Inappropriate prescribing in elderly people with diabetes admitted to hospital.
OBJECTIVE
To assess inappropriate prescribing in older people with diabetes mellitus during the month prior to a hospitalization, using tools on potentially inappropriate medicines (PIMs) and potential prescribing omissions (PPOs) and comparing inappropriate prescribing in patients with without diabetes.


METHODS
In an observational, prospective multicentric study, we assessed inappropriate prescribing in 672 patients aged 75 years and older during hospital admission. The Beers, Screening Tool of Older Person's Prescriptions (STOPP) and Screening Tool to Alert Doctors to Right Treatment (START) criteria and Assessing Care of Vulnerable Elders (ACOVE-3) medicine quality indicators were used. We analysed demographic and clinical factors associated with inappropriate prescribing.


RESULTS
Of 672 patients, 249 (mean age 82.4 years, 62.9% female) had a diagnosis of diabetes mellitus. The mean number of prescribing drugs per patient with diabetes was 12.6 (4.5) vs. 9.4 (4.3) in patients without diabetes (P < 0.001). Of those patients with diabetes, 74.2% used 10 or more medications; 54.5% of patients with diabetes had at least one Beers-listed PIM, 68.1% had at least one STOPP-listed PIM, 64.6% had at least one START-listed PPO and 62.8% had at least one ACOVE-3-listed PPO. Except for the Beers criteria, these prevalences were significantly higher in patients with diabetes than in those without. After excluding diabetes-related items from these tools, only STOPP-listed PIMs remained significantly higher among patients with diabetes (P = 0.04).


CONCLUSIONS
Polypharmacy is common among older patients with diabetes mellitus. Inappropriate prescribing is higher in older patients with diabetes, even when diabetes-related treatment is excluded from the inappropriate prescribing evaluation.
Internal Medicine Service, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain.|Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain.
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http://orcid.org/0000-0002-3587-298X
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Formiga
Clinical Pharmacology Service, Fundació Institut Català de Farmacologia, Hospital Universitari Vall D'Hebron, Barcelona, Spain.|Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Vidal
Clinical Pharmacology Service, Fundació Institut Català de Farmacologia, Hospital Universitari Vall D'Hebron, Barcelona, Spain.|Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Agustí
Internal Medicine Service, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain.|Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain.
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Chivite
Internal Medicine Service, Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain.
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Rosón
Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain.|Internal Medicine Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain.|Universitat Autònoma de Barcelona, Barcelona.
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Barbé
Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain.|Internal Medicine Service, Hospital Clínic, Barcelona, Spain.
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López-Soto
Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain.|Internal Medicine Service, Hospital Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
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OH
Torres
Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain.|Internal Medicine Service, Hospital San Juan De Dios del Aljarafe, Seville, Spain.
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Fernández-Moyano
Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain.|Internal Medicina Service, Hospital General Juan Ramón Jiménez, Huelva, Spain.
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García
Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain.|Internal Medicine Service, Hospital Universitario Virgen del Rocío, Seville, Spain.
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Ramírez-Duque
Multimorbidity and Elderly Patients Group of the Spanish Society of Internal Medicine, Barcelona, Spain.|Internal Medicine Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain.|Universitat Autònoma de Barcelona, Barcelona.
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San José
D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D015331:Cohort Studies; D015897:Comorbidity; D019049:Developed Countries; D048909:Diabetes Complications / Q000188:drug therapy* / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D057286:Electronic Health Records; D005260:Female; D006760:Hospitalization; D006801:Humans; D057970:Inappropriate Prescribing; D007388:Internal Medicine; D008297:Male; D059065:Medication Reconciliation; D019338:Polypharmacy; D011320:Primary Health Care; D011446:Prospective Studies; D013030:Spain / Q000453:epidemiology