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Study Shows Examining, Reducing Overtreatment in Diabetes and Hypertension Can Improve Health

Appropriate intensification and deintensification in medication use may be of benefit.

Overtreatment could cause many additional health problems in patients, such as increasing side effects and affecting medication adherence. However, medication deintensification, which was defined as discontinuation or dosage decrease within 6 months, was also complicated because patients may perform worse after losing tight control of their blood pressure or glycemic level.

A Veterans Administration study published in JAMA Internal Medicine evaluated the association between blood pressure or HbA1c levels and medication deintensification in older patients with diabetes. The call for concern was medication deintensification and prevention of overtreatment, which should be emphasized in practice guidelines.

This retrospective cohort study collected data at VA primary-care clinics and included 211,667 diabetes patients age 70 years or older. Participants were on antihypertensive agents or were on antidiabetes medications. In this study, researchers defined very low BP as less than 120/65mmHg and very low HbA1c as less than 6.0%.

The results showed only 27% or fewer older patients with diabetes who had very low blood pressure or very low HbA1c levels because of overtreatment had medication deintensification. Most of patients did not get opportunities to lessen their medication dosage or reduce their medication use. The study also pointed out low HbA1c, BP value or life expectancy had little association with reducing medications.

For older people, more medication could pose more side effects and less benefits. Healthcare providers should assess patients’ clinical performance and avoid unnecessary treatment on patients. Among older patients whose treatment resulted in very low levels of HbA1c or BP, 27% or fewer underwent deintensification, representing a lost opportunity to reduce overtreatment.

Practice Pearls:

  • A retrospective cohort study accessed the relationship of medication deintensfication and BP or glycemic levels in older diabetic participants.
  • Researchers found out few older patients with diabetes who had very low blood pressure or very low HbA1c levels because of overtreatment had medication deintensification.
  • Medication deintensification should be emphasized in practice guidelines.

Sussman JB, Kerr EA, Saini SD, Holleman RG, Klamerus ML, Min LC, Vijan S, Hofer TP. “Rate of Deintnsification of Blood Pressure and Glycemic Medication Treatment Based on of Control and Life Expectancy in Older Patients with Diabetes Mellitus.” JAMA Inern Med. 2015 OCT26. Online