POTENTIAL OF ORAL ANTIDIABETIC INTERACTIONS IN TYPE 2 DIABETES MELLITUS OUTPATIENTS AT PKU MUHAMMADIYAH YOGYAKARTA HOSPITAL
Abstract
Indonesia is ranked fifth with the highest number of Diabetes Mellitus (DM) patients in the
world, with 19.5 million patients in 2021, and is estimated to be 28.6 million in 2045. DM
patients can experience comorbidities and complications, so they are at risk of
polypharmacy and drug interactions. The average number of drugs for DM patients is 8.9
drugs per day and 38.8% have the potential to experience interactions. The purpose of this
study was to determine the potential incidence of oral antidiabetic interactions in the
prescription of type 2 DM patients. The study used an observational design.The sample was
a prescription for outpatient type 2 DM patients at PKU Muhammadiyah Yogyakarta in the
period October 2021 - March 2022, totaling 112 prescription sheets. Data analysis used chisquare test on SPSS ver. 23 to see the relationship between the number of drugs and
potential interactions. Drug interaction evaluation was based on drugs.com,
go.drugbank.com and Drug Interaction Facts by Tatro (2009). The study showed that the
highest comorbidity was hypertension (25%) and the highest use of oral antidiabetics was
metformin (45.9%). Potential oral antidiabetic interactions were identified in 52
prescriptions out of 112 prescription sheets, with the highest percentage being the
interaction of metformin with furosemide (16%). There was a significant association
between the number of drugs prescribed and the incidence of potential oral antidiabetic
interactions (p=0.000). Type 2 DM patients who receive polypharmacy have a greater
potential for drug interactions.
world, with 19.5 million patients in 2021, and is estimated to be 28.6 million in 2045. DM
patients can experience comorbidities and complications, so they are at risk of
polypharmacy and drug interactions. The average number of drugs for DM patients is 8.9
drugs per day and 38.8% have the potential to experience interactions. The purpose of this
study was to determine the potential incidence of oral antidiabetic interactions in the
prescription of type 2 DM patients. The study used an observational design.The sample was
a prescription for outpatient type 2 DM patients at PKU Muhammadiyah Yogyakarta in the
period October 2021 - March 2022, totaling 112 prescription sheets. Data analysis used chisquare test on SPSS ver. 23 to see the relationship between the number of drugs and
potential interactions. Drug interaction evaluation was based on drugs.com,
go.drugbank.com and Drug Interaction Facts by Tatro (2009). The study showed that the
highest comorbidity was hypertension (25%) and the highest use of oral antidiabetics was
metformin (45.9%). Potential oral antidiabetic interactions were identified in 52
prescriptions out of 112 prescription sheets, with the highest percentage being the
interaction of metformin with furosemide (16%). There was a significant association
between the number of drugs prescribed and the incidence of potential oral antidiabetic
interactions (p=0.000). Type 2 DM patients who receive polypharmacy have a greater
potential for drug interactions.
Keywords:
DDI (Drug-Drug Interaction), Drug interactions, Type 2 Diabetes Mellitus, Hypoglicemic agent, Polypharmacy
References
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12) Tonolo, G. 2021. Sex-Gender Awareness in Diabetes. Diabetologi MDPI
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16) Bagus, P.S., Mengenali Faktor-Faktor Resiko Pasien DM. 2016. Intisari Sains Medis. 6(1)
17) Kekenusa, J.S., Budi, T.R., Gloria, W., Analisis Hubungan Antara Umur Dan Riwayat Keluarga Menderita DM Dengan Kejadian Penyakit Dm Tipe 2 Pada Pasien Rawat Jalan Di Poliklinik Penyakit Dalam Blu Rsup Prof. Dr. R.D Kandou Manado. Skripsi. Fakultas Kesehatan Masyarakat: Universitas Sam Ratulangi Manado.2013
