Prescribing Trends of Antidiabetic Drugs among Patients with Type 2 Diabetes Mellitus Attending a Tertiary Care Hospital in Eastern India: A Cross-sectional Study

Background: Type 2 diabetes mellitus (T2DM) imposes a growing global burden, necessitating evidence-based pharmacotherapy.Real-world prescribing patterns provide critical insights into guideline adherence, rational drug use, and optimization opportunities, particularly in tertiary care settings in resource-limited regions.Objective: To analyze antidiabetic drug prescribing trends, National List of Essential Medicines (NLEM) compliance, polypharmacy prevalence, and the relationship between treatment regimens and glycemic control in T2DM patients at a tertiary hospital in Eastern India.Materials and methods: A 6-month cross-sectional observational study was conducted at the Medicine OPD of ESI-PGIMSR, ESIC Medical College and Hospital, Joka, Kolkata.A total of 256 consenting adult T2DM patients (≥18 years, on treatment ≥6 months) were included and patients with gestational diabetes, type 1 diabetes, or eGFR <45 mL/min/1.73m² were excluded.Prescription data, demographic details, and glycemic parameters [fasting blood sugar (FBS), post-prandial blood sugar (PPBS), and glycated hemoglobin (HbA1c)] were collected and analyzed using descriptive statistics, one-way analysis of variance (ANOVA), and Tukey honest significant difference (HSD) post hoc tests [Statistical Package for the Social Sciences (SPSS) v24].Results: Metformin dominated prescribing (96.48%), followed by dipeptidyl peptidase-4 (DPP-4) inhibitors (60.16%), sulfonylureas (51.56%), and sodium-glucose cotransporter-2 (SGLT-2) inhibitors (42.97%); insulin analogues were used in 16.02%.Triple therapy was most frequent (35.55%), followed by dual (27.73%), quadruple (19.92%), and monotherapy (11.33%).Mean FBS and PPBS increased significantly with regimen intensity (ANOVA p < 0.001 for both), whereas HbA1c showed no significant difference across groups (p = 0.196).A total of 96.09% of prescriptions included ≥1 NLEM drug; polypharmacy (≥5 drugs) occurred in 43.36% of patients.Conclusion: Metformin remains first-line therapy with increasing use of DPP-4 and SGLT-2 inhibitors.Combination regimens predominate, reflecting disease progression in tertiary settings.High NLEM adherence is positive, but substantial polypharmacy underscores the need for deprescribing strategies, adherence enhancement, and personalized care to improve outcomes and reduce treatment burden.