Managing elderly diabetes no simple task
Most elderly diabetics are prescribed glucose-lowering medications, and only one in five use insulin to manage their diabetes, according to a report by the Australian Institute of Health and Welfare.
Highlighting the complexity of treating type 2 diabetes in older patients, the AIHW used linked data from the Pharmaceutical Benefits Scheme and the National Diabetes Services Scheme (NDSS) to show that while most (85 per cent) of patients 65 years and older were on glucose lowering medications, just 40 per cent used a single medication. One in five used two glucose lowering therapies simultaneously, and 11 per cent were on triple therapies.
In addition, 77 per cent were also using agents to lower their blood pressure, 74 per cent were using drugs to modify lipids (68 per cent were using both), 24 per cent were being supplied with anti-depressants, 20 per cent were using insulin and 4 per cent were on anti-psychotics.
Generally, the authors of the report said, the longer since type 2 diabetes was diagnosed, the more likely it was that a patient would be prescribed with all medicine types, and the more intensive (dual or triple therapy) their glucose lowering treatment regimens would be.
Increasingly, type 2 diabetes in older patients is being treated with drugs rather than diet and exercise alone.
This was significant, the authors said, because the high prevalence of co-morbidities in such patients made the balance of risks and benefits in using medicines a finely-tuned calculation.
The release of the report coincides with changes to the NDSS that came into effect on 1 July.
Under the changes, people with diabetes can continue to access NDSS products such as needles, syringes, blood glucose test strips and urine test strips from NDSS community pharmacies, but can no longer access the products from Diabetes Australia or local state and territory diabetes organisations.
In addition, people with type 2 diabetes not using insulin will receive an initial six month supply of subsidised blood glucose test strips under the NDSS. After six months, they will only be eligible for further access to subsidised test strips if their doctor or other authorised health professional considers it clinically necessary to use test strips.
The change follows advice from the Pharmaceutical Benefits Advisory Committee which recommended restrictions to access blood glucose test strips based on research which found there was limited evidence that self-monitoring of blood glucose improved blood glucose control, quality of life or long term complications in people with type 2 diabetes who are not using insulin.
Patients with diabetes using insulin or women with gestational diabetes will not be affected by these changes.
The restrictions will come into effect six months from the date of a NDSS Registrant’s first test strip purchase.
There is no limit on the number of extensions to access that may be obtained from an authorised health professional while there is a continuing clinical need.
For more information about the changes visit https://www.ndss.com.au/important-changes-to-the-ndss
The AIHW report can be found at http://www.aihw.gov.au/publication-detail/?id=60129555607