Medication management of type 2 diabetes in residential aged care

Stasinopoulos, Jacquelina; Bell, John; Manski-Nankervis, Jo Anne; Hogan, Michelle; Jenkin, Peter; Sluggett, Janet K.

doi:10.31128/ajgp-05-18-4582

Cited by 9 publications

(7 citation statements)

References 21 publications

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“…For example, intensive management of type 2 diabetes is no longer recommended for residents of RACFs. Care should instead be individualised to maximise the residents’ quality of life . While monitoring may detect and prevent adverse drug events (ADEs), in some cases the rate of detection may not justify invasive testing .…”

Section: Discussionmentioning

confidence: 99%

Process, impact and outcomes of medication review in Australian residential aged care facilities: A systematic review

et al. 2019

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Objective: To systematically review literature reporting processes, impact and outcomes of medication review and reconciliation in Australian residential aged care facilities (RACFs). Methods: PubMed/MEDLINE, EMBASE, CINAHL, Informit Health and grey literature were searched from 1995 to July 2018. Studies reporting outcomes of a stand-alone medication review or reconciliation interventions in Australian RACFs were included. Results: Thirteen studies investigated medication review, eight of which studied Residential Medication Management Reviews (RMMRs). Five studies reported that medication reviews identified an average of 2.7-3.9 medication-related problems (MRPs) per resident. One study reported medication reviews had no impact on quality of life, hospitalisation or mortality, but was not powered to assess these. Three studies reported general practitioners' acceptance of pharmacists' recommendations to resolve MRPs, ranging between 45 and 84%. Conclusions: Medication review may be a useful strategy to identify and prompt resolution of MRPs. However, the impact on clinical and resident-centred outcomes remains unclear. K E Y W O R D Saged care, geriatric medicine, health services, medication review, medication therapy management, pharmacist interventionThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. Practice ImpactThis review suggests that RMMRs identify 2.7-3.9 medication-related problems (MRPs) per resident and general practitioners (GPs) accept 45-84% of recommendations to resolve these MRPs. This highlights the value of pharmacists and GPs working together to optimise medication management in this setting.

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Section: Discussionmentioning

confidence: 99%

Process, impact and outcomes of medication review in Australian residential aged care facilities: A systematic review

et al. 2019

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“…8 Hence, many of the current guidelines recommend annual renal function monitoring in people with T2DM who are on metformin therapy. 9 According to most guidelines, SUs are the commonly used second-line AHAs along with metformin. 6…”

Section: Guideline Recommendations On the Diagnosis And Treatment Of ...mentioning

confidence: 99%

Position of Sulfonylureas in the Current ERA: Review of National and International Guidelines

Mohan

Saboo

Khader

et al. 2022

Clin Med Insights Endocrinol Diabetes

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Sulfonylureas (SUs) are one of the commonly prescribed oral anti-hyperglycemic agents (AHA) in low- and middle-income countries (LMICs), either in combination with metformin therapy or alone. However, concern about cardiovascular safety has limited the use of SUs in the management of type 2 diabetes mellitus (T2DM). Additionally, lack of uniformity in the national and international guidelines regarding the positioning of SUs in the management of diabetes has also been reported. The objective of this review was to assess the various national and international guidelines on diabetes management and understand the recommendations specific to SUs in various scenarios. A total of 33 national and international guidelines on the management of T2DM published in English were evaluated. These guidelines have considered the latest evidence and suggest the use of certain second-generation SUs as second-line therapy or in combination with other AHAs in select population and specific scenarios. Identification of the appropriate population, classification based on underlying risk, thorough assessment of the comorbid conditions, and a step-wise approach for the selection of appropriate SUs is essential for the effective management of T2DM. Additionally, cost-to–benefit ratio should be considered, particularly in LMICs, and SUs could continue to play an important role in such settings.

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“…It is unknown to what extent prescribers relax treatment targets, deintensify regimens, or deprescribe diabetes medications when people with existing diabetes are diagnosed with dementia. In Australia, it is recommended that treatment targets are individualized based on clinical and functional status 8 . Studies from the United States and the United Kingdom suggest overtreatment of diabetes is common in people living with dementia, particularly in the long‐term care setting where rates of overtreatment up to 86% have been reported 9–11 .…”

Section: Introductionmentioning

confidence: 99%

Diabetes treatment deintensification in Australians with dementia compared to the general population: A national cohort study

Picton

George

Bell

et al. 2023

J American Geriatrics Society

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Background Diagnosis of dementia may change peoples' goals of care. In people with diabetes, this may lead to relaxing treatment targets and reducing the use of diabetes medications. The aim of this study was to examine changes in diabetes medication use before and after initiating medication for dementia. Methods A national cohort of people aged 65–97 years, living with dementia and diabetes, and a general population cohort with diabetes matched for age, sex, and index date were extracted from the Australian national medication claims database. Trajectories of diabetes medication use, expressed as mean defined daily dose (DDD) each month for each individual from 24 months before to 24 months after the index date, were estimated using group‐based trajectory modeling (GBTM). Cohorts were analyzed separately. Results People with dementia (N = 1884) and the matched general population (N = 7067) had a median age of 80 years (interquartile range 76–84) and 55% were female. In both models, people exhibited one of five diabetes medication trajectories, with 16.5% of people with dementia and 24.0% of the general population assigned to trajectories that represented deintensification. In the general population model, those on deintensifying trajectories were older than those on stable trajectories (median 83 vs. 79 years). In the dementia cohort model, those on high or low deintensifying trajectories were slightly older (median age 81 or 82, respectively, vs. 80 years) and had at least 1 more comorbidity (median 8 or 7, respectively, vs. 6) than those on stable trajectories. Conclusions Initiating medication for dementia does not appear to be a trigger for deintensification of diabetes treatment regimens. Deintensification was more common in the general population; people living with dementia are potentially overtreated for diabetes.

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Medication management of type 2 diabetes in residential aged care

Cited by 9 publications

References 21 publications

Process, impact and outcomes of medication review in Australian residential aged care facilities: A systematic review

Process, impact and outcomes of medication review in Australian residential aged care facilities: A systematic review

Position of Sulfonylureas in the Current ERA: Review of National and International Guidelines

Diabetes treatment deintensification in Australians with dementia compared to the general population: A national cohort study

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