Prescribing of antidiabetic medicines to older diabetes type 2 patients in Lagos, Nigeria

Abstract

Background: The incidence of diabetes mellitus in older adults is increasing in Lagos and other parts of Nigeria but there is paucity of information on the use of medicines in this group of patients.

Objective: A survey was therefore carried out to determine the prevalence of potentially inappropriate prescribing of antidiabetic medications to older diabetes adults in Lagos, Nigeria.

Methods: A convenient sample of physicians working in seven health care facilities in Lagos were surveyed using a self-administered pre-tested questionnaire to determine the medications they often prescribed for diabetes patients older than 50 years, whether they consider dosage reduction in these patients, and the counselling information they provide to the patients. AGS 2012 Beer's criteria were used to determine potentially inappropriate medication (PIM) for the patients. Factors associated with the tendency to prescribe inappropriately were then evaluated using logistic regression analyses.

Results: Glibenclamide, metformin , and metformin/glimepiride combination were regularly prescribed by 45.64–87.25% of the physicians but gliclazide, pioglitazone, pioglitazone/metformin and pioglitazone/glimepiride combinations were prescribed occasionally by 41.61–61.74% of them. Majority of the physicians (87.25%) prescribe glibenclamide to the older patients and do not also always consider dosage reduction on account of older age. Some of these (30.2%) of these physicians equally prescribed chlorpropamide to the patients. Postgraduate qualification was the only significant factor associated with prescription of chlorpropamide (p < 0.05).

Conclusion: Inappropriate use of chlorpropamide and glibenclamide, and failure to consider dosage reduction on account of older age have been reported by physicians treating older diabetes patients in Lagos. This calls for continuous education of physicians in Lagos as well as in other parts of Nigeria to promote rational use of antidiabetic medications in the country.

Keywords: Diabetes mellitus, older adults, elderly, antidiatetic medicines, hypoglycemic drugs, potentially inappropriate prescribing