Usefulness of glycated albumin in decisions regarding the discontinuation of a diabetes drug and factors associated with poor glycemic control following discontinuation in patients with type 2 diabetes mellitus

Abstract

We studied the usefulness of glycated albumin (GA) for decisions regarding the discontinuation of a diabetes drug in type 2 diabetic patients with good glycemic control, and the factors associated with increases in GA following discontinuation of a diabetes drug in patients with type 2 diabetes mellitus. Sixteen patients (12 males and 4 females) were enrolled in the present study and discontinued one diabetes drug. When the change in GA was less than 1 % at 4 weeks after the discontinuation of the diabetes drug (DGA4w), discontinuation was continued (the continuous group, n = 10), but when the change in GA was more than a 1 %, the discontinued diabetes drug was resumed (the resume group, n = 6). In the continuous group, HbA1c at 12 weeks after discontinuation (6.2 ± 0.6 %) remained unchanged from its value at discontinuation (6.2 ± 0.7 %) , but it was significantly elevated at 12 weeks after discontinuation in the resume group (changing from 6.3 ± 0.1 to 7.0 ± 0.6 %). Age, duration of diabetes, and GA were significantly lower while body mass index (BMI) was significantly higher in the continuous group than in the resume group, but no significant difference in HbA1c was observed between the groups. The discontinuation of a diabetes drug in patients with low insulin secretion must be performed carefully because factors such as duration of diabetes, BMI, and GA showed significant differences between the continuous group and resume group in our study, and these indicators are known to be linked with insulin secretion.

Rates, determinants and success of implementing deprescribing in people with type 2 diabetes: A scoping review

“… 15,16,27–38 The study periods covered ranged from 2001 to 2017. Study methodologies comprised retrospective cohort studies, 15,16,27–31 prospective cohort or before‐and‐after studies, 32–36 and surveys 37,38 …”

“…The studies looking at participant characteristics associated with deprescribing rates had a low risk of bias (Figure 2). 15,27–29 The studies looking at participant characteristics associated with successful deprescribing and those reporting on the success of deprescribing had a high risk of bias 33,34,36 . Those studies also included very small sample sizes.…”

“…33 In a third study, including 16 eligible adults with stable HbA 1c levels below 53 mmol/mol (7.0%), successful discontinuation was possible in 10 participants (62%), showing no significant changes between baseline HbA 1c of 44 mmol/mol and 12-week HbA 1c of 44 mmol/mol (6.2%). 36 Hypoglycaemia occurrence reduced significantly in a group of older people who had a self-reported risk of hypoglycaemia after deprescribing of glucose-lowering medications (n = 395) compared to those with no change in treatment (n = 387). 30…”

“…15,16,[27][28][29][30][31][32][33][34][35][36][37][38] The study periods covered ranged from 2001 to 2017. Study methodologies comprised retrospective cohort studies, 15,16,[27][28][29][30][31] prospective cohort or before-and-after studies, [32][33][34][35][36] and surveys. 37,38 The studies looking at participant characteristics associated with deprescribing rates had a low risk of bias ( Figure 2).…”

“…15,[27][28][29] The studies looking at participant characteristics associated with successful deprescribing and those reporting on the success of deprescribing had a high risk of bias. 33,34,36 Those studies also included very small sample sizes. Finally, the studies reporting on the success of interventions to enhance deprescribing had an uncertain to high risk of bias.…”