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Potentially inappropriate medication use common among elderly adults with diabetes

26 May 2020

A significant number of older adults with diabetes use potentially inappropriate medications (PIMs), with the most common being benzodiazepine, proton pump inhibitor (PPI) and glibenclamide, according to a recent study.

Researchers used the Quebec Integrated Chronic Disease Surveillance System (QICDSS) database to conduct a population-based cohort study of 286,962 diabetic individuals (mean age, 76.4 years; 51 percent male). Most of them lived in urban area (78.3 percent) and had at least one comorbidity (coronary diseases, chronic obstructive pulmonary disease, and osteoporosis, among others; 70.6 percent).

The population used an average of 12.6 medications yearly, with 91.9 percent of participants having polypharmacy (≥10 different medications per year), 64 percent having hyperpolypharmacy (≥5 different medications per year), and 2.2 percent not using any medication.

More than half (56 percent) of the participants used at least one PIM (defined according to the 2015 Beers Criteria) over a year, with the prevalence higher in women (61.3 percent) than men (51.2 percent). The most common PIMs used were benzodiazepines (41 percent), PPIs (27 percent), and endocrine medication (mainly glibenclamide; 25 percent).

Factors associated with PIM use were female sex (risk ratio [RR], 1.17, 99 percent confidence interval [CI], 1.16–1.18) as well as comorbidities including schizophrenia (RR, 1.48, 99 percent CI, 1.45–1.51), anxiety disorders (RR, 1.34, 99 percent CI, 1.33–1.35), and Alzheimer's disease (RR, 1.14, 99 percent CI, 1.13–1.25).

The current study underscores a need to reduce the use of PIMs through interventions that target the following high-risk subgroups: women, individuals with many comorbidities (especially those psychiatric), and those using high number of medications, according to the researchers.

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