Abstract
Introduction
There has been a recent shift in guidelines regarding HbA1c targets in the frail population. NICE (June 2022) advocate individualised HbA1c targets for frail patients with diabetes in circumstances where the long-term benefit is uncertain or when a tight glycaemic control would increase the risk of poor clinical outcomes. This is backed up by randomised control trials that have showed that Hba1c levels < 53 mmol/mol (7%) because of anti-hyperglycaemic therapy are associated with increased morbidity and mortality in frail patients with diabetes.
This led us to explore the current standards with regards to HbA1c review and consequent anti-hyperglycaemic deprescribing in frail patients in Hereford County Hospital.
Methods
Two audit cycles have been completed from March - June 2024 with a total sample size of 28 patients. Inclusion criteria were patients aged over 65 with a history of diabetes and a Rockwood Frailty score of 5 or more.
Results
The results of the first cycle showed that only 20% of the study group had their HbA1c reviewed. Only one had evidence of de-prescribing considerations. After the first cycle, a poster was created highlighting the importance of considering deprescribing for frail patients. The results of the second cycle indicated improvements following the poster display with 22% of the study population having had their HbA1c reviewed with subsequent considerations to de-prescribe. Furthermore, the poster generated positive informal feedback and stimulated conversations with colleagues about deprescribing.
Discussion and conclusion
For frail diabetic patients presenting to the Emergency department, deprescribing their diabetic medications is often not considered. They may be on medications that could be potentially causing more harm than benefit. Staff education appears to have a positive benefit, but more work needs to be done to ensure that deprescribing is considered for these patients.
Comments
Poster on deprescribing oral hypoglycaemias in type 2 dm
Informative and well presented poster.
Raises awareness of a very important issue.
excellent!