A Study on Insulin use, Prescription Pattern and its Regimens in a Tertiary Care Hospital

 

Abubaker Siddiq¹*, Bharathi DR¹, Rojin Raj², Janet Benny², Shethal Saji², Sree Lakshmi P²

¹Department of Pharmacology, SJM College of Pharmacy, Chitradurga-577502, Karnataka, India

²Department of Pharmacy Practice, SJM College of Pharmacy, Chitradurga-577502, Karnataka, India

 

ABSTRACT:

Objectives: Achieving good glycemic control is of paramount importance in the reduction of diabetes mellitus associated morbidity and mortality. The role of insulin in the management of diabetes mellitus cannot be overemphasized and people with diabetes, use combinations of different types of insulin to better control and manage their condition. The objective of the present work was to evaluate prescribing pattern of insulin and its regimen with dosing frequency and their clinical characteristics. Materials and Methods: A Prospective, observational clinical study was carried out in a tertiary care hospital. A total of 338 patients on various insulin regimens alone or in combination with oral drugs were enrolled and studied for 36 months. Results: The study explored that insulin use is more in males than in females, with a higher use of insulin among elderly patients and with a major incidence in the age group of > 60 years. Most of the study subjects have their normal body mass and few were overweight. The duration of diabetic patients who are on insulin is more between 0-5 years and less in above 15 years. Among the study population greater proportion were using insulin from past 5 years with more twice daily and thrice daily insulin dosing. Furthermore, Human Actrapid was the common human insulin used, followed by fixed dose combination. Conclusion: The use of insulin analogues is very less which are more expensive than human insulin. The use of insulin is important to effectively control the disease process in patients with diabetes mellitus and insulin adherence has been especially proven to be associated with good long term metabolic control.

 

 

 

INTRODUCTION:

Diabetes mellitus (DM) is the most common endocrine disorder recognized as the major public health problems and main threats to human health that is affecting the population of both developed and non-developing countries. This can virtually affect every system of the human body leading to micro vascular and macro vascular complications¹. According to WHO, the prevalence of diabetes has been increasing rapidly over the last decades and at present time the estimated global prevalence of diabetes is around 9%².

 

 

 

The International Diabetes Federation projections predict that the prevalence of diabetes will increase to 8.8% by 2035 worldwide³. Good glycaemic control is of utmost importance in reducing the burden of disease attributable to diabetes mellitus. Optimal management of DM is a key factor in reducing the afore mentioned scenario. Management of DM includes the employment of non pharmacological and pharmacological interventions of which insulin therapy plays a prominent role. Although oral antidiabetic drugs (OADs) remain the mainstay in the treatment of type 2 diabetes mellitus, insulin therapy becomes inevitable in a substantial number of patients as the disease progresses⁴. Insulin therapy is used in the management of diabetes mellitus of all types and the need for insulin depends on the balance between insulin secretion and insulin resistance⁵. Therefore, the present study was carried out to establish current prescribing pattern of insulin in In-patients of general medicine and paediatric department of a teaching hospital.

 

MATERIALS AND METHODS:

The study was carried out at a teaching hospital at Chitradurga district, Karnataka. The institutional Ethical Committee approval was obtained prior to the study. This was a prospective observational study carried out for a period of three years from January 2015 to December 2017. This study aims at evaluation of the Prospective Patients data for Insulin use, its prescription pattern and its regimen for treatment of Diabetes Mellitus in In-Patients admitted at study site. The data was collected to study prescribing pattern of insulin and its types, dose of insulin, duration of diabetes, duration and frequency of insulin use and clinical characteristics of study subjects. All the necessary and relevant information were collected from Case records after obtaining informed consent. The collected data were analysed by using the Microsoft excel 2007.

 

Statistical analysis:

Data obtained from this study were grouped and analysed by tables using Statistical Package for social sciences (SPSS) version 21.0. Categorical variables were described as frequencies with percentages for the total sample.

 

Study design:

A Prospective observational study

 

Inclusion Criteria:

·      Patients of either sex who was admitted to general medicine and Paediatric wards for the treatment of Diabetes were included in the study

·      With atleast one Anti-diabetic drug

·      Admitted with co-morbidities

·      Willing to give informed consent

 

Exclusion Criteria: 

·      Gestational Diabetes

·      Malignancy with Diabetes

·      Psychiatric illness with Diabetes

 

Sources of data:

·      Patient’s Case records during Hospital stay

·      Medication Charts and Lab reports

 

RESULTS:

The 338 Patients with diabetes mellitus who were on insulin solely or in combination with oral hypoglycaemic agents were enrolled in the study, out of which 178 were males and 160 were females. Among the study population, the greatest number of patients were in the age group of > 60 years. Demographic details of enrolled patients are presented in Table No 1 and 2.

 

Table No. 1: Sex Wise Distribution of Patients

Sl. No	Sex	Number of Patients (n=338)	(%)
1	Male	178	53%
2	Female	160	47%

 

Table No.2: Age Distribution of Patients

Sl. No	Age group in Years	Total no of Patients (n=338)	% distribution
1	< 20	05	1.5
2	21-30	10	3
3	31-40	31	9.5
4	41-50	75	22
5	51-60	89	26
6	> 60	128	38

 

Most of the enrolled patients who are on insulin use were Normal in their body mass in which 126 and 56 Patients were Overweight and obese respectively. The clinical characteristics of patients suggested that greater proportion of patients had a history of the disease of 0-5 years followed by 41 from past 6-10 years, 21 patients between 11-15 years and 19 above 15 years. The details of characteristics of study subjects are presented in Table No 3.

