(082) The Utilization Pattern of Glucagon-Like Peptide-1 Receptor Agonist, Dipeptidyl Peptidase-4 Inhibitor, and Sodium Glucose Co-Transporter-2 Inhibitors in Type 2 Diabetes Mellitus in a Tertiary Care Hospital- A Retrospective Study

Publication Number: 744

Background: The newer generation of anti-diabetic drugs like Glucagon-like Peptide 1 Receptor Agonists (GLP1 RA), Dipeptidyl Peptidase 4 Inhibitors (DPP4i) and Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2i) have shown a promising effect in treatment of Type 2 diabetes mellitus (T2DM) patients in both with and without diabetes associated complications. However, there is limited data examining the real-world prescribing practice for these drugs.

Objectives: To study the utilization pattern and drug-drug interactions of GLP1 RA, DPP4i and SGLT2i in T2DM.

Methods: After ethical approval, a retrospective study was carried out at a tertiary care hospital in South India during the period of 2020-2021. In-patients diagnosed with T2DM and aged between 40-80 years with/without diabetes related complications were included. Pregnant women, patients diagnosed with malignancy or autoimmune disorders were excluded. Patient data, including demographic details, social and medical history, drug treatment chart, laboratory investigations, and potential drug-drug interactions were recorded. Data were analyzed using IBM SPSS Statistics 22.0 and potential drug interactions were identified using Micromedex and Lexicomp- Drug interaction

Results: A total of 1023 diabetic patients irrespective of the anti-diabetic drugs received were enrolled during the study period. The median age of the study population was 60 (52-67) years. Hypertension (52.8%) was the most prevalent comorbidity observed. About 45.74% of the patients had diabetes related complications. Of the total patients with complications, the most common was retinopathy (25.3%), followed by nephropathy (23.0%). Out of total enrolled patients, 398 patients (38.9%) received DPP4i, while 21 (2.0%) received SGLT2i and 3 (0.3%) received GLP 1 RA. These drugs were prescribed more frequently as an add-on therapy (97.39%) to the conventional treatment. After 3 months of therapy, patients prescribed these drugs showed an improvement in the HbA1c levels from 9.1 ± 2.4% to 7.8 ± 2.0%. These drugs were preferably used in patients with diabetes related complication (45.08%). Total of 480 interactions were observed with these drug classes of which 2.5% was of major severity and 77.91% was moderate severity. Of all the interactions, most observed drug interaction was with Aspirin (23.3%). Fluctuation of the glycemic levels was the common consequence of the interactions.

Conclusions: DPP4i was used much more than other newer agents. We observed that patients with diabetes associated complications were more likely to receive prescriptions for these drugs. This study tried to highlight potential drug interactions resulting in variations in glycemic levels, that should be monitored systematically to avoid drug related problems.