posted on 2023-07-12, 08:39authored byBrenda 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
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.
Funding
The DISCOVER study program is funded by AstraZeneca. DISCOVER is a non‑interventional study program, and no drugs were supplied or funded. All statistical analyses were funded by AstraZeneca and conducted, independently of the study sponsor, by the statistical group at Saint Luke’s Mid America Heart Institute, Kansas City, Missouri, USA.
History
Citation
Bongaerts B, Arnold SV, Charbonnel BH, et alInappropriate intensification of glucose-lowering treatment in older patients with type 2 diabetes: the global DISCOVER study BMJ Open Diabetes Research and Care 2021;9:e001585. doi: 10.1136/bmjdrc-2020-001585