Potentially Inappropriate Medication Use in Older Hospitalized Patients with Type 2 Diabetes: A Cross-Sectional Study

Abstract

Background: Older patients with type 2 diabetes mellitus (T2DM) are at greater risk of receiving potentially inappropriate medications (PIM) during hospitalization which may result in adverse outcomes. Aim: To evaluate the extent of PIM use in the older population with T2DM during hospitalization in a tertiary care hospital in India. Methods: A cross-sectional study was carried out from August 2019 to January 2020 in a tertiary care teaching hospital among the older population (aged ≥ 65 years) hospitalized with T2DM. Medications prescribed during hospitalization were reviewed following Beers Criteria 2019 to identify the extent of polypharmacy and PIM use. Binary logistic regression was applied to determine the factors associated with PIM use. Results: The mean age of the 150 patients hospitalized with T2DM was 68.85 ± 5.51 years, most of whom were men (54.7%). The participants had at least four comorbidities and were receiving an average of nine medications per day; the median length of hospital stay was 8 days (interquartile range (IQR): 4–19 days). Overall, three quarters (74%) of the participants had at least one PIM prescribed during their hospitalization as per Beers Criteria. Significant factors associated with the use of PIM during hospitalization are patients taking a higher number of medications (odds ratio (OR): 7.85, 95% CI 1.49–41.10), lower creatinine clearance values (OR: 12.90, 95% CI 2.81–59.28) and female patients (OR: 2.29; 95% CI: 1.05–4.97). Conclusions: PIM use is frequently observed in older T2DM patients during hospitalization. Polypharmacy, reduced renal function and female gender are associated with higher PIM use. Engaging clinical pharmacists in evaluating medication appropriateness can improve the outcomes of older patients.

Potentially inappropriate medications in Chinese older outpatients in tertiary hospitals according to Beers criteria: A cross‐sectional study

“…Consistent with research at home and abroad, female patients had a higher risk of PIMs than male patients and was not restricted by the updated version of the Beers criteria. 21,37,38 The number of drugs was associated with the high detection rate of PIM prescriptions, which was similar to the results reported by other scholars. 39,40 Compared with patients with 1 to 4 drugs, patients with 5 to 9 drugs had more than 3 times the risk of PIMs, and patients with 10 or more drugs had at least 13 times the risk of PIMs.…”

“…According to the results of factor analysis, patients with female, aged ≥75 years, and combined medications ≥5 were more likely to receive PIMs when prescribed. Consistent with research at home and abroad, female patients had a higher risk of PIMs than male patients and was not restricted by the updated version of the Beers criteria 21,37,38 . The number of drugs was associated with the high detection rate of PIM prescriptions, which was similar to the results reported by other scholars 39,40 .…”

Prevalence and Determinants of Multimorbidity, Polypharmacy, and Potentially Inappropriate Medication Use in the Older Outpatients: Findings from EuroAgeism H2020 ESR7 Project in Ethiopia

“…However, the current estimates of the prevalence of PIM use using the 2019 AGS Beers criteria were generally higher than those reported by previously published studies in Ethiopia using 2015 STOPP/START criteria and 2012 Beers criteria, reporting inappropriate medication use in 23% to 45% of the participants [ 20 , 31 ]. In addition, international studies using the 2019 AGS Beers criteria reported a high prevalence of PIM use in patients with heart failure in Lebanon (80%) [ 32 ], outpatients in Qatar (76%) [ 33 ], and patients with diabetes in India (74%) [ 34 ].…”

“…The most common classes of PIMs in our study were cardiovascular medications (27.8%), followed by endocrine agents (13.5%). In contrast, 84.2% of the PIMs were gastrointestinal medications in a Qatar study [ 33 ], and 44.6% were endocrine agents in India [ 34 ]. Other studies have reported different classes of PIMs, such as benzodiazepines [ 35 ], antidepressants and antipsychotics [ 36 ], and non-steroidal anti-inflammatory drugs [ 37 ].…”

Potentially Inappropriate Medication and Associated Factors Among Older Patients with Chronic Coronary Syndrome at Hospital Discharge in Beijing, China

“…Glimepiride is frequently observed as a PIM in older diabetes inpatients. 48 Initial treatment with sulfonylurea monotherapy increased ischemic stroke, cardiovascular death and all-cause mortality. 49 As it is cost-effective and has good glucose lowering potency, glimepiride remains competitive.…”