Diabetes mellitus (DM) and hypertension (HTN) are among the most common chronic non-communicable diseases worldwide and represent major public health challenges. Both conditions are independently associated with long-term complications and are well-established risk factors for cardiovascular diseases, including stroke, myocardial infarction, heart failure, and chronic kidney disease.¹˒² The coexistence of DM and HTN further amplifies the risk of morbidity and mortality. Epidemiological evidence indicates a strong bidirectional relationship between DM and HTN. It has been reported that up to 75% of individuals with diabetes also have hypertension, while patients with hypertension often demonstrate insulin resistance, predisposing them to the development of diabetes.³˒⁴ Population-based studies suggest that the prevalence of hypertension among patients with diabetes is 1.5 to 2 times higher than in the non-diabetic population.³ These conditions share several common risk factors, including genetic predisposition, ethnicity, dyslipidaemia, obesity, sedentary lifestyle, and unhealthy dietary habits.⁵–⁷ In addition to their high prevalence, DM and HTN are associated with a wide range of acute and chronic complications. Commonly observed complications include cerebrovascular accident (CVA), diabetic nephropathy (DN), chronic kidney disease (CKD), myocardial infarction (MI), coronary artery disease (CAD), and deep vein thrombosis (DVT).⁸–¹⁰ The burden of these complications is particularly high among hospitalized patients, who often present with multiple comorbidities and advanced disease. One of the key challenges in the management of chronic and sub-chronic illnesses such as DM and HTN is poor medication adherence.¹⁰–¹² Adherence refers to the extent to which a patient’s behaviour—taking medications, following dietary recommendations, and adopting lifestyle changes—corresponds with medical advice.¹³–¹⁶ Suboptimal adherence to prescribed therapy significantly compromises disease control and increases the risk of complications and hospitalisation. Medication adherence can be reliably assessed using validated tools such as the Morisky Medication Adherence Scale (MMAS).¹⁷–²⁰ Understanding adherence patterns in hospitalized patients provides valuable insight into real-world treatment practices and helps identify gaps in chronic disease management. The present study was undertaken to determine the prevalence of diabetes mellitus and hypertension among hospitalized patients, assess the influence of age and gender, evaluate associated comorbidities and complications, and analyze medication adherence patterns using the MMAS-4 questionnaire.

A prospective cross-sectional observational study was conducted in a tertiary care hospital over a period of seven months, from August 2019 to February 2020. The study population comprised patients admitted to the inpatient departments of the tertiary care hospital in Koraput district of Odisha during the study period. All eligible patients were informed about the study, and written informed consent was obtained prior to participation. A total of 500 hospitalized patients were enrolled in the study. Inclusion Criteria • Patients aged 14 years and above • Patients with a past medical history of chronic conditions such as diabetes mellitus, hypertension, asthma, thyroid disorders, or epilepsy • Patients admitted with complications related to chronic diseases • Patients with multiple comorbidities and those receiving long-term pharmacotherapy • Hospitalized patients of both genders during the study period Exclusion Criteria • Patients aged below 14 years • Patients admitted to the oncology department • Female patients admitted to the gynaecology department • Patients with a previous surgical history • Patients admitted exclusively for acute infectious diseases such as dengue or malaria • Patients who declined participation in the study Data were collected over the seven-month study period using patient case records and direct patient interviews. Individual case safety reports and medical records were reviewed, and the following information was documented: 1.Demographic details – age and gender 2.Reason for admission, presenting complaints, and final diagnosis 3.Past medical history and current medication history 4.Lifestyle factors – dietary pattern, smoking, and alcohol consumption 5.Clinical and laboratory parameters – blood pressure and serum biochemical investigations 6.Medication adherence, assessed using the Morisky Medication Adherence Scale–4 (MMAS-4) Data were entered into Microsoft Excel and analyzed descriptively. The analysis included: Stratification of patients based on the presence or absence of prior medical history, Estimation of the prevalence of diabetes mellitus, hypertension, and other comorbid conditions such as asthma, tuberculosis, hypothyroidism, epilepsy, COPD, and hyperthyroidism, Assessment of coexisting disease patterns, including DM with HTN and their association with complications such as CVA, CKD, DN, MI, CAD, and DVT, Calculation of the percentage distribution of disease-related complications, Evaluation of medication adherence levels using MMAS-4, Analysis of the effect of gender on disease prevalence and complications and Identification of the most commonly prescribed medications for the management of diabetes mellitus in the study population

