دورية أكاديمية
أعرض في EDS

Overtreatment and associated risk factors among multimorbid older patients with diabetes.

التفاصيل البيبلوغرافية
العنوان: Overtreatment and associated risk factors among multimorbid older patients with diabetes.
المؤلفون: Baretella O; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.; Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland., Alwan H; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.; Graduate School for Health Sciences, University of Bern, Bern, Switzerland., Feller M; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.; Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland., Aubert CE; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.; Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland., Del Giovane C; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland., Papazoglou D; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.; Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland., Christiaens A; Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, INSERM, Paris, France.; Clinical Pharmacy research group, Louvain Drug Research Institute (LDRI), Université catholique de Louvain, Brussels, Belgium., Meinders AJ; Department of Internal Medicine, St Antonius Hospital, Nieuwegein, the Netherlands., Byrne S; School of Pharmacy, University College Cork - National University of Ireland, Cork, Republic of Ireland., Kearney PM; School of Public Health, University College Cork, Cork, Republic of Ireland.; Department of Medicine Cork, University College Cork - National University of Ireland, Cork, Republic of Ireland., O'Mahony D; Department of Medicine Cork, University College Cork - National University of Ireland, Cork, Republic of Ireland.; Department of Geriatric Medicine Cork, Cork University Hospital Group, Cork, Republic of Ireland., Knol W; Department of Geriatrics and Expertise Centre Pharmacotherapy in Old Persons (EPHOR), University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands., Boland B; Clinical Pharmacy research group, Louvain Drug Research Institute (LDRI), Université catholique de Louvain, Brussels, Belgium.; Department of Geriatric Medicine, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium., Gencer B; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.; Service de cardiologie, Hôpitaux Universitaires de Genève (HUG), Geneva, Switzerland., Aujesky D; Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland., Rodondi N; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.; Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland.
المصدر: Journal of the American Geriatrics Society [J Am Geriatr Soc] 2023 Sep; Vol. 71 (9), pp. 2893-2901. Date of Electronic Publication: 2023 Jun 07.
نوع المنشور: Multicenter Study; Journal Article; Research Support, Non-U.S. Gov't
اللغة: English
بيانات الدورية: Publisher: Blackwell Science Country of Publication: United States NLM ID: 7503062 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-5415 (Electronic) Linking ISSN: 00028614 NLM ISO Abbreviation: J Am Geriatr Soc Subsets: MEDLINE
أسماء مطبوعة: Publication: Malden, MA : Blackwell Science
Original Publication: New York [etc.]
مواضيع طبية MeSH: Diabetes Mellitus, Type 2*/drug therapy , Diabetes Mellitus, Type 2*/epidemiology , Metformin*/therapeutic use, Humans ; Female ; Aged ; Male ; Multimorbidity ; Risk Factors ; Polypharmacy ; Hypoglycemic Agents/therapeutic use
مستخلص: 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 (HbA 1c ) 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 HbA 1c 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 HbA 1c  < 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 HbA 1c 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.
(© 2023 The Authors. Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.)
References: 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.
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.
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.
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.
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.
American Geriatrics Society. Avoid using medications other than metformin to achieve hemoglobin A1c < 7.5% in most older adults; moderate control is generally better. Published February 21, 2013; revised April 23, 2015. Accessed 2 September 2022. https://www.choosingwisely.org/clinician-lists/american-geriatrics-society-medication-to-control-type-2-diabetes/.
Lipska KJ, Ross JS, Miao Y, Shah ND, Lee SJ, Steinman MA. Potential overtreatment of diabetes mellitus in older adults with tight glycemic control. JAMA Intern Med. 2015;175(3):356-362.
Lega IC, Campitelli MA, Austin PC, et al. Potential diabetes overtreatment and risk of adverse events among older adults in Ontario: a population-based study. Diabetologia. 2021;64(5):1093-1102.
Mata-Cases M, Mauricio D, Real J, et al. Potential risk of overtreatment in patients with type 2 diabetes aged 75 years or older: data from a population database in Catalonia, Spain. J Clin Med. 2022;11(17):5134. doi:10.3390/jcm11175134.
