REDUCTION IN POLYPHARMACY BURDEN AMONG TYPE 2 DIABETES MELLITUS PATIENTS THROUGH COMPREHENSIVE DIABETES CARE PLAN-BASED INTEGRATIVE MANAGEMENT: IMPLICATIONS FOR ADVERSE DRUG INTERACTION RISK AND HEALTH SYSTEM COST

Background: Polypharmacy — conventionally defined as the concurrent use of five or more medications — is prevalent among patients with Type 2 Diabetes Mellitus (T2DM) and is associated with adverse drug interactions, treatment non-adherence, and escalating healthcare costs. Integrative management programmes combining Panchakarma-based therapies, structured dietary intervention, and allopathic co-management have shown promise in glycaemic control, yet their impact on medication burden has not been systematically characterised. Objective: To quantify the reduction in allopathic antidiabetic medication burden in T2DM patients enrolled in the Comprehensive Diabetes Care (CDC) programme at Madhavbaug Integrative Clinic, Amravati, Maharashtra, and to assess associated changes in cardiometabolic parameters and post-treatment glycaemic remission. Methods: A retrospective before-after observational study was conducted on 39 T2DM patients enrolled in the Comprehensive Diabetes Care (CDC) programme at Amravati Fr clinic, Vidharbha RIC. Drug burden at enrolment and at last follow-up was quantified by counting individual allopathic agents listed per patient. Primary outcome was the proportion achieving ≥50% medication reduction or complete cessation. Secondary outcomes included changes in HbA1c, fasting blood glucose (RBS), systolic blood pressure (SBP), weight, and BMI. Paired t-tests and descriptive statistics were applied. Reporting followed the STROBE checklist for observational studies. Results: Of 39 CDC-enrolled patients (mean age 51.0 ± 10.1 years; 54% male), 25 (64.1%) were on allopathic OHA at enrolment with a mean drug count of 3.24 ± 2.50 agents. Mean drug count at last follow-up decreased significantly to 2.08 ± 2.40 (paired t=3.32, p=0.0029). Complete medication cessation was achieved in 6 patients (24.0% of OHA-positive cohort), and ≥50% reduction in 12 patients (48.0%). Polypharmacy (five or more drugs) was present in 5 patients at baseline and reduced to 2 at follow-up. HbA1c declined significantly from 9.09 ± 3.6% to 7.87 ± 2.7% (p=0.0040; Cohen's d=0.56). SBP reduced from 124.2 to 119.1 mmHg (p=0.013), weight from 68.9 to 66.5 kg (p<0.001), and BMI from 26.1 to 25.2 kg/m² (p<0.001). Four patients (10.3% of total cohort) achieved post-treatment glucose tolerance test (GTT) negativity, consistent with programme-associated glycaemic remission. Conclusion: The CDC programme was associated with significant reduction in allopathic medication burden alongside clinically meaningful cardiometabolic improvement. These findings suggest that structured integrative diabetes management may offer a viable deprescription pathway, with implications for adverse drug interaction risk reduction and out-of-pocket healthcare cost. Multi-site, prospective replication with standardised follow-up is warranted.

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