(062) Prevalence of potentially inappropriate medications among newly treated patients with type 2 diabetes in UK primary practice

Background: Polypharmacy (i.e., concomitant use of ≥5 drugs) is common in type 2 diabetes mellitus (T2DM) patients, especially those with multiple comorbidities. It increases the risk of potentially inappropriate prescriptions (PIPs), adverse drug events, drug-drug interactions, and drug-disease interactions. Prior research using explicit criteria to assess PIPs has primarily focused on the elderly, overlooking insights into non-elderly patients with T2DM and those receiving polypharmacy. Moreover, previous studies were limited to information on drug prescriptions, and thus, implementation of most criteria was hindered. Consequently, no large-scale, population-based study has applied explicit criteria to identify drugs to be avoided in the context of T2DM.

Objectives: To estimate the prevalence of PIPs in patients initiating their first non-insulin antidiabetic treatment (NIAD) in UK primary care using two explicit criteria, stratified by age and polypharmacy status.

Methods: A descriptive cohort study assessed the prevalence of overall PIPs and individual PIPs criteria at the first NIAD prescription (i.e., index date), stratified by age (i.e., 45-64 years; ≥65 years) and polypharmacy status ( < 5 drugs; ≥5 drugs). We identified new NIAD users aged 45+ within the IQVIA Medical Research Data (IMRD) incorporating data from THIN, A Cegedim Database, between 2016 and 2019. Patients with a diagnosis of gestational diabetes, polycystic ovary syndrome, cancer (excluding non-melanoma skin cancers), those in palliative care or end-of-life stages, and those on insulin therapy prior to or at the index date were excluded. Two explicit criteria were used: The American Geriatrics Society (AGS) Beers criteria 2015 was used for assessing PIPs in older (≥65 years) and the Prescribing Optimally in Middle-age People's Treatments (PROMPT) criteria for middle-aged (45-64 years) patients. We included 75 out of 92 indicators from the Beers criteria and all 22 from the PROMPT criteria in our analysis.

Results: Out of 28,604 patients initiating NIADs, 18,494 (64.7%) received polypharmacy. Among them, 39.6% of older and 22.7% of middle-aged patients received ≥1 PIPs. At the individual PIPs level, long-term proton pump inhibitor use was most common among older adults, and strong opioids without laxatives were frequent among middle-aged patients with polypharmacy (11.1% and 4.1%, respectively).

Conclusions: While polypharmacy and PIPs are more prevalent with increasing age, they affect not only elderly patients. Hence, this study underscores the importance of conducting comprehensive medication reviews and implementing risk reduction strategies for adults aged ≥45 years who are starting NIAD treatment.