ArticleJournal of the American Geriatrics Society2022
Glycemic treatment deintensification practices in nursing home residents with type 2 diabetes.
Article in Journal of the American Geriatrics Society, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed, 20 citations in OpenAlex.
- Deprescribing Following Access to Lifestyle Treatment: A Retrospective Chart Review of Primary Care Outcomes in Patients with Type 2 Diabetes.Journal of clinical medicine · 2026Article
- Demographic Mix of Care Homes and Personalised Use of SGLT-2 Inhibitors and GLP-1RAs in Residents with Type 2 Diabetes Mellitus.Journal of personalized medicine · 2026Review
- Revolutionizing Hypoglycemia Management in Long-Term Care: Lessons Learned From a Pilot Quality Improvement Initiative Using Continuous Glucose Monitoring.JMIR diabetes · 2025Article
- Lifestyle Interventions for Treatment and Remission of Type 2 Diabetes and Prediabetes in Adults: A Clinical Practice Guideline From the American College of Lifestyle Medicine.American journal of lifestyle medicine · 2025Article
- Realigning diabetes regimens in older adults: a 4S Pathway to guide simplification and deprescribing strategies.The lancet. Diabetes & endocrinology · 2025Review
- Tertiary centre study highlights low inpatient deintensification and risks associated with adverse outcomes in frail people with diabetes.Clinical medicine (London, England) · 2024Article
- Glycemic treatment deintensification practices in nursing home residents with type 2 diabetes.Journal of the American Geriatrics Society · 2022Article
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5 authors at 2 institutions in 1 country.
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Abstract
backgroundOlder 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.
methodsWe 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.
resultsOf 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.
conclusionsOvertreatment 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.
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