Evidence map›Paper›PMID 36899347›Full record

Trial reportCardiovascular diabetology2023

Adherence to antidiabetic drug therapy and reduction of fatal events in elderly frail patients.

Federico Rea, Laura Savaré, Valeria Valsassina, Stefano Ciardullo, Gianluca Perseghin, Giovanni Corrao, Giuseppe Mancia

Open access · goldFull text readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Cardiovascular diabetology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
1.4field-weighted citation impact, top 18% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 7 citations in OpenAlex.

  1. Article
  2. Review
  3. Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 3 institutions in 1 country.

Federico ReaNational Centre for Healthcare Research & Pharmacoepidemiology, at the University of Milano-Bicocca Milan, Milan, Italy. federico.rea@unimib.it.
Laura SavaréNational Centre for Healthcare Research & Pharmacoepidemiology, at the University of Milano-Bicocca Milan, Milan, Italy.
Valeria ValsassinaLaboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Via Bicocca Degli Arcimboldi, 8, Edificio, U7, 20126, Milan, Italy.
Stefano CiardulloDepartment of Medicine and Rehabilitation, Policlinico Di Monza, Monza, Italy.
Gianluca PerseghinDepartment of Medicine and Rehabilitation, Policlinico Di Monza, Monza, Italy.
Giovanni CorraoNational Centre for Healthcare Research & Pharmacoepidemiology, at the University of Milano-Bicocca Milan, Milan, Italy.
Giuseppe ManciaUniversity of Milano-Bicocca (Emeritus Professor), Milan, Italy.
University of Milano-Bicocca · ITFondazione Lanza · ITMinistero della Salute · IT

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundTo evaluate the protective effect of oral antidiabetic drugs in a large cohort of elderly patients with type 2 diabetes differing for age, clinical status, and life expectancy, including patients with multiple comorbidities and short survival.

methodsA nested case-control study was carried out by including the cohort of 188,983 patients from Lombardy (Italy), aged ≥ 65 years, who received ≥ 3 consecutive prescriptions of antidiabetic agents (mostly metformin and other older conventional agents) during 2012. Cases were the 49,201 patients who died for any cause during follow-up (up to 2018). A control was randomly selected for each case. Adherence to drug therapy was measured by considering the proportion of days of the follow-up covered by the drug prescriptions. Conditional logistic regression was used to model the risk of outcome associated with adherence to antidiabetic drugs. The analysis was stratified according to four categories of the clinical status (good, intermediate, poor, and very poor) differing for life expectancy.

resultsThere was a steep increase in comorbidities and a marked reduction of the 6-year survival from the very good to the very poor (or frail) clinical category. Progressive increase in adherence to treatment was associated with a progressive decrease in the risk of all-cause mortality in all clinical categories and at all ages (65-74, 75-84 and ≥ 85 years) except for the frail patient subgroup aged ≥ 85 years. The mortality reduction from lowest to highest adherence level showed a tendency to be lower in frail patients compared to the other categories. Similar although less consistent results were obtained for cardiovascular mortality.

conclusionsIn elderly diabetic patients, increased adherence to antidiabetic drugs is associated with a reduction in the risk of mortality regardless of the patients' clinical status and age, with the exception of very old patients (age ≥ 85 years) in the very poor or frail clinical category. However, in the frail patient category the benefit of treatment appears to be less than in patients in good clinical conditions.

Indexed as

Diabetes Mellitus, Type 2MetforminAgedAged, 80 and overCase-Control StudiesFrail ElderlyHumansHypoglycemic AgentsHypoglycemic AgentsMetforminAdherenceAntidiabetic drug therapyElderlyFrailtyMortalityPopulation-based study

Identifiers

PMID36899347
PMCPMC9999593
OpenAlexW4323921262

What Socratic holds

Textfull text, public
LicenceCC BY
Read underepoch 390

Registered trials

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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.