Physicians’ and Pharmacists’ Clinical Considerations for Elderly Patients with Type 2 Diabetes Mellitus: The IMPLICA2 Study
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Management of elderly patients with type 2 diabetes mellitus (T2DM) is complex due to their age-related conditions. Several clinical guidelines provide specific recommendations for management of these patients but little is known about their implementation in clinical practice.
To describe physician and community pharmacist perceptions and routine clinical practice in the management of elderly T2DM patients.
A total of 993 physicians and 999 community pharmacists completed the questionnaire. More physicians than pharmacists agreed on the need to establish more flexible HbA1c targets for elderly (79.4% vs. 30.6%; p < 0.001) and frail (92.6% vs. 31.4%; p < 0.001) patients than for the general diabetic population. HbA1c targets < 7.5% for elderly patients and < 8.5% for frail patients (as recommended by the principle guidelines) were set by 38.9% and 28.7% of physicians, respectively. Furthermore, 62.8% of physicians stated they follow guideline recommendations but, based on their prescription decisions for hypothetical patients, less than 50% were aligned with them. In addition, 73.1% of physicians monitor treatment adherence, mainly by using dispensing control (59.1%). Specific nutritional approaches for elderly patients are provided by 62.9% of physicians and 56.0% of pharmacists, whilst 57.4% and 21.7%, respectively, deliver specific physical exercise programs.
Low adherence to guideline recommendations (i.e. setting more stringent HbA1c targets or delaying treatment intensification) may lead to suboptimal glycaemic control in elderly patients. The standardization of processes, extensive monitoring of patient treatment adherence and providing advice regarding specific personal lifestyle habits may improve the management of elderly T2DM patients.
The authors acknowledge the physicians and pharmacist who took part in this study. They also acknowledge Ana López (Mylan Medical Department), Mariona Lería (Medical Department Head/Product Safety and Risk Management) and Outcomes’10 for their support in coordinating the study.
Compliance with Ethical Standards
This study was funded by BGP Product Operations S.L (Mylan).
Conflict of interest
JFN, FGG and APM, state they have no conflicts of interest. LOP, PRF, MRM and MMK are Mylan employees. HDP and SA work for an independent research organisation (Outcomes’10, S.L.), which has received fees for its contribution to the development and coordination of the project and to the writing of this manuscript.
This article does not contain any studies involving human participants or animals performed by any of the authors.
All participants received adequate information regarding the study and agreed to participate in it.
- 3.CIBERDEM, Sociedad Española de Diabetes (SED), Federación Española de Diabetes (FED). Estudio Di@abet.es [Internet]. Ciberdem Isc. 2016. http://www.ciberdem.org/programas-de-investigacion/proyectos/estudio-di-betes. Accessed 3 Mar 2018.
- 13.Pruitt S, Annandale S, Epping-Jordan J, Fernández Díaz J.M., Khan M, Kisa A, et al. Innovative care for chronic conditions: building blocks for action: global report. Geneva: World Health Organization. 2002. http://www.who.int/chp/knowledge/publications/icccglobalreport.pdf?ua=1. Accessed 9 Oct 2018.
- 15.Ezkurra-Loyola P. Guía de Actualización en Diabetes. redGDPs Found. 2016.Google Scholar
- 16.Gómez R, Díez-Espino J, Formiga F, Latifa J, Rodríguez L, Gonzalez E, et al. Tratamiento de la diabetes tipo 2 en el paciente anciano. Med Clin (Barc). 2012;140:1–12.Google Scholar
- 22.Aguiar PM, de Brito GC, de Lima TM, Santos APAL, Lyra DP, Storpirtis S. Investigating sources of heterogeneity in randomized controlled trials of the effects of pharmacist interventions on glycemic control in type 2 diabetic patients: a systematic review and meta-analysis. PLoS One. 2016;11:e0150999.CrossRefGoogle Scholar
- 25.National Center for Chronic Disease Prevention and Health promotion. Collaborative Practice Agreements and Pharmacists’ Patient Care Services. 2013.Google Scholar
- 27.Gittell JH. Relational coordination: coordinating work through relationships of shared goals, shared knowledge and mutual respect. In: Özbilgin M, Kyriakidou O, editors. Relational perspect organ stud. London: Edward Elgar Publishing; 2006. p. 74–94.Google Scholar
- 28.Oferta y necesidad de médicos especialistas en España (2010–2025) [Internet]. http://www.msssi.gob.es/profesionales/formacion/necesidadespecialistas/home.htm. Accessed 01 Nov 2015.
- 29.Consejo general de colegios oficiales de farmacéuticos. Estadísticas de Colegiados y Farmacias Comunitarias [Internet]. 2015. p. 34. http://static.correofarmaceutico.com/docs/2016/05/20/estadisticas-colegiados-farmacias-comunitarias-2015.pdf. Accessed 7 Feb 2017
- 30.Sinclair A, Morley JE, Rodriguez-Mañas L, Paolisso G, Bayer T, Zeyfang A, et al. Diabetes mellitus in older people: position statement on behalf of the International Association of Gerontology and Geriatrics (IAGG), the European Diabetes Working Party for Older People (EDWPOP), and the international task force of experts in diabetes. J Am Med Dir Assoc. 2012;13:497–502.CrossRefGoogle Scholar
- 34.National Institutre for Health and Care Excellence. Type 2 diabetes in adults: management [Internet]. NICE Guidel. 2017. p. 44. https://www.nice.org.uk/guidance/ng28. Accessed 2018 Mar 7.
- 35.Sinclair AJ, Ahmed Abdelhafiz A, Dunning T, Izquierdo M, Rodriguez Manas L, Bourdel-Marchasson IMJ, Munshi M, Woo JVB. An international position statement on the management of frailty in diabetes mellitus: summary of recommendations 2017. J Frail Aging. 2018;7:10–20.Google Scholar
- 45.Labrador Barba E, de Rodriguez Miguel M, Hernández Mijares A, Alonso-Moreno FJ, Orera Peña ML, Aceituno S, et al. Medication adherence and persistence in type 2 diabetes mellitus: perspectives of patients, physicians and pharmacists on the Spanish health care system. Patient Prefer Adherence. 2017;11:707–18.CrossRefGoogle Scholar
- 49.García-Donaire JA, Franch-Nadal J, Rodríguez-Fortúnez P, Labrador-Barba E, Orera-Peña ML, de Rodríguez Miguel M. Epidemiological multicentre study on the education provided to patients with type 2 diabetes mellitus in the Spanish Health Care System. The Forma2 study. Med Fam Semer. 2018;44:5–12.Google Scholar