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




Philip, Timothy
Cantu, Ramon
Hadley, Lesca
Gibson, John


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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.