Out of the total 320 hospitalized patients, 163 (50.9%) had a documented past medical history, while 157 (49.1%) did not (Table 1). Table 1: Distribution of Participants Based on Past Medical History (N = 320) Past Medical History Number Percentage (%) Present 163 50.9 Absent 157 49.1 Total 320 100 Among the 163 patients with past medical history, hypertension (HTN) was the most prevalent condition, followed by diabetes mellitus (DM). Other chronic diseases and complications were observed in smaller proportions (Table 2). Table 2: Prevalence of Chronic Diseases among Patients with Past Medical History (N = 163) Disease Number Percentage (%) Hypertension (HTN) 89 54.6 Diabetes Mellitus (DM) 48 29.4 Asthma 13 8.0 Tuberculosis (TB) 9 5.5 Hypothyroidism 8 4.9 Cerebrovascular Accident (CVA) 8 4.9 Epilepsy 7 4.3 Chronic Kidney Disease (CKD) 5 3.1 Chronic Obstructive Pulmonary Disease (COPD) 3 1.8 Diabetic Nephropathy (DN) 2 1.2 Myocardial Infarction (MI) 2 1.2 Coronary Artery Disease (CAD) 1 0.6 Hyperthyroidism 1 0.6 Other diseases* 33 20.2 *Other diseases include mixed chronic conditions not individually categorized. Disease-related complications were observed in 54 patients (33.1%) with a past medical history. The most frequent combination associated with complications was the coexistence of both HTN and DM, accounting for 71.2% of all complications. Other complications included diabetic foot, diabetic nephropathy, acute kidney injury, chronic kidney disease, cerebrovascular accident, deep vein thrombosis, and progression of asthma to COPD (Table 3). Table 3: Distribution of Disease Complications (N = 54) Type of Complication Number Percentage (%) HTN + DM 38 71.2 Diabetic foot 5 9.3 Diabetic nephropathy 4 7.4 Chronic kidney disease 3 5.6 Cerebrovascular accident 2 3.7 Deep vein thrombosis 1 1.9 Asthma progressed to COPD 1 1.9 Total 54 100 Medication adherence was assessed using the Morisky Medication Adherence Scale–4 (MMAS-4) among patients with chronic diseases. Medium adherence was the most common category. Low adherence was strongly associated with the presence of disease complications (Table 4). Table 4: Medication Adherence Status Based on MMAS-4 (N = 208*) Adherence Level Number Percentage (%) High adherence (HA) 68 32.7 Medium adherence (MA) 76 36.5 Low adherence (LA) 64 30.8 Total 208 100 *Adherence analysis was possible only in patients receiving long-term therapy and willing to respond to MMAS-4. The mean age of patients affected by HTN and DM was 55 years, with an age range of 37–80 years. Gender distribution among patients with HTN and DM showed no significant difference, indicating that gender was not a major risk factor in this study population (Table 5). Table 5: Gender Distribution among Patients with DM and HTN (N = 173) Gender Number Percentage (%) Female 91 52.6 Male 82 47.4 Total 173 100 Medication history was available for 173 patients, of whom 23 patients could not produce prior prescriptions or medication records. Among the remaining patients, calcium channel blockers and angiotensin receptor blocker combinations were the most commonly prescribed antihypertensive agents, while oral hypoglycaemic agents were the predominant therapy for diabetes (Table 6). Table 6: Commonly Prescribed Drugs for DM and HTN (N = 150) Drug Percentage (%) Amlodipine 14.7 Telmisartan + Hydrochlorothiazide 14.7 Atenolol 13.7 Glimepiride + Metformin 11.7 Telmisartan 9.8 Metformin 9.8 Insulin 9.1 Glimepiride 3.3 Voglibose 3.3 Chlorthalidone 2.6 Metoprolol 2.0 Glibenclamide 2.0 Cilnidipine 2.0 Spironolactone + Torsemide 0.7

