a Narrative Review on Quality of Prescribing in Elderly Patients with Diabetes Mellitus

  • Fisia Niti Admadja
  • Yosi Irawati Wibowo Universitas Surabaya
  • Karina Kumaladewi Widjaja
  • Adji Prayitno Setiadi


The aging populations has increased worldwide, resulting in higher prevalences of non-communicable diseases, including Diabetes Mellitus (DM). Elderly with DM requires long-term prescribing which warrants special considerations. Hence, this narrative review aims to identify quality measurement tools and quality prescribing in elderly patients with DM.

This review included literature searching in three databases [i.e., Pubmed (MEDLINE), Science Direct, and CINAHL] with combination of keywords: (Diabetes) AND (Elderly OR older OR geriatric) AND (“Potentially inappropriate medication” OR “potentially inappropriate prescribing” OR “inappropriate prescribing” OR “quality prescription” OR “rational prescribing”). The searching resulted in 1059 articles; and after the selection process, 10 articles were included in this study.

The extracted data indicated that tools with explicit criteria (such as Beer's Criteria) were more commonly used to measure quality prescribing in elderly patients with DM compared to those with implicit criteria (i.e., Prescribing Quality Assessment Checklist) (9 articles versus 1 article, respectively). Varying quality prescribing were reported dependent on the tools used. The percentage of Potentially Inappropriate Medication (PIM) measured using explicit tools ranged from 22,7% to 68,1%; glibenclamide or glyburide were among the most common PIM. Whereas, 83.2% of precriptions measured with the implicit criteria in one article indicated poor quality. This finding demonstrated the needs of strategy to improve the quality of prescribing in elderly patients with DM.

Keywords: diabetes mellitus; elderly; prescription quality; literature review


[1] Al Khaja, K. A. J., Ahmed Isa, H., Veeramuthu, S., & Sequeira, R. P. (2018). Potentially Inappropriate Prescribing in Older Adults with Hypertension or Diabetes Mellitus and Hypertension in a Primary Care Setting in Bahrain. Medical Principles and Practice, 27(3), 241–249. https://doi.org/10.1159/000488055

[2] Andreassen, L. M., Kjome, R. L. S., Sølvik, U. Ø., Houghton, J., & Desborough, J. A. (2016). The potential for deprescribing in care home residents with Type 2 diabetes. International Journal of Clinical Pharmacy, 38(4), 977–984. https://doi.org/10.1007/s11096-016-0323-4

[3] Badan Pusat Statistik. (2019). Statistik Penduduk Lanjut Usia di Indonesia 2019. Badan Pusat Statistik.

[4] Caughey, G. E., Barratt, J. D., Shakib, S., Kemp-Casey, A., & Roughead, E. E. (2017). Medication use and potentially high-risk prescribing in older patients hospitalized for diabetes: a missed opportunity to improve care? Diabetic Medicine, 34(3), 432–439. https://doi.org/10.1111/dme.13148

[5] Caughey, Gillian E., Roughead, E. E., Vitry, A. I., McDermott, R. A., Shakib, S., & Gilbert, A. L. (2010). Comorbidity in the elderly with diabetes: Identification of areas of potential treatment conflicts. Diabetes Research and Clinical Practice, 87(3), 385–393. https://doi.org/10.1016/j.diabres.2009.10.019

[6] Dipiro, J. T., Talbert, G. C. ., Yee, G. R. ., Matzke, B. G. ., & Wells, L. M. P. (2017). Pharmacotherapy: A Pathophysiology Approach, 10th Edition. In Mc-Graw Hill Education (10th ed.). Mc Graw Hill Education.

[7] Erah, P. O., & Eroje, H. I. (2013). Prescribing of antidiabetic medicines to older diabetes type 2 patients in Lagos, Nigeria. Nigerian Quarterly Journal of Hospital Medicine, 23(1), 12–16.

[8] Fick, D. M., Semla, T. P., Steinman, M., Beizer, J., Brandt, N., Dombrowski, R., DuBeau, C. E., Pezzullo, L., Epplin, J. J., Flanagan, N., Morden, E., Hanlon, J., Hollmann, P., Laird, R., Linnebur, S., & Sandhu, S. (2019). American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. Journal of the American Geriatrics Society, 67(4), 674–694. https://doi.org/10.1111/jgs.15767

[9] Formiga, F., Vidal, X., Agustí, A., Chivite, D., Rosón, B., Barbé, J., López-Soto, A., Torres, O. H., Fernández-Moyano, A., García, J., Ramírez-Duque, N., & San José, A. (2016). Inappropriate prescribing in elderly people with diabetes admitted to hospital. Diabetic Medicine, 33(5), 655–662. https://doi.org/10.1111/dme.12894

[10] Fujita, K., Moles, R. & Chen, T. 2018. Quality indicators for responsible use of medicines: a systematic review. BMJ Open, 8, e020437. doi:10.1136/bmjopen-2017-020437.

