Prescription appropriateness of anti-diabetes drugs in elderly patients hospitalized in a clinical setting: evidence from the REPOSI Register

Succurro E.;Novella A.;Nobili A.;Giofre F.;Arturi F.;Sciacqua A.;Andreozzi F.;Pietrangelo A.;Sesti G.;Perticone F.;Violi F.;Corrao S.;Marengoni A.;Tettamanti M.;Pasina L.;Franchi C.;Franchi C.;Miglio G.;Ardoino I.;Cantiero S.;Prisco D.;Silvestri E.;Emmi G.;Bettiol A.;Mattioli I.;Mazzetti M.;Biolo G.;Zanetti M.;Bartelloni G.;Zaccari M.;Chiuch M.;Martini I.;Pirro M.;Lupattelli G.;Bianconi V.;Alcidi R.;Giotta A.;Mannarino M. R.;Girelli D.;Busti F.;Marchi G.;Barbagallo M.;Dominguez L.;Beneduce V.;Cacioppo F.;Corrao S.;Natoli G.;Mularo S.;Raspanti M.;Argano C.;Cavallaro F.;Zoli M.;Orio G.;Magnolfi E.;Serafini G.;Brunori M.;Lazzari I.;Simili A.;Fabio G.;De Amicis M. M.;Luca G.;Scaramellini N.;Stefano V.;Leoni S.;Seghezzi S.;Di Mauro A. D.;Maira D.;Mancarella M.;Lucchi T.;Clerici M.;Leoni S.;Bonini G.;Conti F.;Prolo S.;Fabrizi M.;Martelengo M.;Vigani G.;Nicolini P.;Sabatino A.;Miceli E.;Pisati M.;Pitotti L.;Antoci V.;Cambie G.;Pitotti L.;Antoci V.;Pontremoli R.;Beccati V.;Nobili G.;Leoncini G.;Alberto J.;Cattaneo F.;Anastasio L.;Sofia L.;Carbone M.;Cipollone F.;Rossi I.;Valeriani E.;D'Ardes D.;Cipollone A.;Esposito L.;Sestili S.;Angelucci E.;Mancuso G.;Calipari D.;Bartone M.;Manetti R.;Sircana M.;Berria M.;Delitala A.;Muscaritoli M.;Molfino A.;Petrillo E.;Giorgi A.;Gracin C.;Imbimbo G.;Romanelli G.;Volpini A.;Lucente D.;Manzoni F.;Pirozzi A.;Zucchelli A.;Geneletti T.;Picardi A.;Bellelli G.;Corsi M.;Antonucci C.;Sidoli C.;Principato G.;Bonfanti A.;Szabo H.;Mazzola P.;Piazzoli A.;Corsi M.;Tassone B.;De Falco A. B. T.;Negro E.;Brenna M.;Trotta L.;Fabris F.;Bertozzi I.;Bogoni G.;Prandini T.;Ratti F.;Zurlo C.;Cerruti L.;Cosi E.;Reni E.;Manfredini R.;Boari B.;Giorgi A.;Tiseo R.;Savrie C.;Fabbian F.;Paolisso G.;Catalano C.;Meo I.;Sabba C.;Suppressa P.;De Vincenzo G. M.;Comitangelo A.;Amoruso E.;Custodero C.;Re G.;Barnaba I.;Schilardi A.;Fenoglio L.;Falcetta A.;D'Aniano S.;Tiraboschi S.;Cespiati A.;Oberti G.;Sigon G.;Cinque F.;Colavolpe L.;Curra J.;Alletto F.;Scaramellini N.;Leoni S.;Di Mauro A. D.;Benzoni G.;Peyvandi F.;Rossio R.;Colombo G.;Agosti P.;Pagliaro E.;Semproni E.;Canetta C.;Monzani V.;Savojardo V.;Ceriani G.;Folli C.;Tognin T.;Purrello F.;Pino A.;Piro S.;Rozzini R.;Falanga L.;Boffelli S.;Ferrandina C.;Mazzeo F.;Spazzini E.;Cono G.;Cesaroni G.;Perri L.;Guasti L.;Rotunno F.;Castiglioni L.;Maresca A.;Squizzato A.;Campiotti L.;Grossi A.;Dentali F.;Behnke V.;Perticone M.;Maio R.;Scozzafava A.;Condoleo V.;Clausi E.;Armentaro G.;Panza A.;Condoleo V.;Stanghellini V.;Ruggeri E.;Vecchio S.;Benzoni I.;Minisola S.;Colangelo L.;Cilli M.;Labbadia G.;Pepe J.;Castellino P.;Zanoli L.;Gaudio A.;Xourafa A.;Spichetti C.;Torre S.;Gennaro A.;Ballestrero A.;Ferrando F.;Gonella R.;Cerminara D.;Setti P.;Traversa C.;Scarsi C.;Famularo G.;Tarsitani P.;Morretti T.;Aglitti A.;Giacco S.;Firinu D.;Costanzo G.;Chessa S.;Montalto G.;Licata A.;Rizzo A.;Corica F.;Basile G.;Catalano A.;Bellone F.;Principato C.;Cocuzza A.;Mecocci P.;Ruggiero C.;Boccardi V.;Meschi T.;Ticinesi A.;Nouvenne A.;Pirisi M.;Sola D.;Bellan M.;Quadri R.;Larovere E.;Novelli M.;Simeone E.;Scurti R.;Tolloso F.;Tarquini R.;Valoriani A.;Dolenti S.;Vannini G.;Volpi R.;Bocchi P.;Vignali A.;Harari S.;Lonati C.;Napoli F.;Aiello I.;Salvatore T.;Monaco L.;Ricozzi C.;Coviello F.;Catalini C.;Pilotto A.;Indiano I.;Gandolfo F.;Gonella D.;Nuti R.;Valenti R.;Ruvio M.;Cappelli S.;Palazzuoli A.;Durante V.;Tirotta D.;Eusebi G.;Tresoldi M.;Bozzolo E.;Damanti S.;Porta M.;Gino M.;Pari B.;Pace E.

