Pharmaceutical care and detection of severe iatrogenic hypoglycemia risk in elderly patients with diabetes mellitus

Abstract

Background: Diabetes in older adults was a critical health problem regarding global diabetes prevalence and the aging of the overall population is a significant driver of the diabetes epidemic Pharmaceutical care in diabetes management has shown benefits in this frail group Meanwhile drug-induced hypoglycemia was the most concerned complication in diabetes care of elderly patients Sequence symmetry analysis (SSA) is a case-only and within individual comparisons tool for signal detection Drugs with high hypoglycemia risk could be detected by this method efficiently Objective: This study aimed to investigate the effect of pharmaceutical care by conducting a randomized controlled trial to assess improvement of HbA1c levels and the change of medical expenses Meanwhile to assess hypoglycemia risk of drugs commonly used in elderly diabetic patients a sequence symmetry analysis was employed to detect the high risk non-antidiabetic drugs (hrNADDs) which were further verified by nested case control study Methods: We conducted a randomized controlled trial from August 2011 to February 2012 in Nantou Hospital Ministry of Health and Welfare Taiwan R O C 100 patients with type 2 diabetes with poor glycemic control (HbA1c levels of ?9 0%) and aged ?65 years were involved over 6 months Participants were randomly assigned to a standard-care (control n = 50) or pharmaceutical-care (intervention n = 50) group Pharmaceutical care was provided by a certified diabetes-educator pharmacist and HbA1c levels improvement and medical expenses were evaluated SSA and nested case control study were conducted using Longitudinal Health Insurance Databases of diabetes datasets established by the NHRI from 1999 to 2012 To evaluate the clinically important hypoglycemia risk after exposure antidiabetic drugs (ADDs) or high risk non-antidiabetic drugs (hrNADDs) in elderly diabetic patients Results: Randomized controlled trial demonstrated that a pharmacist intervention program providing pharmaceutical care services to poorly-controlled ambulatory elderly patients with DM could improve HbA1c levels while medical expenses were not significantly increased Drug-induced hypoglycemia in elderly diabetic patients could also be well-evaluated by SSA Our study results indicated that severe hypoglycemia was observed in one antipyretic (acetylsalicylic acid) two ?-blockers (propranolol and labetalol) two antibacterials (sulfamethoxazole/trimethoprim and chloramphenicol) two tetracyclines (doxycycline and minocycline) two antifungals (ketoconazole and fluconazole) three lipid-lowering drugs (bezafibrate gemfibrozil and fenofibrate) and two antidepressants (trazodone and venlafaxine) in elderly diabetic patients The nested case control study provided evidence that exposure to fibrates (fenofibrate bezafibrate and gemfibrozil) was found to be associated with higher odds of hypoglycemia Conclusion: Including pharmacists in multidisciplinary diabetes care teams and provide pharmaceutical care for elderly diabetic patients would be helpful in poorly-controlled ambulatory elderly patients with DM to improve control of HbA1c levels Drug-induced hypoglycemia was detected clinical significantly in 7 ADDs and 14 hrNADDs by SSA In population-based nested case-control study fibrates were significantly associated with hypoglycemia Prescribers should be cautious as severe hypoglycemia may occur after initiation of these high risk drugs to elderly diabetic patients

Date of Award	2016 Aug 3
Original language	English
Supervisor	Yea-Huei Kao (Supervisor)