Drug Prescribing During the Last Year of Life in Very Old People With Diabetes

Shota Hamada; Martin C. Gulliford

Disclosures

Age Ageing. 2017;46(1):147-151. 

In This Article

Abstract and Introduction

Abstract

Objective: to evaluate primary care drug utilisation during the last year of life, focusing on antidiabetic and cardiovascular drugs, in patients of advanced age with diabetes.

Design: population-based cohort study.

Setting: primary care database in the UK.

Subjects: patients with type 2 diabetes who died at over 80 years of age between 2011 and 13.

Methods: main outcome measures included proportions of patients prescribed different classes of drugs, comparing the first (Q1) and the fourth quarters (Q4) of the last year of life.

Results: the study included 5,324 patients, with the median age 86 years and 50% female. Three-fourths of the patients received five or more drugs, and the total number of drugs prescribed was almost stable at 6.2 ± 3.1 (mean ± SD) during the last year of life. Substantial proportions of patients were treated with antidiabetic drugs (78%), antihypertensive drugs (76%), statins (62%) and low-dose aspirin (46%) in Q1. Prescribing of these drugs slightly decreased by 3–8% in Q4. There were increases in prescribing of anti-infectives (35% in Q1 to 50% in Q4), drugs for nervous system (63% to 73%), drugs for respiratory system (24% to 33%) and systemic hormonal drugs (22% to 27%).

Conclusion: patients of advanced age with type 2 diabetes were often treated with antidiabetic and cardiovascular drugs even when approaching death. More research is needed to generate evidence to guide optimal drug utilisation for older people with a limited life expectancy.

Introduction

The number of very old people is increasing, and both the prevalence of chronic diseases, including diabetes, and the intensity of drug treatment have been increasing in this population.[1] Patients with diabetes are commonly treated with multiple classes of drugs to control risk factor values and to reduce cardiovascular risk, consistent with guideline recommendations.[2] These recommendations are often applied in very old people over 80 years of age.[3] Drugs to lower cardiovascular risk are often prescribed for several decades or even life-long, despite lack of evidence for such a long-term therapy.[4] Some observational studies suggest that low levels of cardiovascular risk factors, including HbA1c, blood pressure and cholesterol, may sometimes be associated with higher mortality in very old patients with type 2 diabetes.[5] As patients approach the end-of-life, care to control symptoms and to improve well-being become important. At present, there is insufficient evidence to guide end-of-life care for patients with diabetes.[6,7] This study aimed to evaluate primary care drug utilisation during the last year of life, focusing on antidiabetic and cardiovascular drugs, in patients of advanced age with diabetes.

processing....