Introduction: Similar to the US, Japan has seen a decline in sulfonylureas (SUs) use in the elderly patients (pts) with diabetes, but the detailed usage status of SU is unknown.

Methods: To investigate real-world SU prescribing patterns, we conducted a retrospective cross-sectional survey using pharmacy data in Japan, targeting pts prescribed SUs, aged 20-100 years. From November 2022 to October 2023, we extracted data for 91,230 pts from the electronic prescription system Musubi (KAKEHASHI Inc., adopted in over 7,000 pharmacies, accounting for 10% market share, as of 2023 in Japan). The most commonly prescribed SUs were glimepiride (73,061 pts, 80.1%), gliclazide (14,841 pts, 16.3%), and glibenclamide (3,327 pts, 3.6%). Our analysis focused on adherence to Japanese guidelines in prescribing these SUs in elderly pts (adhering to limits of 1 mg/day for glimepiride and 40 mg/day for gliclazide, and avoiding glibenclamide).

Results: Of 91,230 pts showed 55,947 were male (61.3%) and a mean age of 68.8 years; 66,319 (72.7%) were aged ≥65 years. Elderly pts on average used 2.7 antidiabetic medications concurrently. The most common additional medications with SUs were DPP-4 inhibitor (49,963 pts, 75.3%), biguanide (34,266 pts, 61.2%), and SGLT-2 inhibitor (25,878 pts, 46.3%). Insulin was used concomitantly in 3,682 elderly pts (6.6%). Among elderly pts, 25.0% and 7.8% exceeded the recommended dosages for glimepiride (>1 mg/day) and gliclazide (>40 mg/day), respectively. Glibenclamide was prescribed to 2,578 elderly pts (77.5%). However, elderly pts used fewer diabetes medications on average: 3.3 for those <65 years, 3.0 for 65-<75 years, and 2.7 for ≥75 years.

Conclusion: We identified high-dose prescription of glimepiride and gliclazide, and glibenclamide use in elderly pts, indicating potential non-adherence to guidelines. Our findings highlight the need for enhanced education and appropriate SU usage to prevent hypoglycemia and diabetic complications.


M. Sakamoto: None. M. Yamazaki: None. T. Takebe: None. M. Hosokawa: None. T. Saika: None. Y. Nakao: None. S. Ikeda: None.

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