Boston—Too many older patients discharged from hospitals might be having their diabetes treatment regimens intensified, even though they are unlikely to benefit.
That’s according to a study in JAMA Network Open which looked at patients discharged from U.S. Veterans’ Affairs medical facilities. It determined that about 10% of the discharged inpatients had their diabetes medication intensified, even though half of them had already reached their blood glucose goals or had limited life expectancy.
The study team from Beth Israel Deaconess Medical Center in Boston, the San Francisco VAMC and the University of California, San Francisco focused on 16,178 older adults hospitalized in the Veterans’ Health Administration national health system.
The authors suggest that, during hospitalization, consideration of long-term diabetes control is needed in addition to inpatient blood glucose recordings to reduce potentially nonbeneficial medication changes when older patients are discharged home.
“Elevated blood glucose levels are common in hospitalized older adults and may lead clinicians to intensify outpatient diabetes medications at discharge, risking potential overtreatment when patients return home,” they write.
Patients were aged 65 years and older with diabetes not previously requiring insulin and were hospitalized for common medical conditions unrelated to diabetes between 2011 and 2013. With a mean age of 73 years, about half of the mostly male participants had a preadmission hemoglobin A1c (HbA1c) level less than 7.0%, although 1,044 (6%) had an HbA1c level greater than 9.0%.
“Understanding the impact of hospitalization on outpatient diabetes control is particularly crucial for older adults, more than 25% of whom have diabetes,” according to the report. “Older adults are the most frequently hospitalized age group, and the balance of risks and benefits from strict blood glucose control may vary owing to limited life expectancy and elevated risks of hypoglycemia, polypharmacy, and adverse drug events.”
Researchers focused on intensification of outpatient diabetes medications, which was defined as receiving a new or higher-dose medication at discharge than was being taken prior to hospitalization.
The study found that, overall, 1,626 patients (10%) were discharged with intensified diabetes medications—8% of them with intensified high-risk diabetes medications. That included 781 (5%) with new insulins and 557 (3%) with intensified sulfonylureas.
Background information in the study cited prior research showing that intensifications of hypertension regimens are common in hospitalized older adults and are driven by inpatient measurements. “Similar to blood pressure, blood glucose levels are monitored frequently in hospitalized patients with diabetes and elevated inpatient recordings may lead clinicians to discharge patients with prescriptions for intensified diabetes medications,” according to researchers.
Yet, they add, nearly half, 49%, of patients receiving intensifications (791 of 1,626) were classified as being unlikely to benefit owing to limited life expectancy or already being at goal HbA1c, while 20% (329 of 1,626) were classified as having potential to benefit. The reminder had an indeterminate benefit.
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That’s according to a study in JAMA Network Open which looked at patients discharged from U.S. Veterans’ Affairs medical facilities. It determined that about 10% of the discharged inpatients had their diabetes medication intensified, even though half of them had already reached their blood glucose goals or had limited life expectancy.
The study team from Beth Israel Deaconess Medical Center in Boston, the San Francisco VAMC and the University of California, San Francisco focused on 16,178 older adults hospitalized in the Veterans’ Health Administration national health system.
The authors suggest that, during hospitalization, consideration of long-term diabetes control is needed in addition to inpatient blood glucose recordings to reduce potentially nonbeneficial medication changes when older patients are discharged home.
“Elevated blood glucose levels are common in hospitalized older adults and may lead clinicians to intensify outpatient diabetes medications at discharge, risking potential overtreatment when patients return home,” they write.
Patients were aged 65 years and older with diabetes not previously requiring insulin and were hospitalized for common medical conditions unrelated to diabetes between 2011 and 2013. With a mean age of 73 years, about half of the mostly male participants had a preadmission hemoglobin A1c (HbA1c) level less than 7.0%, although 1,044 (6%) had an HbA1c level greater than 9.0%.
“Understanding the impact of hospitalization on outpatient diabetes control is particularly crucial for older adults, more than 25% of whom have diabetes,” according to the report. “Older adults are the most frequently hospitalized age group, and the balance of risks and benefits from strict blood glucose control may vary owing to limited life expectancy and elevated risks of hypoglycemia, polypharmacy, and adverse drug events.”
Researchers focused on intensification of outpatient diabetes medications, which was defined as receiving a new or higher-dose medication at discharge than was being taken prior to hospitalization.
The study found that, overall, 1,626 patients (10%) were discharged with intensified diabetes medications—8% of them with intensified high-risk diabetes medications. That included 781 (5%) with new insulins and 557 (3%) with intensified sulfonylureas.
Background information in the study cited prior research showing that intensifications of hypertension regimens are common in hospitalized older adults and are driven by inpatient measurements. “Similar to blood pressure, blood glucose levels are monitored frequently in hospitalized patients with diabetes and elevated inpatient recordings may lead clinicians to discharge patients with prescriptions for intensified diabetes medications,” according to researchers.
Yet, they add, nearly half, 49%, of patients receiving intensifications (791 of 1,626) were classified as being unlikely to benefit owing to limited life expectancy or already being at goal HbA1c, while 20% (329 of 1,626) were classified as having potential to benefit. The reminder had an indeterminate benefit.
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