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. 2024 Nov;15(11):1604-1613.
doi: 10.1111/jdi.14302. Epub 2024 Sep 3.

Sulfonylurea prescription patterns in elderly patients with type 2 diabetes mellitus: A comprehensive analysis of real-world data from pharmacies in Japan

Michiko Yamazaki  1   2 , Tohru Takebe  2 , Masaya Hosokawa  3 , Tomoya Saika  2 , Yutaka Nakao  4 , Shunya Ikeda  1 , Masaya Sakamoto  5   6
Affiliations

Sulfonylurea prescription patterns in elderly patients with type 2 diabetes mellitus: A comprehensive analysis of real-world data from pharmacies in Japan

Michiko Yamazaki et al. J Diabetes Investig. 2024 Nov.

Abstract

Aims/introduction: The study aim was to investigate sulfonylurea prescription patterns in elderly patients (age ≥65 years) with type 2 diabetes mellitus in Japan. Sulfonylurea use among older adults has been insufficiently examined, despite the associated risks of hypoglycemia.

Materials and methods: This retrospective cross-sectional survey entailed analysis of Japanese pharmacy data, extracted from the Musubi database, for patients (age 20-100 years) prescribed sulfonylureas between November 2022 and October 2023. Dose distribution, adherence to the Diabetes Treatment Guidelines for the Elderly 2023 and coprescription of other diabetes medications were investigated.

Results: Of the total 91,229 patients, 80.1% were prescribed glimepiride, 16.3% gliclazide and 3.6% glibenclamide. In patients aged ≥65 years, exceeding the recommended dose (>1 mg/day for glimepiride, >40 mg/day for gliclazide) was numerically higher for glimepiride (25.0%) than for gliclazide (7.8%). The most common prescribing patterns were quadruple therapy with a sulfonylurea, a dipeptidyl peptidase-4 inhibitor, an sodium-glucose transporter 2 inhibitor and a biguanide in patients aged 65 to <75 years, and dual therapy with a sulfonylurea and a dipeptidyl peptidase-4 inhibitor in patients aged ≥75 years. Unfortunately, glinide was coprescribed for 338 (0.5%) of elderly patients. Insulin was coprescribed for 3,682 (5.6%) of elderly patients.

Conclusions: Analysis of real-world sulfonylurea prescription data found guideline non-adherence, namely, excessive prescription of glimepiride, use of glibenclamide in elderly patients, and common coprescription with dipeptidyl peptidase-4 inhibitors. These findings might provide an opportunity to reconsider the treatment of patients with type 2 diabetes mellitus who are over-prescribed sulfonylureas to reduce residual risks, such as hypoglycemia.

Keywords: Elderly; Real‐world data; Sulfonylurea.

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Conflict of interest statement

M Yamazaki, T Takebe, M Hosokawa and T Saika are employees of KAKEHASHI Inc. Y Nakao serves as the President of KAKEHASHI Inc. M Sakamoto has received lecture fees from Eli Lilly Japan K.K., Novo Nordisk Pharma Ltd., Mitsubishi Tanabe Pharma Corporation, Sanofi K.K., MSD K.K. and Daiichi Sankyo Co., Ltd., and has also received a consulting fee from KAKEHASHI Inc. S Ikeda declares no conflict of interest.

Approval of the research protocol: This study was approved (approval number: 23‐Im‐045) by the institutional review board of the International University of Health and Welfare, Japan, and was carried out according to the principles of the Declaration of Helsinki (as revised in Fortaleza, Brazil, October 2013).

Informed consent: The institutional review board of International University of Health and Welfare determined that the requirement for informed consent could be waived owing to the terms of the contract with pharmacies, which included the use of Musubi data for research purposes, and the prior anonymization of the data for research purposes.

Registry and the registration no. of the study/trial: N/A.

Animal studies: N/A.

Figures

Figure 1
Figure 1
Patient disposition. †Pharmacies that had implemented the Musubi system as of November 2021. ‡Information related to age, sex, medication and dose.
Figure 2
Figure 2
Proportions of patients with prescribed doses exceeding prespecified cutoff levels for (a) glimepiride (>1.0 mg/day), (b), gliclazide (>40.0 mg/day) and (c) glibenclamide (>2.5 mg/day), categorized by age (65 to <75, ≥75 and ≥65 years).
Figure 3
Figure 3
Mean ± standard deviation daily dose of (a) glimepiride, (b) gliclazide and (c) glibenclamide, categorized by number of concomitant diabetes medications (vs sulfonylurea therapy alone, indicated by ‘1’ and by age (<65, 65 to <75 and ≥75 years). Dashed lines indicate prespecified cutoff levels for patients aged ≥65 years: (a) glimepiride (>1.0 mg/day), (b) gliclazide (>40.0 mg/day) and (c) glibenclamide (>2.5 mg/day).
Figure 4
Figure 4
The six most common patterns for diabetes medications added to sulfonylurea therapy, categorized by patient age (<65, 65 to <75 and ≥75 years). BG, biguanide; DPP‐4i, dipeptidyl peptidase‐4 inhibitor; GLP‐1, glucagon‐like peptide‐1 receptor agonist; SGLT‐2i, sodium–glucose cotransporter 2 inhibitor; TZD, thiazolidinedione; αGI, alpha‐glucosidase inhibitor.
See this image and copyright information in PMC

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