nach oben

Erschienen in:

25.01.2021 | Article

Potential diabetes overtreatment and risk of adverse events among older adults in Ontario: a population-based study

verfasst von: Iliana C. Lega, Michael A. Campitelli, Peter C. Austin, Yingbo Na, Afshan Zahedi, Freda Leung, Catherine Yu, Susan E. Bronskill, Paula A. Rochon, Lorraine L. Lipscombe

Erschienen in: Diabetologia | Ausgabe 5/2021

Einloggen, um Zugang zu erhalten

Abstract

Aims/hypothesis

More than 25% of older adults (age ≥75 years) have diabetes and may be at risk of adverse events related to treatment. The aim of this study was to assess the prevalence of intensive glycaemic control in this group, potential overtreatment among older adults and the impact of overtreatment on the risk of serious events.

Methods

We conducted a retrospective, population-based cohort study of community-dwelling older adults in Ontario using administrative data. Participants were ≥75 years of age with diagnosed diabetes treated with at least one anti-hyperglycaemic agent between 2014 and 2015. Individuals were categorised as having intensive or conservative glycaemic control (HbA_1c <53 mmol/mol [<7%] or 54–69 mmol/mol [7.1–8.5%], respectively), and as undergoing treatment with high-risk (i.e. insulin, sulfonylureas) or low-risk (other) agents. We measured the composite risk of emergency department visits, hospitalisations, or death within 30 days of reaching intensive glycaemic control with high-risk agents.

Results

Among 108,620 older adults with diagnosed diabetes in Ontario, the mean (± SD) age was 80.6 (±4.5) years, 49.7% were female, and mean (± SD) diabetes duration was 13.7 (±6.3) years. Overall, 61% of individuals were treated to intensive glycaemic control and 21.6% were treated to intensive control using high-risk agents. Using inverse probability treatment weighting with propensity scores, intensive control with high-risk agents was associated with nearly 50% increased risk of the composite outcome compared with conservative glycaemic control with low-risk agents (RR 1.49, 95% CI 1.08, 2.05).

Conclusions/interpretation

Our findings underscore the need to re-evaluate glycaemic targets in older adults and to reconsider the use of anti-hyperglycaemic medications that may lead to hypoglycaemia, especially in setting of intensive glycaemic control.

Graphical abstract

Nur mit Berechtigung zugänglich

Wild S, Roglic G, Green A, Sicree R, King H (2004) Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 27(5):1047–1053. https://doi.org/10.2337/diacare.27.5.1047CrossRefPubMed

Lipscombe LL, Hux JE (2007) Trends in diabetes prevalence, incidence, and mortality in Ontario, Canada 1995-2005: a population-based study. Lancet 369(9563):750–756. https://doi.org/10.1016/S0140-6736(07)60361-4CrossRefPubMed

Cheng YJ, Imperatore G, Geiss LS et al (2013) Secular changes in the age-specific prevalence of diabetes among U.S. adults: 1988-2010. Diabetes Care 36(9):2690–2696. https://doi.org/10.2337/dc12-2074CrossRefPubMedPubMedCentral

(1998) Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet 352(9131):837–853. https://doi.org/10.1128/AAMCol.14Aug.1998

Boucher BJ (1998) Inadequate vitamin D status: does it contribute to the disorders comprising syndrome ‘X’? Br J Nutr 79(4):315–327

Group AC, Patel A, MacMahon S et al (2008) Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 358(24):2560–2572. https://doi.org/10.1056/NEJMoa0802987CrossRef

Budnitz DS, Lovegrove MC, Shehab N, Richards CL (2011) Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med 365(21):2002–2012. https://doi.org/10.1056/NEJMsa1103053CrossRefPubMed

Lipska KJ, Ross JS, Miao Y, Shah ND, Lee SJ, Steinman MA (2015) Potential overtreatment of diabetes mellitus in older adults with tight glycemic control. JAMA Intern Med 175(3):356–362. https://doi.org/10.1001/jamainternmed.2014.7345CrossRefPubMedPubMedCentral

Bolli G, de Feo P, Compagnucci P et al (1983) Abnormal glucose counterregulation in insulin-dependent diabetes mellitus. Interaction of anti-insulin antibodies and impaired glucagon and epinephrine secretion. Diabetes 32(2):134–141. https://doi.org/10.2337/diab.32.2.134CrossRefPubMed

10.

