Physicians’ and Pharmacists’ Clinical Considerations for Elderly Patients with Type 2 Diabetes Mellitus: The IMPLICA2 Study

• Published in: Clinical drug investigation Vol. 39; no. 1; pp. 73 - 84
• Main Authors: Franch-Nadal, Josep, García-Gollarte, Fermín, Pérez del Molino, Alfonso, Orera-Peña, María L., de Miguel, Marta Rodríguez, Melogno-Klinkas, Malena, de Paz, Héctor D., Aceituno, Susana, Rodríguez-Fortúnez, Patricia
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-01-2019; Springer Nature B.V
• Subjects: Addictive behaviors; Adult; Attitudes; Chronic illnesses; Clinical medicine; Cross-Sectional Studies; Diabetes; Diabetes Mellitus, Type 2 - drug therapy; Education; Family physicians; Female; Frailty; Health care; Humans; Hypoglycemia; Insulin; Internal Medicine; Male; Medical personnel; Medicine; Medicine & Public Health; Middle Aged; Older people; Original Research Article; Patients; Pharmacists - organization & administration; Pharmacology/Toxicology; Pharmacotherapy; Physicians; Studies; Substance abuse treatment; Surveys and Questionnaires
• DOI: 10.1007/s40261-018-0713-6
• EISSN: 1179-1918
• ISSN: 1173-2563

Background
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.
Objective
To describe physician and community pharmacist perceptions and routine clinical practice in the management of elderly T2DM patients.
Methods
Cross-sectional study.
Results
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.
Conclusions
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.