RT Journal Article
SR Electronic
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
FD American Diabetes Association
SP e001585
DO 10.1136/bmjdrc-2020-001585
VO 9
IS 1
A1 Brenda Bongaerts
A1 Suzanne V Arnold
A1 Bernard H Charbonnel
A1 Hungta Chen
A1 Andrew Cooper
A1 Peter Fenici
A1 Marilia Gomes
A1 Linong Ji
A1 Kamlesh Khunti
A1 Mikhail Kosiborod
A1 Jesús Medina
A1 Antonio Nicolucci
A1 Marina Shestakova
A1 Iichiro Shimomura
A1 Fengming Tang
A1 Hirotaka Watada
A1 Wolfgang Rathmann
YR 2021
UL http://drc.bmj.com/content/9/1/e001585.abstract
AB 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.