Danish study finds missed recommended prescriptions common in type 2 diabetes
A nationwide register study found frequent prescribing gaps, especially involving cardiovascular care, but it cannot explain why they occurred.
Low evidenceHuman studyInterpret with caution
Medical disclaimer: This article summarizes research findings and is for informational purposes only. It is not medical advice.
Editorial illustration — not from the study.
This nationwide cross-sectional study used Danish health and prescription registers to assess potentially inappropriate prescribing. The researchers looked for medicines that may have been missing, continued when they might have needed stopping, or otherwise not matched selected criteria. They used general STOPP/START criteria and four diabetes-related recommendations.
Nearly one third of participants had at least one general prescribing omission, while 7.5% had at least one prescription classified as one that should potentially have been stopped. Among people with diabetes and cardiovascular disease who were considered eligible for selected cardioprotective medicines, almost two thirds had not received an SGLT2 inhibitor or GLP-1 receptor agonist. These results describe patterns in the registers; they do not establish that every missing or continued prescription was inappropriate for the individual patient.
What was studied
The researchers studied all eligible Danish citizens recorded as having type 2 diabetes on 1 January 2022, provided they had been diagnosed at age 40 or older and remained in the country through the outcome assessment. The final study population included 239,995 people; the median age was 69, 56% were male, and 40% lived alone. Register data covered sociodemographic characteristics, other illnesses, health-care contacts, laboratory results, and redeemed prescriptions. The researchers assessed potentially inappropriate prescribing on 31 December 2022 using general STOPP/START criteria and four selected diabetes-related criteria.
What the analysis found
Nearly one third of the population had at least one general START prescribing omission, meaning a medicine identified by the selected criteria as potentially missing. Cardiovascular-related omissions were the most common general type. The most frequent selected diabetes-related finding was failure to start an SGLT2 inhibitor or GLP-1 receptor agonist among people with type 2 diabetes and cardiovascular disease; among those considered at risk, almost two thirds had not received one of these medicines. A general STOPP finding, involving a medicine that the criteria indicated might have needed discontinuation, occurred in 7.5% of participants. The researchers reported associations between potentially inappropriate prescribing and female sex or living alone. These are associations, not evidence that sex or living arrangements caused the prescribing patterns.
Who this is relevant to
The findings may be most relevant to people and health-care systems resembling the studied Danish population: adults with type 2 diabetes diagnosed at age 40 or older, especially those with cardiovascular disease. They do not establish that the same prevalence occurs in other countries or that any particular person received inappropriate care. The results also should not be interpreted as a determination that a medicine was suitable or unsuitable for an individual, because the study did not contain all clinical reasons behind prescribing decisions.
The significance
The study indicates that prescribing gaps identified by the researchers' criteria were common in this Danish population, particularly in people with diabetes and cardiovascular disease. It may help identify areas for further review of prescribing systems and coordination of care. However, a criteria-based finding is not the same as a confirmed medication error: clinical circumstances, preferences, contraindications, and reasons for not prescribing may not be fully captured in registers.
Limitations & evidence assessment
The provided excerpts do not report a detailed limitations section. Because this was a cross-sectional register study, it cannot determine whether individual factors caused potentially inappropriate prescribing, whether prescribing later changed, or whether the identified patterns led to harm. Register data and coding may miss clinical reasons for prescribing decisions, and the study used only selected general and diabetes-related criteria rather than assessing every possible prescribing issue. The population was limited to Danish residents diagnosed at age 40 or older, so the results may not represent younger people, other countries, or people with different health-care systems. The researchers also assessed prescribing at a particular time rather than following participants to measure clinical outcomes.
Why this evidence level: This was a large human observational study using Danish health registers, but its cross-sectional design can show prevalence and associations rather than cause and effect. The findings also depended on selected prescribing criteria and may not apply equally outside Denmark.
Evidence levels are editorial estimates derived from study metadata — they are not clinical appraisals.
// Source
Journal of Public Health · 2026 · DOI: 10.1007/s10389-026-02900-2
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