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Deintensification in older patients with type 2 diabetes: a systematic review of approaches, rates and outcomes

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Seidu, Samuel, Kunutsor, Setor K., Topsever, Pinar, Hambling, Clare E., Cos, Francesc X., Khunti, Kamlesh·2019·Diabetes, Obesity and Metabolism
DOI 10.1111/dom.13724
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Abstract

Aim: To assess deintensification approaches and rates and evaluate the harm and benefits of deintensification with antidiabetic medication and other therapies among older people (≥ 65 years) with type 2 diabetes with or without cardiometabolic conditions. Methods: We identified relevant studies in a literature search of MEDLINE, Embase, Web of Science and Cochrane databases to 30 October 2018. Data were extracted on baseline characteristics, details on deintensification and outcomes, and was synthesized using a narrative approach. Results: Ten studies (observational cohorts and interventional studies) with data on 26 558 patients with comorbidities were eligible. Deintensification approaches included complete withdrawal, discontinuation, reducing dosage, conversion, or substitution of at least one medication, but the majority of studies were based on complete withdrawal or discontinuation of antihyperglycaemic medication. Rates of deintensification approaches ranged from 13.4%–75%. The majority of studies reported no deterioration in HbA1c levels, hypoglycaemic episodes, falls or hospitalizations on deintensification. On adverse events and mortality, no significant differences were observed among the comparison groups in the majority of studies. Conclusion: Available but limited evidence suggests that the benefits of deintensification outweigh the harm in older people with type 2 diabetes with or without comorbidities. Given the heterogeneity of patients with diabetes, further research is warranted on which deintensification approaches are appropriate and beneficial for each specific patient population.

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  • Deintensification of plans in individuals taking noninsulin glucose-lowering medications can be achieved by either lowering the dose or discontinuing some medications, as long as individualized glycemic goals are maintained.

    “For those seeking to simplify their diabetes medication plan, deintensification of plans in individuals taking noninsulin glucose-lowering medications can be achieved by either lowering the dose or discontinuing some medications, as long as the individualized glycemic goals are maintained (98).”

    From 13. Older Adults: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [98]

    The review identifies dose reduction and discontinuation as deintensification approaches (section 3.3, p. 4). It reports that most studies found no deterioration in HbA1c (section 4.1, p. 9), but it concerns older people with type 2 diabetes, not everyone taking noninsulin medication. It also says evidence is limited on how to achieve safe individual targets (section 4.4, p. 10), so it does not establish that individualized goals will be maintained. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Deintensification of plans in individuals taking noninsulin glucose-lowering medications can be achieved by either lowering the dose or discontinuing some medications, as long as individualized glycemic goals are maintained.

    “deintensification of plans in individuals taking noninsulin glucose-lowering medications can be achieved by either lowering the dose or discontinuing some medications, as long as individualized glycemic goals are maintained (105).”

    From 13. Older Adults: Standards of Care in Diabetes—2025 (2025) · cites this paper as [105]

    The review describes dose reduction and discontinuation as deintensification approaches (section 3.3, p. 4), including withdrawal of oral antidiabetic drugs (section 3.3, p. 6). Most studies reporting glycaemic outcomes found no deterioration, but the evidence concerns older people with type 2 diabetes; the authors say evidence on achieving safe individual targets is limited (sections 4.1 and 4.4, pp. 9–10). The claim therefore overextends the population and presents maintenance of individualized goals more firmly than the review establishes. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Deintensification is safe and possibly beneficial for older adults.

    “There are now multiple studies evaluating deintensification protocols in diabetes as well as hypertension, demonstrating that deintensification is safe and possibly beneficial for older adults (105).”

    From 13. Older Adults: Standards of Care in Diabetes—2025 (2025) · cites this paper as [105]

    The conclusion (p. 10) says limited evidence suggests deintensification’s benefits outweigh its harms in older people with type 2 diabetes. But the review does not establish that deintensification is uniformly safe: the Mortality section (p. 9) reports increased mortality associated with discontinuing antihyperglycaemic or blood-pressure-lowering therapy in two studies. Only one included study examined blood-pressure-lowering therapy (section 3.3, p. 4), so the sentence also overstates the evidence for hypertension. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Multiple studies evaluating deintensification protocols in diabetes and hypertension have shown that deintensification is safe and possibly beneficial for older adults.

