Deintensification in older patients with type 2 diabetes: A systematic review of approaches, rates and outcomes
Deintensification in older patients with type 2 diabetes: A systematic review of approaches, rates and outcomes
Tarih
2019-01-01
Yazarlar
Seidu, Samuel
Kunutsor, Setor K.
Topsever, Pinar
Hambling, Clare E.
Cos, Francesc X.
Khunti, Kamlesh
Süreli Yayın başlığı
Süreli Yayın ISSN
Cilt Başlığı
Yayınevi
WILEY
Dergi Adı
DIABETES OBESITY \& METABOLISM
Özet
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.
Açıklama
Anahtar kelimeler
cardiovascular disease, deintensification, deprescribing, medication, older adults, systematic review, type 2 diabetes