Adherence to American Diabetes Association and National List of Essential Medicines 2022 Guidelines in Antidiabetic Prescriptions: A Cross-sectional Study from Eastern India

Introduction: Adherence to evidence-based guidelines is essential for the rational management of type 2 diabetes mellitus (T2DM).This study evaluates the extent to which prescriptions align with the American Diabetes Association (ADA) and national list of essential medicines (NLEM) 2022 guidelines in a tertiary care hospital in Eastern India.Materials and methods: A prospective, cross-sectional observational study was conducted from July 2022 to September 2023 at Calcutta National Medical College, Kolkata.A total of 150 adult T2DM patients receiving antidiabetic medications were included.Prescription patterns were analyzed for drug selection, dose appropriateness using prescribed daily dose (PDD) and defined daily dose (DDD), and compliance with ADA and NLEM guidelines.Glycemic parameters [HbA1c, fasting blood glucose (FBG), and postprandial glucose (PPG)] were also recorded.Statistical analysis was performed using SPSS v28.0.Results: Metformin was prescribed in 85.3% of patients, reflecting high adherence to first-line therapy recommendations.Sulfonylureas and dipeptidyl peptidase-4 (DPP-4) inhibitors were prescribed in 51.3 and 63.3% of patients, respectively, showing moderate adherence.Sodiumglucose cotransporter-2 (SGLT-2) inhibitors were significantly underutilized (5.3%), despite guideline support for patients with cardiovascular or renal comorbidities.Insulin was used in 70% of patients with HbA1c >10%, but was less frequently initiated in moderately uncontrolled cases.Most PDD/DDD ratios were within acceptable ranges, indicating appropriate dosing.Conclusion: While adherence to first-line therapy was high, underuse of newer, evidence-backed agents like SGLT-2 inhibitors remains a concern.Enhancing access and prescriber awareness could improve the quality of diabetes care and patient outcomes in similar settings.