A UK trial has seen pharmacists intervene for older patients with diabetes – and help 58% stop or reduce sulfonylureas
The medication review was part of NHS West Hampshire Clinical Commissioning Group’s push to assist GPs in reviewing frail patients who were taking multiple drugs, reports Pulse.
The pharmacists used GP practice databases to single out 618 people with type 2 diabetes aged 75 and over, with HbA1c levels of less than 53mmol/mol and who were taking sulfonylureas.
The patients had their diabetes medicines reviewed, their renal function and comorbidities examined.
As a result of the review, 255 people had their treatment with sulfonylureas stopped completely, and another 102 were given a lower dose; for the 261 remaining on their original treatment, further reviews have been recommended.
Pulse spoke to diabetes specialist University Hospitals Southampton consultant pharmacist Philip Newland-Jones, who said that the long-term benefits of tight glycaemic control in frail older patients were suspected to be lower than in younger patients.
“This intervention by CCG practice-based pharmacists is a perfect example of the clinical work that pharmacists undertake on a daily basis that has a direct beneficial impact on patient care,” he said.
The results follow those from another study published in the BMJ, which aimed to assess whether adding or switching to sulfonylureas is associated with an increased risk of myocardial infarction, ischaemic stroke, cardiovascular death, all cause mortality, and severe hypoglycaemia, compared with remaining on metformin monotherapy in patients with type 2 diabetes.
This study found that “sulfonylureas as second line drugs are associated with an increased risk of myocardial infarction, all cause mortality, and severe hypoglycaemia, compared with remaining on metformin monotherapy”.
“Continuing metformin when introducing sulfonylureas appears to be safer than switching.”