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Abstract
Diabetes is a metabolic disorder resulting in chronic microvascular and
macrovascular complications. Diabetes affects an increasing number of
patients, and the number is expected to more than double, worldwide, by the
year 2030. Hypertension affects about 60% of patients with type 2 diabetes.
Serious cardiovascular events are twice more likely in patients with diabetes
and hypertension as either disease alone. Type 2 diabetes mellitus is
commonly associated with elevated BP and with atherogenic lipid
abnormalities and this combination represents a major cause of elevated
coronary risk. The present study was planned with the general objective of
evaluating the prescription patterns and cost of illness of type 2 diabetic
patients. Specific objectives were to determine the trends in anti-diabetic and
anti-hypertensive drug use patterns among patients with type 2 diabetes and
patients with hypertension along with diabetes. Study also aimed to evaluate
prescription pattern of lipid lowering and antiplatelet agents in type 2 diabetic
patients. It was also planned to determine the cost of illness (COI) for diabetic
inpatients. The study was conducted as cross sectional observational study.
The drug utilization data was collected for the years 2008 to 2010. Cost of
illness was calculated in patients with and without complications. Collected
data were analyzed using appropriate statistical techniques. As per the study
criteria, data were collected from 773, 700 and 647 type 2 diabetic patients
who were admitted during the years 2008, 2009 and 2010 respectively in the
medicine wards. The study results showed that majority of the patients were
males in contrast to other published studies where females were reported to
be higher. The mean age of study population was 57.8 years, which is similar
to other studies. Most of the patients were diabetics and had hypertension as
co-morbidity. Majority of patients did not have any microvascular and
macrovascular complications and on an average; they had six to ten years of
diabetic history. Monotherapy was the predominant way of management with
insulin, sulfonylureas or metformin. In diabetic patients with hypertension,
calcium channel blockers were preferably used contrary to the guidelines
which usually recommend ACE inhibitors or ARBs in these patients. About
30% of diabetic patients were on lipid lowering drugs and 20% were on
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antiplatelet agents for secondary prevention of cardiovascular complications.

Total cost of illness includes the cost of treatment, investigation, consultation
fee, intervention cost, transportation, days lost due to work, and
hospitalization. Median of total cost of Illness for diabetic care without any
complication was Rs 22456.97/- per patient per annum and with complication
was Rs 30,634.45/-. Patients on dialysis had to spend 7.3 times higher and
patients with cardiac intervention had to spend 7.4 times higher than diabetic
patients without any complication. It was concluded that males were affected
with type 2 diabetes more during the most productive period of their life.
Mono-therapy was more common in both diabetes and diabetic with
hypertension. Costs were many times higher in patients with complications
and with cardiac and renal interventions.