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