Signorovitch JE, Macaulay D, Diener M et al (2013) Hypoglycaemia and accident risk in people with type 2 diabetes mellitus treated with non-insulin antidiabetes drugs. Diabetes Obes Metab 15(4):335–341. https://doi.org/10.1111/dom.12031CrossRefPubMed

11.

Goto A, Arah OA, Goto M, Terauchi Y, Noda M (2013) Severe hypoglycaemia and cardiovascular disease: systematic review and meta-analysis with bias analysis. BMJ 347:f4533. https://doi.org/10.1136/bmj.f4533CrossRefPubMed

12.

Khunti K, Davies M, Majeed A, Thorsted BL, Wolden ML, Paul SK (2015) Hypoglycemia and risk of cardiovascular disease and all-cause mortality in insulin-treated people with type 1 and type 2 diabetes: a cohort study. Diabetes Care 38(2):316–322. https://doi.org/10.2337/dc14-0920CrossRefPubMed

13.

Whitmer RA, Karter AJ, Yaffe K, Quesenberry CP Jr, Selby JV (2009) Hypoglycemic episodes and risk of dementia in older patients with type 2 diabetes mellitus. JAMA 301(15):1565–1572. https://doi.org/10.1001/jama.2009.460CrossRefPubMedPubMedCentral

14.

Bonds DE, Miller ME, Bergenstal RM et al (2010) The association between symptomatic, severe hypoglycaemia and mortality in type 2 diabetes: retrospective epidemiological analysis of the ACCORD study. BMJ 340:b4909. https://doi.org/10.1136/bmj.b4909CrossRefPubMedPubMedCentral

15.

Group AS, Gerstein HC, Miller ME et al (2011) Long-term effects of intensive glucose lowering on cardiovascular outcomes. N Engl J Med 364(9):818–828. https://doi.org/10.1056/NEJMoa1006524CrossRef

16.

Hayward RA, Reaven PD, Wiitala WL et al (2015) Follow-up of glycemic control and cardiovascular outcomes in type 2 diabetes. N Engl J Med 372(23):2197–2206. https://doi.org/10.1056/NEJMoa1414266CrossRefPubMed

17.

Zoungas S, Chalmers J, Neal B et al (2014) Follow-up of blood-pressure lowering and glucose control in type 2 diabetes. N Engl J Med 371(15):1392–1406. https://doi.org/10.1056/NEJMoa1407963CrossRefPubMed

18.

Lipska KJ, Krumholz H, Soones T, Lee SJ (2016) Polypharmacy in the aging patient: a review of glycemic control in older adults with type 2 diabetes. JAMA 315(10):1034–1045. https://doi.org/10.1001/jama.2016.0299CrossRefPubMedPubMedCentral

19.

Diabetes Canada Clinical Practice Guidelines Expert C, Meneilly GS, Knip A et al (2018) Diabetes in older people. Can J Diabetes 42(Suppl 1):S283–S295. https://doi.org/10.1016/j.jcjd.2017.10.021CrossRef

20.

LeRoith D, Biessels GJ, Braithwaite SS et al (2019) Treatment of diabetes in older adults: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 104(5):1520–1574. https://doi.org/10.1210/jc.2019-00198CrossRefPubMedPubMedCentral

21.

Arnold SV, Lipska KJ, Wang J, Seman L, Mehta SN, Kosiborod M (2018) Use of intensive glycemic management in older adults with diabetes mellitus. J Am Geriatr Soc 66(6):1190–1194. https://doi.org/10.1111/jgs.15335CrossRefPubMedPubMedCentral

22.

Tseng CL, Soroka O, Maney M, Aron DC, Pogach LM (2014) Assessing potential glycemic overtreatment in persons at hypoglycemic risk. JAMA Intern Med 174(2):259–268. https://doi.org/10.1001/jamainternmed.2013.12963CrossRefPubMed

23.

Muller N, Khunti K, Kuss O et al (2017) Is there evidence of potential overtreatment of glycaemia in elderly people with type 2 diabetes? Data from the GUIDANCE study. Acta Diabetol 54(2):209–214. https://doi.org/10.1007/s00592-016-0939-9CrossRefPubMed

24.

McCoy RG, Lipska KJ, Yao X, Ross JS, Montori VM, Shah ND (2016) Intensive treatment and severe hypoglycemia among adults with type 2 diabetes. JAMA Intern Med 176(7):969–978. https://doi.org/10.1001/jamainternmed.2016.2275CrossRefPubMedPubMedCentral

25.