    “Multiple studies evaluating deintensification protocols in diabetes and hypertension have shown that deintensification is safe and possibly beneficial for older adults”

    From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [114]

    The Abstract (p. 1) and Key findings (p. 9) report that most studies found no deterioration after deintensification in older adults with type 2 diabetes, and the authors suggest its benefits may outweigh its harms. But the review includes only one study of blood-pressure-lowering therapy (section 3.3, p. 4), and the Mortality section (p. 9) reports that discontinuing that therapy was associated with increased mortality. It therefore does not establish that deintensification is safe across both diabetes and hypertension. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Deintensification of glucose-lowering plans can be achieved by either lowering the dose or discontinuing some medications, as long as individualized glycemic goals are maintained.

    “Deintensification of glucose-lowering plans can be achieved by either lowering the dose or discontinuing some medications, as long as individualized glycemic goals are maintained”

    From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [114]

    The review identifies dose reduction and discontinuation as deintensification approaches (Section 3.3, p. 4). It reports that most studies with relevant data found no deterioration in HbA1c after deintensification (Section 4.1, p. 9), but does not establish that individualized glycaemic goals were maintained; it says evidence on achieving safe individual targets is limited (Section 4.4, p. 10). (LLM, conf=0.86)

    Experimental — accuracy not yet measured

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Research works printed but not linked: 46

