AUTHOR=Hirai Toshiyuki , Hanaoka Shunsuke , Terakado Yuusuke , Seki Toshiichi , Watanabe Fumiyuki 

TITLE=Investigating the effect of prescribing status and patient characteristics on the therapeutic outcomes in patients with diabetes using a leftover drug adjustment protocol

JOURNAL=Journal of Pharmacy & Pharmaceutical Sciences

VOLUME=Volume 27 - 2024

YEAR=2024

URL=https://www.frontierspartnerships.org/journals/journal-of-pharmacy-pharmaceutical-sciences/articles/10.3389/jpps.2024.12886

DOI=10.3389/jpps.2024.12886

ISSN=1482-1826

ABSTRACT=Diabetes treatment includes anti-diabetic drugs therapy in addition to lifestyle improvements through diet and exercise therapy. In Japan, protocol-based pharmacotherapy management allows for drug treatment to a cooperation between physicians and pharmacists, based on a protocol that is prepared and agreed upon in advance. However, there are no studies clarifying the relationship between patient characteristics and therapeutic effects after pharmacist intervention in protocol-based pharmacotherapy management for patients with diabetes. Therefore, this study aimed to use protocol-based reports from pharmacies to understand the status of outpatient diabetes medication compliance. We classified patients with diabetes based on patient characteristics that can be collected at pharmacies and investigated the characteristics that impacted diabetes treatment. Patients were prescribed oral anti-diabetic drugs at the outpatient clinics of Hitachinaka General Hospital, Hitachi, Ltd., from April 2016 to March 2021. The survey items included patient characteristics (sex, age, number of drugs used, observable number of prescription years for anti-diabetic drugs, number of prescription days for anti-diabetic drugs, and the presence or absence of leftover anti-diabetic drugs) and HbA1c levels. Graphical analyses indicated the relationship of each categorized patient characteristic using multiple correspondence analyses. Subsequently, the patients were clustered using K-means cluster analysis based on the coordinates obtained for each patient. Patient characteristics and HbA1c values were compared between the groups for each cluster. A total of 1910 patients were included and classified into three clusters, Clusters 1, 2, and 3 contained 625, 703, and 582 patients, respectively. Patient characteristics strongly related to Cluster 1 were aged 65–74 years, three or more anti-diabetic drugs used, 3 years or more of anti-diabetic drugs treatment, and leftover anti-diabetic drugs. Furthermore, the ratio of patients with a worsened HbA1c transition was the highest compared with the that in other clusters. Using the leftover drug adjustment protocol, we clarified the patient characteristics that affected the treatment course. We anticipate that through targeted interventions in patients exhibiting these characteristics, we can identify those who are irresponsibly continuing with drug treatment or are not responding well to therapy, or both. This could substantially improve the efficacy of their anti-diabetic care.