Overtreatment of T2DM Common Among VA Nursing Home Residents
Minority of those overtreated or potentially overtreated have their medication regimens appropriately deintensified
FRIDAY, March 25, 2022 (HealthDay News) -- Nursing home residents are often overtreated for type 2 diabetes, and a minority have their medication regimens deintensified, according to a study published online March 23 in the Journal of the American Geriatrics Society.
Lauren I. Lederle, M.D., from San Francisco Virginia Medical Center, and colleagues conducted a cohort study from Jan. 1, 2013, to Dec. 31, 2019, among 7,422 Veterans Affairs nursing home residents age ≥65 with type 2 diabetes. Overtreatment was defined as hemoglobin A1c (HbA1c) <6.5 with any insulin use, while HbA1c <7.5 with any insulin use or HbA1c <6.5 with any glucose-lowering medication other than metformin alone was defined as potential overtreatment.
The researchers found that 17 and 23 percent of the residents met the criteria for overtreatment and potential overtreatment, respectively. Of those who were overtreated and potentially overtreated at baseline, medication regimens were deintensified among 27 and 19 percent, respectively. The odds of continued overtreatment were increased in association with long-acting insulin use and hyperglycemia ≥300 mg/dL before index HbA1c (odds ratios, 1.37 and 1.35, respectively). The odds of continued overtreatment were reduced with severe functional impairment (odds ratio, 0.72). There was no association seen for hypoglycemia with reduced odds of overtreatment.
"Based on our study results, it will be important to develop deprescribing initiatives in nursing homes at time of admission that use behavior change principles to overcome prescribing inertia in overtreated residents," the authors write.