  1. [2]2. Patel P, Macerollo A. Diabetes mellitus: diagnosis and screening. Am Fam Physician. 2010;81:863-870.
  2. [3]3. Coutinho M, Gerstein HC, Wang Y, Yusuf S. The relationship between glucose and incident cardiovascular events. A metaregression analysis of published data from 20 studies of 95 783 individuals followed for 12.4 years. Diabetes Care. 1999;22:233-240.
  3. [4]4. Sherifali D, Nerenberg K, Pullenayegum E, Cheng JE, Gerstein HC. The effect of oral antidiabetic agents on A1C levels: a systematic review and meta-analysis. Diabetes Care. 2010;33:1859-1864.
  4. [5]5. Khunti K, Davies MJ. Clinical inertia-Time to reappraise the terminology? Prim Care Diabetes. 2017;11:105-106.
  5. [6]6. Khunti K, Davies MJ. Clinical inertia versus overtreatment in glycaemic management. Lancet Diabetes Endocrinol. 2018;6:266-268.
  6. [7]7. Abdelhafiz AH, Rodriguez-Manas L, Morley JE, Sinclair AJ. Hypoglycemia in older people - a less well recognized risk factor for frailty. Aging Dis. 2015;6:156-167.
  7. [8]8. Lee SJ, Boscardin WJ, Stijacic Cenzer I, Huang ES, Rice-Trumble K, Eng C. The risks and benefits of implementing glycemic control guidelines in frail older adults with diabetes mellitus. J Am Geriatr Soc. 2011;59:666-672.
  8. [9]9. Rajendran R, Hodgkinson D, Rayman G. Patients with diabetes requiring emergency department care for hypoglycaemia: characteristics and long-term outcomes determined from multiple data sources. Postgrad Med J. 2015;91:65-71.
  9. [10]10. Nicolucci A, Pintaudi B, Rossi MC, et al. The social burden of hypoglycemia in the elderly. Acta Diabetol. 2015;52:677-685.
  10. [11]11. Hsu PF, Sung SH, Cheng HM, et al. Association of clinical symptomatic hypoglycemia with cardiovascular events and total mortality in type 2 diabetes: a nationwide population-based study. Diabetes Care. 2013;36:894-900.
  11. [13]13. Farmer AJ, Brockbank KJ, Keech ML, England EJ, Deakin CD. Incidence and costs of severe hypoglycaemia requiring attendance by the emergency medical services in South Central England. Diabet Med. 2012;29:1447-1450.
  12. [14]14. Newton CA, Adeel S, Sadeghi-Yarandi S, et al. Prevalence, quality of care, and complications in long term care residents with diabetes: a multicenter observational study. J Am Med Dir Assoc. 2013;14:842-846.
  13. [15]15. Mattishent K, Loke YK. Bi-directional interaction between hypoglycaemia and cognitive impairment in elderly patients treated with glucose-lowering agents: a systematic review and meta-analysis. Diabetes Obes Metab. 2016;18:135-141.
  14. [18]18. NIH Consensus Development Panel on Physical Activity and Cardiovascular Health. Physical activity and cardiovascular health. JAMA . 1996;276:241-246.
  15. [19]19. Zaccardi F, Davies MJ, Dhalwani NN, et al. Trends in hospital admissions for hypoglycaemia in England: a retrospective, observational study. Lancet Diabetes Endocrinol. 2016;4:677-685.
  16. [21]21. Penfornis A, Fiquet B, Blickle JF, Dejager S. Potential glycemic overtreatment in patients &gt;/=75 years with type 2 diabetes mellitus and renal disease: experience from the observational OREDIA study. Diabetes Metab Syndr Obes. 2015;8:303-313.
  17. [22]22. Thorpe CT, Gellad WF, Good CB, et al. Tight glycemic control and use of hypoglycemic medications in older veterans with type 2 diabetes and comorbid dementia. Diabetes Care. 2015;38:588-595.
  18. [23]23. Hambling CE, Khunti K, Cos X, et al. Factors influencing safe glucoselowering in older adults with type 2 diabetes: a PeRsOn-centred ApproaCh To IndiVidualisEd (PROACTIVE) Glycemic Goals for older people: a position statement of primary care diabetes Europe. Prim Care Diabetes . 2019. pii:S1751-9918(18)30300-0. https.//doi.org./ 10.1016/j.pcd.2018.12.005. · DOI
  19. [24]24. Reeve E, Gnjidic D, Long J, Hilmer S. A systematic review of the emerging definition of 'deprescribing' with network analysis: implications for future research and clinical practice. Br J Clin Pharmacol. 2015;80:1254-1268.
  20. [25]25. Scott IA, Hilmer SN, Reeve E, et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med. 2015;175: 827-834.
  21. [26]26. Garfinkel D, Mangin D. Feasibility study of a systematic approach for discontinuation of multiple medications in older adults: addressing polypharmacy. Arch Intern Med. 2010;170:1648-1654.
  22. [27]27. Holmes HM, Hayley DC, Alexander GC, Sachs GA. Reconsidering medication appropriateness for patients late in life. Arch Intern Med. 2006;166:605-609.
  23. [28]28. Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of Observational Studies in Epidemiology. JAMA. 2000;283:2008-2012.
  24. [29]29. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6:e1000097.
  25. [31]31. Kunutsor SK, Apekey TA, Laukkanen JA. Association of serum total osteocalcin with type 2 diabetes and intermediate metabolic phenotypes: systematic review and meta-analysis of observational evidence. Eur J Epidemiol. 2015;30:599-614.
  26. [32]32. Sjoblom P, Anders T, Lofgren UB, et al. Can diabetes medication be reduced in elderly patients? An observational study of diabetes drug withdrawal in nursing home patients with tight glycaemic control. Diabetes Res Clin Pract. 2008;82:197-202.
  27. [33]33. Lipska KJ, Wang Y, Kosiborod M, et al. Discontinuation of antihyperglycemic therapy and clinical outcomes after acute myocardial infarction in older patients with diabetes. Circ Cardiovasc Qual Outcomes. 2010;3:236-242.
  28. [34]34. Aspinall SL, Zhao X, Good CB, et al. Intervention to decrease glyburide use in elderly patients with renal insufficiency. Am J Geriatr Pharmacother. 2011;9:58-68.
  29. [35]35. Skoff RA, Waterbury NV, Shaw RF, Egge JA, Cantrell M. Glycemic control and hypoglycemia in Veterans Health Administration patients converted from glyburide to glipizide. J Manag Care Pharm. 2011;17: 664-671.
  30. [36]36. Abdelhafiz AH, Chakravorty P, Gupta S, Haque A, Sinclair AJ. Can hypoglycaemic medications be withdrawn in older people with type 2 diabetes? Int J Clin Pract. 2014;68:790-792.
  31. [37]37. Hariya N, Mochizuki K, Inoue S, et al. Switching alpha-glucosidase inhibitors to miglitol reduced glucose fluctuations and circulating cardiovascular disease risk factors in type 2 diabetic Japanese patients. Drugs R D. 2014;14:177-184.
  32. [38]38. Yoshida N, Babazono T, Hanai K, Uchigata Y. Switching from subcutaneous insulin injection to oral vildagliptin administration in hemodialysis patients with type 2 diabetes: a pilot study. Int Urol Nephrol. 2016; 48:1349-1355.
  33. [39]39. Andreassen LM, Kjome RL, Solvik UO, Houghton J, Desborough JA. The potential for deprescribing in care home residents with Type 2 diabetes. Int J Clin Pharm. 2016;38:977-984.
  34. [40]40. Hirakawa Y, Arima H, Webster R, et al. Risks associated with permanent discontinuation of blood pressure-lowering medications in patients with type 2 diabetes. J Hypertens. 2016;34:781-787.
  35. [41]41. Kondo M, Toyoda M, Kimura M, Ishida N, Fukagawa M. Favorable effect on blood volume control in hemodialysis patients with type 2 diabetes after switching from insulin therapy to liraglutide, a human glucagon-like peptide-1 analog--results from a pilot study in Japan. Tokai J Exp Clin Med. 2017;42:52-57.
  36. [42]42. Avenell A, MacLennan GS, Jenkinson DJ, et al. Long-term follow-up for mortality and cancer in a randomized placebo-controlled trial of vitamin D(3) and/or calcium (RECORD trial). J Clin Endocrinol Metab. 2012;97:614-622.
  37. [43]43. Black CD, Thompson W, Welch V, et al. Lack of evidence to guide deprescribing of antihyperglycemics: a systematic review. Diabetes Ther. 2017;8:23-31.
  38. [44]44. Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2015; 38:140-149.
  39. [45]45. Mosenzon O, Pollack R, Raz I. Treatment of Type 2 Diabetes: from ' Guidelines ' to ' Position Statements ' and Back: recommendations of the Israel National Diabetes Council. Diabetes Care. 2016;39:S146S153.
  40. [46]46. Boussageon R, Bejan-Angoulvant T, Saadatian-Elahi M, et al. Effect of intensive glucose lowering treatment on all cause mortality, cardiovascular death, and microvascular events in type 2 diabetes: metaanalysis of randomised controlled trials. BMJ. 2011;343:d4169.
  41. [47]47. Hambling CE, Seidu SI, Davies MJ, Khunti K. Older people with Type 2 diabetes, including those with chronic kidney disease or dementia, are commonly overtreated with sulfonylurea or insulin therapies. Diabet Med. 2017;34:1219-1227.
  42. [50]50. McCoy RG, Lipska KJ, Yao X, Ross JS, Montori VM, Shah ND. Intensive treatment and severe hypoglycemia among adults with type 2 diabetes. JAMA Intern Med. 2016;176:969-978.
  43. [51]51. Blaum C, Cigolle CT, Boyd C, et al. Clinical complexity in middle-aged and older adults with diabetes: the Health and Retirement Study. Med Care. 2010;48:327-334.
  44. [52]52. Cigolle CT, Kabeto MU, Lee PG, Blaum CS. Clinical complexity and mortality in middle-aged and older adults with diabetes. J Gerontol A Biol Sci Med Sci. 2012;67:1313-1320.
  45. [53]53. Todd A, Holmes HM. Recommendations to support deprescribing medications late in life. Int J Clin Pharm. 2015;37:678-681.
  46. [55]55. Workgroup AGSCW. American Geriatrics Society identifies five things that healthcare providers and patients should question. J Am Geriatr Soc. 2013;61:622-631.

