A new study published in JAMA has found the prevalence of medication intensification for diabetes in older adults to be at 10% when they are released from the hospital. In other words, one in every 10 older adults who were hospitalized for diabetes had their medication intensified at discharge, risking potential over-treatment when patients reach home.
Cohort study estimates the prevalence of diabetes medication intensification and the likelihood of benefit associated with medication intensification among older adults hospitalized in a Veterans Health Administration hospital. https://t.co/CofRMa0Ylr
— JAMA Network Open (@JAMANetworkOpen) March 24, 2020
Medication intensification refers to an addition in oral medicine dose or addition of second oral medicine. More than 34.2 million (10% of the whole population) American adolescents have diabetes. Each year, approximately 1.5 million Americans are diagnosed with diabetes.
Dr. Timothy Anderson, health services researcher and instructor of medicine at Harvard Medical School in the Division of General Medicine at Beth Israel Deaconess Medical Centre (BIDMC), and his colleagues conducted this study to figure out the incidence of changes in medication and its benefits in older adults after they are hospitalized.
The study design for this research was a retrospective cohort including 16,178 patients aged 65 or greater with the diagnosis of diabetes and they were taking insulin before hospitalization. For common medical conditions, they were admitted to the US Veterans Health Administration Hospital. Medical conditions included asthma, chronic obstructive pulmonary disease, pneumonia, sepsis, skin infection and urinary tract infection. Cardiovascular conditions included arrhythmia, chest pain, coronary artery disease, acute coronary syndrome, conduction disorders, congestive heart failure, heart valve disorder, stroke and transient ischemic attack. These conditions were chosen as they are among the most common reasons for hospitalization and their management does not typically require intensification of outpatient diabetes medications. Logistic regression analysis was done to figure out the link between diabetes medication intensification and preadmission and inpatient diabetes control.
The results of the study revealed that out of 16,178 older adults that got discharged from hospital, 70% of them were taking one or more diabetes medicine before admitting to hospital. The most commonly used were metformin and sulfonylureas.
53% of the patients before admission had HbA1c levels less than 7 and 6% had HbA1c levels greater than 9. 10% were discharged with intensified diabetes medications including 5% with new insulins and 3% with intensified sulfonylureas. Congestive heart failure (16%), pneumonia (12%), coronary artery disease (11%), conduction disorders (10%), and chronic obstructive pulmonary disease (10%) were common diagnoses for discharge.
HbA1c means glycated hemoglobin. It is made when hemoglobin within RBCs that carry oxygen throughout the body joins with glucose in the blood and becomes glycated.
The study concluded that 1 in 10 older adults with diabetes were discharged with intensified diabetes medications.