In the present prospective hospital-based study, the prevalence of hypertension (HTN) and diabetes mellitus (DM) among hospitalized patients was found to be 54.6% and 29.4%, respectively, in the age group of 37–80 years. These findings highlight the substantial burden of chronic non-communicable diseases among inpatients and reflect the growing epidemiological transition in India. The observed prevalence of diabetes in the present study is higher than the reported overall national prevalence of 16.6%, which may be attributed to the hospital-based nature of the study and inclusion of patients admitted with complications. State-wise data from previous Indian studies have shown wide variations in diabetes prevalence, ranging from 28.9% in Gujarat to over 40% in Tamil Nadu, underscoring the influence of regional, lifestyle, and socioeconomic factors. The increasing prevalence of type 2 diabetes in India—from 1.2% to nearly 11% over the last three decades—further supports the findings of the present study. Age-specific onset of diabetes has been well documented in earlier studies. Radhakrishnan et al. reported that the majority of diabetic patients fall within the 40–60-year age group, which is consistent with our findings. Globally, the prevalence of diabetes among adults aged 20–79 years is projected to rise from 6.4% in 2010 to 7.7% by 2030, with a disproportionately higher increase in developing countries. This emphasizes the need for early detection and long-term management strategies in middle-aged populations. Hypertension was the most prevalent chronic condition in this study. A systematic review by Anchala et al. reported an overall hypertension prevalence of 29.8% in India, whereas the higher prevalence observed in our study may be explained by the inpatient setting and the presence of comorbid conditions. It is well established that hypertension is almost twice as common in patients with diabetes compared to non-diabetic individuals. Conversely, hypertensive individuals are also at increased risk of developing diabetes, suggesting a bidirectional relationship driven by shared pathophysiological mechanisms such as insulin resistance, obesity, and endothelial dysfunction. The coexistence of HTN and DM was the most common contributor to disease complications in the present study. This combination significantly increases the risk of cardiovascular and renal complications, including cerebrovascular accidents, chronic kidney disease, and diabetic nephropathy. The findings reinforce the importance of integrated management approaches for patients with multiple chronic conditions. Medication adherence plays a crucial role in preventing disease progression and complications in chronic illnesses. In the present study, medium to high medication adherence was observed in a majority of patients, while low adherence was more frequently associated with disease complications. Reduced adherence among elderly patients has been reported in several studies and may be attributed to factors such as memory impairment, visual and hearing difficulties, polypharmacy, and complex drug regimens. Gender-based differences in medication adherence have been inconsistently reported in the literature. While some studies suggest that women demonstrate better adherence to prescribed therapies, others have found no significant association between gender and adherence. In the present study, gender did not appear to be a major determinant of disease prevalence or adherence, indicating that behavioral and clinical factors may play a more significant role. The prescribing pattern observed in this study reflects current clinical practice guidelines, with calcium channel blockers and angiotensin receptor blockers being the most commonly used antihypertensive agents, and metformin-based combinations forming the backbone of diabetes management. These findings highlight the rational use of evidence-based therapies in the study population.

The present study demonstrates a high prevalence of hypertension and diabetes mellitus among hospitalized patients, with a substantial proportion experiencing disease-related complications, particularly when both conditions coexist. Hypertension was more prevalent than diabetes, and middle-aged and elderly patients were predominantly affected. Medication adherence was found to be moderate to good overall, though complications were more common among patients with poor adherence. These findings emphasize the importance of patient counseling, regular follow-up, and simplified treatment regimens to improve adherence and reduce long-term complications. Healthcare professionals should prioritize early screening, patient education, and integrated management strategies for hypertension and diabetes to improve clinical outcomes and reduce the burden of chronic disease complications. Public health initiatives focusing on lifestyle modification and adherence promotion are essential for effective long-term disease control. Funding: No funding sources Conflict of Interest: None declared Ethical Approval: Not required

