Abstract
Objectiveto evaluate primary care drug utilisation during the last year of life, focusing on antidiabetic and cardiovascular drugs, in patients of advanced age with diabetes.Designpopulation-based cohort study.Settingprimary care database in the UK.Subjectspatients with type 2 diabetes who died at over 80 years of age between 2011 and 13.Methodsmain 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.Resultsthe 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%).Conclusionpatients 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.
Highlights
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]
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]
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
Summary
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]. 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]. 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
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