Mahoney GK, Henk HJ, McCoy RG (2019) Severe hypoglycemia attributable to intensive glucose-lowering therapy among US adults with diabetes: population-based modeling study, 2011-2014. Mayo Clin Proc. https://doi.org/10.1016/j.mayocp.2019.02.028

26.

Lipscombe LL, Gomes T, Levesque LE, Hux JE, Juurlink DN, Alter DA (2007) Thiazolidinediones and cardiovascular outcomes in older patients with diabetes. JAMA 298(22):2634–2643. https://doi.org/10.1001/jama.298.22.2634CrossRefPubMed

27.

Hux JE, Ivis F, Flintoft V, Bica A (2002) Diabetes in Ontario: determination of prevalence and incidence using a validated administrative data algorithm. Diabetes Care 25(3):512–516. https://doi.org/10.2337/diacare.25.3.512CrossRefPubMed

28.

Khan H, Lasker SS, Chowdhury TA (2011) Exploring reasons for very poor glycaemic control in patients with type 2 diabetes. Prim Care Diabetes 5(4):251–255. https://doi.org/10.1016/j.pcd.2011.07.001CrossRefPubMed

29.

Reid RJ, Roos NP, MacWilliam L, Frohlich N, Black C (2002) Assessing population health care need using a claims-based ACG morbidity measure: a validation analysis in the Province of Manitoba. Health Serv Res 37(5):1345–1364. https://doi.org/10.1111/1475-6773.01029CrossRefPubMedPubMedCentral

30.

King N, King M (2014) The Ontario cancer registry moves to the 21st century. Cancer Care Ontario, Toronto

31.

Jaakkimainen RL, Bronskill SE, Tierney MC et al (2016) Identification of physician-diagnosed Alzheimer’s disease and related dementias in population-based administrative data: a validation study using family physicians’ electronic medical records. J Alzheimers Dis 54(1):337–349. https://doi.org/10.3233/JAD-160105CrossRefPubMed

32.

Schultz SE, Rothwell DM, Chen Z, Tu K (2013) Identifying cases of congestive heart failure from administrative data: a validation study using primary care patient records. Chronic Dis Inj Can 33(3):160–166

33.

Tam DY, Dharma C, Rocha R et al (2020) Long-term survival after surgical or percutaneous revascularization in patients with diabetes and multivessel coronary disease. J Am Coll Cardiol 76(10):1153–1164CrossRef

34.

Singh SM, Abdel-Qadir H, Pang A et al (2020) Population trends in all-cause mortality and cause specific–death with incident atrial fibrillation. J Am Heart Assoc 9(19):e016810. https://doi.org/10.1016/j.compbiomed.2020.104185

35.

Yu AY, Austin PC, Rashid M et al (2020) Deriving a passive surveillance stroke severity indicator from routinely collected administrative data: the PaSSV Indicator. Circ Cardiovasc Qual Outcomes 13(2):e006269CrossRef

36.

Austin PC (2011) An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivar Behav Res 46(3):399–424. https://doi.org/10.1080/00273171.2011.568786CrossRef

37.

Austin PC, Stuart EA (2015) Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies. Stat Med 34(28):3661–3679. https://doi.org/10.1002/sim.6607CrossRefPubMedPubMedCentral

38.

Duckworth W, Abraira C, Moritz T et al (2009) Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med 360(2):129–139. https://doi.org/10.1056/NEJMoa0808431CrossRef

39.

Mitchell AP, Harrison MR, Walker MS, George DJ, Abernethy AP, Hirsch BR (2015) Clinical trial participants with metastatic renal cell carcinoma differ from patients treated in real-world practice. J Oncol Pract 11(6):491–497. https://doi.org/10.1200/JOP.2015.004929CrossRefPubMed

40.

Gangji AS, Cukierman T, Gerstein HC, Goldsmith CH, Clase CM (2007) A systematic review and meta-analysis of hypoglycemia and cardiovascular events: a comparison of glyburide with other secretagogues and with insulin. Diabetes Care 30(2):389–394. https://doi.org/10.2337/dc06-1789CrossRefPubMed

41.

Hubbard R, Andrew M, Fallah N, Rockwood K (2010) Comparison of the prognostic importance of diagnosed diabetes, co-morbidity and frailty in older people. Diabet Med 27(5):603–606. https://doi.org/10.1111/j.1464-5491.2010.02977.xCrossRefPubMed

42.

