Optimizing drug therapy in frail patients with type 2 diabetes mellitus

Abstract

Background

Type 2 diabetes mellitus (T2DM) is closely linked with ageing. In frail diabetic patients, the risks of intensive antidiabetic therapy outweigh the potential benefits.

Aims

To study the prevalence of T2DM in frail elderly patients, to identify inappropriate prescription (IP) of antidiabetic drugs and to study the relationship between patients’ frailty index (FI) with polypharmacy and IP.

Methods

This was a prospective, descriptive, observational study of elderly patients. Each patient’s antidiabetic treatment was analysed by applying the patient-centred prescription model (PCP), which centres therapeutic decisions on the patient’s global assessment and individual therapeutic goal.

Results

210 patients with T2DM were included (25.15% prevalence). They were characterised by high multimorbidity and frailty. 93.3% presented polypharmacy and 51% excessive polypharmacy. IP was identified in 66.2% of patients. A statistically significant relationship was found between the progression in FI degree and IP prevalence (p < 0.05. During the admission, drug therapy regimens were modified in 97.1% of cases with IP (n = 136).

Discussion

These results suggest that in clinical practice T2DM treatment is not individualised, but rather is based on the same general recommendations for the population as a whole.

Conclusions

There is a high prevalence of T2DM in the elderly. As the frailty of patients increases, so does the prevalence of IP. The application of PCP model enables drug therapy optimization in frail patients according to their main therapeutic goal, and contributes to provide clinical evidences on the applicability of a set of knowledge areas from the theoretical framework to the daily clinical practice.

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Acknowledgments

We thank the team of nurses and team coordinators who serve elders and their caregivers in the ACE Unit, Hospital Universitari de Vic.

Funding

No competing financial interests exist.

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Correspondence to N. Molist-Brunet.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Local Ethics Committee of Hospital Universitari de Vic.

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The study was based on the collection of data generated by clinical practice. Thus, informed consent was not considered necessary because inclusion in this study did not constitute a specific intervention.

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Molist-Brunet, N., Sevilla-Sánchez, D., Puigoriol-Juvanteny, E. et al. Optimizing drug therapy in frail patients with type 2 diabetes mellitus. Aging Clin Exp Res 32, 1551–1559 (2020). https://doi.org/10.1007/s40520-019-01342-z

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Keywords

  • Patient-centred care
  • Frailty
  • Polypharmacy
  • Inappropriate prescription