Assessment of Pharmacotherapy for Treatment and Management of Diabetes Mellitus

Abstract

I gathered and examined the medication histories of 20 patients with diabetes mellitus while doing my clinical pharmacy clerkship rotations in the medical wards at CMH Abbottabad, DHQ Hospital, Haripur, and Yahya Hospital Haripur. The title of my project was “Assessment of Pharmacotherapy for treatment and management of Diabetes Mellitus”. This initiative aimed to evaluate pharmacotherapy for this prevalent chronic illness in order to ensure that medications are used in the community in a safe, acceptable, and economical manner. Diabetes mellitus is a clinical illness marked by abnormalities in the metabolism of proteins, lipids, and carbohydrates as well as persistent hyperglycemia. Defects in either or both of the actions or secretion of insulin may cause the condition. Diabetes Mellitus that is insulin-dependent and non-insulin-dependent. There are two types of diabetes mellitus: primary and secondary. Primary diabetes mellitus is caused by endocrine disorders, drug induced diabetes, and hereditary abnormalities. Common clinical presentations include polyuria, polydipsia, weight loss, blurred vision, paresthesia, and postural hypotension. Diabetic ketoacidosis (DKA) is one of the immediate problems; retinopathy, nephropathy, and neuropathy are among the chronic sequelae. Insulin and dietary adjustments are part of the therapy of type 1 diabetes. The treatment of type 2 diabetes involves controlling blood sugar levels through diet and taking oral hypoglycemic medications at prescribed dosages, such as glucosidase inhibitors, biguanides, and sulfonylureas. Patient identification and demographic data, the chief complaint history of the current illness, previous surgical history, family history, social history, personal history, clinical laboratory tests, allergies review of systems, physical examination, medication history, including past medication histories, hospital treatment, and discharge medications were among the information gathered from ward histories sheets. Twenty patient’s worth of data were gathered, including the patient's demographics, full medical history, medication history, lab results, hospital treatments, monitoring notes, viii discharge drugs, and treatment results. Significant findings of medication history, justification and results of hospitalized pharmacotherapy, identification and management of drug-related issues, and drug information/therapeutic consultation given during hospital rotations were among the key data parameters that were analyzed. Of the twenty patients included in the patient demographic, sixteen were female and four were male. Of the 20 patients included in the patient demographic, 16 were female and 4 were male. Based on the findings, patients between the ages of 50 and 59 are more likely to have disease. Type 2 diabetes, followed by insulin-dependent diabetes mellitus, affected the majority of the patients. Prior to being admitted to the hospital, the patients often took dapagliflozin and metformin; nevertheless, sitagliptin plus metformin was the most commonly prescribed dual therapy combination. Chronic kidney disease, congestive heart failure, and hypertension were co-morbid conditions. The majority of individuals exhibit appropriate response, according to noteworthy drug history findings. The patients most frequently experienced body pains, dizziness, polydipsia, polyuria, and polyphagia. Insulin (n = 11), biguanides (n = 9), SGLT-2 inhibitors (n = 2), thiazolidinesdiones (n = 0), DPP-4 inhibitors (n = 4), and sulfonylureas (n = 0) were the most commonly recommended drugs for hospital treatment. Following the examination of diabetic cases, it was found that the majority of patients had interactions in their prescriptions, and that prescriptions may have pharmacological interactions. Based on data from 20 diabetes patients and references to Medscape and Micromedex, it was found that of the interactions, 39.1% were large, 43.4%) were moderate, and 17.39% were mild. Additionally, following the examination of diabetic cases, it was found that the majority of patients do not comply with medication therapy because they do not receive adequate assistance and counseling from physicians who are overworked and may not be able to help them. Most patients have uncontrolled diabetes as a result of poor compliance with dietary planning and medication therapy due to a lack of supervision or counseling. The assessment of therapy outcome was conducted using many parameters, including complete blood count, liver and renal function tests, serum electrolytes, and lab tests such as FBS and RBS. This study makes it abundantly evident that clinical pharmacists can be quite helpful in maximizing therapy. Therefore, in a hospital context, a clinical pharmacist is required to justify the therapy.