Examining inappropriate medication in UK primary care for type 2 diabetes patients with polypharmacy

Aims To estimate the prevalence of potentially inappropriate prescriptions (PIPs) in patients starting their first non-insulin antidiabetic treatment (NIAD) using two explicit process measures of the appropriateness of prescribing in UK primary care, stratified by age and polypharmacy status. Methods A descriptive cohort study between 2016 and 2019 was conducted to assess PIPs in patients aged ≥45 years at the start of their first NIAD, stratified by age and polypharmacy status. The American Geriatrics Society (AGS) Beers criteria 2015 was used for older (≥65 years) and the Prescribing Optimally in Middle-age People’s Treatments (PROMPT) criteria for middle-aged (45-64 years) patients. Prevalence of overall PIPs and individual PIPs criteria was reported using the IQVIA Medical Research Data incorporating THIN, a Cegedim Database of anonymised electronic health records in the UK. Results Among 28,604 patients initiating NIADs, 18,494 (64.7%) received polypharmacy. In older and middle-aged patients with polypharmacy, 39.6% and 22.7%, respectively, received ≥1 PIPs. At the individual PIPs level, long-term PPI use and strong opioid without laxatives were the most frequent PIPs among older and middle-aged patients with polypharmacy (11.1% and 4.1%, respectively). Conclusions This study revealed that patients starting NIAD treatment receiving polypharmacy have the potential for pharmacotherapy optimisation.