Front Public Health: Correlation of potential inappropriate drug use with complications in older patients with diabetes

Background: Potentially inappropriate drugs (PIM) in older adults are considered drugs that should be avoided because the risks to older adults outweigh the expected benefits to this population; When safer and equivalent or more effective drugs are available, drugs with insufficient evidence of efficacy; drugs used in unreasonable doses or durations; and high-risk drugs
for drug-disease interactions.
Several evaluation tools were compared
in detecting PIM.
The determinants do not appear to differ significantly according to the criteria used to classify PIM, unless the criteria are limited to one subcategory
of drugs such as psychotropic drugs.
The Beers criterion is the standard most commonly used to determine the use of PIM in older adults, ranging from 3.
6% to 92.
0% in healthcare facilities and departments, such as nursing homes, resident care facilities, inpatient units, and emergency departments of hospitals
.

A meta-analysis of observational papers published between 2002 and 2019 estimated a mixed prevalence of 33.
3% in primary care for people aged 65 years or older, from 35.
9% to 59.
2% in high-prevalence countries (UK, Belgium, Australia, and New Zealand) and from 23.
2% to 29.
9% in low-prevalence countries (USA, Canada, and Netherlands
).

In addition, PIM probably accounted for 7.
7% of hospitalisations (associated with older adults in primary care), 10.
2% of adverse drug events, 15.
0% of functional decline, and 17.
3% of emergency department visits; These are preventable when PIM prevalence is 50% lower than it is currently (37 hospitalizations, 48 adverse drug events, 69 functional declines, and 79 emergency department visits per 1000 adverse outcomes in older patients in primary care).

An ageing population and an increasing prevalence of diabetes are medical challenges
facing China.
According to the seventh national census held in China in 2020, China has entered an aging society, with 190 million elderly people aged 65, accounting for 13.
5% of
the total population.
The latest 2019 study of the prevalence of diabetes among the elderly (65-99 years) globally and regionally shows that about 35.
5 million older people in China have diabetes, accounting for a quarter of the world's diabetes patients and the highest prevalence in the world (10 people).

In 2017, a national cross-sectional study covering 31 provinces on the mainland showed that the prevalence of diabetes in China was 28.
8% in adults aged 60-69 years and 31.
8%
in adults aged ≥ 70.
Older diabetics often suffer from multiple chronic diseases, a high risk of hypoglycemia, and poor self-management skills, which need to be targeted in the prescription
.
Appropriate treatment of multiple comorbidities often requires multiple medications, as clinicians are guided by clinical practice guidelines for each chronic disease
.

Miller et al.
found that for each addition to the drug list in older adults, the risk of exposure to PIM increased by 5.
2 percent
.
In older adults, adverse drug events caused by PIM and multidrug combinations may be associated with falls, fractures, constipation, emergency department admissions, rehospitalizations, and all-cause death, which have become major public health challenges
.

Objective: Potentially inappropriate medications have been found to be associated with
adverse drug events such as falls, emergency department admissions, and rehospitalization.
There is a lack of information in China on the prevalence of
potentially inappropriate drugs and related chronic diseases in older people with diabetes.
The aim of this study was to assess the prevalence of potentially inappropriate drugs in older diabetic patients presenting to outpatient clinics and the relationship
with multi-drug combinations due to comorbid conditions.

Materials and methods: This study is a 3-year replicate cross-sectional study conducted in the outpatient clinic of 52 hospitals in Shenzhen using the 2019 Beers criteria
.
The prevalence of potentially inappropriate drugs, multidrug combinations, and comorbidities in older adults with outpatient diabetes is expressed as
a percentage.
Logistic models were used to investigate the relationship
between potentially inappropriate drug exposure and age, sex, polypharmacy, and comorbidities.

Results: Among the 28,484 elderly diabetic patients in 2015, 31,757 in 2016 and 24,675 elderly diabetic patients in 2017, the prevalence of potentially inappropriate drugs was 43.
2%, 44.
88% and 42.
40%,
respectively.
The top five drugs were diuretics (20.
56%), benzodiazepines (13.
85%), androgens (13.
18%), non-steroidal anti-inflammatory drugs (12.
94%) and sulfonylureas (6.
23%)
.
After adjusting for age and taking multiple medications, the potential for potentially inappropriate drug exposure was associated with chronic gastrointestinal disease, followed by osteoarthritis and rheumatoid arthritis, chronic lung disease, chronic kidney disease, tumors, dementia, chronic liver disease, hypertension, cardiovascular disease, cerebrovascular disease, and hyperlipidemia
.

Table 1 Logistic regression analysis
of factors related to potentially inappropriate medication use and multi-drug combination.

Table 2 PIM prevalence in elderly patients with diabetes by beer category, drug class and drug classification, 2015, 2016 and 2017
.

Conclusions: In older patients with diabetes presenting to the outpatient clinic, potentially inappropriate pharmacotherapy is common
.
A higher probability of potentially inappropriate drug exposure is associated
with chronic gastrointestinal disease and comorbid osteoarthritis and rheumatoid arthritis.
To ensure that iatrogenic risk is kept to a minimum in older patients with diabetes, clinical complications
should be considered.

Original source:

Lvliang Lu, Keqin Yao, Jiaqi Chen, et al.
Prevalence of potentially inappropriate medications and association with comorbidities in older adults with diabetes in an outpatient visitation setting.
Front Public Health.
2022 Sep 20; 10:995948.