Abstract
Aim: To assess the drug-related problems (DRPs) and World Health Organization (WHO) core prescribing indicators among hospitalized diabetic patients.
 Methodology: A prospective, observational study was made among the diabetic inpatients of the General Medicine Department of a tertiary care hospital located in Tirupati, Andhra Pradesh, India. A suitable data collection form was used to collect the data pertaining to demographics, clinical variables, DRPs, and WHO prescribing indicators. Descriptive statistics like frequency, mean, and percentage were used to represent the demographics, distribution of DRPs, and prescribing indicators in the study. Inferential statistics like Chi-square test was employed to test the significant association between the demographics and occurrence of DRPs.
 Results: A total of 199 diabetic patients were enrolled in this study. The mean age of the study participants was 55.8±11.3. The study shows the prevalence of DRPs in diabetic in-patients was 48.7%. The most commonly identified DRPs are drug interactions (53; 45.3%), adverse drug reactions (24; 20.5%), and untreated indication (21; 17.9%). Patient characteristics like, advanced age (≥60 years), presence of co-morbid condition, comprising more than 5 drugs in prescription, and stay in the hospital for more than four days are significantly associated with the development of DRPs. Findings of WHO indicators show the average number of drugs, percentage of drugs prescribed by the generic name, percentage of encounters with an antibiotic, injection, and from essential drug list have deviated from standards of WHO.
 Conclusion: The prevalence of DRPs in diabetic in-patients was 48.7%. Drug interactions and adverse drug reactions are the most common DRPs found in our study. Developing the drug policy guidelines focused on factors associated with DRP and WHO prescribing indicators may reduce the burden of DRPs and improves patient outcomes.
Highlights
Diabetes Mellitus (DM) is a chronic disorder of multiple etiologies characterized by prolonged hyperglycemia with disturbance in the metabolism of carbohydrates, proteins, and lipids, due to defect in insulin action, insulin secretion, or both [1]
Drug interactions and adverse drug reactions are the most common drug-related problems (DRPs) found in our study
Developing the drug policy guidelines focused on factors associated with DRP and World Health Organization (WHO) prescribing indicators may reduce the burden of DRPs and improves patient outcomes
Summary
Diabetes Mellitus (DM) is a chronic disorder of multiple etiologies characterized by prolonged hyperglycemia with disturbance in the metabolism of carbohydrates, proteins, and lipids, due to defect in insulin action, insulin secretion, or both [1]. The diabetic patients are highly vulnerable to develop drug-related problems. This was majorly due to multiple medications, polypharmacy, aging, poor medication adherence, co-morbidities, and lifelong requirement of pharmacological and nonpharmacological therapies. Evidence shows that drug therapy in diabetes can cause at least one drug-related problem per patient [7,8]. Irrational use of drugs in diabetic patients can result in increased morbidity, mortality, waste of resources, and adverse drug reactions [2,3]. There was a scarcity of evidence about the prescribing pattern and drug-related problems occurrence in diabetic patients in Indian settings. The study was aimed to assess the prescribing pattern, prevalence, and predictors of drug-related problems in hospitalized diabetic patients
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