Deprescribing oral antidiabetics in elderly patients: Do electronic leaflets across the world address it?

IF 1.8 Q3 PHARMACOLOGY & PHARMACY

Exploratory research in clinical and social pharmacy Pub Date : 2024-11-01 DOI:10.1016/j.rcsop.2024.100537

Kitete Tunda Bunnel, Silvio José Elisei Carvalho Jr, Mariana Linhares Pereira, Renê Oliveira Couto, André Oliveira Baldoni

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引用次数: 0

Abstract

Diabetes caused 6.7 million deaths in 2021, equating to one death every five seconds, with its global financial burden projected to rise from $1.32 trillion in 2015 to $2.12 trillion by 2030. Severe hypoglycemia necessitates interventions like deprescribing, behavioral strategies, and technology for prevention. Deprescribing aims to reduce unnecessary medication use, enhance rational prescribing, prevent prescribing cascades, and improve health outcomes in elderly patients. Evaluating electronic leaflets can support deprescribing based on patient-centered care and shared decision-making.

Objective

To analyze information on deprescribing in oral antidiabetic leaflets from national medicines regulatory authorities, focusing on elderly patients with type 2 diabetes.

Methods

This documental study analyzed electronic leaflets of oral antidiabetics from the official websites of nine Medicines Regulatory Authorities: Australia, Brazil, Canada, New Zealand, Singapore, South Africa, UK, USA, and EU, covering drugs listed in the WHO's Essential Medicines List 2023. The analysis focused on the alignment of deprescribing information with the Ontario deprescribing algorithm for oral antidiabetics developed by the Bruyère Institute in Canada.

Results

Out of 72 expected leaflets, 64 (88.9 %) were retrieved. Only 18 leaflets (28.1 %) explicitly discussed deprescribing oral antihyperglycemics. Hypoglycemia and drug interaction risks were addressed in 55 leaflets (85.9 %). Caution for use in patients over 65 was mentioned in 32 leaflets (50 %), and 23 leaflets (35.9 %) addressed the risks of tight glucose and HbA1c targets.

Conclusion

Despite a high retrieval rate, 11.1 % of leaflets were missing, and those available contained inconsistent deprescribing information. There are significant disparities in guidance across regulatory authorities. Standardized, updated leaflets that address deprescribing in frail older patients could enhance prescribers' confidence and support shared decision-making

查看原文本刊更多论文

老年患者口服抗糖尿病药物的处方减少：世界各地的电子宣传单是否解决了这一问题？

2021 年，糖尿病导致 670 万人死亡，相当于每 5 秒钟就有一人死亡，其全球经济负担预计将从 2015 年的 1.32 万亿美元增至 2030 年的 2.12 万亿美元。严重低血糖需要采取干预措施，如取消处方、行为策略和技术预防。取消处方旨在减少不必要的用药，提高处方的合理性，防止处方连环效应，改善老年患者的健康状况。评估电子宣传页可支持基于以患者为中心的护理和共同决策的去处方化。目的分析各国药品监管机构提供的口服抗糖尿病药物宣传页中有关去处方化的信息，重点关注 2 型糖尿病老年患者：澳大利亚、巴西、加拿大、新西兰、新加坡、南非、英国、美国和欧盟九个药品监管局的官方网站上的口服抗糖尿病药物电子说明书进行了分析，涵盖了世界卫生组织《2023 年基本药物目录》中列出的药物。分析的重点是处方信息与加拿大布鲁耶尔研究所开发的安大略省口服抗糖尿病药处方算法的一致性。只有 18 份宣传单（28.1%）明确讨论了口服降糖药的停药问题。55 份宣传页（85.9%）涉及低血糖和药物相互作用风险。尽管检索率很高，但仍有 11.1% 的宣传单张丢失，而且现有宣传单张中的处方信息也不一致。各监管机构在指导方面存在很大差异。针对老年体弱患者去处方化问题的标准化最新宣传单可增强处方者的信心并支持共同决策。

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