Abstrakt
The article by Bień presented the results of a cross-sectional study aimed to assess the prevalence of and reasons for medication-related harm (MRH) in geriatric patients, as well as to recognize how MRH and drugs prescribed after geriatric interventions affect patients' survival. The analysis of 301 geriatric patients admitted to the hospital for any reason combined with a 2-year survival analysis identified MRH in 35.2% of patients (hypotension [19.3%], hypoglycemia [13.3%], parkinsonism [4.3%], benzodiazepine addiction [5.7%], and other drug- or dosage-related disorders).
Following a geriatric intervention, 4 drug classes showed a positive correlation with survival: thiazides, selective serotonin reuptake inhibitors, paracetamol, and angiotensin-converting enzyme inhibitors. The author concluded that geriatric-based deprescribing and drug optimization mitigate the negative impacts of MRH on patients' survival and may reduce the rehospitalization rate and healthcare costs.
The study team collected and analyzed a large amount of data, leading to an interesting and important debate. Nevertheless, we would like to make a comment focused on hypoglycemia-related MR, which may contribute to a further and more detailed discussion of the issue.
The frequency of hypoglycemic episodes was analyzed in the whole group of patients with diabetes regardless of the type of diabetes and method of treatment (ie, sulfonylureas, metformin, or insulin, as stated by the author). It is known that the frequency of hypoglycemia is higher in patients with type 1 diabetes compared with those with type 2 diabetes treated with a similar insulin therapy.
Still, we may presume that the majority of patients in the study had type 2 diabetes. It also has been proven that the risk of hypoglycemia is much higher in insulin-treated patients with type 2 diabetes compared with those on oral antidiabetic drugs.
For example, the United Kingdom Prospective Diabetes Study 73 showed that patients treated with basal insulin reported hypoglycemia (3.8% per year) more often than those treated with diet (0.1%), sulfonylurea (1.2%), or metformin (0.3%), but less frequently than those treated with a multiple daily insulin regimen (5.3%). Thus, it would be interesting to inspect hypoglycemia-related MRH separately for insulin- and non-insulin-treated patients and, if possible, after excluding those with type 1 diabetes.
Such an analysis could detect the real contribution of insulin and oral antidiabetics to this MRH. With great respect, we suggest performing such an analysis or taking these comments into consideration if the continuation of this relevant study is planned.