Medical Surveys of an Antidiabetic Medication in village area of western Maharashtra.

Diabetes mellitus represents a significant global health challenge, with its prevalence steadily rising across the world. Antidiabetic medications play a crucial role in the management of diabetes, aiding in glycemic control and reducing the risk of complications associated with the condition. Understanding the usage patterns, effectiveness, and patient experiences with antidiabetic medications is essential for optimizing diabetes care and improving patient outcomes. Diabetes mellitus (DM) is a complex chronic illness associated with a state of high blood glucose level, or hyperglycaemia, occurring from deficiencies in insulin secretion, action, or both. The chronic metabolic imbalance associated with this disease puts patients at high risk for long-term macro- and microvascular complications, which if not provided with high quality care, lead to frequent hospitalization and complications, including elevated risk for cardiovascular diseases.[1]

Type 2 diabetes mellitus is a common and increasingly prevalent disease and is thus a major public health concern worldwide. The International Diabetes Federation estimates that there are approximately 387 million people diagnosed with diabetes across the globe.[2]

In general, 1.4 million newly diagnosed cases in the US are being reported every year. If this trend continues, it is projected that in 2050 one in three Americans will have diabetes. Patients with diabetes have increased risk of serious health complications including myocardial infarction, stroke, kidney failure, vision loss, and premature death. Diabetes, with its associated side effects, remains the seventh leading cause of mortality in the US. The World Health Organization estimates that by 2030, mortality related to diabetes will double in number if not given deliberate attention.[3]

The ADA has released a range of recommendations called Standards of Medical Care in Diabetes to improve diabetes outcomes. The recommendations include cost-effective screening, diagnostic and therapeutic strategies to prevent, delay, or effectively manage T2DM and its life-threatening complications.[4]

Background:

Diabetes mellitus encompasses a group of metabolic disorders characterized by hyperglycemia, resulting from defects in insulin secretion, insulin action, or both. According to the International Diabetes Federation (IDF), an estimated 537 million adults aged 20-79 were living with diabetes worldwide in 2021. In India alone, approximately 77 million adults were affected by the condition, highlighting the urgent need for effective diabetes management strategies.

The armamentarium of antidiabetic medications has expanded significantly over the past few decades, offering healthcare providers and patients a wide range of options for glycemic control. These medications include insulin, oral hypoglycemic agents (such as metformin, sulfonylureas, DPP-4 inhibitors, SGLT2 inhibitors), glucagon-like peptide-1 receptor agonists (GLP-1 RAs), and others.

Purpose of the Survey:

This survey aims to assess various aspects related to the use of antidiabetic medications among individuals diagnosed with diabetes mellitus. Specifically, the survey seeks to:

1. Evaluate the prevalence and patterns of antidiabetic medication use among individuals with diabetes.

2. Assess the effectiveness of different classes of antidiabetic medications in achieving glycemic control and preventing complications.

3. Explore patient experiences, preferences, and satisfaction with antidiabetic medications, including perceived efficacy, tolerability, and ease of use.

4. Identify barriers and challenges to adherence and persistence with antidiabetic medications.

5. Inform healthcare providers, policymakers, and other stakeholders about the real-world utilization and outcomes associated with antidiabetic medications, with the ultimate goal of improving diabetes care and management.

Surveys are common in medical research. Although survey research may be subject to inherent self- report bias, surveys have a great impact on policies and practices in medicine, often forming the basis for recommendations or new guidelines. [5,6]

A medical survey is a type of market research that researchers conduct to gain insight into the health and well-being of a population. The goal of a medical survey is to collect information about the prevalence of specific diseases and conditions.

Surveys are important tools for answering questions on topics that are difficult to assess

using other methods. Surveys are important tools for answering questions on topics that are difficult to assess using other methods. Surveys are important tools for answering questions on topics that are difficult to assess

using other methods.

