Examining inappropriate medication in UK primary care for type 2 diabetes patients with polypharmacy

Aims: To estimate the prevalence of potentially inappropriate prescriptions (PIPs) in patients starting their first non-insulin antidiabetic treatment (NIAD) using two explicit process measures of the appropriateness of prescribing in UK primary care, stratified by age and polypharmacy status. Methods: A descriptive cohort study between 2016 and 2019 was conducted to assess PIPs in patients aged ≥45 years at the start of their first NIAD, stratified by age and polypharmacy status. The American Geriatrics Society (AGS) Beers criteria 2015 was used for older (≥65 years) and the Prescribing Optimally in Middle-age People's Treatments (PROMPT) criteria for middle-aged (45-64 years) patients. Prevalence of overall PIPs and individual PIPs criteria was reported using the IQVIA Medical Research Data incorporating THIN, a Cegedim Database of anonymised electronic health records in the UK. Results: Among 28,604 patients initiating NIADs, 18,494 (64.7%) received polypharmacy. In older and middle-aged patients with polypharmacy, 39.6% and 22.7%, respectively, received ≥1 PIPs. At the individual PIPs level, long-term PPI use and strong opioid without laxatives were the most frequent PIPs among older and middle-aged patients with polypharmacy (11.1% and 4.1%, respectively). Conclusions: This study revealed that patients starting NIAD treatment receiving polypharmacy have the potential for pharmacotherapy optimisation. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The authors received no external funding for this work. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The IQVIA has ethical approval from the UK London ethics committee for scientific use of the data. The details of the London ethics board approval available on the IQVIA website. The study protocol was approved by the IQVIA Scientific Research Committee (study reference number: 22SRC047). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The data that support the findings of this study are available from IQVIA Medical Research Data (IMRD) incorporating THIN, a Cegedim database of anonymised electronic health records in the UK. Restrictions apply to the availability of these data, which were used under license for this study. For further information on how to access the data, contact IQVIA at IMRDEnquiries@iqvia.com.