PDB8 - Iatrogenic Hypoglycaemia in the Elderly: An Analysis of Diabetic Medication Usage Patterns According to Age

Abstract

We performed a retrospective data analysis to examine the use of medications that can cause hypoglycaemia in elderly diabetes mellitus patients in Malaysia. We utilised data from the National Diabetes Registry from 2012 containing data from diabetes patients followed up in Malaysian public sector primary care clinics. Medications analysed were anti-diabetic (metformin, sulphonylurea, acarbose, insulin) and anti-hypertensive drugs classes (ACE-inhibitors, beta-blockers) which were widely used in the study population. Descriptive and univariate analyses were performed to examine the use of these medications across various age groups. A total of 130,246 patients with T2DM were included in the study. The patients were divided into 4 age groups, with 8.4% under 45 years old, 58.3% aged between 45–64 years, 29.8% between 65-79 years old and 3.5% over 80 years of age. The mean HbA1c of patients in the <45 years age group was the highest at 8.68% and lowest in the ≥80 years age group at 7.11%. There were significant reductions in the use of metformin (from 83.97% to 68.69% of patients) and insulin (24.70% to 12.03%) with age (all P<0.001). However, sulphonylurea use was similar cross all age groups (52.55% to 57.44%, P=0.500) while use of acarbose was generally higher in older patients (3.12% to 3.94%, P<0.001). In the subset of diabetics with hypertension, use of ACE inhibitors declined with age (64.43% to 49.95%, P<0.001) while use of beta blockers increased with age (20.11% to 35.56%, P<0.001). Despite limitations of our study especially related to reasons for prescribing different drugs, we note that a large proportion of older patients are still prescribed with medications that potentially cause hypoglycaemia, in particular, sulphonylureas and beta-blockers. This finding is to remind doctors to proceed with caution in treating the elderly when treating the elderly with certain medications.