| Objective: Potentially inappropriate medications(PIMs)continue to be prescribed and used as first-line treatment for the most vulnerable of older adults.Beers criteria are currently the most widely used PIM evaluation criteria.The primary purpose is to systematically review the clinical,economic and humanistic outcomes that resulted from PIM,whiched was idenfied by Beers criteria.The second purpose is to systematically review the safety profile of commonly used antidiabetic drugs in the elderly patients,and the GRADE method was used to evaluate the overall quality of evidence and strength of recommendation.Methods: 1.A systematic literature search was conducted to screen elderly PIM studies with outcomes reported from 2003 to 2016.The studies were screened according to the pre-designed inclusion and exclusion criteria,and risk of bias was assessed using Newcastle-Ottawa Scale(NOS).Data were extracted to perform meta-analysis or descriptive analysis.2.Randomized controlled trial(RCT),observational study and systematic review about safety of antidiabetic drugs used in the elderly patinets were screened according to inclusion criteria and exclusion criteria,and the qualities of included studies were evaluated by modified Jadad scoring,NOS scale and the AMSTAR scale respectively.Meta analysis or descriptive analysis was conducted for different safety endpoints.Grade the strength and quality of each safety statement based on the level of evidence and strength of recoomnedation.Results: 1.A total of 23 studies on outcome of Beers-related PIM were included in this systematic review.Quality scores of all studies were more than 6 stars.Meta analysis results showed that patient with PIM identified by Beers criteria had higher incidence of hospitalization[OR=1.47,95% CI(1.14,1.89),P=0.003],higher incidence of ADR[OR=1.74,95% CI(1.23,2.47),P<0.001],higher incidence of emergency department visit(ED visit)[OR=1.69,95% CI(1.21,2.37),P=0.002],and higher cost compared with patients without PIM.Mortality and HRQOL were not significantly different between patients with PIM and those without PIM.2.Safety review of antidiabetic drugs used in elderly patients showed that: compared with placebo,the main ADR of metformin was gastrointestinal reaction [RR = 1.80,95% CI(1.25,2.60),P = 0.002] and vitamin B12 deficiency [RR = 1.80,95% CI(1.25,2.60),P = 0.002].The main ADR of?-glucosidase inhibitorwas gastrointestinal reaction [RR = 5.64,95% CI(3.70,8.61),P <0.001].The main ADR of thiazolidinediones were edema [RR = 1.38,95% CI(1.10,1.74),P = 0.006],increased risk of heart failure [RR = 1.38,95% CI(1.13,2.17),P = 0.006],increased risk of hypoglycemia when combined with sulfonylureas and insulin,weight gain and increased risk of fracture.The main ADR of insulin secretagogues were hypoglycemia(RR = 3.73,95% CI(2.38,5.84),P <0.001],and weight gain and cardiovascular adverse reactions should be paid attention to.DPP-4 inhibitors were safer than other antidiabetic drugs.The main ADR of GLP-1 receptor agonists were gastrointestinal reactions [RR = 3.19,95% CI(2.83,3.60),P <0.001] and hypoglycemia [RR = 1.75,95% CI(1.35,2.25)P <0.001].Conclusion: 1.Beers-related PIM resulted in increased hospitalization,ED visit and ADR,and no significant change in mortality and quality of life in elderly patients.2.DPP-4 inhibitors,in addition to a slight increase in body weight,are much safer than other hypoglycemic agents.Thiazolidinediones have higher safety risk for the elderly patients,and theynot only increased risk of weight gain and hypoglycemia,but also increased risk of cardiovascular adverse reactions,edema and fracture.Antidiabetic drugs that are prone to increase the risk of hypoglycemia include insulin secretagogues,GLP-1 receptor agonists,and thiazolidinedione.Antidiabetic drugs that increase gastrointestinal side effects include metformin,alpha glucosidase inhibitors and GLP-1 receptor agonists.Drugs that increase body weight include thiazolidinediones,insulin secretagogues and DPP-4 inhibitors.In addition,some rare and serious adverse reactions should be paied attention to,such as risk of lactic acidosis caused by metformin,and increased cardiovascular risk caused by insulin secretagogue. |
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