A recent retrospective cohort study has explored the prevalence and predictors of diabetic medication de-intensification among Veterans with diabetes and limited life expectancy and/or advanced dementia admitted to Veterans Affairs nursing homes in the USA. Researchers reported that among 6,960 Veterans with HbA1c ≤ 7.5% receiving hypoglycaemic medications, 43.9% were being potentially over-treated for diabetes. Cumulative incidence of de-intensification (which involved discontinuation or dose reduction for 7 consecutive days) was 45.5% at 90 days. De-intensification was less likely among Veterans with higher baseline HbA1c values (adjusted risk ratio [aRR]: 0.57; 95% CI: 0.50-0.66). Comparisons with non-sulfonylurea oral agents such as metformin were utilised to assess the prevalence of de-intensification; other treatments were more likely to be de-intensified (aRR: 1.31-1.88) with the exception of basal insulin (aRR: 0.59). Likelihood of de-intensification was decreased among Veterans who were admitted from home/assisted living, or who were obese or had peripheral vascular disease. Increased likelihood was only associated with documented end-of-life status. These conclusions suggest that de-intensification of potentially overused glucose lowering medication was more strongly linked to lower HbA1c values and certain treatments than it was to resident characteristics. Full details of the study, published in the Journal of the American Geriatrics Society, can be viewed here.
Contributed by Australian Medication Safety Services Associate, Isabella Singh