1455-P: Evaluating Opportunities for Deprescribing in the Elderly and Extreme Elderly with Diabetes

Individualised approaches to diabetes management are essential so that an optimal balance is realised between the risk and benefits of treatment. In the elderly (E, 75-84 years) and extreme elderly (EE, ≥ 85 years) treatment adjustment is the cornerstone of management, in order to provide medicines that deliver efficacy, and to de-prescribe agents to limit iatrogenic adverse effects. To assess the opportunity to de-prescribe and better target prescribing, we performed a retrospective audit of 1,806 patients (E, n=1,649; EE, n=157). Data are presented as E and EE respectively. The majority had T2DM (99.1%), with long duration (median, IQR 13.9, 7.4-21.7; 17.5, 10.3-25.1 years); and were overweight (mean ± SD BMI 28.7 ± 5.4; 27.0 ± 4.5 kg/m²). Over 50% used polypharmacy for glycaemic control; 37.9% and 40.8% used insulin +/- tablets. 39.4% of E and 33.3% of EE achieved an HbA1c of <7.0%, with HbA1c 7.5 ±1.4% and 7.8 ± 1.6% (mean± SD NGSP units). Over half (55.8%) of the EE group with an HbA1c <7.0% were treated with insulin and/or sulphonyureas, whereas only 38.2% of E were treated with these agents (p=0.01). While reported severe hypoglycaemia was uncommon (1.5% E and 2.8% EE), 35% of EE patients using insulin and/or sulphonyureas experienced hypoglycaemia. Metformin had appropriately been ceased in all but 7 of the 63 patients with an eGFR < 30 ml/min/1.73m². While lipid profiles were favourable (HDL: 1.3 ± 0.4 mmol/L; LDL: 2.3 ± 0.9 mmol/L, Trig: 1.5, IQR: 1.1-2.1 mmol/L and HDL: 1.3 ± 0.3 mmol/L; LDL: 2.3 ± 1.0 mmol/L, Trig: 1.5, IQR: 1.0-2.1 mmol/L), lipid lowering therapy was used less frequently in EE (51.0%) versus E (62.6%) (p=0.004). Only 1 in 2 patients with known macrovascular disease were on anti-platelet treatment. This data demonstrates the potential over treatment of glycaemia in the EE specifically in hypoglycaemia inducing agents, highlighting the need to consider de-prescribing. Conversely, under-utilisation of evidence-based medication to address macrovascular risk is also evident.