Potentially Inappropriate Medications Found in Most Older Adults with Type 2 Diabetes, Landmark Study Reveals

A new study has found that nearly two-thirds of older adults living with type 2 diabetes mellitus are prescribed at least one potentially inappropriate medication (PIM), raising serious concerns about medication safety in a population already vulnerable to adverse drug events. The research, conducted among 227 patients aged 65 and older, revealed that 63.9% of participants received medications flagged as inappropriate under the widely used STOPP/START criteria, a rate substantially higher than previously reported in comparable European cohorts.

The study, published in the Journal of Clinical Medicine, examined prescribing patterns in older adults with type 2 diabetes, a group particularly susceptible to the risks of polypharmacy. Participants had a mean age of 74.1 years, and the cohort included 119 men and 108 women. The researchers assessed medication appropriateness using the STOPP/START criteria version 3, an internationally recognized screening tool that identifies both potentially inappropriate medications and prescription omissions that should be corrected.

Among the findings, benzodiazepines emerged as the most frequently prescribed potentially inappropriate medication class, detected in 22.9% of participants. These sedative-anxiolytic drugs, which include medications such as diazepam and alprazolam, are known to increase the risk of falls, cognitive impairment, and dependence in older adults. The second most common PIM class was proton pump inhibitors, found in 20.7% of participants, often prescribed for extended periods without a clear clinical indication.

The researchers also identified significant prescription omissions, with 41.5% of participants missing at least one medication that should have been prescribed according to the START component of the criteria. The most frequent omission was the failure to prescribe vitamin D supplementation in patients with documented vitamin D deficiency, followed by missing statin therapy in patients with established cardiovascular disease. These omissions suggest that the problem extends beyond overprescribing to include undertreatment of clinically important conditions.

Polypharmacy, defined as the concurrent use of five or more medications, was observed in 55.1% of participants, and excessive polypharmacy, involving ten or more medications, was present in 9.3% of the cohort. The study found a strong association between the degree of polypharmacy and the likelihood of receiving potentially inappropriate medications, with patients on ten or more drugs facing a markedly elevated risk. This pattern reflects the complex interplay between type 2 diabetes and its frequent comorbidities, including hypertension, dyslipidemia, and chronic kidney disease, which often result in multiple specialists prescribing independently.

The mean number of potentially inappropriate medications per participant was 1.2, and the mean number of prescription omissions was 0.9. The researchers noted that the prevalence of PIMs in their cohort exceeded rates reported in previous studies of older adults in Europe, which typically range from 40% to 50%. They attributed this difference partly to the specific characteristics of their population, which included patients with multiple chronic conditions and frequent specialist consultations.

The study also examined the relationship between medication appropriateness and clinical outcomes. Participants with a higher number of potentially inappropriate medications had a greater burden of comorbidities, as measured by the Charlson Comorbidity Index, and were more likely to have experienced falls in the preceding year. The researchers emphasized that while the cross-sectional design of the study prevents establishing causality, the associations align with a growing body of literature linking PIM exposure to adverse health outcomes in older adults.

The researchers highlighted several clinical implications of their findings. They recommended routine medication review using structured screening tools such as the STOPP/START criteria during clinical encounters with older adults with type 2 diabetes. They also called for improved communication between primary care physicians and specialists to reduce prescribing fragmentation, and for greater involvement of clinical pharmacists in medication reconciliation. The study’s authors noted that deprescribing, the planned and supervised reduction of inappropriate medications, should be considered a core component of comprehensive geriatric care.

Limitations of the study include its cross-sectional design, which cannot establish temporal relationships between medication exposure and clinical outcomes, and its reliance on a single cohort from one geographic region, which may limit generalizability. The researchers also acknowledged that the STOPP/START criteria, while widely validated, may not capture all clinically relevant medication risks in every individual patient. Despite these constraints, the study provides valuable data on prescribing patterns in a growing population of older adults with type 2 diabetes.

As populations worldwide continue to age and the prevalence of type 2 diabetes in older adults rises, the findings underscore the urgent need for systematic approaches to medication safety in geriatric care. The researchers concluded that their results support the integration of structured medication screening into routine clinical practice, along with ongoing education for healthcare providers on the principles of appropriate prescribing in older adults. They emphasized that optimizing pharmacotherapy in this vulnerable population requires a balance between controlling diabetes and its comorbidities while minimizing the risks of inappropriate medication exposure.

Subject of Research: Potentially inappropriate medication prescribing in older adults with type 2 diabetes

Article Title: Prevalence of potentially inappropriate medications in older adults with type 2 diabetes mellitus based on the Beers criteria

Article References: Hadžifejzović Trnka, A., Žiga Smajić, N., & Škrbo, S. (2026). Prevalence of potentially inappropriate medications in older adults with type 2 diabetes mellitus based on the Beers criteria. Pharmacia, 73, Article e198333. https://doi.org/10.3897/pharmacia.73.e198333

Image Credits: AI Generated

DOI: 10.3897/pharmacia.73.e198333

Keywords: potentially inappropriate medications, type 2 diabetes, older adults, polypharmacy, STOPP/START criteria, benzodiazepines, proton pump inhibitors, prescription omissions, deprescribing, medication safety, geriatric care, comorbidities