Association between hypoglycaemic drug de-intensification, mortality and hospital admission in older adults with type 2 diabetes: a cohort study emulating a target trial
(2025) Age and Ageing — Vol. 54, n° 6 (2025)
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Tubach, Florence 
Zerah, Lorene
- Abstract
- (en) BACKGROUND: Hypoglycaemic drugs (sulfonylureas, glinides or insulins) are commonly prescribed for older adults with type 2 diabetes (T2D) but may carry risks of adverse events. Whether de-intensifying hypoglycaemic drugs is associated with clinical benefit in older adults remains unknown. OBJECTIVE: To evaluate the association between de-intensification of hypoglycaemic drugs and clinical outcomes in older adults with T2D. METHODS: Cohort study conducted with the target trial emulation approach, using data collected from 2000 French general practises between January 2010 and February 2019 (The Health Improvement Network-THIN database). Eligible participants were ≥75 years old, on stable hypoglycaemic drugs (no change in drug or dose) for at least 6 months, and had an HbA1c value <9%. Hypoglycaemic drug de-intensification (exposure) was defined as cessation or reduction of ≥50% of total dose. The primary outcome was a composite measure of all-cause death or hospital admissions within 3 months, and its association with exposure was assessed using multivariable logistic regression adjusted for potential baseline confounders. RESULTS: The study included 14 383 unique individuals corresponding to 177 314 trial emulation participants (mean age 80 years; 44.7% female). Of these, 6480 participants were allocated to de-intensification group, and 170 834 to the control group. At 3 months, the primary outcome occurred in 3.96% of the de-intensification group and 2.99% of controls [adjusted relative risk, 1.33 (95% CI, 1.22-1.43)]. Subgroup analyses showed consistent associations across most participants' profiles. CONCLUSIONS: In older adults with T2D, de-intensification of hypoglycaemic drugs was associated with a higher short-term risk of all-cause death or hospitalisation.
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Citations
Christiaens, A., Cochard, A., Tubach, F., Thompson, W., Sinclair, A. J., Henrard, S., Boland, B., Slaouti-Jégou, Y., Lekens, B., Bonnet-Zamponi, D., Simon-Tillaux, N., & Zerah, L. (2025). Association between hypoglycaemic drug de-intensification, mortality and hospital admission in older adults with type 2 diabetes: a cohort study emulating a target trial. Age and Ageing, 54(6). https://doi.org/10.1093/ageing/afaf160 (Original work published 2025)