Diabetes therapy in geriatric patients requires consideration of frailty, comorbidities, function, and life expectancy. With progressive age and frailty, the goals of diabetic management shift from strict glycaemic control towards preventing extremes of hyperglycaemia and hypoglycaemia. Inpatient audits are an opportunity to review diabetes therapy in this population cohort.
This prospective audit aimed to review diabetes medication profiles in geriatric patients and observe prescribing and de-prescribing trends during inpatient admission.
Patients discharged from the Concord Hospital Geriatric Medicine service in May 2024 with any type of diabetes were prospectively included. Patients on end-of-life care pathways were excluded. Data was collected from electronic medical records, including demographics, medical history, and diabetes medications before and upon discharge.
Fifty patients with a mean age of 84.5±6.8 years and a mean length of stay of 22.4±59.9 days were included. The mean HbA1c was 7.24±1.52%. Most patients had type 2 diabetes (98%). 20% of patients had insulin on admission, and half of this group had changes to their insulin during admission, most commonly reduced dose. 64% of patients had at least one oral hypoglycaemic agent (OHA) on admission, which decreased to 62% on discharge. Changes to OHAs were observed in 30% of patients during admission. The most commonly de-prescribed OHAs were metformin and sulfonylureas, occurring in three cases each. DPP4i was newly prescribed for four patients. On admission, 42% were on monotherapy for diabetes and 22% were on no diabetes medications, whilst on discharge, 40% were on monotherapy and 26% were on no medications. Patients with renal impairment (eGFR<30mL/min/1.73m2) had higher rates of insulin use compared to patients with eGFR>30mL/min/1.73m2 (45% vs 15%).
De-prescribing of metformin and sulfonylureas was observed, while DPP4i was the preferred agent of new prescription. There was overall a low rate of polypharmacy in this cohort with well-controlled diabetes.