Elderly put at risk by diabetes drugs ‘they don’t need’

ELDERLY people are routinely given diabetes drugs they do not need because of an incentive scheme which rewards GPs for prescribing pills, experts have warned.

This ‘over-treatment’ is putting frail people at risk of falls, cognitive impairment and dementia, it is claimed.

Diabetes specialists said the ‘payment by results’ programme, introduced by the Labour Government in 2004, left many patients at risk of dangerous side-effects. Prescriptions for diabetes drugs have soared by 70 per cent in a decade with almost 55million given out last year, official figures show.

A booming crisis in type two diabetes – which is linked to obesity and lifestyle – has seen the number of people diagnosed almost double from 1.9million in 2008 to 3.7million today. The specialists – a top official at NHS England and a consultant at Exeter University – said a ‘one-size-fits-all’ approach to treatment is putting patients at risk. They called for all over-70s with diabetes to be reviewed to ensure any unnecessary treatment is stopped.

For many people the pills risk pushing blood sugar too low – putting them at risk of a dangerous ‘hypo’ which can cause a serious fall, cognitive impairment or even dementia. The experts said a key problem is that the blood sugar targets which formed the basis of the GP incentive scheme are based on young people, rather than the elderly who are more sensitive to diabetes medication.

For many elderly patients the targets are too low, meaning inappropriate diabetes medication may push blood sugar down too far. Dr David Strain, of Exeter University, and Dr Partha Kar, national clinical deputy director for diabetes at NHS England, said the use of financial incentives to encourage GPs to prescribe drugs has driven up the numbers.

Many patients were prescribed the drugs more than a decade ago but have never had their treatments reviewed, they said. The Quality and Outcomes Framework (QOF) rewards GP practices with points if they hit targets for diabetes, heart disease, stroke, asthma, epilepsy and obesity.

The points are converted into cash at the end of the year and divided between GP partners.

Writing in the Pharmaceutical Journal, the experts said drugs, including metformin, meglitinides and thiazolidinediones, can push blood sugar levels too low in the elderly, putting them at risk of hypos. Emma Elvin, of Diabetes UK, said: ‘Inappropriate treatment can have serious, life-threatening consequences.’

Professor Helen Stokes-Lampard, of the Royal College of GPs, said: ‘The QOF was designed to maintain and improve the service GPs and our teams deliver for patients. It is important that the system is consistently reviewed to ensure it is doing just that.’

Under the latest GP contracts all people over the age of 70 should have their ‘frailty’ assessed – which should pick up problems.