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Deintensification in older patients with type 2 diabetes: A systematic review of approaches, rates and outcomes

Research output: Contribution to journalArticle

Original languageEnglish
Pages (from-to)1668-1679
Number of pages12
JournalDiabetes, Obesity and Metabolism
Volume21
Issue number7
Early online date29 Apr 2019
DOIs
DateAccepted/In press - 27 Mar 2019
DateE-pub ahead of print - 29 Apr 2019
DatePublished (current) - 1 Jul 2019

Abstract

Aim: To assess deintensification approaches and rates and evaluate the harm and benefits of deintensification with antidiabetic medication and other therapies among older people (≥ 65 years) with type 2 diabetes with or without cardiometabolic conditions. Methods: We identified relevant studies in a literature search of MEDLINE, Embase, Web of Science and Cochrane databases to 30 October 2018. Data were extracted on baseline characteristics, details on deintensification and outcomes, and was synthesized using a narrative approach. Results: Ten studies (observational cohorts and interventional studies) with data on 26 558 patients with comorbidities were eligible. Deintensification approaches included complete withdrawal, discontinuation, reducing dosage, conversion, or substitution of at least one medication, but the majority of studies were based on complete withdrawal or discontinuation of antihyperglycaemic medication. Rates of deintensification approaches ranged from 13.4%–75%. The majority of studies reported no deterioration in HbA1c levels, hypoglycaemic episodes, falls or hospitalizations on deintensification. On adverse events and mortality, no significant differences were observed among the comparison groups in the majority of studies. Conclusion: Available but limited evidence suggests that the benefits of deintensification outweigh the harm in older people with type 2 diabetes with or without comorbidities. Given the heterogeneity of patients with diabetes, further research is warranted on which deintensification approaches are appropriate and beneficial for each specific patient population.

    Research areas

  • deintensification, deprescribing, medication, Older Adult, Type 2 Diabetes, cardiovascular disease, systematic revew

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    Rights statement: This is the author accepted manuscript (AAM). The final published version (version of record) is available online via Wiley at https://onlinelibrary.wiley.com/doi/full/10.1111/dom.13724 . Please refer to any applicable terms of use of the publisher.

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    Embargo ends: 29/04/20

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