EFFECT OF DE-INTENSIFYING HYPOGLYCAEMIC DRUGS IN OLDER ADULTS WITH TYPE 2 DIABETES: A COHORT STUDY EMULATING A TARGET TRIAL

Christiaens, Antoine;et.al.
(2024) Di-Prescribe — Location: Bruxelles, Belgique

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STUDY OBJECTIVES. To evaluate the impact of deintensifying hypoglycemic drugs (HDs) on clinical outcomes in older adults with type 2 diabetes (T2D) in primary care (general practice). METHODS. We conducted a cohort study with a target trial emulation, using data from The Health Improvement Network (THIN) France database of primary care. The study sequentially included patients aged 75 years or older with T2D who had been on stable HDs for at least six months, each month between January 2010 and February 2019. Participants were allocated to either intervention arm (HDs deintensification: reduction of ≥50% of total dose of HDs) or control arm (no deintensification). The primary outcome was a composite measure of all-cause hospitalization or mortality within three months. RESULTS. This study included 177,329 participants (55.1% female, mean [SD] age 81.0±4.4 years), among whom 6,480 had an HD deintensification at baseline. This intervention was associated with an increased risk of the primary outcome (Adjusted Odds Ratio: 1.39; 95%CI: 1.21–1.52), corresponding to a small increase in standardized risk difference (0.97%; 95%CI: 0.68%–1.29%). Subgroup analyses indicated that the negative effects of deintensification were non-significant in specific subpopulations, including those with multimorbidity, polypharmacy, diabetes with complications, or long-standing diabetes. CONCLUSIONS. Deintensification of HDs in older adults with T2D was associated to a modestly increased risk of all-cause hospitalization or mortality. While HDs deintensification may be justified in certain clinical context, these findings highlight potential risks associated in all older T2D patients. Further interventional studies are needed to confirm these results, with careful attention to potential confounding factors.
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Christiaens, A., & et al. (2024). EFFECT OF DE-INTENSIFYING HYPOGLYCAEMIC DRUGS IN OLDER ADULTS WITH TYPE 2 DIABETES: A COHORT STUDY EMULATING A TARGET TRIAL. Di-Prescribe, Bruxelles, Belgique. https://hdl.handle.net/2078.5/238450