Glucose Lowering Medicines and Older People with Diabetes: The Importance of Comprehensive Assessments and Pharmacovigilance

Abstract

Diabetes is a chronic incurable disease of high prevalence in older people due to changes in glucose homeostasis, diabetes-related complications and other comorbidities that affect physical and cognitive functioning and have implications for medicines use. Polypharmacy is common and represents a significant medicine and self-care burden, risk of medicine-related adverse events, and inappropriate prescribing. Some medicines used to treat diabetes such as insulin, sulphonylureas, warfarin and antiplatelet agents are known as 'high risk' medicines because of their association with adverse events. Managing medicines is a complex process that requires particular knowledge and skills and strategies to proactively identify risks and plan care to reduce the risk such as following evidence based recommendations/ guidelines, comprehensive assessment and monitoring, using decision support tools such as BEERs, STOPP and START criteria, and importantly, involving the individual and/or carers in medicine decisions to personalise medicines education and the medicine regimen.