Almost 40% of older adults with polypharmacy given inappropriate prescription when starting treatment for type 2 diabetes, study finds

In older patients with type 2 diabetes mellitus but no polypharmacy, 6.5% of patients were given a potentially inappropriate prescription.
Pharmacy technician preparing prescriptions at a pharmacy.

Almost 40% of older adults with polypharmacy starting treatment for type 2 diabetes mellitus (T2DM) are given at least one potentially inappropriate prescription (PIP), study results have shown.

The study, published in the British Journal of Clinical Pharmacology on 26 February 2024, looked at the prevalence of PIPs among newly treated patients with T2DM who had polypharmacy (considered as taking five or more medicines) or did not have polypharmacy.

Researchers found that 22.7% of middle-aged adults (aged 45–65 years) with polypharmacy, and 39.6% of older adults (aged 65 years or over) were given one or more PIPs, which could add to the burden of existing polypharmacy.

The study used data from the IQVIA Medical Research Database, which includes data from UK GP practices, on 28,604 patients who began treatment on non-insulin antidiabetic treatment (NIAD) between January 2016 and December 2019.

A total of 18,494 (64.7%) patients had polypharmacy at the date that they began NIAD or within a prior 90-day window.

Of older patients with no polypharmacy, 173 patients (6.5%) were given one or more PIP, and of middle-aged patients with no polypharmacy, 114 patients (1.5%) were given one or more PIP.

The researchers said the results show that while “the burden of polypharmacy, and thus PIPs, increases with age, this problem is not exclusive to the elderly”.

At the individual PIP level, long-term proton pump inhibitor use was the most frequent among older adults and strong opioids without laxatives was the most frequent PIP in middle-aged patients (11.1% and 4.1%, respectively).

The researchers concluded that patients starting NIAD treatment and already receiving polypharmacy should “trigger a comprehensive medication review to optimise prescribing decisions”.

Commenting on the findings, Helen O’Neil, medicines optimisation lead for diabetes for North East and North Cumbria Integrated Care Board, said: “People living with diabetes are already at an increased risk of developing polypharmacy, and this study highlights the importance of comprehensive medication reviews upon diagnosis.

“The diagnosis of a long-term health condition, such as diabetes, is an excellent trigger to review and optimise prescribing, ensuring we prevent inappropriate polypharmacy and thereby reduce adverse effects associated with polypharmacy.

“Pharmacy professionals have the ideal skill set to undertake these types of comprehensive medication reviews.”

Last updated
The Pharmaceutical Journal, PJ, March 2024, Vol 312, No 7983;312(7983)::DOI:10.1211/PJ.2024.1.268372

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