Opportunities to enhance prescribing efficiency for patients

with diabetes in Abu Dhabi without compromising care

Dr Mohammed AbuelkhairHead, Pharma/Medicine & Medical Product

Regulation

The goal of the Pharmacovigilance and Rational Medicine Use program of at HAAD is to identify and promote optimal drug prescribing and use.

Strategies, tools, and services are provided to encourage the use of evidence-based clinical and cost-effectiveness information in decision making among health care providers, consumers and policy makers.

The aim of the audit was to analyze current treatment approaches among patients with Type 2 diabetes (T2DM) and compare with international standards. Secondly, assess the extent of different management approaches/prescribing pattern among different facilities.

GOALS AND OBJECTIVES

Audit of 561 random patients across 3 facilities treating T2DM patients over 1 year.

1 specialist diabetes center, 1 government (SKMC) diabetes center 1 independent private sector hospita

Data included extent of patient monitoring (BP, lipids, HbA1c, weight, renal function, etc.), oral glycemic drugs prescribed, whether these prescribed at maximal doses (NICE guidance) before insulins, whether insulin treatment delayed and insulin type.

 

METHODS

Prescribing High use of patent protected drugs including:

Expensive modified release medicines (e.g. metformin MR / gliclazide MR) versus generic standard release preparations

Gliptins including sitagliptin 50mg TWICE DAILY doseExpensive insulins such as insulin glargine

High use of glimepiride

Quality of care HbA1crecorded in(83% to100%) of all patients with diabetes Less than 50% of patients had a recorded HbA1c of < 7.5%

MAJOR FINDINGS

MAJOR FINDINGS

No of patients at each participating facility

Types of medical intervention used to control diabetes

MAJOR FINDINGS

HbA1c

Types of medical intervention used to control diabetes

MAJOR FINDINGS

Prescribing of agents to control hyperglycemia

  

Independent hospital (Private)

Government Hospital

Specialist Center

 Metformin  

 39 % 

 85.5 %

  87.6 % 

 Sulphonylurea

 47 % 

 57.4 %

  50.5 %

 Glitazone 

 13 % 

 20.3 %

 12.4 %

 Prandial regulators

 0 %

 3.1 %

 5.7 %

 Gliptins

 33%

 64.5 %

 61 % 

Newer Agents      (eg: Exanetide) 

 0 %

 7.4 %

 3.8 %

 Older anti -hyperglycemic agents (eg:Acarbose)

 2%

 0.8 %

 1.0 %

Trends in prescribing of oral anti-hyperglycemics.

MAJOR FINDINGS

Trends in prescribing of generics Trends in prescribing sitagliptin

MAJOR FINDINGS

Trends in prescribing Insulins

MAJOR FINDINGS

Trends in prescribing sulphonylureas

Gliclazide modified release preparations may be useful in patients who suffer with hypoglycaemia with standard release preparations. However the cost of the modified release tablets is significantly higher than standard tablets. In addition Glimepiride is significantly more expensive than Gliclazide

There is no strong evidence to suggest increased efficacy or lower incidence of side effects from Glimepiride use.

MAJOR FINDINGS AND CONCLUSIONS

We estimate costs could be reduced by approximately 30% through following international guidelines and reducing utilisation of expensive modified release preparations

Care could also improved by regular monitoring of HbA1c levels

Introduction of Pharmacy Benefit Management Systems should also help improve appropriate step wise care and reduce costs. In addition, increase INN prescribing, help monitor compliance, as well as monitor doses of drugs prescribed, e.g. statins