2023-01-01

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Abstract

Diabetes is an increasing global health burden with the highest prevalence (24.0%) observed in elderly people. Older diabetic adults have a greater risk of hospitalization and several geriatric syndromes than older nondiabetic adults. For these conditions, special care is required in prescribing therapies including anti- diabetes drugs. Aim of this study was to evaluate the appropriateness and the adherence to safety recommendations in the prescriptions of glucose-lowering drugs in hospitalized elderly patients with diabetes. Data for this cross-sectional study were obtained from the REgistro POliterapie–Società Italiana Medicina Interna (REPOSI) that collected clinical information on patients aged ≥ 65 years acutely admitted to Italian internal medicine and geriatric non-intensive care units (ICU) from 2010 up to 2019. Prescription appropriateness was assessed according to the 2019 AGS Beers Criteria and anti-diabetes drug data sheets.Among 5349 patients, 1624 (30.3%) had diagnosis of type 2 diabetes. At admission, 37.7% of diabetic patients received treatment with metformin, 37.3% insulin therapy, 16.4% sulfonylureas, and 11.4% glinides. Surprisingly, only 3.1% of diabetic patients were treated with new classes of anti- diabetes drugs. According to prescription criteria, at admission 15.4% of patients treated with metformin and 2.6% with sulfonylureas received inappropriately these treatments. At discharge, the inappropriateness of metformin therapy decreased (10.2%, P < 0.0001). According to Beers criteria, the inappropriate prescriptions of sulfonylureas raised to 29% both at admission and at discharge. This study shows a poor adherence to current guidelines on diabetes management in hospitalized elderly people with a high prevalence of inappropriate use of sulfonylureas according to the Beers criteria.