title: Comorbidity in the elderly with diabetes: Identification of areas of potential treatment conflicts.
abstract: OBJECTIVE
  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 >or=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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Australia. gillian.caughey@unisa.edu.au <gillian.caughey@unisa.edu.au>
authors.forename: Gillian E
authors.initials: GE
authors.lastname: Caughey
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Roughead
authors.forename: Agnes I
authors.initials: AI
authors.lastname: Vitry
authors.forename: Robyn A
authors.initials: RA
authors.lastname: McDermott
authors.forename: Sepehr
authors.initials: S
authors.lastname: Shakib
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Gilbert
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000453:epidemiology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000453:epidemiology*; D004347:Drug Interactions; D011307:Drug Prescriptions; D005260:Female; D006306:Health Surveys; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D008508:Medication Errors; D019338:Polypharmacy; D010818:Practice Patterns, Physicians' / Q000592:standards; D015995:Prevalence
chemical_list: D007004:Hypoglycemic Agents