Evaluation of Oral Antidiabetes Drugs in Patients of Uncontrolled Type 2 Diabetes Mellitus: A Cohort Study

Introduction: The prevalence of uncontrolled Type 2 Diabetes Mellitus (T2DM) is higher due to non compliance to non pharmacological measures or pharmacotherapy, or due to disease progression, despite the availability of various oral antidiabetic drugs. Aim: To evaluate Oral Antidiabetic Drugs (OADs) in terms of treatment outcome as well as adherence. Materials and Methods: This was a single-centre cohort study, patients of uncontrolled T2DM on OAD(s) were enrolled for 12 months and followed-up monthly for six months. Details of blood sugar levels and antidiabetic treatment were recorded at each visit. Adherence to Antidiabetic Diet (ADD) and OAD(s) was studied using drug adherence diary, pill count method and Medication Adherence Report Scale (MARS-5) questionnaire. Data was presented in percentage, mean, standard deviation or as p-value (Z test of significance). Results: A total with 56 patients with uncontrolled T2DM were included in the study. There were 36 (64%) female patients, and mean age group and Body Mass Index (BMI) of patients was 57.14±10.3 years and 26.4±5.53 kg/m², respectively. Hypertension was present in 45 (80%) of patients. There was statistically significant reduction in mean HbA1c% to 6.85±0.83% compared to the baseline. Percentage patients prescribed single OAD decreased, and that described dual OADs regimen increased during study period. At time of enrollment, a total of 29 (52%) patients were adherent to ADD, and 44 (79%) were adherent to OAD(s). By the end of the study, 49 (94%, n=52) patients were adherent to ADD, and 51 (98%, n=52) patient were adherent to OAD(s). MARS-5 assessment showed that main reason for non adherence was that patients forgot to take the medicine; Adverse Drug Reactions (ADRs) was observed in seven patients, mainly belonged to gastrointestinal system organ class. Conclusion: Regular assessment of T2DM patients aids in monitoring of blood glucose levels and treatment modification. Increased number of OAD(s) and complexity of the regimen reduce drug adherence in the uncontrolled T2DM patients. Implementation of different tools for drug adherence evaluation in uncontrolled T2DM patients reinforces the importance of treatment adherence for better therapeutic outcome.