Older people with Type 2 diabetes are being ‘over prescribed’

Dr Clare Hambling

Older people with Type 2 diabetes are being over treated with certain drugs, according to a recent service evaluation carried out in Leicester. 


The findings come as a NHS Digital report recently showed 52 million diabetes prescriptions were issued last year, which is an 81 per cent increase over the past decade. 


The prevalence of Type 2 diabetes – which is strongly linked to lifestyle – has spiraled out of control as the obesity epidemic continues to grip the nation. The elderly are especially vulnerable to the condition and larger proportion of newly diagnosed people with diabetes are from the older generation.


A team from the Leicester Diabetes Centre, based at the University of Leicester and led by Dr Clare Hambling, a GP with an interest in diabetes who is based in West Norfolk, discovered potential overtreatment with sulfonylurea and insulin therapies was “common” in people aged 70 or over. 


Dr Hambling said: “Sulfonylureas are a group of medications commonly used to help people control their Type 2 diabetes as they help the pancreas produce more insulin and keep blood sugar levels low.


“However, these treatments have also been linked to a condition called hypoglycemia, which occurs when blood sugar levels drop dangerously low. As people get older the complications of hypoglycemia can be severe, with the risk of injury and poor health outcomes rising significantly. 


“Despite this, evidence suggests many older people with diabetes and other serious health conditions are being over-treated on therapies associated with low blood sugar, which could have serious implications to their health.”


The team were able to identify older people with Type 2 diabetes who were being prescribed sulfonylurea or insulin therapies using a pioneering software tool called Education and Cost-analysis Leading to Improved Prescribing Safety and Efficiency (ECLIPSE Live). It was specifically developed to help GPs improve safety in prescribing. The anonymous data they collected also included other health issues the people identified had, as well as their blood sugar level results across the last few months.


Professor Kamlesh Khunti

Professor Kamlesh Khunti, who is Professor of Primary Care Diabetes and Vascular Medicine at the University of Leicester, said: “We know from ambulance call-out data that older people are particularly vulnerable to severe hypoglycaemia and they sometimes suffer harm as a consequence, including such as fractures, head injuries or cardiac events. 


“We are uncertain as to the benefits older people gain from intensive blood glucose management, as well as being concerned that too intensive treatment may inadvertently increase mortality.”


Dr Hambling added: “We believe rolling out nationally the process we used to find older people who are being over treated, we can adapt their medication which could help alleviate hypoglycaemia and associated complications, which will improve people’s health and save NHS resources.” 


Off the back of the results local healthcare professionals were provided with education and guidelines were created to help clinicians manage older people with diabetes and other co-existing complex healthcare needs.


The findings of the audit, which was supported by NIHR CLAHRC East Midlands, have been published in the prestigious Diabetic Medicine journal.




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