# Vertigo Management – Mapping prevalence and treatment. Understanding once a day preparation usage and place in therapy.

Interpretation:
·         The % of female patients who seek anti-vertigo medications were found to be on the higher side amongst Diabetologists.
·         50% of the Diabetologists felt that a 40:60 (Male:Female) ratio is most observed in their practice.
·         30:70 (Male:Female) ratio was observed amongst 30% Diabetologists.
·         20% Diabetologists observed an equal ratio of 50:50 (Male:Female) in their practice.

3.      Is it more predominant in any particular age group?

Total Respondents = 10

 Age of Patients Responses % of Responses Below 20 years 0 0 20-40 years 0 40-50 years 5 50 Above 50 years 5 50

Table 76: Responses for prevalent age group of patients requiring Anti-Vertigo Medication per week

Interpretation:
·         70% Diabetologists reported that 40-50 years was the prevalent category of the patients.
·         17.5% Diabetologists found 20-40 years category to be more prevalent in their practice.
·         Patients above 50 years age was reported with 12.5% Diabetologists, while there were no patients reported below 20 years.

4.      Of these patients reported, do you get most patients as primary vertigo/dizziness patients or it is secondary to some pre-existing ailment?

Total Respondents = 40

 Type Responses % of Responses Primary 1 10 Secondary 9 90

Table 77: Responses for category of patient having secondary to pre-existing ailment

Interpretation:
·         It was revealed through the study that only 10% of the Diabetologists, observed patients with Primary Vertigo.
·         90% of Diabetologists observed Vertigo patients with Secondary to pre-existing ailment.

5.      If it is secondary to pre-existing ailment, what is the most common pre-existing disease/disorder you see?

Total Respondents = 9 Multiple Responses (out of 10 Diabetologists)

 Disorder Responses % of Responses Diabetes Mellitus 9 47.39 Hypertension & Cardiac problems 4 21.05 Otitis Media 2 10.53 Spondylosis 4 21.05

Table 78: Responses for patents having most common secondary to pre-existing ailment

Interpretation:
·         Diabetes Mellitus (47.39%) is the most common secondary to pre-existing ailment, followed by Spondylosis and Hypertension & Cardiac problems amongst 21.05% Diabetologists.
·         Otitis Media was also reported in 10.53% Diabetologists.

6.      What are the most common causes of Vertigo that you see in your practice?

Total Respondents = 10

 Cause Frequency of Ranks Rank 1 Rank 2 Rank 3 Rank 4 Rank 5 Rank 6 BPPV 7 2 Labyrinthitis 1 3 2 Meniere’s Disease 1 2 3 Spondylosis 3 2 Vestibular Neuronitis 5 Migraine 1

Table 79: Table depicting the most common cause of Vertigo as ranked

Interpretation:
·         BPPV is the most common cause of Vertigo, followed by Labyrinthitis and Meniere’s Disease amongst the sampled Diabetologists.
·         Spondylosis, and Vestibular Neuronitis were the other causes reported by the Diabetologists (in decreasing order of occurrence).
·         Migraine is the least significant cause of Vertigo.

7.      What is the usual line of treatment?

Total Respondents = 10 (multiple responses)

 Line of Treatment Responses % of Responses Lifestyle modification 0 0 Pharmacological 7 70 Manoeuvres only 0 0 Pharmacological and Manoeuvres 3 30

Table 80: Responses for usual line of treatment in Vertigo management

Interpretation:
·         Pharmacological therapy is the most preferred line of treatment amongst  70% Diabetologists. for effective Vertigo management.
·         30% Diabetologists. also resort to Pharmacological and Manoeuvres therapy for treating Vertigo.
·         Lifestyle modification and only manoeuvres were not opted by the Diabetologists.

8.      In pharmacological treatment what is your drug of choice?

Total Respondents = 10 (multiple responses)

 Molecule Responses % of Responses Betahistine 10 90.9 Cinnarizine 0 0 Dimenhydrinate 1 9.09 Combination 0 0 Any other 0 0

Table 81: Responses for molecule management in Vertigo management pharmacologically

Interpretation:
·         Betahistine) is the most preferred drug of choice for treating vertigo amongst 90.9% Diabetologists.
·         9.09% Diabetologists prescribed Dimenhydrinate.
·         None of the sampled Diabetologists prefer to use a combination of drugs or any other drugs for treating Vertigo.

9.      May I know your usual treatment approach?

Total Respondents = 10

 8 mg 16mg 24mg 24mg C.R 48 mg C.R OD -- -- -- 2 -- BID -- 1 1 -- -- TID 3 3 -- -- --

Table 82: Chart showing the type of Betahistine dose prescribed for treating Vertigo

Interpretation:
·         30% of the Diabetologists prefer to give 8mg TID dose of Betahistine to patients to treat vertigo.
·         10% of the Diabetologists prescribe 24mg BID dosage, while 10% of them prefer 16mg BID, for pharmacological therapy with Betahistine for Vertigo.
·         Only 20% of Diabetologists prescribes 24mg C.R once a day formulation (Betahistine O.D) for treatment in of Vertigo.
·         Also, 30% Diabetologists prescribe 16mg TID of Betahistine to their patients.

Duration:

Total Respondents = 10

 Duration Responses % of responses 1-2 weeks 9 90 3-4 weeks 1 10 4-8 weeks 0 0

Table 83: Responses for duration of pharmacological therapy for Vertigo

Interpretation:
·         1-2 weeks is the most preferred duration of therapy with Betahistine amongst 90% Diabetologists.
·         10% Diabetologists opted for 3-4 weeks of therapy with Betahistine, while none of the sampled Diabetologists preferred 4-8 weeks therapy with Betahistine.

10.  Do you titrate dosage?

Fig 77 : Bar chart showing dosage titration in Vertigo treatment

Total Respondents = 10

 Response to question Responses % of Responses Yes 9 90 No 1 10

Table 84: Responses for dosage titration in treating Vertigo

Interpretation:
·         90% of the Diabetologists were found to titrate the dosage in Vertigo treatment.
·         With the usual approach being tapering down the dosage in patients where symptoms are relieved and do not recur, and then putting it off. But in some recurrent cases of vertigo the dosage was increased.
·         Where as 10% of the Diabetogists did not titrate the dosage.

11.  Doctor, are you aware of once a day Betahistine preparation?

Total Respondents = 10

 Response to question Responses % of Responses Yes 9 90 No 1 10

Table 85: Responses for Betahistine O.D awareness

Interpretation:
·         Majority (90%) of the Diabetologists were found to be aware of Betahistine once a day preparation. Only 10% Diabetologists were still unaware of Betahistine O.D formulation.

12.  If Yes, have you used?

Fig 79: Bar chart showing Betahistine once a day usage

Total Respondents = 40

 Response to question Responses % of Responses Yes 4 40 No 6 60

Table 86: Responses for Betahistine O.D usage

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