Residents at risk

Aged care residents with type 2 diabetes are potentially being overtreated – or missing out on treatment altogether

A new international study led by Monash’s Centre for Medicine Use and Safety, published in the Journal of the American Medical Directors Association, has synthesised data from 15 studies published around the world in the last 20 years.

It found that potential overtreatment was more likely among residents with dementia who received insulin and sulfonylurea medications, residents with advanced dementia, and those requiring more assistance with daily activities.

The proportion of residents potentially overtreated ranged from 5% to 86%, while the proportion undertreated ranged from 1.4% to 35%.

There was wide variation across geographical locations and individual aged care facilities, where up to a third of residents have diabetes.

Lead author, pharmacist and CMUS PhD candidate Jacquelina Stasinopoulos, who also holds a degree in nutrition and dietetics, said, “Our study findings highlight the complex nature of diabetes management in residential aged care”.

“Potential overtreatment places residents at risk of hypoglycaemia which can lead to falls and hospitalisations among frail older people.

“Diabetes medications are among the medication classes most frequently implicated in preventable hospitalisations.

“Potential undertreatment was less common than overtreatment although fewer studies have investigated undertreatment.

“Individualised diabetes management plans are particularly important for residents, and there is a need for more comprehensive research to guide clinical decision-making for frail residents in this setting.”

Ms Stasinopoulos says she now plans to work with University of South Australia Senior Research Fellow and CMUS Adjunct Research Fellow Dr Janet Sluggett, CMUS Director Professor Simon Bell, and a group of international researchers through the Optimizing Geriatric Pharmacotherapy through Pharmacoepidemiology Network (OPPEN) to further explore this topic.

Ms Stasinopoulos is a recipient of the Cyril Tonkin Scholarship for PhD research at the Faculty of Pharmacy and Pharmaceutical Sciences, Monash University. The Scholarship recognises and supports an outstanding pharmacy or pharmaceutical sciences graduate who undertakes postgraduate research to advance science and clinical practice.

The present study was conducted in collaboration with the Department of Epidemiology and Preventive Medicine, Monash University; Department of General Practice; The University of Melbourne; Helping Hand Aged Care; and the UniSA Allied Health and Human Performance, University of South Australia.

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