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Physicians’ and Pharmacists’ Clinical Considerations for Elderly Patients with Type 2 Diabetes Mellitus: The IMPLICA2 Study

  • Josep Franch-Nadal
  • Fermín García-Gollarte
  • Alfonso Pérez del Molino
  • María L. Orera-Peña
  • Marta Rodríguez de Miguel
  • Malena Melogno-Klinkas
  • Héctor D. de Paz
  • Susana Aceituno
  • Patricia Rodríguez-Fortúnez
Original Research Article
  • 3 Downloads

Abstract

Background

Management of elderly patients with type 2 diabetes mellitus (T2DM) is complex due to their age-related conditions. Several clinical guidelines provide specific recommendations for management of these patients but little is known about their implementation in clinical practice.

Objective

To describe physician and community pharmacist perceptions and routine clinical practice in the management of elderly T2DM patients.

Methods

Cross-sectional study.

Results

A total of 993 physicians and 999 community pharmacists completed the questionnaire. More physicians than pharmacists agreed on the need to establish more flexible HbA1c targets for elderly (79.4% vs. 30.6%; p < 0.001) and frail (92.6% vs. 31.4%; p < 0.001) patients than for the general diabetic population. HbA1c targets < 7.5% for elderly patients and < 8.5% for frail patients (as recommended by the principle guidelines) were set by 38.9% and 28.7% of physicians, respectively. Furthermore, 62.8% of physicians stated they follow guideline recommendations but, based on their prescription decisions for hypothetical patients, less than 50% were aligned with them. In addition, 73.1% of physicians monitor treatment adherence, mainly by using dispensing control (59.1%). Specific nutritional approaches for elderly patients are provided by 62.9% of physicians and 56.0% of pharmacists, whilst 57.4% and 21.7%, respectively, deliver specific physical exercise programs.

Conclusions

Low adherence to guideline recommendations (i.e. setting more stringent HbA1c targets or delaying treatment intensification) may lead to suboptimal glycaemic control in elderly patients. The standardization of processes, extensive monitoring of patient treatment adherence and providing advice regarding specific personal lifestyle habits may improve the management of elderly T2DM patients.

Notes

Acknowledgements

The authors acknowledge the physicians and pharmacist who took part in this study. They also acknowledge Ana López (Mylan Medical Department), Mariona Lería (Medical Department Head/Product Safety and Risk Management) and Outcomes’10 for their support in coordinating the study.

Compliance with Ethical Standards

Funding

This study was funded by BGP Product Operations S.L (Mylan).

Conflict of interest

JFN, FGG and APM, state they have no conflicts of interest. LOP, PRF, MRM and MMK are Mylan employees. HDP and SA work for an independent research organisation (Outcomes’10, S.L.), which has received fees for its contribution to the development and coordination of the project and to the writing of this manuscript.

Ethical approval

This article does not contain any studies involving human participants or animals performed by any of the authors.

Informed consent

All participants received adequate information regarding the study and agreed to participate in it.

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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Josep Franch-Nadal
    • 1
    • 2
  • Fermín García-Gollarte
    • 3
  • Alfonso Pérez del Molino
    • 4
  • María L. Orera-Peña
    • 5
  • Marta Rodríguez de Miguel
    • 5
  • Malena Melogno-Klinkas
    • 5
  • Héctor D. de Paz
    • 6
  • Susana Aceituno
    • 6
  • Patricia Rodríguez-Fortúnez
    • 5
  1. 1.CAP Drassanes Raval-SudBarcelonaSpain
  2. 2.CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM)MadridSpain
  3. 3.Ballesol Mediterráneo Nursing Home GroupValenciaSpain
  4. 4.Hospital of SierrallanaCantabriaSpain
  5. 5.Medical Affairs at MylanMadridSpain
  6. 6.Outcomes’10CastellónSpain

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