QI project to reduce prescription of high risk medications for type 2 diabetes in patients over 65 years old

Purpose Patients over the age of 65 are at risk of hypoglycemia, which can increase risk of death. The objective of this project is to change high-risk medication (HRM) prescription, in diabetic patients over 65 years old, of long-term sulfonylureas or sliding-scale insulin to medication with less risk of hypoglycemia. Methods Patients over 65 years with non-HRM and HRM diabetes medications prescribed to them were identified. Post-exam, a recommendation was made to change medication from HRM to non-HRM. Results of the encounter will be recorded in data tables. Results After the implementation, only 1 out of 3 possible patients on Glimepiride was changed to an anti-diabetic medication that was not an HRM. This particular patient was prescribed basal-bolus insulin to replace the glimepiride. Conclusions One obstacle in preventing a change from Glimepiride to a non-HRM was cost. Therefore, due to cost of medication, socioeconomic status of the patient, and number of other medications, most patients declined a change. One patient denied the change because he was well-controlled on glimepiride for years. Although the data suggests lower rates of prescribing HRMs, this however is due to natural variability within the patient population and not a significant change caused by the enhancement.