mäntyselkä, P. (2019). Clinically relevant drug‐drug interactions and the risk for drug adverse effects among home‐dwelling older persons with and without type 2 diabetes. Journal of clinical pharmacy and therapeutics, 44(5), 735-741. https://doi.org/10.1111/jcpt.12854
Koto, R., Nakajima, A., Miwa, T., & Sugimoto, K. (2023). Multimorbidity, polypharmacy, severe hypoglycemia, and glycemic control in patients using glucose-lowering drugs for type 2 diabetes: a retrospective cohort study using health insurance claims in Japan. Diabetes Therapy, 14(7), 1175-1192. https://doi.org/10.1007/s13300-023-01421-5
Kulkarni, V., Bora, S. S., Sirisha, S., Saji, M., & Sundaran, S. (2013). A study on drug–drug interactions through prescription analysis in a South Indian teaching hospital. Therapeutic advances in drug safety, 4(4), 141-146. https://doi.org/10.1177/2042098613490009
Lipscombe, L., Booth, G., Butalia, S., Dasgupta, K., Eurich, D. T., & Goldenberg, R. (2018). Diabetes Canada 2018 clinical practice guidelines for the prevention and management of diabetes in Canada: pharmacologic glycemic management of type 2 diabetes in adults. Can J Diabetes, 42(Suppl 1), S88-S103.
Liu, Y., Yang, M., Ding, Y., Wang, H., Zhang, H., Wang, D., Zhuang, T., Ji, M., Cui, Y., & Wang, H. (2022). Clinical significance of potential drug–drug interactions in older adults with psychiatric disorders: A retrospective study. BMC Psychiatry, 22, 563. https://doi.org/10.1186/s12888-022-04207-4
Magot, A. A., Karimi, P. N., Guantai, E. M., Maru, S. M., & Nyamu, D. G. (2018). Identification and characterization of potential drug interactions in hypertensive patients in a Kenyan tertiary hospital. African Journal of Pharmacology and Therapeutics, 7(1).
Nagpure, S., Kela, K., & Dahiwele, A. C. (2021). Polypharmacy and Drug Interactions Study on Diabetic Patients of Geriatric Age Group at Rural Tertiary Care Hospital. Int J Cur Res Rev| Vol, 13(12), 39–43. http://dx.doi.org/10.31782/IJCRR.2021.131216
Patel, R. I., & Beckett, R. D. (2016). Evaluation of resources for analyzing drug interactions. Journal of the Medical Library Association: JMLA, 104(4), 290.
Petrie, J. R., Guzik, T. J., & Touyz, R. M. (2018). Diabetes, hypertension, and cardiovascular disease: clinical insights and vascular mechanisms. Canadian Journal of Cardiology, 34(5), 575-584. https://doi.org/10.1016/j.cjca.2017.12.005
Joint Commission of Pharmacy Practitioners. (2014). Pharmacists' patient care process. Available at https://jcpp.net/wp-content/uploads/2016/03/PatientCareProcess-with-supporting-organizations.pdf
Sankar, V., Saaed, Y., Joseph, R. M., Azizi, H., & Mariyam Thomas, P. (2015). Serious drug-drug interactions in the prescriptions of diabetic patients. Medical Sciences, 3(4), 93-103. https://doi.org/10.3390/medsci3040093
Scheen, A. J. (2014). Drug–drug interactions with sodium-glucose cotransporters type 2 (SGLT2) inhibitors, new oral glucose-lowering agents for the management of type 2 diabetes mellitus. Clinical pharmacokinetics, 53, 295-304. https://doi.org/10.1007/s40262-013-0128-8
Sheikh-Taha, M., & Asmar, M. (2021). Polypharmacy and severe potential drug-drug interactions among older adults with cardiovascular disease in the United States. BMC geriatrics, 21, 1-6. https://doi.org/10.1186/s12877-021-02183-0
Triplitt, C. (2006). Drug interactions of medications commonly used in diabetes. Diabetes Spectrum, 19(4), 202.
Tuladhar, L. R., Shrestha, S. L., Regmi, D., Bimali, S., Bhusal, S., & Khadka, P. (2021). Drug-drug Interactions between Hypoglycemic and Non-hypoglycemic Medication in Diabetic Patients with Comorbidities in a Tertiary Care Center: A Descriptive Cross-sectional Study. JNMA: Journal of the Nepal Medical Association, 59(243), 1125–1130. https://doi.org/10.31729/jnma.7080
UpToDate Inc. (2024). UpToDate LexiDrug/Drug interactions (Version 8.4.4) [Mobile app]. Accessed March 28, 2024.
