Prescription Patterns, Responsiveness To Oral Hypoglycemic Agents and Compliance Factors Among Patients With Type 2 Diabetes Mellitus Across Urban, Semi-Urban and Rural Settings

Abstract

Background

Type 2 diabetes mellitus (T2DM) is a major chronic metabolic disorder associated with progressive hyperglycemia and substantial microvascular and macrovascular morbidity. Despite the availability of multiple pharmacological options, achieving sustained glycemic control remains challenging. Differences in healthcare access, prescribing practices, socioeconomic circumstances and medication adherence may contribute to variation in treatment outcomes across urban, semi-urban and rural populations.

Aim

To evaluate prescription patterns, glycemic control, short-term treatment responsiveness and medication compliance among patients with OHAs in T2DM across urban, semi-urban and rural settings.

Methods

This study included 380 patients with T2DM recruited over a one-year period from the General Medicine Department of Sree Balaji Medical College and Hospital, associated rural and urban health centres, village medical camps and gated communities. An observational approach was used to evaluate prescribing patterns, while an experimental component assessed acute responsiveness to patients' regular oral hypoglycemic therapy following an oral glucose tolerance test (OGTT). Data included demographic characteristics, prescribed antidiabetic medications, fasting and postprandial blood glucose, HbA1c,  measurements and medication compliance.

Results

The mean age of participants was 54.2 ± 10.8 years, with males comprising 53.3% of the study population. Urban participants constituted 55.0%, semi-urban participants 25.0% and rural participants 20.0%. Metformin was the most frequently prescribed individual antidiabetic agent (12.6%), followed by glimepiride plus metformin (9.5%) and vildagliptin (7.9%). A significant association was observed between area of residence and prescribing pattern (p = 0.039). Overall, 28.4% of participants were categorized as having good glycemic control, 38.4% as moderate and 33.2% as poor. Glycemic control differed significantly by area (p = 0.029). Antidiabetic regimen was significantly associated with glycemic control (p = 0.042). Mean HbA1c was 7.82 ± 1.36%. Acute OGTT responsiveness was observed in 61.8% of participants and was significantly associated with the prescribed regimen (p = 0.045). Good medication compliance was observed in only 35.0% of participants. Compliance was strongly associated with glycemic control (p = 0.0005). Hypertension was the most frequently reported comorbidity (46.6%), followed by dyslipidemia (30.0%) and obesity (20.0%).

Conclusion

The study demonstrates substantial variation in oral antidiabetic prescribing patterns across urban, semi-urban and rural settings, together with a high burden of suboptimal glycemic control and inadequate medication compliance. Combination regimens were associated with better glycemic control and greater short-term treatment responsiveness. The findings highlight the importance of treatment optimization, medication adherence, regular monitoring and improved access to diabetes care, particularly in rural populations.