Pharmacist review of GP patients drastically reduces sulfonylurea prescriptions

A medication review of over 600 elderly GP patients with diabetes has seen 40% completely stop being prescribed sulfonylureas.

The review, which forms part of NHS West Hampshire CCG’s ongoing drive to help GPs review frail patients receiving multiple medicines, resulted in 58% either stopping the drugs completely or reducing the dosage.

This comes after a major UK study found that switching diabetes patients to sulfonylurea increased their risk of heart attack and all-cause death.

http://www.pulsetoday.co.uk/clinical/clinical-specialties/diabetes/pharmacist-review-of-gp-patients-drastically-reduces-sulfonylurea-prescriptions/20037162.article

This is a good news/bad news story.

On the one hand, sulphs seem to be getting a bad rep, which is probably no bad thing. In the past they were accused of overdriving the pancreas and causing beta cell failure.

By the time she reached her nineties my mother was on huge numbers of medications, just like too many other old folks, and no doubt some of them were to counter the side effects of some of the others.

On the other hand there's a push to target higher HbA1c, principally but not exclusively in older folks, and higher A1c has been linked to CVD and increased death in general, so this may be a form of soft euthanasia.

Especially when institutionalised, old folks are usually put on a high carb low fat low protein diet, which isn't going to help any. If they weren't they'd need fewer diabetes drugs.

chris c wrote:This is a good news/bad news story.

On the one hand, sulphs seem to be getting a bad rep, which is probably no bad thing. In the past they were accused of overdriving the pancreas and causing beta cell failure.

By the time she reached her nineties my mother was on huge numbers of medications, just like too many other old folks, and no doubt some of them were to counter the side effects of some of the others.

On the other hand there's a push to target higher HbA1c, principally but not exclusively in older folks, and higher A1c has been linked to CVD and increased death in general, so this may be a form of soft euthanasia.

Especially when institutionalised, old folks are usually put on a high carb low fat low protein diet, which isn't going to help any. If they weren't they'd need fewer diabetes drugs.

Meanwhile 

Poor Glycemic Control Is Associated With Increased Extracellular Volume Fraction in Diabetes

http://care.diabetesjournals.org/content/early/2018/07/11/dc18-0324.long

http://sci-hub.tw/10.2337/dc18-0324

thanks, added to my reading list.

Add that sulfonylureas are the poor man insulin. They prevent MD from prescribing all the new expensive medications. Also sulfonylureas are not all the same they lumped so that all the bad are associated with the cheap class of medications. They have a lot of risk in them, but they are probably just as bad as all the expensive medications they prescribe now and they hand out like candy.

There's even a push to put Type 1s on "Type 2" medications alongside their insulin. Currently DPP-4 inhibitors and SGLT-2 inhibitors. Well "diabetics deserve the right to eat carbs" as that dreadful woman whose name fortunately escapes me claims.