Surveys are important tools for answering questions on topics that are difficult to assess using other methods. They allow us to gather data systematically from subjects by asking questions, in order to make inferences about a larger population.[7]

Clinicians use surveys to explore the opinions, beliefs, and perceptions of a group, or to investigate physician practice patterns and adherence to clinical guidelines. They may also use surveys to better understand why patients are not engaging in recommended behavioural or lifestyle changes.[8]

Diabetes Mellitus:

Diabetes mellitus (DM) also known as simply diabetes, is a group of metabolic diseases in which there are high blood sugar levels over a prolonged period This high blood sugar produces the symptoms of frequent urination, increased thirst, and increased hunger. Untreated, diabetes can cause many complications. Acute complications include diabetic ketoacidosis and nonketotic hyperosmolar coma. Serious long-term complications include heart disease, stroke, kidney failure, foot ulcers and damage to the eyes. Diabetes is due to either the pancreas not producing enough insulin, or the cells of the body not responding properly to the insulin produced. There are three main types of diabetes mellitus:

• Type 1 DM results from the body's failure to produce enough insulin. This form was previously referred to as "insulin-dependent diabetes mellitus" (IDDM) or "juvenile diabetes". The cause is unknown
• Type 2 DM begins with insulin resistance, a condition in which cells fail to respond to insulin properly. As the disease progresses a lack of insulin may also develop. This form was previously referred to as "non-insulin-dependent diabetes mellitus" (NIDDM) or "adult-onset diabetes". The primary cause is excessive body weight and not enough exercise.
• Gestational diabetes, is the third main form and occurs when pregnant women without a previous history of diabetes develop a high blood glucose level. [9] diseases in which there are high blood sugar levels over a prolonged period This high blood sugar produces the symptoms of frequent urination, increased thirst, and increased hunger. Untreated, diabetes can cause many complications. Acute complications include diabetic ketoacidosis and nonketotic hyperosmolar coma.

Serious long-term complications include heart disease, stroke, kidney failure, foot ulcers and damage to the eyes. Diabetes is due to either the pancreas not producing enough insulin, or the cells of the        body not responding properly to the insulin produced. There are three main types of

diabetes mellitus:

• Type 1 DM results from the body's failure to produce enough insulin. This form was previously referred to as "insulin-dependent diabetes mellitus" (IDDM) or "juvenile diabetes". The cause is unknown
• Type 2 DM begins with insulin resistance, a condition in which cells fail to respond to insulin properly. As the disease progresses a lack of insulin may also develop. This form was previously referred to as "non-insulin-dependent diabetes mellitus" (NIDDM) or "adult-onset diabetes". The primary cause is excessive body weight and not enough exercise.
• Gestational diabetes, is the third main form and occurs when pregnant women without a previous history of diabetes develop a high blood glucose level Prevention and treatment involve a healthy diet, physical exercise, not using tobacco, and being a normal body weight. Blood pressure control and proper foot care are also important for people with the disease. Type 1 diabetes must be managed with insulin injections. Type 2 diabetes may be treated with medications with or without insulin. Insulin and some oral medications can cause low blood sugar Weight loss surgery in those with obesity is an effective measure in those with type 2 DM. Gestational diabetes usually resolves after the birth of the baby. Prevention and treatment involve a healthy diet, physical exercise, not using tobacco, and being a normal body weight. Blood pressure control and proper foot care are also important for people with the disease. Type 1 diabetes must be managed with insulin injections. Type 2 diabetes may be treated with medications with or without insulin. Insulin and some oral medications can cause low blood sugar. Weight loss surgery in those with obesity is an effective measure in those with type 2 DM. Gestational diabetes usually resolves after the birth of the baby.

Signs and symptoms:

The classic symptoms of untreated diabetes are weight loss, polyuria (frequent urination), polydipsia (increased thirst), and polyphagia (increased hunger).The classic symptoms of untreated diabetes are weight loss, polyuria (frequent urination), polydipsia (increased thirst), and polyphagia (increased hunger). Symptoms may develop rapidly (weeks or months) in type usually develop much more slowly and may be subtle or absent in type Several other signs and symptoms can mark the onset of diabetes, a not specific to the disease. In addition to the known ones above, they include blurry vision, headache, fatigue, slow healing of cuts, and itchy skin. Prolonged high blood glucose can cause glucose absorption in the lens of the eye, which its shape, resulting in vision changes. A number of skin rashes that can occur in diabetes is collectively known as Symptoms may develop rapidly (weeks or months) in type usually develop much more slowly and may be subtle or absent in type Several other signs and symptoms can mark the onset of diabetes, a not specific to the disease. In addition to the known ones above, they include blurry vision, headache, fatigue, slow healing of cuts, and itchy skin. Prolonged high blood glucose can cause glucose absorption in the lens of the eye, which its shape, resulting in vision changes. A number of skin rashes that can occur in diabetes are collectively known as Diabetic emergencies. [10,11,12]

Literature review:

James Bagonza ck of adherence to anti-diabetic medication causes suboptimal blood sugar control among patients with diabetes and can lead to treatment failures, accelerated development of complications and increased mortality. This study assessed factors associated with adherence to anti-diabetic medication in rural eastern Uganda

Sushmita Khan The usage of medicinal plants is traditionally rooted in Bangladesh and still an essential part of public healthcare. Recently, a dramatically increasing prevalence brought diabetes mellitus and its therapy to the focus of public health interests in Bangladesh. We conducted an ethnobotanical survey to identify the traditional medicinal plants being used to treat diabetes in Bangladesh and to critically assess their anti-diabetic potentials with focus on evidence-based criteria.

