Can diabetes medication be reduced in elderly patients? An observational study of diabetes drug withdrawal in nursing home patients with tight glycaemic control

Abstract

Aim: To explore the feasibility of withdrawal of diabetes medication in elderly patients with HbA1c<or=6.0%.

Methods: HbA1c was measured in 98 patients with known diabetes in 17 nursing homes in Sweden. Thirty-two subjects with HbA1c <or=6.0% participated in the drug withdrawal study. After measuring plasma glucose on 3 consecutive days, diabetes drugs were reduced, i.e. complete withdrawal of oral anti-diabetic drugs (OADs), complete insulin withdrawal when doses were <or=20units/day and reduced by half in patients on more than 20units/day.

Results: We identified 31 episodes of plasma glucose <or=4.4mmol/l, most of them nocturnal (n=17). Mean HbA1c was 5.2+/-0.4% compared to 7.1+/-1.6% in the non-intervention group. Three months after the diabetes drug discontinuation, 24 patients (75%) remained in the intervention group and mean HbA1c was then 5.8.+/-0.9%. Six months after baseline investigation mean HbA1c in the intervention group was 5.8+/-1.1% compared with 6.6+/-1.4% in the non-intervention group.

Conclusions: Hypoglycaemic events are common among elderly patients with type 2 diabetes. The withdrawal of diabetes medication in elderly with tight glycaemic control is safe and may decrease the risk for hypoglycaemia.