Optimizing drug therapy in frail patients with type 2 diabetes mellitus
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ORIGINAL ARTICLE
Optimizing drug therapy in frail patients with type 2 diabetes mellitus N. Molist‑Brunet1,2 · D. Sevilla‑Sánchez2,3 · E. Puigoriol‑Juvanteny2,3 · J. González‑Bueno2,3 · N. Solà‑ Bonada3 · M. Cruz‑Grullón1 · J. Espaulella‑Panicot1,2 Received: 11 July 2019 / Accepted: 27 August 2019 © Springer Nature Switzerland AG 2019
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 0.50.
Inclusion criteria Patients admitted to the AGU during the established period. The criteria for admission to the AGU are (a) age 85 years or over, (b) and/or presence of cognitive deterioration, (c) and/ or identification as advanced chronic illness.
Exclusion criteria Patients who deceased within 48 h of admission.
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Aging Clinical and Experimental Research
FI degrees analysed • • • •
Qualitative criteria regarding drug prescription to consider inappropriate prescription
Degree 0: FI 0.50: severe frailty
Intervention
• The prescription of SU was considered inappropriate due • •
Each patient’s antidiabetic treatment was analysed by applying the patient-centred prescription model (PCP) [21]. This is a systematic 4-stage process, carried out by a multi-disciplinary team formed by a geriatric doctor and a clinical pharmacist. The model centres therapeutic decisions on the patient’s global assessment (comprehensive geriatric assessment (CGA), calculation of the frailty index (Frail-VIG) [22, 23] and the resulting individual therapeutic goal (prolonging survival, maintaining functionality or prioritising symptomatic control) [24]. With the result of this assessment and the established individual therapeutic goal, decisions could be taken regarding each patient’s HbA1c target according to ADA guidelines [4, 14, 25] (Table 1).The decisions were taken in conjunction with the patient or with the main carer in cases of incapacity.
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to the high risk of hypoglycaemia associated with them [2, 4, 26]. Patients with doses of metformin not adjusted for renal failure [4]. Patients with gliflozins (SGLT2 inhibitors) and renal failure (gl
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