Dr Rutuja Management of Diabetes in tribal populations who have lower access to education and health care services poses unique challenges. Understanding patterns at local level will help implement comprehensive primary care services better

P. Nagaraja Rao Diabetes mellitus is a group of metabolism disorder (A. J. Boulton., 2005) resulting from defects in insulin secretion or synthesis reduced sensitivity of the tissues to insulin action or both (Lanza et al., 1999). It is characterized by chronic high blood glucose that causes glycation of body protein which could lead to severe complications.

Satyajit Patnaik Treatment adherence will help to achieve good glycaemic control among diabetics and will lead to lesser complications associated with the disease. This study was carried out to determine the compliance to treatment among previously diagnosed diabetic patient and their level of glycaemic control, in a rural area. Materials and Methods: This cross sectional study was conducted among all previously diagnosed diabetics above 30 years, on treatment for more than 6 months. Nonadherence was defined as “missing more than 2 doses” in the last 15 days. Glycaemic control was assessed by performing glycated haemoglobin (HbA1c). Results: Among 155 people interviewed, 140 (90.3%) were found to be compliant to the treatment.

What Is Mean By Medical Survey?

A medical survey typically refers to a research method used to gather information about various aspects of health, illness, medical practices, or healthcare services. These surveys are designed to collect data from a sample of individuals or populations, often using questionnaires, interviews, or other data collection techniques. Medical surveys can cover a wide range of topics, including prevalence of diseases, risk factors, treatment outcomes, patient satisfaction, healthcare access, and healthcare utilization patterns. The data collected from medical surveys is often used to inform healthcare policy, guide medical research, assess the effectiveness of healthcare interventions, and improve healthcare delivery.The introduction to a medical survey is typically the opening section that provides background information and context for the survey. It serves to introduce the purpose, objectives, and scope of the survey to the participants or readers. Here are some key components that may be included in the introduction of a medical survey:

1. Purpose: Clearly state the main goal or objective of the survey. This could be to gather information about a specific health issue, assess healthcare needs, evaluate the effectiveness of a treatment or intervention, or explore healthcare utilization patterns, among other possibilities.

2. Background: Provide relevant background information to contextualize the survey topic. This may include information about the prevalence of a particular health condition, recent developments in medical research or healthcare policy related to the topic, or any other pertinent information that helps to frame the survey.

3. Importance: Explain why the topic of the survey is important and why it warrants investigation. Discuss the potential implications of the survey findings for healthcare practice, policy, or research.

4. Scope: Outline the scope of the survey, including the target population (e.g., patients with a specific medical condition, healthcare providers, general population), the geographic area covered, and the time frame of the survey.

5. Confidentiality and Ethics: Assure participants of the confidentiality of their responses and explain any ethical considerations involved in conducting the survey, such as obtaining informed consent and protecting participant privacy.

6. Instructions: Provide instructions for completing the survey, including any specific guidelines for responding to questions or providing feedback.

Worldwide Diabetes Statistics:

Diabetes is indeed a significant worldwide problem with far-reaching implications for public health, healthcare systems, and individuals. Here's an overview of why it's considered a global concern:

1. Prevalence: Diabetes is increasingly prevalent worldwide. According to the International Diabetes Federation (IDF), approximately 537 million adults (aged 20-79) were living with diabetes in 2021, and this number is projected to rise to 784 million by 2045. Both type 1 and type 2 diabetes contribute to this burden.[13]

2. Health Impacts: Diabetes can lead to a range of serious health complications, including cardiovascular disease, kidney disease, nerve damage, vision loss, and lower limb amputations. It significantly reduces quality of life and life expectancy if not managed effectively.

3. Economic Costs: Diabetes imposes substantial economic costs on individuals, families, healthcare systems, and societies. These costs include expenses related to medical care, treatment, complications, disability, and lost productivity. The IDF estimates that global healthcare expenditure on diabetes was USD 850 billion in 2019.[14]

4. Risk Factors: Diabetes is influenced by various risk factors, including genetics, lifestyle factors (such as unhealthy diet, physical inactivity, and obesity), socio-economic factors, and environmental factors. Urbanization, sedentary lifestyles, and unhealthy dietary patterns contribute to the rising prevalence of diabetes worldwide.

