Comorbidity in the elderly with diabetes: Identification of areas of potential treatment conflicts

Caughey, Gillian E.; Roughead, Elizabeth E.; Vitry, Agnes I.; McDermott, Robyn A.; Shakib, Sepehr; Gilbert, Andrew L.

doi:10.1016/j.diabres.2009.10.019

« Previous Next »Diabetes Research and Clinical Practice
Volume 87, Issue 3 , Pages 385-393, March 2010

Comorbidity in the elderly with diabetes: Identification of areas of potential treatment conflicts

Gillian E. Caughey
- Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Australia
- Corresponding author at: Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide 5001, Australia. Tel.: +61 8 8302 1749; fax: +61 8 8302 1087.
Elizabeth E. Roughead
- Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Australia
Agnes I. Vitry
- Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Australia
Robyn A. McDermott
- Division of Health Sciences, University of South Australia, Australia
Sepehr Shakib
- Department of Clinical Pharmacology, Royal Adelaide Hospital and Department of Clinical Pharmacology, University of Adelaide, Australia
Andrew L. Gilbert
- Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Australia

Received 29 June 2009; received in revised form 13 October 2009; accepted 26 October 2009. published online 18 November 2009.

Abstract

Aims

To investigate the prevalence of comorbid conditions in the elderly with diabetes and the prescribing of potentially inappropriate medicines or treatment conflicts.

Methods

A cross-sectional study of diabetics aged ≥65 years, using prescription dispensing data from the Australian Department of Veterans’ Affairs. Comorbidities were determined using the comorbidity index Rx-Risk-V. Potentially inappropriate prescribing or treatment conflicts specific for the elderly were determined from guidelines or reference compendia, in addition to the 2003 updated Beers criteria.

Results

Of 18,968 diabetics, the median number of comorbidities was 5 (IQR 3–8). Diabetes and associated cardiovascular medicines accounted for 41.9% of all medicine use. Associated cardiovascular diseases were highly prevalent comorbidities. 46% had gastro-oesophageal reflux disease, 25% depression, 20% chronic airways disease or chronic pain and 15% also had heart failure or inflammation-pain. At least 16% were dispensed a medicine associated with adverse effects in patients with diabetes and 22.7% were dispensed at least one potentially inappropriate medicine.

Conclusion

Significant comorbid conditions in elderly diabetic patients with potential for inappropriate prescribing or treatment conflicts include arthritis, heart failure, chronic airways diseases and diseases treatable with systemic corticosteroids. Appropriate management of comorbidity should be included in guidelines for the elderly with diabetes.

Keywords: Diabetes, Comorbidity, Inappropriate prescribing, Elderly, Polypharmacy