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.
S.A. Sharp: None. J. Overland: None. M. McGill: None. L.M. Molyneaux: None. T. Wu: Advisory Panel; Self; Boehringer Ingelheim International GmbH, Eli Lilly and Company, Novo Nordisk A/S, Sanofi. Speaker's Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi. S.M. Twigg: Advisory Panel; Self; Abbott, Boehringer Ingelheim Pharmaceuticals, Inc., Novo Nordisk Inc., Sanofi-Aventis. Board Member; Self; AstraZeneca. Research Support; Self; Abbott. Speaker's Bureau; Self; Abbott, AstraZeneca, Merck Sharp & Dohme Corp., Novo Nordisk Inc., Sanofi-Aventis. J. Wong: Advisory Panel; Self; Sanofi. Speaker's Bureau; Self; AstraZeneca, Lilly Diabetes.