5. Health Disparities: Diabetes disproportionately affects certain populations, including ethnic minorities, Indigenous peoples, and socio-economically disadvantaged groups. These disparities may be due to differences in access to healthcare, education, healthy food, and other social determinants of health.[15]

6. Challenges in Management: Effective management of diabetes requires a comprehensive approach that includes lifestyle modifications, medication, regular monitoring, and access to healthcare services. However, many people with diabetes face barriers to accessing these services, including financial barriers, lack of education, and inadequate healthcare infrastructure.

worldwide diabetes ratio:

 last update in January 2022, the worldwide ratio of diabetes varies depending on the type of diabetes and the population being considered.

1. Type 1 Diabetes: Type 1 diabetes accounts for approximately 5-10% of all diabetes cases worldwide. It is more common in children and young adults but can occur at any age. The global incidence of type 1 diabetes is increasing, particularly in younger age groups.

2. Type 2 Diabetes: Type 2 diabetes is the most common form of diabetes, accounting for the majority of cases worldwide. It is strongly associated with lifestyle factors such as unhealthy diet, physical inactivity, and obesity. The prevalence of type 2 diabetes varies widely by region, with higher rates observed in urban areas and among certain ethnic groups.

3. Gestational Diabetes: Gestational diabetes occurs during pregnancy and affects approximately 1 in 7 births globally. Women with gestational diabetes have an increased risk of developing type 2 diabetes later in life, and their children are also at higher risk of obesity and type 2 diabetes.

4. Overall Prevalence: According to the International Diabetes Federation (IDF), approximately 1 in 10 adults aged 20-79 worldwide had diabetes in 2021. This translates to around 537 million adults. However, the prevalence of diabetes varies significantly by region, with higher rates observed in low- and middle-income countries.

5. Trends: The global prevalence of diabetes has been steadily increasing over the past few decades, driven by factors such as population growth, aging populations, urbanization, and changes in lifestyle behaviours. If current trends continue, it is projected that the number of people with diabetes will continue to rise in the coming years.

Diabetes Problem In India:

Diabetes is a significant and growing health problem in India, presenting several challenges to public health and healthcare systems.

1. High Prevalence: India has one of the highest numbers of people living with diabetes globally. According to the International Diabetes Federation (IDF), India had an estimated 77 million adults aged 20-79 living with diabetes in 2021. This number is expected to increase to 134 million by 2045 if current trends continue.

2. Rising Incidence: The prevalence of diabetes in India has been steadily increasing over the past few decades, driven by factors such as rapid urbanization, sedentary lifestyles, unhealthy dietary patterns, and genetic predisposition. Type 2 diabetes is particularly common, accounting for the majority of diabetes cases in India. [16,17]

3. Early Onset: Diabetes in India often occurs at a younger age compared to Western countries. This early onset increases the risk of developing complications such as cardiovascular disease, kidney disease, and neuropathy at a relatively young age, leading to a significant burden of morbidity and mortality.

4. Regional Variations: There are significant regional variations in the prevalence of diabetes within India, with higher rates observed in urban areas compared to rural areas. However, diabetes is also increasingly becoming a rural health problem due to changes in lifestyle and dietary habits. [18,19]

5. Challenges in Management: Managing diabetes in India faces several challenges, including limited access to healthcare services, inadequate infrastructure for diabetes care, shortage of healthcare providers trained in diabetes management, high out-of-pocket healthcare expenditures, and low awareness about the condition and its complications among the general population.

6. Complications and Economic Burden: Diabetes and its complications impose a significant economic burden on individuals, families, and the healthcare system in India. The costs associated with medical care, treatment of complications, loss of productivity, and disability can be substantial and contribute to poverty and socioeconomic disparities. [20,21]

Diabetic patient ratio in India:

1. High Prevalence: India has a large population of individuals living with diabetes. The IDF estimated that approximately 77 million adults aged 20-79 in India had diabetes in 2021.

2. Urban-Rural Divide: While diabetes is prevalent across both urban and rural areas of India, the prevalence tends to be higher in urban areas due to factors such as changing lifestyles, increased consumption of processed foods, reduced physical activity, and higher stress levels. However, the gap between urban and rural prevalence rates is narrowing as urbanization spreads to rural areas.

