Inappropriate intensification of glucose-lowering treatment in older patients with type 2 diabetes: the global DISCOVER study.

Abstract

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.

• Authors: Brenda Bongaerts, Suzanne V Arnold, Bernard H Charbonnel, Hungta Chen, Andrew Cooper, Peter Fenici, Marilia Gomes, Linong Ji, Kamlesh Khunti, Mikhail Kosiborod, Jesús Medina, Antonio Nicolucci, Marina Shestakova, Iichiro Shimomura, Fengming Tang, Hirotaka Watada, Wolfgang Rathmann
• Journal: BMJ open diabetes research & care (BMJ Open Diabetes Res Care) Vol. 9 Issue 1 (05 2021) ISSN: 2052-4897 [Electronic] England
• PMID: 33941550 (Publication Type: Journal Article, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Chemical References

• Glycated Hemoglobin A
• Hypoglycemic Agents
• Glucose

Topics

• Aged
• Diabetes Mellitus, Type 2 (drug therapy, epidemiology)
• Glucose
• Glycated Hemoglobin (analysis)
• Humans
• Hypoglycemia
• Hypoglycemic Agents (therapeutic use)