Retrospective Analysis of Pharmacological Management and Referral Patterns of Patients with Type 2 Diabetes Mellitus Referred from Primary Care to Specialists

Background: Type 2 diabetes mellitus (T2DM), obesity, and hypertension (HTN) present a rapidly escalating public health crisis in India.Effective management at the primary care level and seamless transition to specialist care are critical for preventing long-term complications.This study evaluated pharmacological management patterns and referral characteristics for patients with these comorbidities to identify gaps in care quality at the primary-specialist interface.Materials and methods: We conducted a retrospective observational study of 1,381 adults with T2DM referred from 12 primary health centers (PHCs) to a multispecialty tertiary care center in Ahmedabad, India, between April 2023 and March 2024.Electronic health records (EHRs) were analyzed to assess patient demographics, clinical characteristics, and pharmacological regimens [oral antidiabetic drugs (OADs) and insulin] relative to glycemic control (HbA1c), obesity status [body mass index (BMI) 25 kg/m], and HTN.Results: The cohort (mean age 52.6 12.6 years) exhibited a high prevalence of comorbidities, with 66.2% having HTN and 65.2% classified as obese or overweight.Prescription patterns revealed significant therapeutic inertia; treatment intensity and class selection did not vary significantly across HbA1c categories (<7, 7-8.99, and 9%), even for patients with poor control (p > 0.05).Utilization of guideline-recommended cardiorenal-protective agents was suboptimal: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) were prescribed to only 26.6% of patients, and glucagon-like peptide-1 receptor agonists (GLP1 RAs) were negligible (0.7%), despite the high prevalence of obesity and cardiovascular risk.Furthermore, obesity status did not influence the choice of glucose-lowering therapy. Conclusion:This study highlights significant gaps in the pharmacological management of cardiometabolic conditions in Indian primary care, characterized by therapeutic inertia and the underutilization of modern, weight-centric, and cardiorenal-protective therapies.These findings underscore an urgent need for quality improvement initiatives, including the implementation of standardized treatment protocols, decisionsupport tools, and enhanced prescriber education to optimize care continuity and clinical outcomes.