Case scenario

Alan is a 79-year-old male with a 30-year history of type 2 diabetes. Alan lives at home and is functionally independent with comorbidities of hypertension, hyperlipidaemia, benign prostatic hypertrophy and osteoarthritis. Alan has a creatinine clearance of 45 mL/min and a HbA1c of 55 mmol/mol (7.2%). He has recently been experiencing recurrent asymptomatic hypoglycaemia with a BSL of approximately 3 mmol/L that may be related to a reduced appetite.

His prescribed medications are:

  • insulin aspart-insulin aspart protamine 30/70, 18 units subcut twice daily
  • metformin 1,000 mg, ONE tablet twice daily
  • ramipril 10 mg, ONE tablet each morning
  • atorvastatin 20 mg, ONE tablet each morning
  • prazosin 1 mg, ONE tablet twice daily
  • paracetamol 500 mg, TWO tablets when required.

Learning objectives

After successful completion of this CPD activity, pharmacists should be able to:

  • Discuss why stringent glycaemic control may not be desirable in older patients with type 2 diabetes
  • Describe patient characteristics where deintensification (relaxation of HbA1c target) would be appropriate
  • Develop strategies for deintensification of antihyperglycaemics.

Accreditation: CAP1903C

Competencies (2016): 1.1, 1.5, 2.1, 2.2, 3.1, 3.3, 3.5

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Rationale for deintensification of antihyperglycaemics in older patients with type 2 diabetes

Deintensification is defined as ‘stopping or scaling back the intensity or frequency of medical interventions that are currently part of a patient’s ongoing management.’1,2 The risk to benefit ratio

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