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De-Intensification Of Blood Glucose Lowering Medication In People Identified As Being Over-Treated: A Mixed Methods

Huberta E Hart1,2, Kim Ditzel1, Guy E Rutten1

  • 1Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands.

Patient Preference and Adherence
|November 8, 2019
PubMed
Abstract

Insights

More than half of elderly patients with type 2 diabetes had their glucose-lowering medications de-intensified after overtreatment notification. Both patients and providers favored gradual, person-centered care adjustments.

Area of Science:

  • Endocrinology
  • Geriatrics
  • Pharmacology

Background:

  • Overtreatment of type 2 diabetes in elderly patients is a concern.
  • De-intensification of glucose-lowering medications requires understanding provider and patient perspectives.

Purpose of the Study:

  • To assess medication de-intensification in elderly type 2 diabetes patients one year post-notification of possible overtreatment.
  • To explore care provider and patient views on diabetes medication de-intensification.

Main Methods:

  • Mixed-methods approach utilizing routine care data from five Dutch health-care centers.
  • Patient medical records were reviewed for characteristics and medication prescriptions.
  • Care provider interviews and patient questionnaires/focus groups gathered opinions and beliefs.

Main Results:

  • De-intensification occurred in 56.3% (n=36) of 64 elderly patients with type 2 diabetes.
  • Care providers prioritized person-centered care, considering patient specifics and preferences over strict HbA1c targets.
  • Patients emphasized glucose levels' importance, with both groups preferring gradual de-intensification.

Conclusions:

  • Over half of elderly patients with type 2 diabetes experienced medication de-intensification.
  • Understanding reasons for non-de-intensification is crucial for implementing person-centered care.
  • Diabetes medication de-intensification is an iterative and time-intensive process.
Keywords:
elderlyhypoglycaemiainsulin therapyovertreatmentprimary caretype 2 diabetes

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