Residents with dementia at higher risk of overtreatment for diabetes

Overtreating diabetes in aged care is most likely among residents who receive oral glucose-lowering medications, get assistance for activities of daily living or have dementia, a Monash University study has found.

The study, published in the Journal of the American Medical Directors Association, explored the prevalence, outcomes and factors associated with the overtreatment and undertreatment of type 2 diabetes through a systemic review of 15 international research papers.

It found the overtreatment of diabetes across the studies ranged from 5 per cent to 86 per cent and undertreatment ranged from 1.4 per cent to 35 per cent.

Co-author on the study Professor Simon Bell said overtreatment occurred more frequently in residents with dementia, residents who receive glucose lowering medications such as insulin and sulfonylurea, or residents that require more assistance with daily activities.

“Overtreatment occurred more frequently in certain types of people… there were potential implications, which was associated with having polypharmacy or multimorbidity and dementia, and that also increases the risk of adverse events,” Professor Bell told Australian Ageing Agenda.

He said 10 per cent to 35 per cent of aged care residents internationally have diabetes.

“It’s a common condition. But we also know that glucose lowering medicines such as insulin and sulfonylureas are high risk medications,” said Professor Bell, director of Monash University’s Centre for Medicine Use and Safety.

He said overtreating diabetes placed residents at risk of hypoglycaemia, which is low blood glucose.

“Hyperglycaemia can also be an issue and both [hypoglycemia] and hyperglycemia can be associated with unplanned hospitalisations,” Professor Bell said

“We would advocate an approach that’s focused on minimising hypoglycemia,” he said.

No studies reported factors associated with potential undertreatment, the report said.

The study also found wide variations in the definitions of overtreatment and undertreatment of diabetes.

“If there was a uniform or consensus definition of over and under treatment, that would help us to estimate the size of this issue,” Professor Bell said.

The findings of the study highlight the need to adjust diabetes management to the right setting, including in aged care, he said.

“The findings highlight the importance of regularly reviewing resident’s medication regimens to ensure they’re consistent with each resident’s goal of care,” he said.

“In the context of residents who may be frail or have dementia and therefore susceptible to adverse events, it’s very important that we adjust the management of diabetes and we should really individualise that management to that person,” Professor Bell said.

Aged care providers should conduct regular medication reviews “to ensure that the residents medication regimens are the most appropriate,” he said.

Lead researcher of the study, pharmacist and CMUS PhD student Jacquelina Stasinopoulos is undertaking further research on the undertreatment and overtreatment of diabetes in residential aged care.

Access the paper.

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