3. Type 2 Diabetes Dominance: Type 2 diabetes is the most common form of diabetes in India, accounting for the vast majority of cases. This is often attributed to lifestyle factors such as poor diet, lack of physical activity, and obesity, as well as genetic predisposition.

4. Increasing Incidence: The incidence of diabetes in India is increasing, particularly among younger age groups. This trend is concerning as diabetes at a younger age increases the risk of developing complications such as cardiovascular disease, kidney disease, and neuropathy.

5. Challenges in Management: Managing diabetes in India faces numerous challenges, including limited access to healthcare services, shortage of trained healthcare professionals, high out-of-pocket healthcare expenditures, and low awareness about the condition and its complications among the general population.

6. Economic and Social Impact: Diabetes and its complications impose a significant economic burden on individuals, families, and the healthcare system in India. The costs associated with medical care, treatment of complications, loss of productivity, and disability can be substantial and contribute to poverty and socioeconomic disparities.

Aim of work:

Medical Surveys of an Antidiabetic Medication in village area of western Maharashtra.

OBJECTIVES:

1. Research and Data Collection: Surveys help gather data on various medical conditions, treatments, and healthcare practices. This data can be used for research purposes to understand disease prevalence, treatment efficacy, patient demographics, and healthcare trends.

2. Public Health Planning: Surveys provide insights into public health needs and help in planning and implementing healthcare programs. For example, surveys on vaccination coverage can help identify areas with low immunization rates and target interventions accordingly.

3. Quality Improvement: Surveys can be used to assess the quality of healthcare services and identify areas for improvement. Patient satisfaction surveys, for instance, provide feedback on the patient experience and help healthcare providers enhance the quality of care they deliver.

4. Disease Surveillance: Surveys play a crucial role in disease surveillance by monitoring the spread of infectious diseases and tracking changes in disease patterns over time. Surveillance surveys help identify outbreaks, assess the effectiveness of control measures, and inform public health responses.

5. Effectiveness Evaluation: Surveys can assess the effectiveness of anti-diabetic drugs in real-world settings by gathering data on patient outcomes such as glycaemic control, complications, and quality of life. This information complements data from clinical trials and provides insights into how these drugs perform in diverse patient populations and clinical settings.

6. Adherence and Compliance: Surveys help evaluate patient adherence and compliance to anti-diabetic medication regimens. Understanding factors influencing medication adherence, such as side effects, cost, and patient education, can inform strategies to improve treatment adherence and health outcomes.

7. Safety Monitoring: Surveys contribute to post-marketing surveillance of anti-diabetic drugs by detecting and monitoring adverse drug reactions (ADRs) and unexpected side effects in larger patient populations. This ongoing pharmacovigilance is essential for identifying potential safety concerns and ensuring the continued safety of these medications.

8. Patient Preferences and Satisfaction: Surveys can assess patient preferences for different anti-diabetic drugs and treatment modalities, as well as patient satisfaction with their current medication regimen. Understanding patient perspectives helps tailor treatment plans to individual needs and preferences, ultimately improving patient engagement and treatment outcomes.

9. Quality of Care and Treatment Disparities: Surveys help assess the quality of care received by patients with diabetes, including access to anti-diabetic drugs, healthcare services, and diabetes education programs. By identifying disparities in care delivery and treatment outcomes across different population groups, surveys support efforts to reduce healthcare inequalities and improve the overall quality of diabetes care.

Medical Survey Procedure:

1. Research Objective: Define the purpose of the survey. Are you looking to gather information on the prevalence of diabetes, treatment methods, patient satisfaction, or any other specific aspect related to antidiabetic patients?  Develop a structured questionnaire that includes both closed-ended (multiple-choice) and open-ended questions to gather quantitative and qualitative data. Identify the target population for the survey. In this case, it would be antidiabetic patients. Consider factors like age, gender, type of diabetes, treatment regimen, etc Ensure that participants are informed about the purpose of the survey, their rights, and how the data will be used. Obtain their consent to participate.

Engagement with Medical Shops: Encourage collaboration with local medical shops to ensure availability and accessibility of antidiabetic medications in rural areas. Develop a structured questionnaire that includes both closed-ended (multiple-choice) and open-ended questions to gather quantitative and qualitative data. Identify the target population for the survey.

Consultation with Doctors: Advocate for regular visits by doctors or healthcare professionals to rural medical shops.

Data Analysis:

Once the data is collected, analyse it using statistical methods to draw meaningful conclusions. Look for patterns, trends, and correlations in the data.

Preparation Of Formate

Survey Report:

DISCUSSION OF SURVEY: