Our project was undertaken to support primary care diabetes teams in working with patients to optimise prescribing through implementation of NICE guidelines to adapt an individualised approach to diabetes care considering the need for relaxed individualised HbA1c targets for older people with frailty balancing the drive for tight glycaemic targets and prevention of harm.
As a result of our pharmacist led reviews, 55% (n= 238) of patients had a blood glucose lowering agent stopped. 45% (n=198) of patients had a medication change whereby the blood glucose lowering agent was continued, but at a lowered dose. 541 medication optimisation recommendations not relating to blood glucose management were also made. Of the elderly patients reviewed, 60% (n=204) were found to have a recent HbA1c of ≤48mmol/mol, of which 19% (n=66) had an HbA1c ≤ 42mmol/mol. All these patients were receiving blood glucose lowering therapies.
Through undertaking holistic polypharmacy reviews, there was the opportunity to review inappropriate prescribing and rationalise therapy. This reduced the potential for harm from inappropriate polypharmacy, improved patient safety and providing financial benefits to the health economy, (e.g. preventing an admission to hospital owing to hypoglycaemia) and the prescribing budget.
