@article {Bongaertse001585, author = {Brenda Bongaerts and Suzanne V Arnold and Bernard H Charbonnel and Hungta Chen and Andrew Cooper and Peter Fenici and Marilia Gomes and Linong Ji and Kamlesh Khunti and Mikhail Kosiborod and Jes{\'u}s Medina and Antonio Nicolucci and Marina Shestakova and Iichiro Shimomura and Fengming Tang and Hirotaka Watada and Wolfgang Rathmann}, title = {Inappropriate intensification of glucose-lowering treatment in older patients with type 2 diabetes: the global DISCOVER study}, volume = {9}, number = {1}, elocation-id = {e001585}, year = {2021}, doi = {10.1136/bmjdrc-2020-001585}, publisher = {BMJ Specialist Journals}, abstract = {Introduction Although 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 \<7.0\% (53.0 mmol/mol)) in a global study. Factors associated with intensive glycemic management and using glucose-lowering medications associated with a high risk of hypoglycemia (high-risk medications (insulin, sulfonylureas, and meglitinides)) were also assessed.Research design and methods DISCOVER 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.Results Of 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.Conclusions A 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.Data underlying the findings described in this manuscript may be obtained in accordance with AstraZeneca{\textquoteright}s data sharing policy described at https://astrazenecagrouptrials.pharmacm.com/ST/Submission/Disclosure.}, URL = {https://drc.bmj.com/content/9/1/e001585}, eprint = {https://drc.bmj.com/content/9/1/e001585.full.pdf}, journal = {BMJ Open Diabetes Research and Care} }