1. Actual and Potential Drug Related Problems in Diabetic Patients through Medication Reconciliation Process Presented in Indonesian – Japan Joint Scientific Symposium, 21 – 23 November 2016
Nurul Maziyyah
School of Pharmacy
Universitas Muhammadiyah Yogyakarta, Indonesia

2. Outline Introduction Material and Method Result and Discussion
Conclusion

3. Introduction High Prevalence of DM Drug Related Problems
Use of Complementary and Alternative Medicines
Medication Reconciliation
Medication reconciliation
Identification of actual & potential DRPs

4. Identification of Actual & Potential DRPs
Material & Methods
Patient selection:
35 selected
based on inclusion & exclusion criteria
Medrec proccess
collect & gather med & CAM usage (herb and dietary supplement)
Identification of Actual & Potential DRPs
Actual: Onsite identified DRPs
Potential: Literature-based DRPs

5. Result and Discussion

6. Patients’ characteristics
Description
Percentage
Gender
Male
31.43%
Female
68.57%
Age
40 – 50 years old
14.29%
51 – 65 years old
20%
>65 years old
65.71%
Co-morbids
Hypertension
76.93%
Dyslipidemia
7.69%
Hypertension + Dyslipidemia
Hypertension + Hyperuricaemia
The relationship between diabetes and hypertension can be associated with the overlapping on pathophysiology of both diseases which is usually related with obesity, inflammation, oxidative stress and insulin resistance (Cheung and Li, 2012).

7. Drug Usage Pattern Drug Combination CAMs usage
No. of Patients (%)
Single Drug -
2 – combination drugs
7 (20%)
3 – combination drugs
15 (42.86%)
4 – combination drugs
11 (31.43%)
5 – combination drugs
2 (5.71%)
Total
35 (100%)
United States and Southern India  average of 4.1 and 4.77 drugs combined in diabetic and diabetic hypertension patients respectively (Grant et al, 2003; Hussain et al, 2014).
Boiled insulin leaves  give effective glycemic control although (preclinic result) (Lachman et al, 2003; Serra-Barcelona et al, 2014)
curcumin (active compound in turmeric)  role in prevention and treatment for diabetes and associated disorders. Only few clinical trials available (Zhang et al, 2013).
Japanese ant  potential as an antidiabetic agent (Fauzi et al, 2016)

8. Drug Related Problems
Drug-Related Problems
DRP Type
No. of cases (%)
Inadherence
Actual
13 (39.39%)
Adverse drug reaction
Actual & Potential
8 (24.24%)
Drug Interaction
Potential
12 (36.36%)
Total
33 (100%)
Inadherence  Disease and medication beliefs were known as significant predictors for inadherence (Mann et al, 2009) which was also seen in patients from our study.
Adverse drug reaction  mostly caused by NSAIDs. The routine use of NSAIDs has been known to give risk on gastrointestinal irritation which could lead to gastrointestinal bleeding (Becker, 2004)
Potential drug interaction  drug – drug and drug – CAMs

9. Potential Drug Interactions
Interaction type
Interacting drugs
No. of cases
Percentage
Minor
Hydrochlorothiazide + glimepiride 1
41,67%
Furosemide + metformin
Nifedipine + metformin
Metformin + turmeric-tamarind 2
Moderate
Diclofenac + glimepiride 3
50%
Diclofenac + glibenclamide
Antacid + glibenclamide
Glibenclamide + simvastatin
Major
Amlodipine + simvastatin
8,33% 12
100%
turmeric and tamarind mixture drink – metformin  potential for hypoglycemic effect

10. Conclusion
Through medication reconciliation process, the study was able to identify several actual and potential DRPs occuring in diabetes mellitus patients having their routine visit to the Primary Healthcare Center such as inadherence, adverse drug reactions and also durg interactions.
The deep interview in the beginning has led to a more comprehensive understanding on how patients consume their medication and also CAMs usage which contribute to a better way on identifying DRPs compared to the usual visit in a Primary Healthcare Center.