Glycemic treatment deintensification practices in nursing home residents with type 2 diabetes.
Glycemic treatment deintensification practices in nursing home residents with type 2 diabetes.
复制标题
疗养院2型糖尿病患者的降糖治疗。
DOI：
10.1111/jgs.17735
复制
发表时间：
2022-07
影响因子：
6.3
通讯作者：
Lee, Sei J.
中科院分区：
文献类型：
--
作者：
Lederle, Lauren, I;Steinman, Michael A.;Jing, Bocheng;Nguyen, Brian;Lee, Sei J.
有血糖过度治疗的老年疗养院(NH)居民有很大的低血糖和其他伤害的风险，并可能从去强化治疗中受益。然而，人们对这种情况下的去强化做法知之甚少。我们于2013年1月1日至2019年12月31日在退伍军人事务部(VA)NH居民中进行了一项队列研究。参与者是VA NH居民，年龄65岁，患有2型糖尿病，NH住院时间(LOS) ≥ 30 天，在NH期间HbA1c结果。我们将过度治疗定义为HbA1c<；6.5伴任何胰岛素使用，潜在过度治疗为HbA1c<；7.5伴任何胰岛素使用，或HbA1c <；6.5仅使用二甲双胍以外的任何降糖药物。我们的主要结果是在HbA1c后14 天继续进行血糖过度治疗而没有降糖。在纳入的7422名居民中，17%的居民符合过度治疗的标准，另外23%的居民符合潜在过度治疗的标准。在基线时过度治疗和潜在过度治疗的居民中，分别有27%和19%的人药物治疗方案减弱(分别为73%和81%，继续过度治疗)。长效胰岛素使用和HbA1c指数前高血糖≥30 0 mg/dL与继续过度治疗的几率增加相关(优势比[OR]1.37，95%可信区间[CI]1.14~1.65；OR1.35，95%CI 1.10~1.66)。功能严重受损( ≥ 评分19分)与继续过度治疗的几率降低(OR0.72，95%CI0.56-0.95)相关。低血糖与过度治疗几率的降低无关。糖尿病的过度治疗在NH居民中很常见，少数居民适当地降低了他们的药物治疗方案。针对伤害风险高、受益可能性低的居民取消处方，例如那些有低血糖病史或认知或功能损害水平较高的居民，最有可能确定NH居民最有可能从非强化治疗中受益。本文评论了Lam 等 等人的一篇文章。和一篇由Lega 等 等人撰写的社论。在这一期中。
Older nursing home (NH) residents with glycemic overtreatment are at significant risk of hypoglycemia and other harms and may benefit from deintensification. However, little is known about deintensification practices in this setting. We conducted a cohort study from January 1, 2013 to December 31, 2019 among Veterans Affairs (VA) NH residents. Participants were VA NH residents age ≥65 with type 2 diabetes with a NH length of stay (LOS) ≥ 30 days and an HbA1c result during their NH stay. We defined overtreatment as HbA1c <6.5 with any insulin use, and potential overtreatment as HbA1c <7.5 with any insulin use or HbA1c <6.5 on any glucose‐lowering medication (GLM) other than metformin alone. Our primary outcome was continued glycemic overtreatment without deintensification 14 days after HbA1c. Of the 7422 included residents, 17% of residents met criteria for overtreatment and an additional 23% met criteria for potential overtreatment. Among residents overtreated and potentially overtreated at baseline, 27% and 19%, respectively had medication regimens deintensified (73% and 81%, respectively, continued to be overtreated). Long‐acting insulin use and hyperglycemia ≥300 mg/dL before index HbA1c were associated with increased odds of continued overtreatment (odds ratio [OR] 1.37, 95% confidence interval [CI] 1.14–1.65 and OR 1.35, 95% CI 1.10–1.66, respectively). Severe functional impairment (MDS‐ADL score ≥ 19) was associated with decreased odds of continued overtreatment (OR 0.72, 95% CI 0.56–0.95). Hypoglycemia was not associated with decreased odds of overtreatment. Overtreatment of diabetes in NH residents is common and a minority of residents have their medication regimens appropriately deintensified. Deprescribing initiatives targeting residents at high risk of harms and with low likelihood of benefit such as those with history of hypoglycemia, or high levels of cognitive or functional impairment are most likely to identify NH residents most likely to benefit from deintensification. This article comments on an article by Lam et al. and an editorial by Lega et al. in this issue.
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影响因子：
16.2
作者：
Munshi MN;Florez H;Huang ES;Kalyani RR;Mupanomunda M;Pandya N;Swift CS;Taveira TH;Haas LB
通讯作者：
Haas LB
影响因子：
39.2
作者：
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通讯作者：
Pogach, Leonard
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158.5
作者：
Duckworth, William;Abraira, Carlos;Huang, Grant D.
通讯作者：
Huang, Grant D.
影响因子：
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通讯作者：
Schwartz JB
影响因子：
158.5
作者：
Gerstein, Hertzel C.;Miller, Michael E.;Friedewald, William T.
通讯作者：
Friedewald, William T.