Influence of Age, BMI, and Renal Function on Anti-Diabetic Drug Choice: Real-World Data from Eastern India

Abstract

Background: Personalized management of Type 2 Diabetes Mellitus (T2DM) requires tailoring drug therapy to patient characteristics such as age, body mass index (BMI), and renal function. Real-world prescribing practices in India often diverge from evidence-based guidelines. Objectives: To evaluate the influence of age, BMI, and renal function on the selection of anti-diabetic drugs in a tertiary care hospital in Eastern India. Methods: A cross-sectional, observational study was conducted over six months (January–June 2023) among 150 adults with T2DM attending the General Medicine OPD of Calcutta National Medical College, Kolkata. Demographic and clinical data were recorded, BMI calculated per WHO criteria, and renal function estimated using the CKD-EPI equation. Prescriptions were categorized according to major anti-diabetic drug classes following ADA 2022 and ESC/EASD 2019 guidelines. Data were analyzed descriptively. Results: The mean age, BMI, and eGFR of participants were 56.3 ± 10.4 years, 27.1 ± 4.6 kg/m², and 78.2 ± 18.9 mL/min/1.73 m², respectively. Metformin was the most prescribed drug (86.7%), followed by DPP-4 inhibitors (64%) and sulfonylureas (52%). SGLT-2 inhibitors were underutilized (<8%), and insulin use increased with advancing age, lower BMI, and renal impairment. Conclusion: Age, BMI, and renal function significantly influenced anti-diabetic drug prescribing in this Eastern Indian cohort. While patterns reflect growing personalization, gaps remain between guideline recommendations and real-world practice, underscoring the need for enhanced clinician awareness and policy support for equitable access to modern therapies.