1. Venugopal K, Mohammed MZ. Prevalence of hypertension in type 2 diabetes mellitus. CHRISMED J Health Res. 2014;1:223–227. 2. Huang XB, Tang WW, Liu Y, Hu R, Ouyang LY, Liu JX, et al. Prevalence of diabetes and unrecognized diabetes in hypertensive patients aged 40–79 years in southwest China. Diabetes Res Clin Pract. 2017. 3. Simonson DC. Etiology and prevalence of hypertension in diabetic patients. Diabetes Care. 1988;11(10):821–827. 4. Shah A, Afzal M. Prevalence of diabetes and hypertension and association with various risk factors among different Muslim populations of Manipur, India. J Diabetes Metab Disord. 2013;12:52. 5. Gupta A, Gupta R, Sarna M, Rastogi S, Gupta VP, Kothari K. Prevalence of diabetes, impaired fasting glucose, and insulin resistance syndrome in an urban Indian population. Diabetes Res Clin Pract. 2003;61(1):69–76. 6. Fowler MJ. Microvascular and macrovascular complications of diabetes. Clin Diabetes. 2008;26:77–82. 7. Long AN, Jack SD. The comorbidities of diabetes and hypertension: mechanisms and approach to target organ protection. J Clin Hypertens. 2011;13(4):244–251. 8. Radhakrishnan S, Ekambaram M. Prevalence of diabetes and hypertension among a tribal population in Tamil Nadu. Arch Med Health Sci. 2015;3:66–71. 9. Gupta A, Gupta R, Sharma KK, Lodha S, Achari V, Arthur J, et al. Prevalence of diabetes and cardiovascular risk factors in middle-class urban participants in India. BMJ Open Diabetes Res Care. 2014;2:e000048. 10. Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010;87(1):4–14. 11. Plakas S, Mastrogiannis D, Mantzorou M. Validation of the 8-item Morisky Medication Adherence Scale in chronically ill ambulatory patients in rural Greece. Electron Physician. 2016;8(3):158–169. 12. Unni EJ, Farris KB. Unintentional non-adherence and belief in medicines in older adults. Patient Educ Couns. 2011;83(2):265–268. 13. Tan X, Patel I, Chang J. Review of the four-item Morisky Medication Adherence Scale (MMAS-4) and eight-item Morisky Medication Adherence Scale (MMAS-8). Innov Pharm. 2014;5(3):1–8. 14. Uresin Y, Taylor AA, Kilo C, Tschöpe D, Santonastaso M, Ibram G, et al. Efficacy and safety of the direct renin inhibitor aliskiren and ramipril alone or in combination in patients with diabetes and hypertension. J Renin Angiotensin Aldosterone Syst. 2007;8(4):190–200. 15. Konzem SL, Devore VS, Bauer DW. Controlling hypertension in patients with diabetes. Am Fam Physician. 2002;66(7):1209–1214. 16. Gress TW, Nieto FJ, Shahar E, Wofford MR, Brancati FL. Hypertension and antihypertensive therapy as risk factors for type 2 diabetes mellitus. N Engl J Med. 2000;342(13):905–912. 17. Anchala R, Kannuri NK, Pant H, Khan H, Oscar H, Franco C, et al. Hypertension in India: a systematic review and meta-analysis of prevalence, awareness, and control. J Hypertens. 2014;32(6):1170–1177. 18. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353:487–497. 19. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27(5):1047–1053. 20. Pinhas-Hamiel O, Zeitler P. The global spread of type 2 diabetes mellitus in children and adolescents. J Pediatr. 2005;146(5):693–700. 21. National High Blood Pressure Education Program Working Group. Report on hypertension in diabetes. Hypertension. 1994;23(2):145–158. 22. Sowers JR, Epstein M, Frohlich ED. Diabetes, hypertension, and cardiovascular disease: an update. Hypertension. 2001;37(4):1053–1059. 23. Praska JL, Kripalani S, Seright AL, Jacobson TA. Identifying and assisting low-literacy patients with medication use: a survey of community pharmacies. Ann Pharmacother. 2005;39:1441–1445. 24. Hill-Briggs F, Gary TL, Bone LR, Hill MN, Levine DM, Brancati FL. Medication adherence and diabetes control in urban African Americans with type 2 diabetes. Health Psychol. 2005;24:349–357. 25. Rubin RR. Adherence to pharmacologic therapy in patients with type 2 diabetes mellitus. Am J Med. 2005;118(Suppl 5A):27S–34S. 26. Grant RW, Singer DE, Meigs JB. Medication adherence before an increase in antihypertensive therapy: a cohort study using pharmacy claims data. Clin Ther. 2005;27:773–781. 27. Pendota S, Surabhineni SAK, Katnapally AS, Porandla D, Beemreddy SK. Classification and application of pharmacovigilance principles to study adverse drug reactions and their management. Int J Basic Clin Pharmacol. 2017;6(11):2633–2638. 28. Akshaya Kalyani SS, Srihitha P. An epidemiological study on adverse drug reactions in Indian population: a meta-analysis. Int J Pharm Clin Res. 2017;9(10):654–659. 29. Sweileh WM, Aker O, Hamooz S. Rate of compliance among patients with diabetes mellitus and hypertension. An-Najah Univ J Res. 2005;19:1–12. 30. Al-Mehza AM, Al-Muhailije FA, Khalfan MM, Al-Yahya AA. Drug compliance among hypertensive patients: an area-based study. Eur J Gen Med. 2009;6:6–10. 31. Kumar PN, Halesh LH. Antihypertensive treatment: a study on correlates of non-adherence in a tertiary care facility. Int J Biol Med Res. 2010;1:248–252. 32. Rao CR, Kamath VG, Shetty A, Kamath A. Treatment compliance among patients with hypertension and type 2 diabetes mellitus in a coastal population of Southern India. Int J Prev Med. 2014;5(8):992–997.