학술논문
Effect of Deintensifying Diabetes Medications on Negative Events in Older Veteran Nursing Home Residents.
Document Type
Academic Journal
Author
Niznik JD; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA.; Division of Geriatric Medicine and Center for Aging and Health, University of North Carolina School of Medicine, Chapel Hill, NC.; Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC.; Zhao X; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA.; Slieanu F; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA.; Mor MK; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA.; Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.; Aspinall SL; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA.; VA Center for Medication Safety, Hines, Illinois.; University of Pittsburgh School of Pharmacy, Pittsburgh, PA.; Gellad WF; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA.; Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA.; Ersek M; Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA.; School of Nursing, University of Pennsylvania, Philadelphia, PA.; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.; Hickson RP; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA.; Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA.; Springer SP; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA.; University of New England School of Pharmacy, Portland, ME.; Schleiden LJ; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA.; University of Pittsburgh School of Pharmacy, Pittsburgh, PA.; Hanlon JT; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA.; Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA.; Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA.; Thorpe JM; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA.; Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC.; Thorpe CT; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA.; Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC.
Source
Publisher: American Diabetes Association Country of Publication: United States NLM ID: 7805975 Publication Model: Print Cited Medium: Internet ISSN: 1935-5548 (Electronic) Linking ISSN: 01495992 NLM ISO Abbreviation: Diabetes Care Subsets: MEDLINE
Subject
Language
English
Abstract
Objective: Guidelines advocate against tight glycemic control in older nursing home (NH) residents with advanced dementia (AD) or limited life expectancy (LLE). We evaluated the effect of deintensifying diabetes medications with regard to all-cause emergency department (ED) visits, hospitalizations, and death in NH residents with LLE/AD and tight glycemic control.
Research Design and Methods: We conducted a national retrospective cohort study of 2,082 newly admitted nonhospice veteran NH residents with LLE/AD potentially overtreated for diabetes (HbA1c ≤7.5% and one or more diabetes medications) in fiscal years 2009-2015. Diabetes treatment deintensification (dose decrease or discontinuation of a noninsulin agent or stopping insulin sustained ≥7 days) was identified within 30 days after HbA1c measurement. To adjust for confounding, we used entropy weights to balance covariates between NH residents who deintensified versus continued medications. We used the Aalen-Johansen estimator to calculate the 60-day cumulative incidence and risk ratios (RRs) for ED or hospital visits and deaths.
Results: Diabetes medications were deintensified for 27% of residents. In the subsequent 60 days, 28.5% of all residents were transferred to the ED or acute hospital setting for any cause and 3.9% died. After entropy weighting, deintensifying was not associated with 60-day all-cause ED visits or hospitalizations (RR 0.99 [95% CI 0.84, 1.18]) or 60-day mortality (1.52 [0.89, 2.81]).
Conclusions: Among NH residents with LLE/AD who may be inappropriately overtreated with tight glycemic control, deintensification of diabetes medications was not associated with increased risk of 60-day all-cause ED visits, hospitalization, or death.
(© 2022 by the American Diabetes Association.)
Research Design and Methods: We conducted a national retrospective cohort study of 2,082 newly admitted nonhospice veteran NH residents with LLE/AD potentially overtreated for diabetes (HbA1c ≤7.5% and one or more diabetes medications) in fiscal years 2009-2015. Diabetes treatment deintensification (dose decrease or discontinuation of a noninsulin agent or stopping insulin sustained ≥7 days) was identified within 30 days after HbA1c measurement. To adjust for confounding, we used entropy weights to balance covariates between NH residents who deintensified versus continued medications. We used the Aalen-Johansen estimator to calculate the 60-day cumulative incidence and risk ratios (RRs) for ED or hospital visits and deaths.
Results: Diabetes medications were deintensified for 27% of residents. In the subsequent 60 days, 28.5% of all residents were transferred to the ED or acute hospital setting for any cause and 3.9% died. After entropy weighting, deintensifying was not associated with 60-day all-cause ED visits or hospitalizations (RR 0.99 [95% CI 0.84, 1.18]) or 60-day mortality (1.52 [0.89, 2.81]).
Conclusions: Among NH residents with LLE/AD who may be inappropriately overtreated with tight glycemic control, deintensification of diabetes medications was not associated with increased risk of 60-day all-cause ED visits, hospitalization, or death.
(© 2022 by the American Diabetes Association.)