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Cited by 72Diabetes Treatment and ManagementPharmaceutical Practices and Patient OutcomesDiabetes Management and Research

Deintensification of hypoglycaemic medications-use of a systematic review approach to highlight safety concerns in older people with type 2 diabetes

Abdelhafiz, A.H., Sinclair, A.J.·2018·Journal of Diabetes and its Complications
DOI 10.1016/j.jdiacomp.2017.11.011
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Abstract

Importance Intensive treatment of older people with diabetes is common placing them at increased risk of adverse events such as hypoglycaemia and hospitalisation for drug errors. Little is known about when, how or for whom to deintensify hypoglycaemic medications. Objective To explore the characteristics of patients for whom deintensification is appropriate and to determine the outcome of deintensification. Evidence review Medline, Google scholar and EmBase search from 1997 to present was performed using keywords relating to diabetes mellitus, polypharmacy, hypoglycaemia, hospitalisation, deintensification, deprescribing and reduction, simplification or withdrawal of hypoglycaemic medications. Only English language articles were selected. Articles were reviewed for relevance by abstract. A manual review of citations in retrieved articles was performed in addition to the electronic literature search. Findings Those who are over treated appear to be of older age group, frail with weight loss and have multiple medical morbidities especially renal impairment and dementia. Simplification, reduction or even complete withdrawal of hypoglycaemic medications in these patients appears to be feasible without deterioration of glycaemic control. Conclusions Over treatment is common in frail older people with multiple comorbidities and deintensification appears safe in this group of patients. Current recommendations emphasise preventing underuse rather than overuse of medications, and ther…

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  • Simplification of the insulin plan to match an individual's self-management abilities and available social and medical support reduces hypoglycemia and disease-related distress without worsening glycemic outcomes.

    “Simplification of the insulin plan to match an individual's self-management abilities and their available social and medical support in these situations has been shown to reduce hypoglycemia and diseaserelated distress without worsening glycemic outcomes (100-103).”

    From 13. Older Adults: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [100]

  • Simplification of the insulin plan to match an individual's self-management abilities and their available social and medical support reduces hypoglycemia and disease-related distress without worsening glycemic outcomes.

    “Simplification of the insulin plan to match an individual's self-management abilities and their available social and medical support in these situations has been shown to reduce hypoglycemia and disease-related distress without worsening glycemic outcomes (107-110).”

    From 13. Older Adults: Standards of Care in Diabetes—2025 (2025) · cites this paper as [107]

  • Simplification of the insulin plan to match an individual's self-management abilities and available social and medical support is associated with reduced hypoglycemia and disease-related distress without worsening glycemic outcomes.

    “Studies suggest that simplification of the insulin plan to match an individual’s self-management abilities and their available social and medical support is associated with reduced hypoglycemia and disease-related distress without worsening glycemic outcomes”

    From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [149]

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Authors
Abdelhafiz, A. H., & Sinclair, A. J.
Affiliations
  • Rotherham General Hospital (GB)
  • Aston University (GB)
Corresponding author
Sinclair, A.J.
ORCID
Venue
Journal of Diabetes and its Complications
Publisher
Elsevier BV
Published
2018-04
Volume
32
Issue
4
Pages
444-450
ISSN
  • 0891-6632 (ISSN-L)
  • 1056-8727
DOI
10.1016/j.jdiacomp.2017.11.011
OpenAlex
W2768271705
Cited by
72
References
3
Citations by year
2026: 3 · 2025: 12 · 2024: 9 · 2023: 4 · 2022: 11 · 2021: 11 · 2020: 9 · 2019: 10 · 2018: 3
FWCI
0.88
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Journal of Diabetes and its Complications (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Keywords
treatment deintensification, type 2 diabetes, older adults, hypoglycemia, polypharmacy, deprescribing, overtreatment, frailty, renal dysfunction, dementia, glycemic control, hospitalization, medication errors
MeSH terms
Medical Overuse, Age Factors, Blood Glucose, Diabetes Mellitus, Type 2, Glycated Hemoglobin, Humans, Hypoglycemia, Hypoglycemic Agents, Practice Guidelines as Topic

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