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Multicenter Study
. 2023 Sep;71(9):2893-2901.
doi: 10.1111/jgs.18465. Epub 2023 Jun 7.

Overtreatment and associated risk factors among multimorbid older patients with diabetes

Oliver Baretella  1   2 , Heba Alwan  1   3 , Martin Feller  1   2 , Carole E Aubert  1   2 , Cinzia Del Giovane  1 , Dimitrios Papazoglou  1   2 , Antoine Christiaens  4   5 , Arend-Jan Meinders  6 , Stephen Byrne  7 , Patricia M Kearney  8   9 , Denis O'Mahony  9   10 , Wilma Knol  11 , Benoît Boland  5   12 , Baris Gencer  1   13 , Drahomir Aujesky  2 , Nicolas Rodondi  1   2
Affiliations
Free article
Multicenter Study

Overtreatment and associated risk factors among multimorbid older patients with diabetes

Oliver Baretella et al. J Am Geriatr Soc. 2023 Sep.
Free article

Abstract

Background: In multimorbid older patients with type 2 diabetes mellitus (T2DM), the intensity of glucose-lowering medication (GLM) should be focused on attaining a suitable level of glycated hemoglobin (HbA1c ) while avoiding side effects. We aimed at identifying patients with overtreatment of T2DM as well as associated risk factors.

Methods: In a secondary analysis of a multicenter study of multimorbid older patients, we evaluated HbA1c levels among patients with T2DM. Patients were aged ≥70 years, with multimorbidity (≥3 chronic diagnoses) and polypharmacy (≥5 chronic medications), enrolled in four university medical centers across Europe (Belgium, Ireland, Netherlands, and Switzerland). We defined overtreatment as HbA1c < 7.5% with ≥1 GLM other than metformin, as suggested by Choosing Wisely and used prevalence ratios (PRs) to evaluate risk factors of overtreatment in age- and sex-adjusted analyses.

Results: Among the 564 patients with T2DM (median age 78 years, 39% women), mean ± standard deviation HbA1c was 7.2 ± 1.2%. Metformin (prevalence 51%) was the most frequently prescribed GLM and 199 (35%) patients were overtreated. The presence of severe renal impairment (PR 1.36, 1.21-1.53) and outpatient physician (other than general practitioner [GP], i.e. specialist) or emergency department visits (PR 1.22, 1.03-1.46 for 1-2 visits, and PR 1.35, 1.19-1.54 for ≥3 visits versus no visits) were associated with overtreatment. These factors remained associated with overtreatment in multivariable analyses.

Conclusions: In this multicountry study of multimorbid older patients with T2DM, more than one third were overtreated, highlighting the high prevalence of this problem. Careful balancing of benefits and risks in the choice of GLM may improve patient care, especially in the context of comorbidities such as severe renal impairment, and frequent non-GP healthcare contacts.

Keywords: HbA1c; glucose-lowering medication; multimorbidity; polypharmacy; type 2 diabetes mellitus.

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References

REFERENCES

    1. Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants. Lancet. 2016;387(10027):1513-1530.
    1. Lipska KJ, Krumholz H, Soones T, Lee SJ. Polypharmacy in the aging patient: a review of glycemic control in older adults with type 2 diabetes. JAMA. 2016;315(10):1034-1045.
    1. American Diabetes Association Professional Practice Committee, Draznin B, Aroda VR, et al. 13. Older adults: standards of medical Care in Diabetes-2022. Diabetes Care. 2022;45(Suppl. 1):S195-S207.
    1. American Geriatrics Society Expert Panel on the Care of Older Adults with Diabetes Mellitus, Moreno G, Mangione CM, Kimbro L, Vaisberg E. Guidelines abstracted from the American Geriatrics Society guidelines for improving the Care of Older Adults with diabetes mellitus: 2013 update. J Am Geriatr Soc. 2013;61(11):2020-2026.
    1. American Geriatrics Society Choosing Wisely Workgroup. American Geriatrics Society identifies five things that healthcare providers and patients should question. J Am Geriatr Soc. 2013;61(4):622-631.

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