Utami, P. R., & Octavia, D. (2022). Study of potential interactions of oral antidiabetic drugs in patients with type 2 diabetes mellitus with comorbidities: A retrospective study. Pharmacy Education, 22(2), 200–206.
Yosmar, R., Shepany, E., & Fitria, N. (2024). A comprehensive analysis of antidiabetic drug interactions in geriatric non-insulin dependent diabetes mellitus patients. Int J Appl Pharm, 16(1), 62-65.
Zheng, W. Y., Richardson, L. C., Li, L., Day, R. O., Westbrook, J. I., & Baysari, M. T. (2018). Drug-drug interactions and their harmful effects in hospitalised patients: a systematic review and meta-analysis. European journal of clinical pharmacology, 74, 15-27. https://doi.org/10.1007/s00228-017-2357-5
American Diabetes Association. (2023). Hyperglycemia (High Blood Glucose). https://diabetes.org/healthy-living/medication-treatments/blood-glucose-testing-and-control/hyperglycemia. Accessed February 3, 2023.
Anjana, R. M., Unnikrishnan, R., Deepa, M., Pradeepa, R., Tandon, N., Das, A. K., ... & Ghosh, S. (2023). Metabolic non-communicable disease health report of India: the ICMR-INDIAB national cross-sectional study (ICMR-INDIAB-17). The Lancet Diabetes & Endocrinology, 11(7), 474-489.
Arow, M., Waldman, M., Yadin, D., Nudelman, V., Shainberg, A., Abraham, N. G., ... & Arad, M. (2020). Sodium–glucose cotransporter 2 inhibitor Dapagliflozin attenuates diabetic cardiomyopathy. Cardiovascular diabetology, 19, 1-12. https://doi.org/10.1186/s12933-019-0980-4
Dagnew, E. M., Ergena, A. E., Wondm, S. A., & Sendekie, A. K. (2022). Potential drug-drug interactions and associated factors among admitted patients with psychiatric disorders at selected hospitals in Northwest Ethiopia. BMC Pharmacology and Toxicology, 23(1), 88. https://doi.org/10.1186/s40360-022-00630-1
Good, C. B. (2002). Polypharmacy in elderly patients with diabetes. Diabetes Spectrum, 15(4), 240-248.
Hamadouk, R. M., Alshareif, E. M., Hamad, H. M., & Yousef, B. A. (2023). The Prevalence and Severity of Potential Drug–Drug Interactions in Internal Medicine Ward at Soba Teaching Hospital. Drug, Healthcare and Patient Safety, 149-157.
Hammad, M. A., Tangiisuran, B., Kharshid, A. M., Abdul-Aziz, N., Hassan, Y., Aziz, N. A., & Elsayed, T. M. (2017). Drug-drug interaction-related uncontrolled glycemia. Journal of Pharmacy and Bioallied Sciences, 9(4), 221-228. https://doi.org/10.4103/jpbs.JPBS_26_17
Ikäheimo, I., Karjalainen, M., Tiihonen, M., Haanpää, M., Kautiainen, H., Saltevo, J., & Mäntyselkä, P. (2019). Clinically relevant drug‐drug interactions and the risk for drug adverse effects among home‐dwelling older persons with and without type 2 diabetes. Journal of clinical pharmacy and therapeutics, 44(5), 735-741. https://doi.org/10.1111/jcpt.12854
Koto, R., Nakajima, A., Miwa, T., & Sugimoto, K. (2023). Multimorbidity, polypharmacy, severe hypoglycemia, and glycemic control in patients using glucose-lowering drugs for type 2 diabetes: a retrospective cohort study using health insurance claims in Japan. Diabetes Therapy, 14(7), 1175-1192. https://doi.org/10.1007/s13300-023-01421-5
Kulkarni, V., Bora, S. S., Sirisha, S., Saji, M., & Sundaran, S. (2013). A study on drug–drug interactions through prescription analysis in a South Indian teaching hospital. Therapeutic advances in drug safety, 4(4), 141-146. https://doi.org/10.1177/2042098613490009
Lipscombe, L., Booth, G., Butalia, S., Dasgupta, K., Eurich, D. T., & Goldenberg, R. (2018). Diabetes Canada 2018 clinical practice guidelines for the prevention and management of diabetes in Canada: pharmacologic glycemic management of type 2 diabetes in adults. Can J Diabetes, 42(Suppl 1), S88-S103.
