Drug related problems in type 2 diabetes patients with hypertension: a cross-sectional retrospective study

BMC Endocrine Disorders

Hoo Fun Wee¹  Hasniza Zaman Huri¹ 

[1] Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia

关键词: Drug-related problems;    Hypertension;    Type 2 diabetes;   

Others  :  1086015
DOI  :  10.1186/1472-6823-13-2

 received in 2012-08-20, accepted in 2012-12-31,  发布年份 2013

【 摘 要 】

Background

Type 2 diabetes (T2DM) patients with hypertension are at increased risk for experiencing drug-related problems (DRPs) since they often receive multiple medications and have multiple comorbidities. To date, there is a lack of studies conducted in T2DM patients with hypertension. This study aims to analyze the DRPs and identify factors affecting the DRPs in this patient population.

Method

This retrospective study involved T2DM patients with hypertension and was conducted at a tertiary hospital in Malaysia from January 2009 to December 2011. The assessment of DRPs was based on the Pharmaceutical Network Care Europe (PCNE) tool version 5.01.

Results

Two hundred patients with a total of 387 DRPs were identified. Among these patients, 90.5% had at least one DRP, averaging 1.9 ± 1.2 problems per patient. The most common DRPs encountered were insufficient awareness of health and diseases (26%), drug choice problems (23%), dosing problems (16%) and drug interactions (16%). The most implicated drugs were aspirin, clopidogrel, simvastatin, amlodipine and metformin. The six domains of DRPs found to have statistically significant associations were renal impairment, polypharmacy, cardiovascular disease, elderly status, and duration of hospital stay.

Conclusions

Early identification of the types and patterns of DRPs and the factors associated to them may enhance the prevention and management of DRPs in T2DM patients with hypertension.