18) Susilawati, R.R. Hubungan Usia, Jenis Kelamin Dan Hipertensi Dengan Kejadian Diabetes Mellitus Tipe 2 Di Puskesmas Tugu Kecamatan Cimanggis Kota Depok. ARKESMAS (Arsip Kesehatan Masyarakat). 2021. (6): 15-22
19) Kurniawati E., dan Bella, Y., Faktor-Faktor yang Berhubungan dengan Kejadian Diabetes Melitus Tipe II. Majority. 2016. 5(2)
20) Fatimah, R. Diabetes Melitus Tipe 2 Restyana. Indonesian Journal Of Pharmacy. 2015. 4(5)
21) Silva,E.F.F., Cristiane, M.M.F., Lucineia, D.P. Risk Factors And Complications In Type 2 Diabetes Outpatients. Revista da Associação Médica Brasileira. 2017; 63(7)
22) Yamazaki, D., Hirofumi, H., Akira, N., Hypertension With Diabetes Mellitus Complications. Hypertension Research.2018
23) Liza Dan Laraswati. Komplikasi Dan Komorbid Pada Pasien Diabetik Ketoasidosis. Skripsi. Pharmacy Study Program, Faculty Of Medicine:Hang Tuah University, Surabaya. 2020
24) Patel, B., Supriya, D.M., Bhavit, O., Varisha, P., Pattern of antidiabetic drugs use in type-2 diabetic patients in a medicine outpatient clinic of a tertiary care teaching hospital. International Journal of Basic & Clinical Pharmacology. 2013
25) PERKENI (Perkumpulan Endokrinologi Indonesia). Pedoman Pengelolaan dan Pencegahan Diabetes Melitus Tipe 2 Dewasa di Indonesia 2021. PB PERKENI. 2020
26) Papanas Dan Maltezos. Metformin: A Review Of Its Use In The Treatment Of Type 2 Diabetes. Review. Clinical Medicine: Therapeutics. 2009
27) Samardžić, Marinović., N. Kuča., V. Bačić Vrca. Potential Clinically Significant Drug-Drug Interactions In Prescribed Pharmacotherapy In An Outpatient Setting. Pharmazie. 2021
28) Drugs.com, 2022. https://www.drugs.com/drug_interactions.html. Diakses 15 Agustus 2022
29) Yaiza Rivero Viera, Rita Guerra Rodríguezb, Noemí Esparza Martínb, Saulo Fernández Granadosb, César García Cantón. 2019. Metformin and diuretics. Nefrologia; 39( 5)
30) Rang, H. dan Dale, M. Pharmacology, 7th edn. Edinburgh: Elsevier Churchill Livingstone. 2012
31) Wendling, P. PSA Screening Often Unnecessary in Elderly Men. Urology. 2006
32) Choi YH, Lee MG. Pharmacokinetic and pharmacodynam-ics interaction between nifedipine and metformin in rats: competitive inhibition for metabolism of nifedipine and metformin by each other via CYP isozymes. Xenobiotica. 2012; 42(5)
33) Bello, S.S., FB Sani. MT Odunola. M Garba. Interaction of Metformin and Nifedipine in Type II Diabetic Patients with Hypertension and MA Garba. Journal of Chemical and Pharmaceutical Research. 2017; 9(4)
34) Niu J, Straubinger RM, Mager DE. Pharmacodynamic Drug-Drug Interactions. Clin Pharmacol Ther. 2019;105(6)
35) Elshimy G, Techathaveewat P, Alysayed M. Simple reason for hypoglycemia: ACE inhibitor-induced severe recurrent hypoglycemia in a non-diabetic patient. Cureus. 2019;11(8)
36) Daoud N, Qadi O, Al-talhi D, Al-sharabi H. Effect of anti-hypertensive agents on Biochemical Parameters in Diabetic Patients in Taif – KSA. International Journal of Diabetes and Clinical Research. 2019
37) Rahmawaty A., dan Putri H.H., Hubungan Drug Related Problems (DRPs) Kategori Interaksi Obat Pada Penggunaan Obat Pasien Diabetes Melitus Tipe 2. Cendekia Journal of Pharmacy. 2020
38) Utami, P.R dan Devi, R.O., Study of potential interactions of oral antidiabetic drugs in patients with type 2 diabetes mellitus with comorbidities : A retrospective study. Pharmacy Education. 2022; 22(2)
39) WHO. Medication Safety in Polypharmacy. WHO. 2019
40) Cahyaningsih, I. dan Winda, A.W., Penilaian Risiko Interaksi Obat pada Pasien dengan Diabetes Melitus Tipe 2. Indonesian Journal of Clinical Pharmacy. 2020; 9(1):9
