ArticleJournal of the American Geriatrics Society2020
Deintensification of Diabetes Medications among Veterans at the End of Life in VA Nursing Homes.
Article in Journal of the American Geriatrics Society, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
18 citing papers in PubMed, 1 synthesis or guideline pooled it, 47 citations in OpenAlex.
- Deprescribing in cardiometabolic conditions in older patients: a systematic review.GeroScience · 2023Pooled it
- Information technology-supported integrated health service for older adults in long-term care settings.BMC medicine · 2024Trial
- The Development of a Framework to Classify Medication Deprescribing Among Patients with Type 2 Diabetes in Primary Care Practices.Journal of clinical medicine · 2026Article
- Burden of Hypoglycemia and Hyperglycemia in Insulin-Treated Veterans Affairs Nursing Home Residents.Journal of the American Geriatrics Society · 2026Article
- 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 · 2025Article
- Defining key deprescribing measures from electronic health data: A multisite data harmonization project.Journal of the American Geriatrics Society · 2025Article
- Clinician and Family Caregiver Perspectives on Deprescribing Chronic Disease Medications in Older Nursing Home Residents Near the End of Life.Drugs & aging · 2024Article
- Prescriber Perspectives and Experiences with Deprescribing Versus Continuing Bisphosphonates in Older Nursing Home Residents with Dementia.Journal of general internal medicine · 2023Article
- Deprescribing research in nursing home residents using routinely collected healthcare data: a conceptual framework.BMC geriatrics · 2023Review
- Diabetes Medication Changes in Older Adults With Type 2 Diabetes: Insights Into Physician Factors and Questions Ahead.Diabetes care · 2023Article
- Operationalizing deprescribing as a component of goal-concordant dementia care.Journal of the American Geriatrics Society · 2023Article
- Supporting deprescribing in long-term care: An approach using stakeholder engagement, behavioural science and implementation planning.Exploratory research in clinical and social pharmacy · 2022Article
- Time-resolved trajectory of glucose lowering medications and cardiovascular outcomes in type 2 diabetes: a recurrent neural network analysis.Cardiovascular diabetology · 2022Article
- Effect of Deintensifying Diabetes Medications on Negative Events in Older Veteran Nursing Home Residents.Diabetes care · 2022Article
- Glycemic treatment deintensification practices in nursing home residents with type 2 diabetes.Journal of the American Geriatrics Society · 2022Article
- Antihyperglycemic Drug Use in Long-Stay Nursing Home Residents with Diabetes Mellitus.The journal of nursing home research sciences · 2022Article
- Deintensification of Treatment With Sulfonylurea and Insulin After Severe Hypoglycemia Among Older Adults With Diabetes.JAMA network open · 2021Article
- Rates, determinants and success of implementing deprescribing in people with type 2 diabetes: A scoping review.Diabetic medicine : a journal of the British Diabetic Association · 2021Article
Corrections and comments
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Authors and funding
13 authors at 5 institutions in 1 country.
Funding
Abstract
objectivesMany older adults with limited life expectancy and/or advanced dementia (LLE/AD) are potentially overtreated for diabetes and may benefit from deintensification. Our aim was to examine the incidence and predictors of diabetes medication deintensification in older Veterans with LLE/AD who were potentially overtreated at admission to Veterans Affairs (VA) nursing homes (community living centers [CLCs]).
designRetrospective cohort study using linked VA and Medicare clinical/administrative data and Minimum Data Set assessments.
settingVA CLCs.
participantsA total of 6960 Veterans with diabetes and LLE/AD admitted to VA CLCs in fiscal years 2009 to 2015 with hemoglobin (Hb)A1c measured within 90 days of admission. MEASUREMENTS: We evaluated treatment deintensification (discontinuation or dose reduction for a consecutive 7-day period) among residents who were potentially overtreated (HbA1c ≤7.5% and receiving hypoglycemic medications). Competing risk models assessed 90-day cumulative incidence of deintensification.
resultsMore than 40% (n = 3056) of Veteran CLC residents with diabetes were potentially overtreated. The cumulative incidence of deintensification at 90 days was 45.5%. Higher baseline HbA1c values were associated with a lower likelihood of deintensification (e.g., HbA1c 7.0-7.5% vs <6.0%; adjusted risk ratio [aRR] = .57; 95% confidence interval [CI] = .50-.66). Compared with non-sulfonylurea oral agents (e.g., metformin), other treatment regimens were more likely to be deintensified (aRR = 1.31-1.88), except for basal insulin (aRR = .59; 95% CI = .52-.66). The only resident factor associated with increased likelihood of deintensification was documented end-of-life status (aRR = 1.12; 95% CI = 1.01-1.25). Admission from home/assisted living (aRR = .85; 95% CI = .75-.96), obesity (aRR = .88; 95% CI = .78-.99), and peripheral vascular disease (aRR = .90; 95% CI = .81-.99) were associated with decreased likelihood of deintensification.
conclusionDeintensification of treatment regimens occurred in less than one-half of potentially overtreated Veterans and was more strongly associated with low HbA1c values and use of medications with high risk for hypoglycemia, rather than other resident characteristics. J Am Geriatr Soc 68:736-745, 2020.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.