A Study on Prescribing Pattern of Medications and Adherence in Geriatric Patients Having Type 2 Diabetes Mellitus with Hypertension.

Abstract

Type 2 diabetes mellitus (T2DM) and hypertension (HTN) are common co-morbidities in older adults and, together with age-related polypharmacy, impair rational prescribing and medication-taking behavior. OBJECTIVES: To analyze the pattern of prescribing oral antidiabetic and antihypertensive drugs in geriatric patients having type 2 diabetes mellitus (T2DM) and hypertension (HTN), to evaluate the medication adherence by Morisky medication adherence scale-8 (MMAS-8), and to determine barriers affecting adherence. Methods: A cross-sectional observational study was done in the Department of General Medicine, ESIC MC-PGIMSR & Model Hospital, Bengaluru, for a period of three months. One hundred and fifty patients aged 65 years or more with pre-existing T2DM and HTN were enrolled following informed consent. Data were extracted from medical charts and structured interviews with patients. Prescription complexity and the MMAS-8 were used to characterize regimens and adherence. Associations were examined with Spearman's rho correlation and chi-square test. Results: The mean age of participants was 69.7 ± 4.7 years, and the majority were males (56%). Metformin (84%), DPP-4 inhibitors (68%), and SGLT-2 inhibitors (37%) were the most commonly given antidiabetics. Calcium channel blockers (64%) and angiotensin receptor blockers (57%) were the most commonly prescribed antihypertensives. The main treatment approach for both illnesses was combination therapy (71% in T2DM, 63% in HTN). Low adherence was seen in 40% of the patients, medium in 29%, and high in 31%. The main hurdles were forgetfulness (43%), cessation after feeling better (29%), polypharmacy (15%), and prescription complexity, which trended toward lower adherence (p = 0.051). Conclusion: Metformin and ARB/CCB-based regimens remain the foundation of therapy in older individuals with concomitant T2DM and HTN with a definite trend toward newer and better-tolerated medications. However, adherence is poor in this group due to forgetfulness, regimen complexity, and polypharmacy, and so there is a need for regimen simplification and adherence-focused counseling.