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Authors
Seidu, S., Kunutsor, S. K., Topsever, P., Hambling, C. E., Cos, F. X., & Khunti, K.
Affiliations
  • University of Leicester (GB)
  • University Hospitals Bristol NHS Foundation Trust (GB)
  • Department of Family Medicine Acibadem Mehmet Ali Aydinlar University School of Medicine Istanbul Turkey
  • University of Cambridge (GB)
  • Diabetes &amp; Metabolic Medicine, Jordi Gol Institute for Research in Primary Care The Foundation University Institute for Primary Health Barcelona Spain
Corresponding author
Seidu, Samuel
ORCID
Venue
Diabetes, Obesity and Metabolism
Publisher
Wiley
Published
2019-04-29
Volume
21
Issue
7
Pages
1668-1679
ISSN
  • 1462-8902 (ISSN-L)
  • 1463-1326
DOI
10.1111/dom.13724
OpenAlex
W2933592800
Cited by
97
References
6
Citations by year
2026: 10 · 2025: 18 · 2024: 17 · 2023: 12 · 2022: 14 · 2021: 13 · 2020: 8 · 2019: 4 · 2017: 1
FWCI
1.50
Type
journal article
Language
en
Open access
Licence
Locations
  • Diabetes Obesity and Metabolism (publishedVersion)
  • PubMed (publishedVersion)
  • Bristol Research (University of Bristol) (acceptedVersion, other-oa)
  • Acibadem University Open Access Repository (submittedVersion)
  • Figshare (submittedVersion, cc-by)
  • Leicester Research Archive (University of Leicester) (submittedVersion, other-oa)
  • Explore Bristol Research (submittedVersion, other-oa)
Funders
  • Eli Lilly and Company
  • University Hospitals Bristol NHS Foundation Trust
  • University Hospitals of Leicester NHS Trust
  • National Institute for Health and Care Research
  • University of Leicester
  • Loughborough University
  • University of Bristol
  • Novo Nordisk
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, antidiabetic drugs, drug withdrawal, hypoglycemia, HbA1c, comorbidities, cardiometabolic disease, adverse events, mortality
MeSH terms
Deprescriptions, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Female, Humans, Hypoglycemic Agents, Male, Comorbidity, Treatment Outcome

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