Prescription appropriateness of anti-diabetes drugs in elderly patients hospitalized in a clinical setting: evidence from the REPOSI Register

• Published in: Internal and emergency medicine Vol. 18; no. 4; pp. 1049 - 1063
• Main Authors: Succurro, Elena, Novella, Alessio, Nobili, Alessandro, Giofrè, Federica, Arturi, Franco, Sciacqua, Angela, Andreozzi, Francesco, Pietrangelo, Antonello, Sesti, Giorgio
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-06-2023; Springer Nature B.V
• Subjects: Aged; Antidiabetics; Cross-Sectional Studies; Diabetes; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2; Drug Prescriptions; Geriatrics; Hospitalization; Humans; Im - Original; Intensive care units; Internal Medicine; Medicine; Medicine & Public Health; Metformin; Older people; Patients; Prescription drugs; Public health; Elderly people; Diabetes; Hospitalized patients; Prescription appropriateness; Anti-diabetes drugs
• ISSN: 1828-0447; 1970-9366
• DOI: 10.1007/s11739-023-03254-3

Diabetes is an increasing global health burden with the highest prevalence (24.0%) observed in elderly people. Older diabetic adults have a greater risk of hospitalization and several geriatric syndromes than older nondiabetic adults. For these conditions, special care is required in prescribing therapies including anti- diabetes drugs. Aim of this study was to evaluate the appropriateness and the adherence to safety recommendations in the prescriptions of glucose-lowering drugs in hospitalized elderly patients with diabetes. Data for this cross-sectional study were obtained from the REgistro POliterapie–Società Italiana Medicina Interna (REPOSI) that collected clinical information on patients aged ≥ 65 years acutely admitted to Italian internal medicine and geriatric non-intensive care units (ICU) from 2010 up to 2019. Prescription appropriateness was assessed according to the 2019 AGS Beers Criteria and anti-diabetes drug data sheets.Among 5349 patients, 1624 (30.3%) had diagnosis of type 2 diabetes. At admission, 37.7% of diabetic patients received treatment with metformin, 37.3% insulin therapy, 16.4% sulfonylureas, and 11.4% glinides. Surprisingly, only 3.1% of diabetic patients were treated with new classes of anti- diabetes drugs. According to prescription criteria, at admission 15.4% of patients treated with metformin and 2.6% with sulfonylureas received inappropriately these treatments. At discharge, the inappropriateness of metformin therapy decreased (10.2%, P < 0.0001). According to Beers criteria, the inappropriate prescriptions of sulfonylureas raised to 29% both at admission and at discharge. This study shows a poor adherence to current guidelines on diabetes management in hospitalized elderly people with a high prevalence of inappropriate use of sulfonylureas according to the Beers criteria.