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The prescription pattern of antidiabetic medication and glycemic control in type 2 diabetes in Iran; A patient- level study

Majid Davari , Yahya Bayazidi *, Alireza Esteghamati, Bagher Larijani, Abbas Kebriaeezadeh

Type 2 Diabetes (T2DM) is one of the most prevalent chronic diseases which was the seventh leading cause of death in 2016 worldwide [1]. The main goal of drug therapy in diabetic patients is to control their blood glucose levels and consequently to control their complications. As the control of blood glucose gets worse, the patient will encounter a number of micro and macro vascular complications [2,3]. The American Diabetes Association (ADA) recommends that diabetic patients should be treated in such a way that glycosylated hemoglobin (HbA1c) reaches less than 7% [4]. Nevertheless, most diabetic patients still have not achieved the recommended goals [5-8]. Though diet and lifestyle are very effective in controlling blood glucose, but it usually fails and leads to oral drug therapy. If drug therapy fails at the second step, oral multiple-therapy will be applied. Multiple-therapy will get optimized and it will be switched to oral-injectable multiple therapies in the final steps [9]. With widespread changes in medication therapies to reduce hyperglycemia, recommendations for controlling blood glucose levels have changed over the years In regard to these changes in diabetes management, the trend in the utilization of glucose-lowering therapies as well as their ability to control blood glucose are also of great importance [7].The utilization of medication is defined by the WHO as marketing, prescription, distribution and drug usage in the community and particular emphasis has been given to its medical, social and economic consequences. Drug utilization studies try to synchronize the information of drugs consumptions in various types of disease, the outcome of treatment, and quality of care to consider the ultimate goal of whether drug therapy is rational or not [10[.Different studies have shown different patterns of anti-diabetic utilization among different countries [11-14]. For example, Lipska and colleagues examined the pattern of utilization and the ability to achieve control of hyperglycemia in the United States between 2006 and 2013 in different regions of the United States. Their findings, in addition to the big variation in the utilization of blood glucose lowering agents, showed that the proportion of people with HbA1c less than 7% (as an indicator of good control) decreased and poor control (> 9 %) increased during that period of time. They revealed that over the last eight years, despite dramatic changes in the consumption of hyperglycemic agents, the overall blood glucose control was not improved, and poor control exists among nearly a quarter of the youngest patients [9]. Yurgin and his colleagues, also investigated the utilization pattern and the ability to achieve blood glucose control and found that only 52.7% of the patients achieved the targets for HbA1c;  and insulin-treated patients were in the worst situation compared to HbA1 targets [8]. In 2012, more than 4.5 million adults in Iran suffered from diabetes. It was anticipated that more than a quarter of them had not yet been diagnosed [15]. The number of Iranian population with diabetes is expected to reach 9.2 million in 2030 (16). Although several studies have been conducted on the pattern of administration of anti-diabetic drugs in Iran [17,18] but none of these studies have been large enough to be generalized to the country. The aim of this study was conducted to evaluate the prescription pattern and their effectiveness in controlling blood glucose in patients with type 2 diabetes in public and private clinics in two of the country's largest provinces; Tehran and Isfahan