De-intensification in older people with type 2 diabetes: why, when and for whom?

Tertiary centre study highlights low inpatient deintensification and risks associated with adverse outcomes in frail people with diabetes

“… 10 The evidence for the benefits of deintensification in older people with diabetes and frailty is also emerging with studies suggesting the benefits of deintensification outweigh the harm regardless of the co-morbidities. 7 , 15 Moreover, episodes of hypoglycaemia in older people with diabetes and frailty are associated with increased mortality and morbidity including increased cardiovascular risks further highlighting the need for deintensification especially for those with the highest risk. 16 , 17 In line with this, our findings also showed that people with inpatient hypoglycaemia who were overtreated had higher odds of inpatient mortality.…”

“… 6 The importance of deintensification in people with diabetes and frailty has been increasingly highlighted due to increasing polypharmacy, endocrine deficits, suboptimal food and drink intake, cognitive impairment, cardiovascular disease, and renal dysfunction, that increase susceptibility to hypoglycaemia and its potentially severe consequences. 7 Moreover, whilst there is good evidence that tight glycaemic control can delay diabetes complications, evidence in people with diabetes and frailty is lacking. Studies on treatment deintensification, despite being limited to the primary care and older people with diabetes (rather than frailty), have shown low rates of deintensification.…”

Geriatrische Aspekte bei Diabetes mellitus (Update 2023)

“…Wenn eine Insulintherapie durch die Patienten nicht mehr adäquat umsetzbar ist, muss eine Anpassung auf die Fähigkeiten und das soziale Umfeld der Patienten erfolgen. Die Reduktion der Therapieintensität kann sicher und auch ohne Verschlechterung der Betreuung für ältere Patienten umgesetzt werden [108], führt zu einer Reduktion von Hypoglykämien und nicht zu einer Verschlechterung der glykämischen Kontrolle. In der Abb.…”

Type 2 Diabetes mellitus treatment intensification and deintensification in primary care: a retrospective cohort study

“…Deintensification is the discontinuation or dosage reduction of medicine treatment with an aim to manage polypharmacy and improve patient outcomes 15–17 . There is a growing body of evidence demonstrating the benefits of deintensification outweigh the harms in older patients with type 2 diabetes, for patients both with or without pre‐existing comorbidities 18,19 . To date, few studies have examined the epidemiologic and clinical characteristics of patients who have undergone intensification or deintensification of prescription of glucose‐lowering therapies, as well as what factors contribute to individualisation of treatment modalities and medicine deintensification, especially in Asia.…”

“…[15][16][17] There is a growing body of evidence demonstrating the benefits of deintensification outweigh the harms in older patients with type 2 diabetes, for patients both with or without pre-existing comorbidities. 18,19 To date, few studies have examined the epidemiologic and clinical characteristics of patients who have undergone intensification or deintensification of prescription of glucose-lowering therapies, as well as what factors contribute to individualisation of treatment modalities and medicine deintensification, especially in Asia. Hence, we conducted a retrospective observational cohort study to determine the predictors of treatment intensification or deintensification approaches among patients with type 2 diabetes in Malaysia.…”