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Improving IV Insulin Administration in a Community Hospital
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Published on: June 11, 2012

Intervention to decrease glyburide use in elderly patients with renal insufficiency.

Sherrie L Aspinall1, Xinhua Zhao, Chester B Good

  • 1VA Center for Medication Safety, Hines, Illinois, USA. sherrie.aspinall@va.gov

The American Journal of Geriatric Pharmacotherapy
|April 5, 2011
PubMed
Summary
This summary is machine-generated.

A risk reduction project successfully decreased glyburide use in elderly patients with kidney issues. This intervention improved prescribing safety without negatively impacting blood sugar control.

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Area of Science:

  • Geriatric Medicine
  • Pharmacology
  • Public Health

Background:

  • Glyburide, an oral hypoglycemic agent, is associated with an increased risk of hypoglycemia, particularly in elderly patients with renal insufficiency.
  • Identifying and mitigating risks associated with glyburide prescribing in vulnerable populations is crucial for patient safety.

Purpose of the Study:

  • To evaluate the impact of a risk reduction project on glyburide prescribing patterns in elderly veterans with renal insufficiency.
  • To identify factors associated with glyburide discontinuation.
  • To assess the effect of the intervention on glycemic control and rates of serious hypoglycemia.

Main Methods:

  • Historical cohort study comparing a targeted cohort (n=4368) with a nontargeted cohort (n=1886) of elderly veterans with renal insufficiency and active glyburide prescriptions.
  • Intervention involved providing regional pharmacy leaders with information on glyburide risks and a list of targeted patients.
  • Data analyzed from Veterans Affairs administrative databases, with primary outcome as glyburide discontinuation.

Main Results:

  • Glyburide discontinuation rates were significantly higher in the targeted cohort compared to the nontargeted cohort during the 3-month post-intervention period.
  • Factors independently associated with discontinuation included the intervention, black race, serum creatinine, Charlson comorbidity score, new glyburide use, and VA region.
  • No significant changes in glycated hemoglobin (HbA1c) levels or rates of serious hypoglycemia were observed after glyburide discontinuation.

Conclusions:

  • A single intervention effectively reduced glyburide use in elderly outpatients with renal insufficiency over a 3-month period.
  • The risk reduction project demonstrated that glyburide prescribing can be modified without compromising glycemic control.
  • These findings support targeted interventions to improve medication safety in vulnerable patient populations.