Shota Hamada1, Martin C Gulliford2. 1. Department of Primary Care and Public Health Sciences, King's College London, London, UK. 2. Department of Primary Care and Public Health Sciences and National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust, King's College London, London, UK.
Abstract
BACKGROUND: there is a lack of evidence to inform treatment recommendations for very old people with type 2 diabetes mellitus (T2DM). OBJECTIVE: to evaluate trends in antidiabetic and cardiovascular drug utilisation for patients developing T2DM over 80 years of age. METHODS: a population-based cohort was sampled from the UK Clinical Practice Research Datalink between 1990 and 2013. Eligible patients were those with T2DM diagnosed after the age of 80 years and prescribed antidiabetic drugs. RESULTS: twelve thousand eight hundred and eighty-one patients, with 61% of females, were included. From 1990 to 2013, use of sulphonylureas declined from 94 to 29%, while metformin use increased from 22 to 86%. Prescribing of antihypertensive drugs increased substantially from 46 to 77%, lipid-lowering drugs from 1 to 64%, antiplatelets from 34 to 47% and oral anticoagulants from 5 to 19%. Women were more frequently prescribed antihypertensive drugs (odds ratio 1.26, 95% confidence interval 1.17 to 1.37) but less prescribed antiplatelets (0.83, 0.78 to 0.89). Compared with those diagnosed with T2DM from 80 to 89 years (n = 11,467, 89%), patients diagnosed after the age of 90 years (n = 1,414, 11%) were less likely to be prescribed insulin (0.37, 0.24 to 0.58), metformin (0.67, 0.60 to 0.75), antihypertensive drugs (0.42, 0.38 to 0.48), lipid-lowering drugs (0.26, 0.23 to 0.30) and anticoagulants (0.55, 0.44 to 0.68). CONCLUSIONS: there have been major increases in the intensity of pharmacological management of patients diagnosed with T2DM over 80 years of age, but the effectiveness and safety of these interventions in very old people require further evaluation.
BACKGROUND: there is a lack of evidence to inform treatment recommendations for very old people with type 2 diabetes mellitus (T2DM). OBJECTIVE: to evaluate trends in antidiabetic and cardiovascular drug utilisation for patients developing T2DM over 80 years of age. METHODS: a population-based cohort was sampled from the UK Clinical Practice Research Datalink between 1990 and 2013. Eligible patients were those with T2DM diagnosed after the age of 80 years and prescribed antidiabetic drugs. RESULTS: twelve thousand eight hundred and eighty-one patients, with 61% of females, were included. From 1990 to 2013, use of sulphonylureas declined from 94 to 29%, while metformin use increased from 22 to 86%. Prescribing of antihypertensive drugs increased substantially from 46 to 77%, lipid-lowering drugs from 1 to 64%, antiplatelets from 34 to 47% and oral anticoagulants from 5 to 19%. Women were more frequently prescribed antihypertensive drugs (odds ratio 1.26, 95% confidence interval 1.17 to 1.37) but less prescribed antiplatelets (0.83, 0.78 to 0.89). Compared with those diagnosed with T2DM from 80 to 89 years (n = 11,467, 89%), patients diagnosed after the age of 90 years (n = 1,414, 11%) were less likely to be prescribed insulin (0.37, 0.24 to 0.58), metformin (0.67, 0.60 to 0.75), antihypertensive drugs (0.42, 0.38 to 0.48), lipid-lowering drugs (0.26, 0.23 to 0.30) and anticoagulants (0.55, 0.44 to 0.68). CONCLUSIONS: there have been major increases in the intensity of pharmacological management of patients diagnosed with T2DM over 80 years of age, but the effectiveness and safety of these interventions in very old people require further evaluation.
Authors: John B Buse; J Thomas Bigger; Robert P Byington; Lawton S Cooper; William C Cushman; William T Friedewald; Saul Genuth; Hertzel C Gerstein; Henry N Ginsberg; David C Goff; Richard H Grimm; Karen L Margolis; Jeffrey L Probstfield; Denise G Simons-Morton; Mark D Sullivan Journal: Am J Cardiol Date: 2007-04-16 Impact factor: 2.778
Authors: Alan J Sinclair; Simon R Heller; Richard E Pratley; Ran Duan; Robert J Heine; Andreas Festa; Jacek Kiljański Journal: Diabetes Obes Metab Date: 2020-03-11 Impact factor: 6.577
Authors: Hassan Alwafi; Li Wei; Abdallah Y Naser; Pajaree Mongkhon; Gary Tse; Kenneth K C Man; J Simon Bell; Jenni Ilomaki; Gang Fang; Ian C K Wong Journal: BMJ Open Date: 2020-05-15 Impact factor: 2.692