Hambling CE, Seidu SI, Davies MJ, Khunti K (2017) Older people with type 2 diabetes, including those with chronic kidney disease or dementia, are commonly overtreated with sulfonylurea or insulin therapies. Diabet Med 34(9):1219–1227. https://doi.org/10.1111/dme.13380CrossRefPubMed

43.

American Diabetes Association (2019) 12. Older adults: standards of medical care in diabetes – 2019. Diabetes Care 42(Suppl 1):S139–S147. https://doi.org/10.2337/dc19-S012

44.

Canadian Diabetes Association Clinical Practice Guidelines Expert Committee; Meneilly GS, Knip A, Tessier D (2013) Diabetes in the elderly. Can J Diabetes 37:184–190

45.

Yu CH, Gall Casey C, Ke C, Lebovic G, Straus SE (2019) Process evaluation of the Diabetes Canada guidelines dissemination strategy using the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework. Can J Diabetes 43(4):263–270.e9. https://doi.org/10.1016/j.jcjd.2018.08.189

46.

Yu CH, Lillie E, Mascarenhas-Johnson A, Gall Casey C, Straus SE (2018) Impact of the Canadian Diabetes Association guideline dissemination strategy on clinician knowledge and behaviour change outcomes. Diabetes Res Clin Pract 140:314–323. https://doi.org/10.1016/j.diabres.2018.02.041CrossRefPubMed

47.

Markovitz AA, Hofer TP, Froehlich W et al (2018) An examination of deintensification recommendations in clinical practice guidelines: stepping up or scaling back? JAMA Intern Med 178(3):414–416. https://doi.org/10.1001/jamainternmed.2017.7198CrossRefPubMed

48.

Caverly TJ, Fagerlin A, Zikmund-Fisher BJ et al (2015) Appropriate prescribing for patients with diabetes at high risk for hypoglycemia: national survey of veterans affairs health care professionals. JAMA Intern Med 175(12):1994–1996. https://doi.org/10.1001/jamainternmed.2015.5950CrossRefPubMed

49.

Godolphin W (2009) Shared decision-making. Healthc Q 12 Spec No Patient: e186–190

Titel: Potential diabetes overtreatment and risk of adverse events among older adults in Ontario: a population-based study
verfasst von: Iliana C. Lega
Michael A. Campitelli
Peter C. Austin
Yingbo Na
Afshan Zahedi
Freda Leung
Catherine Yu
Susan E. Bronskill
Paula A. Rochon
Lorraine L. Lipscombe
Publikationsdatum: 25.01.2021
Verlag: Springer Berlin Heidelberg
Erschienen in: Diabetologia / Ausgabe 5/2021
Print ISSN: 0012-186X
Elektronische ISSN: 1432-0428
DOI: https://doi.org/10.1007/s00125-020-05370-7

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

23.04.2024 | Ablationstherapie | Nachrichten

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Potential diabetes overtreatment and risk of adverse events among older adults in Ontario: a population-based study

Abstract

Aims/hypothesis

Methods

Results

Conclusions/interpretation

Graphical abstract

Leitlinien kompakt für die Innere Medizin

Neu im Fachgebiet Innere Medizin

Wie erfolgreich ist eine Re-Ablation nach Rezidiv?

Europäische Ernährungsgewohnheiten: Das sind die häufigsten Fehler

Hinter dieser Appendizitis steckte ein Erreger

Demenzkranke durch Antipsychotika vielfach gefährdet

Update Innere Medizin

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Abstract

Aims/hypothesis

Methods

Results

Conclusions/interpretation

Graphical abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 5/2021

Heterogeneity in insulin-stimulated glucose uptake among different muscle groups in healthy lean people and people with obesity

Current and future therapies for type 1 diabetes

The discovery of insulin in Toronto: beginning a 100 year journey of research and clinical achievement

Genetic ablation of C-reactive protein gene confers resistance to obesity and insulin resistance in rats

Transforming type 1 diabetes: the next wave of innovation

Consequences of recurrent hypoglycaemia on brain function in diabetes

Leitlinien kompakt für die Innere Medizin

Neu im Fachgebiet Innere Medizin

Wie erfolgreich ist eine Re-Ablation nach Rezidiv?

Europäische Ernährungsgewohnheiten: Das sind die häufigsten Fehler

Hinter dieser Appendizitis steckte ein Erreger

Demenzkranke durch Antipsychotika vielfach gefährdet

Update Innere Medizin