Evaluation of Drug Utilization and Dose Intensity Pattern in Dyslipidemic Patients with Type 2 Diabetes Mellitus

Introduction

Dyslipidemia is irregularities in lipid levels, including cholesterol, low-density lipoprotein cholesterol (LDL-C), triglycerides, and high-density lipoprotein (HDL).¹ Cholesterol is a fatty substance synthesized in the liver and obtained from fatty foods like oil, meat, and cheese, which is essential for the body's systematic functioning. Dyslipidemia is characterized by an excess of LDL, triglycerides, total cholesterol, and a deficient in HDL, leading to an abnormal lipid profile. Hyperlipidemia is the term used to describe the metabolic disorder of these lipoproteins. A slight increase in LDL is a warning sign of cardiovascular disease (CVD). Therefore, dyslipidemia is a significant contributor to CVD, along with type 2 diabetes mellitus (T2DM).²³⁴ Recent research indicates that the prevalence of high cholesterol is approximately 25 to 30% in urban areas and 15 to 20% in rural areas, which is lower than in high-income countries.⁵ According to a 2008 report by the World Health Organization (WHO), Europe (53.7%) and America (47.7%) exhibit the highest prevalence of hypercholesterolemia in adults, followed by South East Asia (30.3%). Africa, on the other hand, shows a comparatively lower prevalence (23.1%).⁶ According to the WHO reports from 2019, 17.9 million people died due to CVD, accounting for approximately 32% of all global deaths.⁷

Statins are the most commonly recommended drugs for managing dyslipidemia and hypercholesterolemia in patients with T2DM, as they can prevent or serve as prophylaxis for CVD.³ Statins are classified as high intensity and low intensity. High-intensity statin therapy is more commonly used. Other drugs used in the management of dyslipidemia include fibrates such as fenofibrate, bezafibrate, ciprofibrate, and gemfibrozil, and drugs that specifically reduce the intestinal absorption of phytosterols and dietary cholesterol, such as cholestyramine, colesevelam, colestipol, and ezetimibe. Niacin, also known as vitamin B3, PP, or nicotinic acid, substantially increases HDL levels while lowering very LDL (VLDL) levels.⁸

Insulin is widely used to treat diabetes, with approximately 4 out of 10 patients in India using it. South India shows a higher prevalence of dyslipidemia with diabetes compared to North India.⁹ Therefore, we intend to analyze the drug utilization and dose intensity pattern of dyslipidemia drugs in patients with diabetes mellitus.

Methodology

Results

In the study, a total of 384 patient records were included from the Medical Records Department. The files were screened using the International Classification of Diseases 10th Revision coding in the Medical Records Department software.

Discussion

The current study analyzed 384 patients' case sheets to determine the characteristics and treatment patterns of individuals with dyslipidemia. A similar pattern was observed in the study conducted by Gazzaz et al¹⁰ and Elnaem et al.⁷

The research revealed a higher prevalence of the disease among males compared to females, which is similar to the findings of Mehta et al.¹¹ However, it is important to note that the prevalence of the disease can vary depending on the geographical location. Furthermore, the study found a higher prevalence in the age group between 45 and 59, which aligns with the results reported by Gazzaz et al.¹⁰

Metformin was the most commonly prescribed oral antidiabetic agent, with a DDD/100 bed days of 0.0654, consistent with the findings of the study conducted by Poonam et al¹² and Hannan et al.¹³ Among the study population, the most frequently prescribed combination therapy was metformin with glimepiride (17.44%). This finding is similar to the study by Dada et al¹⁴ which reported that biguanides and sulphonylureas were the most frequently prescribed agents (32.8%).

Atorvastatin was the most commonly prescribed drug (40.62%) for patients with hyperlipidemia, consistent with the findings of Raja et al.¹⁵ However, it is important to note that the overall utilization of hypolipidemic medication was relatively low. The most frequently prescribed hypolipidemic medication in our study was the combination of atorvastatin with a DDD/100 bed days of 0.0513. Nevertheless, the Raja et al¹⁵ study reported that atorvastatin along with aspirin was the most frequently prescribed likely due to the presence of comorbid conditions in those patients.

The study found a significant relationship between VLDL levels and gender (p-value 0.034). In contrast, Shahwan et al¹⁶ reported a significant difference in HDL cholesterol (HDL-C). Furthermore, we observed significant variations in cholesterol and triglyceride levels among the age group of 45 to 59 years (p-value 0.026 for cholesterol and p-value 0.007 for triglycerides). Conversely, a study conducted in China by Wei et al¹⁷ reported higher incidences of LDL, total cholesterol, and non-HDL-C in nonelderly patients (< 60 years).

Conclusion

Metformin and glimepiride were the predominant oral hypoglycemic agents prescribed, while human insulin was the preferred option for insulin therapy. Atorvastatin was identified as the most commonly prescribed medication for managing dyslipidemia, often administered at lower dose intensities. The combination of atorvastatin and fenofibrate was frequently prescribed. These findings offer crucial insights to health care professionals, to provide precise treatment approaches for patients.