Liu, Y., Yang, M., Ding, Y., Wang, H., Zhang, H., Wang, D., Zhuang, T., Ji, M., Cui, Y., & Wang, H. (2022). Clinical significance of potential drug–drug interactions in older adults with psychiatric disorders: A retrospective study. BMC Psychiatry, 22, 563. https://doi.org/10.1186/s12888-022-04207-4
Magot, A. A., Karimi, P. N., Guantai, E. M., Maru, S. M., & Nyamu, D. G. (2018). Identification and characterization of potential drug interactions in hypertensive patients in a Kenyan tertiary hospital. African Journal of Pharmacology and Therapeutics, 7(1).
Nagpure, S., Kela, K., & Dahiwele, A. C. (2021). Polypharmacy and Drug Interactions Study on Diabetic Patients of Geriatric Age Group at Rural Tertiary Care Hospital. Int J Cur Res Rev| Vol, 13(12), 39–43. http://dx.doi.org/10.31782/IJCRR.2021.131216
Patel, R. I., & Beckett, R. D. (2016). Evaluation of resources for analyzing drug interactions. Journal of the Medical Library Association: JMLA, 104(4), 290.
Petrie, J. R., Guzik, T. J., & Touyz, R. M. (2018). Diabetes, hypertension, and cardiovascular disease: clinical insights and vascular mechanisms. Canadian Journal of Cardiology, 34(5), 575-584. https://doi.org/10.1016/j.cjca.2017.12.005
Joint Commission of Pharmacy Practitioners. (2014). Pharmacists' patient care process. Available at https://jcpp.net/wp-content/uploads/2016/03/PatientCareProcess-with-supporting-organizations.pdf
Sankar, V., Saaed, Y., Joseph, R. M., Azizi, H., & Mariyam Thomas, P. (2015). Serious drug-drug interactions in the prescriptions of diabetic patients. Medical Sciences, 3(4), 93-103. https://doi.org/10.3390/medsci3040093
Scheen, A. J. (2014). Drug–drug interactions with sodium-glucose cotransporters type 2 (SGLT2) inhibitors, new oral glucose-lowering agents for the management of type 2 diabetes mellitus. Clinical pharmacokinetics, 53, 295-304. https://doi.org/10.1007/s40262-013-0128-8
Sheikh-Taha, M., & Asmar, M. (2021). Polypharmacy and severe potential drug-drug interactions among older adults with cardiovascular disease in the United States. BMC geriatrics, 21, 1-6. https://doi.org/10.1186/s12877-021-02183-0
Triplitt, C. (2006). Drug interactions of medications commonly used in diabetes. Diabetes Spectrum, 19(4), 202.
Tuladhar, L. R., Shrestha, S. L., Regmi, D., Bimali, S., Bhusal, S., & Khadka, P. (2021). Drug-drug Interactions between Hypoglycemic and Non-hypoglycemic Medication in Diabetic Patients with Comorbidities in a Tertiary Care Center: A Descriptive Cross-sectional Study. JNMA: Journal of the Nepal Medical Association, 59(243), 1125–1130. https://doi.org/10.31729/jnma.7080
UpToDate Inc. (2024). UpToDate LexiDrug/Drug interactions (Version 8.4.4) [Mobile app]. Accessed March 28, 2024.
Utami, P. R., & Octavia, D. (2022). Study of potential interactions of oral antidiabetic drugs in patients with type 2 diabetes mellitus with comorbidities: A retrospective study. Pharmacy Education, 22(2), 200–206.
Yosmar, R., Shepany, E., & Fitria, N. (2024). A comprehensive analysis of antidiabetic drug interactions in geriatric non-insulin dependent diabetes mellitus patients. Int J Appl Pharm, 16(1), 62-65.
Zheng, W. Y., Richardson, L. C., Li, L., Day, R. O., Westbrook, J. I., & Baysari, M. T. (2018). Drug-drug interactions and their harmful effects in hospitalised patients: a systematic review and meta-analysis. European journal of clinical pharmacology, 74, 15-27. https://doi.org/10.1007/s00228-017-2357-5
Statistics
67 Views | 53 Downloads
How to Cite
Pavithran, V., Pandiyan, B., Ismail, S., & Hariharan, A. (2024). Assessment of Prevalence, Determinants and Management of Potential Antidiabetic Drug Interactions Altering Glycemic Control in Patients with Type II Diabetes Mellitus- A Cross-Sectional Analysis. International Journal of Advancement in Life Sciences Research, 7(4), 98-106. https://doi.org/https://doi.org/10.31632/ijalsr.2024.v07i04.009
Section
Research Articles
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
.