41) Handayani, K., yardi, S., Potensi Interaksi Obat Pada Resep Pasien Diabetes Melitus Rawat Jalan di RS X Jakarta Pusat. Pharmaceutical and Biomedical Sciences Journal. 2019;(1): 43-4
42) Saibi Y., DElina, H., dan Verona, S., Drug Interaction Potency on Type 2 Diabetes Mellitus Patient in Hospital X in South Tangerang. Journal of Management and Pharmacy Practice. 2018; 8(3):100
43) Guthrine B, Makubate B, Santiago VH, Dreischulte T. The rising tide of polypharmacy and drug-drug interactions: Population database analysis 1995–2010. BMC Med. 2015;13(74)
2) Kementrian Kesehatan Republik Indonesia (Kemenkes RI). Hasil Riset Kesehatan Dasar Tahun 2018. Kementrian Kesehatan RI. 2018
3) Nurlaelah, I., Alwiyah, M., Ingrid, F. Kajian Interaksi Obat Pada Pengobatan Diabetes Melitus (DM) Dengan Hipertensi di Instalasi Rawat Jalan RSUD Undata Periode Maret-Juni Tahun 2014. Galenika Journal of Pharmacy.2015
4) Herdaningsih, S., Muhtadi, A., Lestari, K., & Annisa, N. Potensi interaksi obat-obat pada resep polifarmasi: studi retrospektif pada salah satu Apotek di kota Bandung. Jurnal Farmasi Klinik Indonesia. 2016
5) Maindoka, F. S., Mpila, D., & Citraningtyas, G. Kajian interaksi obat pada pasien geriatri rawat inap di RSUP Prof. DR. R. D. Kandou Manado. Pharmaconjurnal Ilmiah Farmasi. 2017
6) Sankar, V., Yousif, S., Rinku, M.J., Hudson, A dan Pinky, M.T., Serious Drug-Drug Interactions in the Prescriptions of Diabetic Patients. medical science. 2015
7) May M, Schindler C. Clinically and pharmacologically relevant interactions of antidiabetic drugs. Ther Adv Endocrinol Metab. 2016.7(2)
8) Poluan, O.A., Weny, I.W., Paulina, V.Y.Y., Identifikasi Potensi Interaksi Obat Pada Pasien Diabetes Melitus Tipe 2 Rawat Inap Di Rumah Sakit Gunung Maria Tomohon Periode Januari – Mei 2018. Jurnal Ilmiah Farmasi. 2020; 9 (1)
9) Ramdini, D.A., Lilik, K.W., Dwi, A., Evaluasi Rasionalitas Penggunaan Obat Diabetes Melitus Tipe 2 Pada Pasien Rawat Jalan di Puskesmas Pasir Sakti Tahun 2019. Jurnal Farmasi Lampung. 2020
10) Kardela, W., Rahmad. A., Garmi, H. Rasionalitas Penggunaan Obat Diabetes Mellitus Tipe 2 Komplikasi Nefropati Di Rumah Sakit Umum Pusat Dr. M.Djamil Padang. Jurnal Farmasi Higea. 2019
11) Azhar, M. N., Suwendar, & Fitrianingsih, S. P. Analisis Rasionalitas Penggunaan Obat Diabetes Melitus Tipe 2 Pada Pasien Rawat Jalan di Rumah Sakit Muhammadiyah Bandung. Prosiding Farmasi SPeSIA.2020.
12) Tonolo, G. 2021. Sex-Gender Awareness in Diabetes. Diabetologi MDPI
13) Machado-Alba, J.C., Medina-Morales, D.A, Echeverri-Cataño, L.F., Evaluation Of The Quality Of Life Of Patients With Diabetes Mellitus Treated With Conventional Or Analogue Insulins. Diabetes Research And Clinical Practice; 116(2)
14) Gurka Mj, Vishnu A, Santen Rj, Deboer. Progression Of Metabolic Syndrome Severity During The Menopausal Transition. J Am Heart Assoc.2016; 5(8)
15) ADA (American Diabetes Association). American Diabetes Association Standards of Medical Care In Diabetes-2019. Diabetes Journal. 2019;42(1)
16) Bagus, P.S., Mengenali Faktor-Faktor Resiko Pasien DM. 2016. Intisari Sains Medis. 6(1)
17) Kekenusa, J.S., Budi, T.R., Gloria, W., Analisis Hubungan Antara Umur Dan Riwayat Keluarga Menderita DM Dengan Kejadian Penyakit Dm Tipe 2 Pada Pasien Rawat Jalan Di Poliklinik Penyakit Dalam Blu Rsup Prof. Dr. R.D Kandou Manado. Skripsi. Fakultas Kesehatan Masyarakat: Universitas Sam Ratulangi Manado.2013
18) Susilawati, R.R. Hubungan Usia, Jenis Kelamin Dan Hipertensi Dengan Kejadian Diabetes Mellitus Tipe 2 Di Puskesmas Tugu Kecamatan Cimanggis Kota Depok. ARKESMAS (Arsip Kesehatan Masyarakat). 2021. (6): 15-22
19) Kurniawati E., dan Bella, Y., Faktor-Faktor yang Berhubungan dengan Kejadian Diabetes Melitus Tipe II. Majority. 2016. 5(2)
20) Fatimah, R. Diabetes Melitus Tipe 2 Restyana. Indonesian Journal Of Pharmacy. 2015. 4(5)