[11] Gagnon, M. E., Sirois, C., Simard, M., Roux, B., & Plante, C. (2020). Potentially inappropriate medications in older individuals with diabetes: A population-based study in Quebec, Canada. Primary Care Diabetes. https://doi.org/10.1016/j.pcd.2020.03.003

[12] International Diabetes Federation. IDF Diabetes Atlas Edisi ke-10. Belgium: International Diabetes Federation Inc; 2021.

[13] Kaufmann, C. P., Tremp, R., Hersberger, K. E., & Lampert, M. L. (2014). Inappropriate prescribing: A systematic overview of published assessment tools. European Journal of Clinical Pharmacology, 70(1), 1–11. https://doi.org/10.1007/s00228-013-1575-8

[14] Kementerian Kesehatan. (2013). Penyajian Pokok-Pokok Hasil Riset Kesehatan Dasar 2013.

[15] Kementerian Kesehatan. (2018). Hasil Utama Riset Kesehata Dasar (RISKESDAS) 2018. Journal of Physics A: Mathematical and Theoretical, 44(8), 1–200. https://doi.org/10.1088/1751-8113/44/8/085201

[16] Kirkman, M. S., Briscoe, V. J., Clark, N., Florez, H., Haas, L. B., Halter, J. B., Huang, E. S., Korytkowski, M. T., Munshi, M. N., Odegard, P. S., Pratley, R. E., & Swift, C. S. (2012). Diabetes in older adults. Diabetes Care, 35(12), 2650–2664. https://doi.org/10.2337/dc12-1801

[17] Krishnapillai, V., Nair, S., Anand, T. N., Sreelal, T. P., & Soman, B. (2020). Quality of medical prescriptions in diabetes and hypertension management in Kerala and its associated factors. BMC Public Health, 20(1), 1–9. https://doi.org/10.1186/s12889-020-8214-y

[18] Lopez-Rodriguez, J. A., Rogero-Blanco, E., Aza-Pascual-Salcedo, M., Lopez-Verde, F., Pico-Soler, V., Leiva- Fernandez, F., Daniel Prados-Torres, J., Prados-Torres, A., & Cura-Gonzalez, I. (2020). Potentially inappropriate prescriptions according to explicit and implicit criteria in patients with multimorbidity and polypharmacy. MULTIPAP: A cross-sectional study. PLoS ONE, 15(8 August), 1–20. https://doi.org/10.1371/journal.pone.0237186

[19] O’Connor, M. N., Gallagher, P., & Omahony, D. (2012). Inappropriate prescribing: Criteria, detection and prevention. Drugs and Aging, 29(6), 437–452. https://doi.org/10.2165/11632610-000000000-00000

[20] Rakes, K. B., Chowta M. N., Shenoy A. K., Shastry R., Pai S. B. (2017). Evaluation of polypharmacy and appropriateness of prescription in geriatric patients: A cross-sectional study at a tertiary care hospital. Indian J Pharmacol, 49(1), 16-20. https://doi.org/10.4103/0253-7613.201036

[21] Smits, K. P. J., Sidorenkov, G., Kleefstra, N., Hendriks, S. H., Bouma, M., Meulepas, M., Navis, G., Bilo, H. J. G., & Denig, P. (2018). Is guideline-adherent prescribing associated with quality of life in patients with type 2 diabetes? PLoS ONE, 13(8), 1–13. https://doi.org/10.1371/journal.pone.0202319

[22] Swanoski, M. T., Little, M. M., St. Hill, C. A., Ware, K. B., Chapman, S., & Lutfiyya, M. N. (2017). Potentially Inappropriate Medication Prescribing in U.S. Older Adults with Selected Chronic Conditions. The Consultant Pharmacist, 32(9), 525–534. https://doi.org/10.1111/j.1365-2710.1990.tb00350.x

[23] Syaripuddin, M. (2013). Peranan Pharmaceutical Care dalam Meningkatkan Hasil Klinis dan Kualitas Hidup Pasien Penderita Diabetes Melitus. Pusat Teknologi Intervensi Kesehatan Masyarakat, 3.2.2013(7), 52–59.

[24] Whittlesea, C., & Hodson, K. (2019). Clinical Pharmacy and Therapeutics Sixth Edition. In Elsevier (6th ed.). Elsevier Ltd. https://doi.org/10.3126/jcmc.v9i3.25793

[25] World Health Organisation (WHO) 2012. The pursuit of responsible use of medicines: sharing and learning from country experiences, Geneva, Switzerland, WHO.