Naser, Abdallah Yousef Mustafa; (2018) The Use of Multiple Antidiabetic Medications and Hypoglycaemia in Patients with Diabetes Mellitus. Doctoral thesis (Ph.D), UCL (University College London).

Abstract

Background: Antidiabetic monotherapy does not always achieve the optimal glycaemic control, and patients with diabetes mellitus may need multiple drug therapy. The use of multiple antidiabetic medications may be associated with adverse events, such as hypoglycaemia. Aim: To assess the use of multiple antidiabetic medications and hypoglycaemia in patients with diabetes mellitus from clinical and economic perspectives. Method: Firstly, an ecological study on the population level was conducted using publicly available data from the United Kingdom to examine the primary research question of this project. Secondly, a case-crossover study was conducted in Jordan to answer the research question on the individual level. Thirdly, two cross-sectional survey studies were conducted in Jordan to understand a) physicians’ perceptions regarding de-intensifying antidiabetic medications therapy and factors affecting their treatment choices; and b) patients’ attitudes and perceptions regarding their hypoglycaemia. Finally, a cross-sectional study was conducted to estimate the cost of hypoglycaemia hospitalisation in patients with diabetes to explore its economic impact. Results: There has been a concurrent increase in the trends of hypoglycaemia admissions and antidiabetic medications prescriptions during the duration between 2004 and 2016. The use of multiple antidiabetic medications increases the risk of hypoglycaemia (OR, 5.00 (95%CI, 1.10 – 22.82)). Patients with diabetes had moderate hypoglycaemia problem-solving abilities. A majority of the physicians reported that they were aware of the principle of antidiabetic treatment de-intensification (78.4%), but only 55% of them were applying it. Patients’ clinical data were the most relevant factors considered when prescribing antidiabetic therapy. Median hypoglycaemia hospitalisation cost was £182.7 (IQR = £242.3). Conclusion: This project highlighted the clinical and economic impact of hypoglycaemia in patients with diabetes from drug-use, patient, physician, and economic perspectives. Physicians and patients need to take extra care regarding hypoglycaemia when patients are on multiple antidiabetic medications. Patients should be educated more on how to self-manage their disease.

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