TY - JOUR
T1 - Overtreatment and associated risk factors among multimorbid older patients with diabetes
AU - Baretella, Oliver
AU - Alwan, Heba
AU - Feller, Martin
AU - Aubert, Carole E
AU - Del Giovane, Cinzia
AU - Papazoglou, Dimitrios
AU - Christiaens, Antoine
AU - Meinders, Arend-Jan
AU - Byrne, Stephen
AU - Kearney, Patricia M
AU - O'Mahony, Denis
AU - Knol, Wilma
AU - Boland, Benoît
AU - Gencer, Baris
AU - Aujesky, Drahomir
AU - Rodondi, Nicolas
N1 - Funding Information:
This study is a subproject of the “OPERAM: OPtimising thERapy to prevent Avoidable hospital admissions in Multimorbid older adults” supported by the European Union's Horizon 2020 research and innovation program under the grant agreement number 634238, and by the Swiss State Secretariat for Education, Research and Innovation (SERI) under contract number 15.0137. The opinions expressed and arguments employed herein are those of the authors and do not necessarily reflect the official views of the European Commission and the Swiss government. This project was also partially funded by the Swiss National Scientific Foundation (SNSF 320030_188549 and 325130_204361/1). OB obtained a Protected Research Time (PRT) Grant from the University of Bern. Open access funding provided by Universitat Bern.
Funding Information:
This study is a subproject of the “OPERAM: OPtimising thERapy to prevent Avoidable hospital admissions in Multimorbid older adults” supported by the European Union's Horizon 2020 research and innovation program under the grant agreement number 634238, and by the Swiss State Secretariat for Education, Research and Innovation (SERI) under contract number 15.0137. The opinions expressed and arguments employed herein are those of the authors and do not necessarily reflect the official views of the European Commission and the Swiss government. This project was also partially funded by the Swiss National Scientific Foundation (SNSF 320030_188549 and 325130_204361/1). OB obtained a Protected Research Time (PRT) Grant from the University of Bern. Open access funding provided by Universitat Bern.
Publisher Copyright:
© 2023 The Authors. Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.
PY - 2023/9
Y1 - 2023/9
N2 - Background: In multimorbid older patients with type 2 diabetes mellitus (T2DM), the intensity of glucose-lowering medication (GLM) should be focused on attaining a suitable level of glycated hemoglobin (HbA
1c) while avoiding side effects. We aimed at identifying patients with overtreatment of T2DM as well as associated risk factors. Methods: In a secondary analysis of a multicenter study of multimorbid older patients, we evaluated HbA
1c levels among patients with T2DM. Patients were aged ≥70 years, with multimorbidity (≥3 chronic diagnoses) and polypharmacy (≥5 chronic medications), enrolled in four university medical centers across Europe (Belgium, Ireland, Netherlands, and Switzerland). We defined overtreatment as HbA
1c < 7.5% with ≥1 GLM other than metformin, as suggested by Choosing Wisely and used prevalence ratios (PRs) to evaluate risk factors of overtreatment in age- and sex-adjusted analyses. Results: Among the 564 patients with T2DM (median age 78 years, 39% women), mean ± standard deviation HbA
1c was 7.2 ± 1.2%. Metformin (prevalence 51%) was the most frequently prescribed GLM and 199 (35%) patients were overtreated. The presence of severe renal impairment (PR 1.36, 1.21–1.53) and outpatient physician (other than general practitioner [GP], i.e. specialist) or emergency department visits (PR 1.22, 1.03–1.46 for 1–2 visits, and PR 1.35, 1.19–1.54 for ≥3 visits versus no visits) were associated with overtreatment. These factors remained associated with overtreatment in multivariable analyses. Conclusions: In this multicountry study of multimorbid older patients with T2DM, more than one third were overtreated, highlighting the high prevalence of this problem. Careful balancing of benefits and risks in the choice of GLM may improve patient care, especially in the context of comorbidities such as severe renal impairment, and frequent non-GP healthcare contacts.
AB - Background: In multimorbid older patients with type 2 diabetes mellitus (T2DM), the intensity of glucose-lowering medication (GLM) should be focused on attaining a suitable level of glycated hemoglobin (HbA
1c) while avoiding side effects. We aimed at identifying patients with overtreatment of T2DM as well as associated risk factors. Methods: In a secondary analysis of a multicenter study of multimorbid older patients, we evaluated HbA
1c levels among patients with T2DM. Patients were aged ≥70 years, with multimorbidity (≥3 chronic diagnoses) and polypharmacy (≥5 chronic medications), enrolled in four university medical centers across Europe (Belgium, Ireland, Netherlands, and Switzerland). We defined overtreatment as HbA
1c < 7.5% with ≥1 GLM other than metformin, as suggested by Choosing Wisely and used prevalence ratios (PRs) to evaluate risk factors of overtreatment in age- and sex-adjusted analyses. Results: Among the 564 patients with T2DM (median age 78 years, 39% women), mean ± standard deviation HbA
1c was 7.2 ± 1.2%. Metformin (prevalence 51%) was the most frequently prescribed GLM and 199 (35%) patients were overtreated. The presence of severe renal impairment (PR 1.36, 1.21–1.53) and outpatient physician (other than general practitioner [GP], i.e. specialist) or emergency department visits (PR 1.22, 1.03–1.46 for 1–2 visits, and PR 1.35, 1.19–1.54 for ≥3 visits versus no visits) were associated with overtreatment. These factors remained associated with overtreatment in multivariable analyses. Conclusions: In this multicountry study of multimorbid older patients with T2DM, more than one third were overtreated, highlighting the high prevalence of this problem. Careful balancing of benefits and risks in the choice of GLM may improve patient care, especially in the context of comorbidities such as severe renal impairment, and frequent non-GP healthcare contacts.
KW - glucose-lowering medication
KW - HbA
KW - multimorbidity
KW - polypharmacy
KW - type 2 diabetes mellitus
UR - http://www.scopus.com/inward/record.url?scp=85161545419&partnerID=8YFLogxK
U2 - 10.1111/jgs.18465
DO - 10.1111/jgs.18465
M3 - Article
C2 - 37286338
SN - 0002-8614
VL - 71
SP - 2893
EP - 2901
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 9
ER -