The aim of the study was to evaluate type 2 diabetes mellitus (DM) medicine management in
Government Clinics in Maseru, Lesotho. A two-dimensional research method was employed,
consisting of a literature review and an empirical investigation. The objective of the literature
review was to provide information on the pathophysiology, signs and symptoms, diagnosis,
treatment and clinical management of DM. The empirical investigation consisted of a descriptive
pharmacoepidemiological study, in which data for analysis was collected retrospectively from
patients‘ medical records (―bukanas‖) at dispensing points, a using data collection tool. The
selected study sites were Domiciliary Health Center, Mabote, Likotsi, and Qoaling filter clinics in
Maseru district of Lesotho. Data on costs of antidiabetic agents was collected from purchase
invoices provided by the pharmacy department of Domiciliary Health Center.
Results showed that the overall ratio of males to females was 1.3. There were no statistical
difference in DM prevalence between males and females in the different clinics (p = 0.48). The
mean age of males and females was 57.5 ± 14.2 years and 58.6 ± 11.3 years, respectively
(Cohen‘s d = 0.07).
DM was more prevalent in patients 59 to 69 years for both males and females, with the
exception of Mabote and Qoaling filter clinics, where DM was more prevalent in patients 49 to
59 years. These differences in prevalence were not statically significant. Overall, 20% (n = 69)
of the study sample had DM alone, while 80.0% of patients had DM concurrently with
hypertension. The odds ratio implicated that women were 1.7 times more likely to have
hypertension concurrently with Type 2 Diabetes Mellitus.
The mean blood glucose level at 95% confidence interval for females and males were
10.1 ± 5.9 mmol/L (95% CI: 10.1–11.7) and 10.9 ± 6.2 mmol/L (95% CI: 11.0–14.0) respectively.
The difference in the mean blood glucose levels of males vs. females was not statistically
significant (p = 0.07). In both males and females there were outliers as high as 33.3 mmol/L. Metformin 850 mg given three times, metformin 500 mg three times a day, glibenclamide 10 mg
daily and glibenclamide 5 mg twice daily are oral hypoglycaemic agents that were first, second,
third and fourth choice treatment of DM at all four study sites at a frequency of 54.2% (n = 160),
27.7% (n = 82), 4% (n = 12) and 2.7% (n = 27), respectively. Actraphane® 20 units in the
morning and 10 units in the evening was prescribed at a frequency of 11.6% (n = 432) in
comparison to other Actraphane®-containing regimens. The frequencies of prescribing
metformin and Actraphane® as combination therapies represented 10.6% (n = 40), 7.1% (n =
27), and 6.6% (n = 25), respectively, for Actraphane® 20 units in the morning and 10 units in the
evening, plus metformin 500 mg three times per day; Actraphane® 20 units in the morning and
10 units in the evening plus metformin 850 mg three times per day; and Actraphane® 30 units in
the morning and 15 units in the evening plus metformin 850 mg three times per day.
The combination therapy of metformin and glibenclamide were prescribed at frequencies of
24.6% (n = 172), 22.9% (n = 160), and 13.4% (n = 94) respectively for glibenclamide 10 mg
daily plus metformin 850 mg three times per day, glibenclamide 5 mg daily plus metformin
850 mg three times per day, and glibenclamide 5 mg once a day plus metformin 500 mg three
times per day as first, second and third choice treatments at all study sites.
The total cost incurred for all the oral drugs prescribed alone within different regimens was
M75.6 with the weighted average cost per patient of M0.81 ± 2.06 per day compared to the cost
of Actraphane® which was M40 660.52 per month at a weighted average daily cost of
M21.43 ± 6.23 per patient. The overall cost of Actraphane® and metformin combination therapy
amounted to M50 676.50, at an average cost per patient of M21.77 ± 6.80 per day. The cost of
combination therapy consisting of metformin and glibenclamide amounted to M377.10, at a
weighted average cost amounting to M0.49 ± 0.16 per patient, per day.
Based on the results of this study some conclusions were reached on the prevalence of DM,
prescribing patterns and the cost of antidiabetic agents. Recommendations pertaining to the
clinics and further research were made. / MPham (Pharmacy Practice), North-West University, Potchefstroom Campus, 2014
| Identifer | oai:union.ndltd.org:NWUBOLOKA1/oai:dspace.nwu.ac.za:10394/11839 |
| Date | January 2014 |
| Creators | Marite, M A |
| Source Sets | North-West University |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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