(P-187) Potentially Inappropriate Medication Use in Older Hospitalized Patients with Type 2 Diabetes: A Cross-sectional Study

Background: Older patients with type 2 diabetes mellitus (T2DM) are at greater risk of receiving potentially inappropriate medications (PIM) during hospitalization which may result in adverse outcomes . However, no studies have applied the updated 2019 Beers Criteria to identify PIM use in older patients with T2DM.

Objectives: To evaluate the extent of PIM use begun in hospital in the older population with T2DM during hospitalization in a tertiary care hospital in India.

Methods: A cross-sectional study was conducted from August 2019 to January 2020 in a tertiary care teaching hospital in India. The study included older patients aged > 65 years with T2DM, hospitalized due to various health complications in the internal medicine ward. We included those older patients who provided written informed consent, admitted for more than one day, and with underlying T2DM. Patients aged < 65 years of age, those who were not diagnosed with T2DM, and those who were not willing to give informed consent were excluded from the study. Patient demographic details and clinical data such as patient history, the presence of different comorbidities, prescribed medications hospital length of stay, laboratory test reports, and radiological examinations were obtained from the patient medical record, using a pre-designed data collection form. Medications prescribed during hospitalization were reviewed following Beers Criteria 2019 to identify the extent of polypharmacy and PIM use. The predictors of PIM prescribing, including socio-demographic variables such as age, gender, number of medications, length of hospital stay, and creatinine clearance of older patients, were assessed using binary logistic regression.

Results: The mean age ± standard deviation of the 150 patients hospitalized with T2DM was 68.85 ± 5.51 years, and over half were men (54.7%). The median number of diagnoses was four and were receiving an average of nine medications per day; the median length of hospital stay was 8 days (interquartile range (IQR): 4–19 days). Overall, three quarters (74%) of the participants had at least one PIM prescribed during their hospitalization as per Beers Criteria. In our study, the most commonly prescribed PIMs were human insulin according to random blood sugar, proton pump inhibitors, glimepiride, enoxaparin and ranitidine. Significant factors associated with the use of PIM during hospitalization are ≥10 medications per day (odds ratio (OR): 7.85, 95% CI 1.49–41.10), lower creatinine clearance values (OR: 12.90, 95% CI 2.81–59.28) and female sex (OR: 2.29; 95% CI: 1.05–4.97).

Conclusions: PIM use is frequently observed in older T2DM patients during hospitalization. Polypharmacy, reduced renal function and female gender are associated with higher likelihood of PIM use.