Inappropriate intensification of glucose-lowering treatment in older patients with type 2 diabetes: the global DISCOVER study
| Autor: | Linong Ji, Jesús Medina, Fengming Tang, Marília B. Gomes, Peter Fenici, Hungta Chen, Andrew Cooper, Kamlesh Khunti, Bernard Charbonnel, Marina Vladimirovna Shestakova, Hirotaka Watada, Brenda Bongaerts, Wolfgang Rathmann, Antonio Nicolucci, Iichiro Shimomura, Mikhail Kosiborod, Suzanne V. Arnold |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Research design
Pediatrics medicine.medical_specialty Endocrinology Diabetes and Metabolism Type 2 diabetes Diseases of the endocrine glands. Clinical endocrinology Odds chemistry.chemical_compound Diabetes mellitus Medicine Humans Hypoglycemic Agents Disease management (health) Aged Glycated Hemoglobin business.industry medicine.disease RC648-665 Hypoglycemia Glucose chemistry type 2 disease management Diabetes Mellitus Type 2 Cohort diabetes mellitus Observational study Epidemiology/Health services research observational study Glycated hemoglobin business |
| Zdroj: | BMJ Open Diabetes Research & Care BMJ Open Diabetes Research & Care, Vol 9, Iss 1 (2021) |
| ISSN: | 2052-4897 |
| Popis: | IntroductionAlthough individualized target glycated hemoglobin (HbA1c) levels are recommended in older people with type 2 diabetes, studies report high levels of potential overtreatment. We aimed to investigate the proportion of older patients (aged ≥65 years) who potentially received an inappropriately intensive treatment (HbA1c level Research design and methodsDISCOVER is a 3-year observational study program of 15 992 people with type 2 diabetes initiating second-line glucose-lowering therapy in 38 countries. Data were collected at baseline (initiation of second-line therapy) and at 6, 12, and 24 months. Factors associated with an inappropriately intensive treatment or using high-risk medications were assessed using a hierarchical regression model.ResultsOf the 3344 older patients with baseline HbA1c data in our analytic cohort, 23.5% received inappropriate treatment intensification. Among those who had follow-up HbA1c data, 55.2%, 54.2%, and 53.5% were inappropriately tightly controlled at 6, 12, and 24 months, respectively, with higher proportions in high-income than in middle-income countries. The proportion of patients receiving high-risk medications was higher in middle-income countries than in high-income countries. Gross national income (per US$5000 increment) was associated with increased odds of inappropriately intensive treatment but with decreased odds of receiving high-risk medications.ConclusionsA large proportion of older DISCOVER patients received an inappropriately intensive glucose-lowering treatment across the 2 years of follow-up, with substantial regional variation. The use of high-risk medications in these patients is particularly concerning. |
| Databáze: | OpenAIRE |
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