Medication reviews cut prescribing in older people with diabetes

A review of older people with diabetes who take sulfonylureas led to 58% being deprescribed the medication, according to results of research carried out by West Hampshire Clinical Commissioning Group (CCG).

The research looked at 618 patients aged 75 years and over identified at GP surgeries within West Hampshire CCG who were prescribed sulfonylureas and had controlled diabetes (HbA_1C <53mmol/mol).

A pharmacist reviewed each patient’s diabetes medication and a decision was made following discussions with the patient and their GP to decide whether to continue sulfonylurea therapy, reduce the dosage, or stop.

In data collected to the end of March 2018, sulfonylureas were stopped in 255 patients and dose reduced in 102. The remaining 261 patients continued with their current therapy but will receive regular reviews to check this treatment is still appropriate.

West Hampshire CCG launched the review following the death of a sulfonylurea-treated patient from a hypoglycaemic coma. Hypoglycaemia is a major concern in the use of sulfonylureas and may be particularly difficult to identify in older patients.

The researchers also pointed out that the benefits of tight glycaemic control in older people may be less than in younger patients.

The team say they plan to collect further data in the study, including on long-term outcomes. There are also plans to carry out similar reviews within other CCGs, including in Devon.

“The work shows that with careful systematic review and good communication across the primary-secondary care interface, a potentially dangerous medication can be safely deprescribed, thereby minimising risks to patients and reducing the need for long-term monitoring,” they conclude.