Reducing diabetes medication benefits older people

Seidu S, Kunutsor SK, Topsever P et al (2019) Deintenstification in older patients with type 2 diabetes: A systematic review of approaches, rates and outcomes. Diabetes Obes Metab 21: 1668–79

• The main aim of type 2 diabetes management is to lower patients’ glycaemic levels, thereby reducing the risk of associated complications developing; however, the benefits of glycaemic control need to be weighed against the risks of overtreatment, particularly in older people in whom adverse effects such as hypoglycaemia are common.
• This study examined the literature to determine whether the benefits of reducing antihyperglycaemic and other treatment people aged over 65 years with type 2 diabetes outweighed the risk of harm. It also considered whether the method (complete withdrawal, discontinuation, dosage reduction, conversion or substitution) and rate of deintensification had an impact.
• Four databases were searched for papers on the deintensification of treatment in older people with diabetes and comorbidities, such as coronary heart disease and kidney dysfunction. Ten studies including data on 26,558 patients met the study criteria. 
• Antihyperglycaemic medication withdrawal and discontinuation were the most commonly used methods of deintensification. The rates of deintensification across the 10 studies ranged from 13.4% to 75%. Risk of hypoglycaemia and tight glycaemic control were the main reasons given for considering deintensification.
• No increases in hypoglycaemic episodes, falls or hospitalisation or deterioration in HbA_1clevels were reported in most studies and there were no significant differences in adverse events or mortality when compared with  control groups.
• It was concluded that deintensification of treatment in older patients with diabetes with or without comorbidities is associated with benefits but that further research is needed to determine which approaches are appropriate in specific subgroups.

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