Background: Diabetes is an increasingly prevalent disease and is common in older people. The combined effects of ageing and diabetes on glucose homeostasis, counter-regulatory and other hormone function and organ function affects medicine choices, safety and benefit. The McKellar Guidelines consist of 18 individual guidelines and five risk assessment tools, two of which are directly relevant to medicines: Aim: To identify medicine-related factors that could impact on quality use of glucose lowering medicines (GLM) in five Victorian residential aged care facilities (RACF).
Method: The study was undertaken as part of a larger study implementing and evaluating the McKellar Guidelines in 2013. Data were collected from a medical record audit of residents with diabetes (RDM) (n = 74) researcher observation of staff practice during visits to the RACFS and interviews with staff (n = 22).
Findings: RDM used an average of 7 medicines; range 4–12. Common classes of medicines included GL,(mostly Metformin, sulphonylureas and insulin, antihypertensive and lipid lowering medicines. Several issues likely to affect medicine safety were identified: Inadequate staff knowledge of diabetes generally and medicines in particular Blood glucose testing was not related to onset peak action of GLMs; GLM administration times did not always correspond with meal times; GPs appeared to regard hyperglycaemia as a benign condition; Reportable blood glucose ranges varied widely and ranged from 2.5–25 mmol/L. There was no evidence for any of the reportable ranges set for RWD; Top up doses/sliding insulin scales were used to manage hyperglycaemia outside the range. Many RWD are prescribed at least one high risk medicine HRM.
Conclusion: Managing medicines in RACFs is complicated. Several issues were identified that put RWD at risk of medicine-related adverse events and raise ethical issues.