eng Oriental Scientific Publishing Company Biosciences Biotechnology Research Asia 0973-1245 2025-12-30 22 4 1654 1662 10.13005/bbra/3467 57058 article Indraj Kumar Yadav 1 Awanish Tiwari 1 Mohd. Anas 1 Gberme Alfred Gongbo 1 Javed Akhtar Ansari 1 Parvez Saeed 2 Department of Pharmacy Practice, Faculty of Pharmacy, Integral University, Lucknow, India. Department of General Medicine, Faculty of Medicine and Health Sciences, Integral University, Lucknow, India. This prospective observational study on Type 2 diabetes mellitus (T2DM) often occurs with multiple comorbidities, predisposing patients to polypharmacy and a higher risk of adverse drug reactions (ADRs) and drug–drug interactions (DDIs). This study included 105 T2DM patients receiving oral hypoglycemic agents (OHAs) in a tertiary care hospital over six months. Prescriptions were reviewed for utilization patterns, brand versus generic use, and extent of polypharmacy. ADRs were assessed using Naranjo, Hartwig, and Schumock–Thornton scales, and DDIs were identified through the Micromedex database. The mean patient age was 56.8 ± 10.2 years, and females comprised 54.3%. Each prescription contained an average of 10.9 ± 2.3 drugs, with 97.9% prescribed by brand name. Metformin alone (27.6%) and metformin–glimepiride (39.0%) were most common. ADRs occurred in 35.2% of patients, predominantly gastrointestinal (45.9%) and neurological (43.2%), with 14% preventable. Polypharmacy (OR = 2.13, p = 0.041) and hypertension (OR = 2.46, p = 0.029) significantly predicted ADRs. Thirty-five clinically relevant DDIs were detected, 60% classified as major, mainly involving aspirin–metformin and aspirin–glimepiride. The study highlights extensive polypharmacy, minimal generic prescribing, and substantial safety concerns, emphasizing the need for rational drug use and strengthened pharmacovigilance in diabetes care. https://www.biotech-asia.org/vol22no4/prescribing-patterns-safety-outcomes-and-predictors-of-adverse-events-with-oral-hypoglycemic-agents-in-type-2-diabetes-mellitus-patients-with-comorbidities-a-prospective-observational-study/ Adverse Drug Reactions; Drug–Drug Interactions; Oral Hypoglycemic Agents; Prescribing Patterns; Type 2 Diabetes Mellitus