【 授权许可】

   
2013 Zaman Huri and Fun Wee; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Shaw J, Sicree R, Zimmet P: Global estimates of the prevalence of diabetes for, and 2030. Diabetes Res Clin Pract 2010, 87(1):4-14.
• [2]Letchuman G, Nazaimoon WMW, Mohamad WBW, Chandran L, Tee G, Jamaiyah H, et al.: Prevalence of diabetes in the Malaysian national health morbidity survey III 2006. Medical Journal of Malaysia 2010, 65(3):173-179.
• [3]Mafauzy M, Hussein Z, Chan S: The status of diabetes control in Malaysia: results of DiabCare 2008. Medical Journal of Malaysia 2011, 66(3):175-181.
• [4]American Diabetes Association: Standards of medical care in diabetes-2012. Diabetes Care 2012, 35(Suppl.1):S11-S63.
• [5]Adler AI, Stratton IM, Neil HAW, Yudkin JS, Matthews DR, Cull CA, et al.: Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study. Br Med J 2000, 321(7258):412-419.
• [6]Stratton IM, Cull CA, Adler AI, Matthews DR, Neil HAW, Holman RR: Addictive effects of glycaemia and blood pressure exposure on risk of complications in type 2 diabetes: a prospective observational study (UKPDS 75). Diabetologia 2006, 2006(49):1761-1769.
• [7]Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al.: Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension 2003, 42(6):1206-1252.
• [8]Ministry of Health Malaysia: Clinical practice guidelines on the management of type 2 diabetes mellitus. 4th edition. 2009. http://www.acadmed.org.my/index.cfm?&menuid=67 webcite
• [9]Munger MA: Polypharmacy and combination therapy in the management of hypertension in elderly patients with Co-morbid diabetes mellitus. Drug Aging 2010, 27(11):871-883.
• [10]Haugbolle LS, Sorensen EW: Drug-related problems in patients with angina pectoris, type 2 diabetes and asthma–interviewing patients at home. Pharm World Sci 2006, 28(4):239-247.
• [11]Van Roozendaal BW, Krass I: Development of an evidence-based checklist for the detection of drug related problems in type 2 diabetes. Pharm World Sci 2009, 31(5):580-595.
• [12]Cramer JA, Benedict A, Muszbek N, Keskinaslan A, Khan Z: The significance of compliance and persistence in the treatment of diabetes, hypertension and dyslipidaemia: a review. Int J Clin Pract 2008, 62(1):76-87.
• [13]Ernst FR, Grizzle AJ: Drug-related morbidity and mortality: updating the cost-of-illness model. J Am Pharm Assoc 2001, 41(2):192-199.
• [14]Leendertse AJ, Egberts ACG, Stoker LJ, van den Bemt PMLA: Frequency of and risk factors for preventable medication-related hospital admissions in the Netherlands. Arch Intern Med 2008, 168(17):1890-1896.
• [15]Blix HS, Viktil KK, Reikvam A, Moger TA, Hjemaas BJ, Pretsch P, et al.: The majority of hospitalised patients have drug-related problems: results from a prospective study in general hospitals. Eur J Clin Pharmacol 2004, 60(9):651-658.
• [16]Hajjar ER, Hanlon JT, Artz MB, Lindblad CI, Pieper CF, Sloane RJ, et al.: Adverse drug reaction risk factors in older outpatients. Am J Geriatr Pharmacother 2003, 1(2):82-89.
• [17]Barber N, Parsons J, Clifford S, Darracott R, Horne R: Patients’ problems with new medication for chronic conditions. Qual Saf Health Care 2004, 13(3):172-175.
• [18]Dipiro JT, Talbert RL, Yee GC, Matzke GR, Wellls BG, Michael Posey L: Pharmacotherapy, A pathophysiologic approach. 8th edition. United States of America: The McGraw-Hill Companies; 2011.
• [19]Van Staa T, Abenhaim L, Monette J: Rates of hypoglycemia in users of sulfonylureas. J Clin Epidemiol 1997, 50(6):735-741.
• [20]Tolman KG, Fonseca V, Dalpiaz A, Tan MH: Spectrum of liver disease in type 2 diabetes and management of patients with diabetes and liver disease. Diabetes Care 2007, 30(3):734-743.
• [21]Chan DC, Chen JH, Kuo HK, We CJ, Lu IS, Chiu LS, et al.: Drug-related problems (DRPs) identified from geriatric medication safety review clinics. Arch Gerontol Geriatr 2011, 54:168-174.
• [22]Pharmaceutical Care Network Europe Foundation: PCNE classification for drug-related problems V5.01. 2006. http://www.pcne.org/sig/drp/documents/PCNE%20classification%20V5.01.pdf webcite
• [23]Delafuente JC: Understanding and preventing drug interactions in elderly patients. Crit Rev Oncol Hematol 2003, 48(2):133-143.
• [24]Bjorkman IK, Sanner MA, Bernsten CB: Comparing 4 classification systems for drug-related problems: Processes and functions. Res Social Adm Pharm 2008, 4(4):320-331.
• [25]Eichenberger PM, Lampert ML, Kahmann IV, van Mil JWF, Hersberger KE: Classification of drug-related problems with new prescriptions using a modified PCNE classification system. Pharm World Sci 2010, 32(3):362-372.
• [26]NW Levin EG: K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002, 39(2 Suppl 1):S1-S266.
• [27]Inzucchi S: Diabetes facts and guidelines 2011–2012. New Haven:Yale Diabetes Center; 2010.
• [28]British National Formulary Joint Formulary Committee: British national formulary. 60th edition. London: British Medical Association and Royal Pharmaceutical Society of Great Britain; 2010.
• [29]Lacy CF, Armstrong LL, Goldman MP, Lance LL: Drug information handbook. 20th edition. Lexi-Comp Inc: Hudson, Ohio; 2011.
• [30]American Geriatrics Society: Updated beers criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatric Society 2012, 60:616-631.
• [31]Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH, et al.: Updating the beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med 2003, 163(22):2716-2724.
• [32]Manley HJ, Drayer DK, Muther RS: Medication-related problem type and appearance rate in ambulatory hemodialysis patients. BMC Nephrol 2003, 4:10. BioMed Central Full Text
• [33]Gandhi TK, Weingart SN, Borus J, Seger AC, Peterson J, Burdick E, et al.: Adverse drug events in ambulatory care. N Engl J Med 2003, 348(16):1556-1564.
• [34]Goncalves CBC, Moreira LB, Gus M, Fuchs FD: Adverse events of blood-pressure-lowering drugs: evidence of high incidence in a clinical setting. Eur J Clin Pharmacol 2007, 63(10):973-978.
• [35]Sweileh WM: Contraindications to metformin therapy among patients with type 2 diabetes mellitus. Pharm World Sci 2007, 29(6):587-592.
• [36]Hassan Y, Al-Ramahi RJ, Abd Aziz N, Ghazali R: Drug use and dosing in chronic kidney disease. Ann Acad Med Singapore 2009, 38(12):1095-1103.
• [37]Manlucu J, Tonelli M, Ray J, Papaioannou A, Youssef G, Thiessen-Philbrook H, Holbrook A, et al.: Dose-reducing H2 receptor antagonists in the presence of low glomerular filtration rate: a systematic review of the evidence. Nephrol Dial Transplant 2005, 20(11):2376-2384.
• [38]Pladevall M, Williams LK, Potts LA, Divine G, Xi H, Lafata JE: Clinical outcomes and adherence to medications measured by claims data in patients with diabetes. Diabetes Care 2004, 27(12):2800-2805.
• [39]Koh Y, Kutty FBM, Li SC: Drug-related problems in hospitalized patients on polypharmacy: the influence of age and gender. Ther Clin Risk Manag 2005, 1(1):39-48.
• [40]Cramer JA: A systematic review of adherence with medications for diabetes. Diabetes Care 2004, 27:1218-1224.
• [41]Ali SM, Jusoff K: Barriers to optimal control of type 2 diabetes in Malaysian Malay patients. Global Journal of Health Science 2009, 1(2):P106.
• [42]Samoy LJ, Zed PJ, Wilbur K, Balen RM, Abu-Laban RB, Roberts M: Drug–related hospitalizations in a tertiary care internal medicine service of a Canadian hospital: a prospective study. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy 2006, 26(11):1578-1586.
• [43]Viktil KK, Blix HS, Moger TA, Reikvam A: Polypharmacy as commonly defined is an indicator of limited value in the assessment of drug‐related problems. Br J Clin Pharmacol 2007, 63(2):187-195.
• [44]Moura CS, Acurcio FA, Belo NO: Drug-drug interactions associated with length of stay and cost of hospitalization. J Pharm Pharm Sci 2009, 12(3):266-272.
• [45]Aparasu R, Baer R, Aparasu A: Clinically important potential drug-drug interactions in outpatient settings. Res Social Adm Pharm 2007, 3(4):426-437.
• [46]Munar MY, Singh H: Drug dosing adjustments in patients with chronic kidney disease. Am Fam Physician 2007, 75(10):1487-1496.
• [47]Field TS, Gurwitz JH, Harrold LR, Rothschild J, DeBellis KR, Seger AC, et al.: Risk factors for adverse drug events among older adults in the ambulatory setting. J Am Geriatr Soc 2004, 52(8):1349-1354.
• [48]Riechelmann RP, Moreira F, Smaletz Ò, Saad ED: Potential for drug interactions in hospitalized cancer patients. Cancer Chemother Pharmacol 2005, 56(3):286-290.