<p>De-Intensification Of Blood Glucose Lowering Medication In People Identified As Being Over-Treated: A Mixed Methods Study</p>

Abstract

AimTo evaluate if, one year after notification of possible overtreatment, diabetes care providers de-intensified glucose-lowering medications and to gain insight into the opinions and beliefs of both care providers and patients regarding de-intensification.MethodsMixed methods using routine care data from five health-care centres in the Netherlands. Patient characteristics and medication prescription of patients, previously identified as possibly over-treated, were extracted from patients’ medical records. Opinions of care providers were obtained through interviews. Patients received questionnaires about their diabetes treatment and were asked to participate in focus groups.ResultsA total of 64 elderly patients with type 2 diabetes were previously identified as possibly over-treated and included; 57.8% male, median age 75 years (IQR=72–82), median diabetes duration 12 years (IQR=8–18). De-intensification was implemented in more than half (n=36) of them. Care providers preferred person-centred care above just setting general HbA1c target values, considering patient characteristics (such as comorbidity) and patient’s preference. Patients valued glucose levels as most important in determining their treatment. Both patients and care providers felt that de-intensification should occur gradually.ConclusionTreatment had been de-intensified in more than half of the patients (56.3%). Insight in reasons for not de-intensifying elderly patients is important since treatment for them can be “person-centred care”. De-intensification is an iterative and time-intensive process.

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

“…5 Hart and colleagues found that de-intensification occurred more frequently in people who used sulfonylureas and who had complications and comorbidities. 6 These findings are contrary to the finding by Kosjerina and colleagues of an increased complication load being associated with a decreased rate of discontinuation.…”

Az intenzív inzulinkezelés korai deeszkalálásának lehetőségei

“…A fő oka, hogy bizonyos betegek túlzottan intenzív antidiabetikus terápiában részesülnek, hogy a "túlkezelt" és "jól kezelt" cukorbetegség nehezen elkülöníthetőek. 9 Ha krónikus egészségügyi problémákkal nem rendelkező betegnél metabolikus instabilitást mutató cukorbetegséget fedeznek fel, és a korán elkezdett ICT-vel a kiszabott glikémiás célokat gyorsan elérik, a beteg elnyeri a "jól kezelt" jelzőt. A betegségkarrier előrehaladásával azonban szövődmények lépnek fel, amelyek a T2DM progresszív jellegéből és az öregedés természetes folyamatából adódnak.…”

Expanding the Role of Continuous Glucose Monitoring in Modern Diabetes Care Beyond Type 1 Disease

“…The goal of symptom control and maintaining quality of life as people reach advanced age creates a need for treatment de-intensification in a safe manner [ 133 ]. Deprescribing sulfonylurea drugs is a clear target [ 133 , 134 ], particularly in elderly people with T2DM with more complications and comorbidities. Clinical management of diabetes in elderly and frail people with diabetes is hampered by the paucity of studies that include this population.…”