 

 

 

Table No.3: Clinical characteristics of study subjects

Sl. No	Body mass index (kgm2)	No. of Patients (n=338)	Percentage (%)	Duration of Diabetes	No. of Patients (n=338)	Percentage (%)
1	Under weight (< 18.5)	01	0.5	0-5 years	206	61
2	Normal (18.5-24.9)	155	46	6-10 years	69	20
3	Over weight (25-30)	126	37	11-15 years	34	10
4	Obese (> 30)	56	16.5	> 15 years	29	09

 

Among 338 patients majority were using insulin as a treatment from past 5 years in which insulin dosing regimen ranged from one to four times daily. 32% study subjects were using insulin three times a day followed by 48% twice daily and very less on once and four times daily. The Details of duration of insulin use and distribution of the dosing frequency of insulin is shown in Table No 4.

 

 

 

 

Table No.4: Duration and frequency of Insulin use

Sl. No.	Duration	No. of Patients (n=338)	Percentage %	Frequency of Insulin dosing	Frequency distribution of daily Insulin dosing %
1	0-5 years	109	57	Once Daily	15%
2	6-10 years	41	22	Twice Daily	48%
3	11-15 years	21	11	Thrice Daily	32%
4	> 15 years	19	10	Four times Daily	05%

 

Human insulin was the commonly used insulin with Actrapid preparation taking the lead. It follows premixed preparations like biphasic Isophane insulin which is a combination of short and intermediate acting insulin. The use of insulin analogues for the treatment is very less as compared to human insulin. The results are depicted in Table No.5.

 

Table No. 5: Pattern of Insulin use

Type of Insulin		No. of Insulin Prescribed (n=338)	Percentage %
Human Insulin	Regular (Human Actrapid)	124	65
	Biphasic Isophane insulin (30% short acting + 70% Intermediate acting)	41	22
	Mixture of Regular + NPH insulin (Human Mixtard)	31	16
	Human Insulatard	09	05
Insulin Analogues	Glargine	03	02

 

DISCUSSION:

The role of insulin in the management of diabetes mellitus cannot be overemphasized and people with diabetes use combinations of different types of insulin to better control and manage their condition^6,7. A total of 338 patients were enrolled in the study who are on insulin alone or in combination with oral drugs. The study showed that insulin use is more in males than in females. The study also found a higher use of insulin was among elderly patients, with a high incidence in the age group of > 60 years, which is in concordance with the earlier published studies in india which showed majority of the patients with diabetes mellitus belongs to age group greater than 60 years of age⁸ This implies that these subjects develop DM in the most productive years of their life, because of their lifestyle modification, increase in stress rates and various physical changes in the body. So this age group also has a great chance of developing various other chronic complications associated with diabetes. The burden of diabetes is mainly due to consequence of long term complications like macrovascular and microvascular complications of disease⁹. Duration of diabetes mellitus plays an important role in its management with patients who have diabetes of less than 1-5 years could usually be managed with single oral hypoglycaemic agent or insulin. Whereas patients with more 5-10 years duration of diabetes may require combination of oral hypoglycaemic agents or insulin with oral hypoglycaemic agents for its management. In our study we found, more than two third of the patients had a history of Diabetes mellitus for less than 10 years. These findings was similar to the observation made in previous studies¹⁰. According to the results obtained from our study, we observed more patients either obese or overweight. Boffetta et al., reported that there is a strong association between BMI and the prevalence of diabetes in Asian populations¹¹. This study showed human Actrapid was the common human insulin used in most of the patients which is followed by fixed dose combination. The use of insulin analogues is very less which are more expensive than human insulin. The use of insulin is important to effectively control the disease process in patients with diabetes mellitus and insulin adherence has been especially proven to be associated with good long term metabolic control. There was also a higher prescribing percentage of insulin therapy, Insulin preparations help in decreasing the insulin resistance effectively hence lead to better Glycemic control¹². Hence, it is observed that long term glycaemic control in patients with diabetes is poorer who show non adherence to prescribed insulin.

 

CONCLUSION:

From the foregoing Prospective observational study on insulin use and its prescription pattern was carried out on 338 patients and it is concluded that use of insulin is more in males with higher use among elderly patients. Human actrapid was the most frequently used insulin due to less cost compare to insulin analogues.  Insulin preparations help in decreasing the insulin resistance effectively, hence lead to better Glycemic control.

 

ACKNOWLEDGEMENT:  

The authors are thankful to the management of SJM vidyapeetha, Chitradurga through the Principals of SJM College of pharmacy and Basveshwara medical college & hospital for providing necessary facilities, support and encouragement throughout the study.

 

CONFLICT OF INTEREST:

The authors declare no conflict of interest.

 

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Received on 08.03.2019          Modified on 30.03.2019

Accepted on 20.04.2019        © RJPT All right reserved