21) Silva,E.F.F., Cristiane, M.M.F., Lucineia, D.P. Risk Factors And Complications In Type 2 Diabetes Outpatients. Revista da Associação Médica Brasileira. 2017; 63(7)
22) Yamazaki, D., Hirofumi, H., Akira, N., Hypertension With Diabetes Mellitus Complications. Hypertension Research.2018
23) Liza Dan Laraswati. Komplikasi Dan Komorbid Pada Pasien Diabetik Ketoasidosis. Skripsi. Pharmacy Study Program, Faculty Of Medicine:Hang Tuah University, Surabaya. 2020
24) Patel, B., Supriya, D.M., Bhavit, O., Varisha, P., Pattern of antidiabetic drugs use in type-2 diabetic patients in a medicine outpatient clinic of a tertiary care teaching hospital. International Journal of Basic & Clinical Pharmacology. 2013
25) PERKENI (Perkumpulan Endokrinologi Indonesia). Pedoman Pengelolaan dan Pencegahan Diabetes Melitus Tipe 2 Dewasa di Indonesia 2021. PB PERKENI. 2020
26) Papanas Dan Maltezos. Metformin: A Review Of Its Use In The Treatment Of Type 2 Diabetes. Review. Clinical Medicine: Therapeutics. 2009
27) Samardžić, Marinović., N. Kuča., V. Bačić Vrca. Potential Clinically Significant Drug-Drug Interactions In Prescribed Pharmacotherapy In An Outpatient Setting. Pharmazie. 2021
28) Drugs.com, 2022. https://www.drugs.com/drug_interactions.html. Diakses 15 Agustus 2022
29) Yaiza Rivero Viera, Rita Guerra Rodríguezb, Noemí Esparza Martínb, Saulo Fernández Granadosb, César García Cantón. 2019. Metformin and diuretics. Nefrologia; 39( 5)
30) Rang, H. dan Dale, M. Pharmacology, 7th edn. Edinburgh: Elsevier Churchill Livingstone. 2012
31) Wendling, P. PSA Screening Often Unnecessary in Elderly Men. Urology. 2006
32) Choi YH, Lee MG. Pharmacokinetic and pharmacodynam-ics interaction between nifedipine and metformin in rats: competitive inhibition for metabolism of nifedipine and metformin by each other via CYP isozymes. Xenobiotica. 2012; 42(5)
33) Bello, S.S., FB Sani. MT Odunola. M Garba. Interaction of Metformin and Nifedipine in Type II Diabetic Patients with Hypertension and MA Garba. Journal of Chemical and Pharmaceutical Research. 2017; 9(4)
34) Niu J, Straubinger RM, Mager DE. Pharmacodynamic Drug-Drug Interactions. Clin Pharmacol Ther. 2019;105(6)
35) Elshimy G, Techathaveewat P, Alysayed M. Simple reason for hypoglycemia: ACE inhibitor-induced severe recurrent hypoglycemia in a non-diabetic patient. Cureus. 2019;11(8)
36) Daoud N, Qadi O, Al-talhi D, Al-sharabi H. Effect of anti-hypertensive agents on Biochemical Parameters in Diabetic Patients in Taif – KSA. International Journal of Diabetes and Clinical Research. 2019
37) Rahmawaty A., dan Putri H.H., Hubungan Drug Related Problems (DRPs) Kategori Interaksi Obat Pada Penggunaan Obat Pasien Diabetes Melitus Tipe 2. Cendekia Journal of Pharmacy. 2020
38) Utami, P.R dan Devi, R.O., Study of potential interactions of oral antidiabetic drugs in patients with type 2 diabetes mellitus with comorbidities : A retrospective study. Pharmacy Education. 2022; 22(2)
39) WHO. Medication Safety in Polypharmacy. WHO. 2019
40) Cahyaningsih, I. dan Winda, A.W., Penilaian Risiko Interaksi Obat pada Pasien dengan Diabetes Melitus Tipe 2. Indonesian Journal of Clinical Pharmacy. 2020; 9(1):9
41) Handayani, K., yardi, S., Potensi Interaksi Obat Pada Resep Pasien Diabetes Melitus Rawat Jalan di RS X Jakarta Pusat. Pharmaceutical and Biomedical Sciences Journal. 2019;(1): 43-4
42) Saibi Y., DElina, H., dan Verona, S., Drug Interaction Potency on Type 2 Diabetes Mellitus Patient in Hospital X in South Tangerang. Journal of Management and Pharmacy Practice. 2018; 8(3):100
43) Guthrine B, Makubate B, Santiago VH, Dreischulte T. The rising tide of polypharmacy and drug-drug interactions: Population database analysis 1995–2010. BMC Med. 2015;13(74)
Published
2025-11-28
Section
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