Maciejewski ML, Mi X, Sussman J, et al. Overtreatment and deintensification of diabetic therapy among Medicare beneficiaries. J Gen Intern Med. 2018;33(1):34-41.
Blum MR, Sallevelt B, Spinewine A, et al. Optimizing therapy to prevent avoidable hospital admissions in multimorbid older adults (OPERAM): cluster randomised controlled trial. BMJ. 2021;374:n1585.
Barros AJ, Hirakata VN. Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol. 2003;3:21.
Tamhane AR, Westfall AO, Burkholder GA, Cutter GR. Prevalence odds ratio versus prevalence ratio: choice comes with consequences. Stat Med. 2016;35(30):5730-5735.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-383.
Arnold SV, Lipska KJ, Wang J, Seman L, Mehta SN, Kosiborod M. Use of intensive glycemic Management in Older Adults with diabetes mellitus. J Am Geriatr Soc. 2018;66(6):1190-1194.
Hart HE, Rutten GE, Bontje KN, Vos RC. Overtreatment of older patients with type 2 diabetes mellitus in primary care. Diabetes Obes Metab. 2018;20(4):1066-1069.
Sussman JB, Kerr EA, Saini SD, et al. Rates of deintensification of blood pressure and glycemic medication treatment based on levels of control and life expectancy in older patients with diabetes mellitus. JAMA Intern Med. 2015;175(12):1942-1949.
Christiaens A, Henrard S, Zerah L, Dalleur O, Bourdel-Marchasson I, Boland B. Individualisation of glycaemic management in older people with type 2 diabetes: a systematic review of clinical practice guidelines recommendations. Age Ageing. 2021;50(6):1935-1942.
Jadad AR, To MJ, Emara M, Jones J. Consideration of multiple chronic diseases in randomized controlled trials. JAMA. 2011;306(24):2670-2672.
Adam L, Moutzouri E, Baumgartner C, et al. Rationale and design of OPtimising thERapy to prevent avoidable hospital admissions in multimorbid older people (OPERAM): a cluster randomised controlled trial. BMJ Open. 2019;9(6):e026769.
Sacks DB, John WG. Interpretation of hemoglobin A1c values. JAMA. 2014;311(22):2271-2272.
Khan SU, Khan MZ, Raghu Subramanian C, et al. Participation of women and older participants in randomized clinical trials of lipid-lowering therapies: a systematic review. JAMA Netw Open. 2020;3(5):e205202.
Cowie CC, Casagrande SS, Geiss LS. Prevalence and incidence of type 2 diabetes and prediabetes. In: Cowie CC, Casagrande SS, Menke A, et al., eds. Diabetes in America. 3rd ed. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases. https://www.ncbi.nlm.nih.gov/pubmed/33651562; 2018.
Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008;359(15):1577-1589.
Frank C, Weir E. Deprescribing for older patients. CMAJ. 2014;186(18):1369-1376.
Kosjerina V, Carstensen B, Jørgensen ME, et al. Discontinuation of diabetes medication in the 10 years before death in Denmark: a register-based study. Lancet Healthy Longev. 2021;2(9):e561-e570.
Action to Control Cardiovascular Risk in Diabetes (ACCORD) Study Group, Gerstein HC, Miller ME et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358(24):2545-2559.
معلومات مُعتمدة: 634238 International ERC_ European Research Council; SNSF 320030_188549 Switzerland SNSF_ Swiss National Science Foundation; SNSF 325130_204361/1 Switzerland SNSF_ Swiss National Science Foundation
فهرسة مساهمة: Keywords: HbA1c; glucose-lowering medication; multimorbidity; polypharmacy; type 2 diabetes mellitus
المشرفين على المادة: 9100L32L2N (Metformin)
0 (Hypoglycemic Agents)
تواريخ الأحداث: Date Created: 20230607 Date Completed: 20230915 Latest Revision: 20230918
رمز التحديث: 20231215
DOI: 10.1111/jgs.18465
PMID: 37286338
قاعدة البيانات: MEDLINE
الوصف
تدمد:1532-5415
DOI:10.1111/jgs.18465