Factors contributing to acute heart failure after a first acute coronary syndrome episode

Background: Diabetes and hypertension are common among the elderly and significantly increase the risk of cardiovascular and renal complications. Managing type 2 diabetes mellitus (T2DM) in geriatric patients is challenging due to age-related changes, polypharmacy, and susceptibility to adverse drug reactions. This study aimed to assess prescribing patterns of antidiabetic medications in elderly patients with T2DM and coexisting hypertension at a tertiary care center in India. Methods: A retrospective cross-sectional study was conducted at Government General Hospital, Srikakulam, Andhra Pradesh, from February 2024 to February 2025. Prescriptions of patients aged ≥60 years with both diabetes and hypertension were analyzed. Data on drug classes, dosages, and regimens were collected. Statistical analysis was done using Microsoft Excel, with categorical variables expressed as percentages. Results: A total of 586 prescriptions were reviewed. Metformin was the most prescribed antidiabetic (49.10%), followed by sulfonylureas (30.04%), dipeptidyl peptidase-4 (DPP-4) inhibitors (6.98%), sodium-glucose co-transporter-2 (SGLT2) inhibitors (3.93%), and α-glucosidase inhibitors (3.06%). Insulin was used in 3.06% of cases. Combination therapy was common, with 69.65% on dual-drug regimens, 12.02% on triple therapy, and 0.92% on more than three drugs. Most prescriptions (99.22%) used generics, with 84.15% from the National List of Essential Medicines (NLEM) 2022 and 89.80% from the World Health Organization Essential Medicines List (WHO-EML) 2023. Conclusions: Metformin remains the mainstay of T2DM treatment in elderly patients. A high prevalence of combination and generic prescribing was noted. Ongoing evaluation of prescribing practices is essential to optimize care, minimize polypharmacy, and enhance outcomes in this population.