Deprescribing in Diabetes: Pharmacist Involvement Would Help

Older patients’ medications tend to multiply like weeds in a garden. As a result, there’s been increased attention on deprescribing, the process of withdrawing an inappropriate medication under the supervision of a health care professional with the goal of managing polypharmacy and improving outcomes.

Now, an article published ahead-of-print in the International Journal of Clinical Pharmacy indicates that British care home residents with type 2 diabetes have more comorbidities, total prescriptions, and inappropriate medications.

British care homes are similar to American nursing homes and independent living facilities in that they are staffed around-the-clock with or without nurses (nursing homes and residential homes, respectively). Care home residents usually have limited life expectancy and commonly suffer from disabilities and comorbidities, and type 2 diabetes is one of the most common diagnoses among them (15% prevalence).

Providers must balance the limited benefit of treatment in diabetic care home residents with the adverse effects caused by treatment.

In the study, the researchers extracted diagnoses and medications from 826 care home residents across 30 locations in the United Kingdom. The study used the Optimising Safe and Appropriate Medicines Use tool to identify inappropriate medications.

UK care home residents with type 2 diabetes had more comorbidities, current prescriptions, and polypharmacy than community-based elders. Nine of 10 residents had at least one potentially inappropriate medication largely due to lack of proper indication.

The Northumbria Shine 2012 project found that 90.5% of patients needed medication interventions; a lack of indication was the most common reason to discontinue medications.

Withdrawal effect concerns and lack of guidance on how and when to discontinue a medication discourage clinicians from deprescribing. Multiple practitioners have published their desire for deprescribing guidelines. However, simply involving general practitioners and pharmacists in care is cost effective and reduces unnecessary prescribing.

Greater deprescribing can reduce regimen complexity and inappropriate prescribing in care home residents with type 2 diabetes. Future studies should involve full prescriber access to all patient information, interprofessional collaboration, residents, and quality of life assessment.