Sulfonylurea being ‘over prescribed’ to older people with type 2 diabetes
Older people with type 2 diabetes are being over treated with prescribed sulfonylurea or insulin therapies, according to new research.
The research team from the Leicester Diabetes Centre at the University of Leicester, wanted to find out how much sulfonylurea or insulin therapies were being given to people, even in the presence of comorbidities known to increase hypoglycaemia risk.
They used the Education & Cost-analysis Leading to Improved Prescribing Safety & Efficiency (ECLIPSE) Live software tool to develop a search to examine data on older people aged 70 or older with the condition who had been prescribed sulfonylurea or insulin therapies over the previous 90 days.
As part of the trial, 16 general practices in Norfolk took part, which included 24 661 older people, of which 3,862 had type 2 diabetes.
The researchers discovered that 35.7 per cent of people who had type 2 diabetes had been given prescribed sulfonylurea or insulin therapies.
The results showed that a total of 644 people (47.8 per cent) had chronic kidney disease (estimated GFR < 60 mL/min/1.73m2) and 60 people (4.35 per cent) had dementia.
The median (interquartile range) HbA1c concentration for the entire cohort was 58 (51–69) mmol/mol [7.5 (6.8–8.5) per cent], with no difference in median HbA1c between those with or without either chronic kidney disease or dementia.
In total, 400 older people (29.9 per cent) had an HbA1c concentration < 53 mmol/mol (7 per cent), of whom 162 (12.1 per cent) had HbA1c < 48 mmol/mol (6.5 per cent).
Stratified by prescription for sulfonylurea, insulin or combined insulin and sulfonylurea therapies, 282 (35.2 per cent), 93 (24.2 per cent) and 25 people (16.3 per cent), respectively, had HbA1c < 53 mmol/mol (7.0 per cent).
Treatment to an HbA1c target of < 53 mmol/mol (7.0 per cent) was as prevalent in those with chronic kidney disease or dementia as in those without.
The findings of the research were published in the Diabetic Medicine journal.