New research has found that people with type 2 diabetes are likely to stop taking important diabetes medicines after being admitted to hospital, with potentially severe implications for their heart and kidney health.
A new study from UNSW Medicine & Health has found people with diabetes regularly stop taking sodium-glucose cotransporter 2 (SGLT2) inhibitors after a hospital admission, highlighting the need for hospitals to strengthen safeguards that ensure patients restart crucial medicines when they leave.
The study, which is one of the largest of its kind, analysed health records of more than 100,000 people in New South Wales on SGLT2 inhibitors – a class of medicines that play an important role in treating type 2 diabetes, heart failure and chronic kidney disease.
The study found that more than one third of people taking SGLT2 inhibitors had experienced at least one hospital admission. Those who were admitted to hospital were 83% more likely to stop taking their SGLT2 inhibitor medicine during, or soon after, a hospital stay than at other times.
Endocrinologist and study lead, Dr Tamara Milder from the Medicines Intelligence Research Program at UNSW Medicine & Health, said SGLT2 inhibitors were often paused by doctors when people were admitted to hospital because of valid concerns about a rare, life-threatening side effect that can occur in acute illness settings.
“These medicines are then meant to be restarted after hospital discharge. In reality, they’re being stopped for longer than may be intended,” said Dr Milder.
“This is a problem because even short periods of discontinuation of these medicines – which are vital for heart and kidney function – can cause harm.”
Previous research has shown that stopping this medicine for 30 days is linked to an increased risk of hospitalisation for heart failure or death in people with heart problems.
The researchers also examined another commonly used diabetes medicine class, known as DPP-4 inhibitors. They found that hospitalisation increased the likelihood of stopping treatment for these medicines as well, suggesting that moving between hospital and community care is a very important time in the management of people’s medicines.
Dr Ben Basger, Pharmacist and Senior Lecturer at UNSW Sydney said this example was the tip of the iceberg when it comes to medicine misadventure in Australia.
“Every year in Australia, 250,000 hospital admissions are because of medication misadventure, with more than half of medication errors occurring at transitions of care,” said Dr Basger.
“When someone enters the hospital there will always be a lot going on during their stay. Medications are changed, added or subtracted at various points by their doctors."
"At the end there needs to be a reconciliation, clearly written down and explained directly to the patient: ‘This is what’s new, what we’ve commenced, what we’ve ceased and when; when the dose was reduced, when the dose was increased and what you need to do from here’.”
“It sounds like common sense but, due to systemic failures in our healthcare systems, most of the time this is not done. Instead, notes are written in a discharge summary that is at best handed to the patient when they leave to try to interpret at home or, at worst, posted to their GP who may or may not know their patient was even in hospital or why.”
“In addition to better medication reconciliation processes and clearer discharge instructions, other potential solutions could include greater pharmacist involvement and electronic alerts that flag when an SGLT2 inhibitor has not been included on a patient's discharge medication list,” said Dr Milder.