TY - JOUR T1 - Inappropriate intensification of glucose-lowering treatment in older patients with type 2 diabetes: the global DISCOVER study JF - BMJ Open Diabetes Research & Care JO - BMJ Open Diab Res Care DO - 10.1136/bmjdrc-2020-001585 VL - 9 IS - 1 SP - e001585 AU - Brenda Bongaerts AU - Suzanne V Arnold AU - Bernard H Charbonnel AU - Hungta Chen AU - Andrew Cooper AU - Peter Fenici AU - Marilia Gomes AU - Linong Ji AU - Kamlesh Khunti AU - Mikhail Kosiborod AU - Jesús Medina AU - Antonio Nicolucci AU - Marina Shestakova AU - Iichiro Shimomura AU - Fengming Tang AU - Hirotaka Watada AU - Wolfgang Rathmann Y1 - 2021/05/01 UR - http://drc.bmj.com/content/9/1/e001585.abstract N2 - 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’s data sharing policy described at https://astrazenecagrouptrials.pharmacm.com/ST/Submission/Disclosure. ER -