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Glyburide Use in Older Adults: Pharmacy Claims Data Analysis of a Regional Healthcare Organization
Author(s) -
Herzik Kristen A.,
Barnett Mitchell J.,
Thanh Danielle M.,
Doroudgar Shadi,
Ip Eric J.
Publication year - 2020
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.16723
Subject(s) - medicine , pharmacy , medicare part d , beers criteria , odds ratio , comorbidity , medical prescription , odds , diabetes mellitus , retrospective cohort study , glipizide , geriatrics , polypharmacy , family medicine , prescription drug , logistic regression , endocrinology , nursing , psychiatry
BACKGROUND/OBJECTIVES Glyburide was added to the 2012 American Geriatrics Society (AGS) Beers Criteria® due to the risk of hypoglycemic events in older adults. The objective of this study was to evaluate trends of glyburide use in persons aged 65 and older with diabetes mellitus, type II, before, during, and after the 2012 AGS Beers Criteria® Update. DESIGN Multicenter retrospective cohort study comparing pharmacy claims data from four Sharp Rees‐Stealy clinic regions over 5 years (2010–2015). SETTING Pharmacy claims database. PARTICIPANTS A total of 3,005 patients with diabetes mellitus, type II, aged 65 and older. MEASUREMENTS Prescription fill history of the sulfonylureas glyburide, glipizide, and glimepiride were collected along with comorbidity (Elixhauser) and demographic information. Odds of glyburide prescribing were stratified by year, clinic region, and by prescriber type. RESULTS Glyburide use decreased across each study year (35.8%, 27.7%, and 4.2% in 2011, 2013, and 2015, respectively; P < .01). Adjusted odds of glyburide use indicated that regions A and D were 24% ( P = .045) and 11% ( P < .01) less likely to prescribe glyburide in 2011, regions A and D were 37% ( P < .01) and 8% ( P = .03) less likely to prescribe glyburide in 2013, respective to the overall average, whereas region B was 41% ( P = .04) more likely. No significant regional site variations remained in 2015. Internists were 47% more likely to prescribe glyburide than family medicine providers in 2013; P < .01), but not in any other study years. CONCLUSION Rates of glyburide use decreased after release of the 2012 AGS Beers Criteria® demonstrating successful adoption of evidence‐based medicine at a large multiregional site. However, regional differences may affect timing of implementation. Education, system‐level initiatives, and strong professional support may help enhance more uniform adoption. J Am Geriatr Soc 68:2354–2358, 2020.