Charlotte Andriessen1, Marieke Blom, Anna de Boer, Petra Denig, Ardine de Wit, Ron Herings, Rob van Marum, Jacqueline Hugtenburg, Daniël van Raalte, Liselotte van Bloemendaal, Peter P. Harms, Giel Nijpels, Rimke Vos, and Petra J.M. Elders1
Affiliations: 1) Amsterdam UMC, location Vrije Universiteit, Department of General Practice, Amsterdam, the Netherlands
Background The OMED2-study is a cluster randomised intervention study to examine the effects of deprescribing glucose-lowering medication in general practices (according to Dutch [NHG] guidelines) using care registration data. In this preliminary analysis, we examined the change in HbA1c-levels after deprescribing and the factors involved in this change.
Methods For the current analysis, data were used from all 197 overtreated (defined as HbA1c < 54 mmol/mol) older adults (≥ 70 years) with T2D in the intervention arm who used sulphonylureas and/or insulin and who were deprescribed. The change in HbA1c-level was calculated using the baseline HbA1c-level measurement and the first HbA1c-level measurement that was performed 3 months after deprescribing. Multivariate regression analysis was performed with the change in HbA1c-level as outcome variable. Independent variables included sex, age, diabetes duration, frailty, baseline HbA1c, kidney function, medication use, medication deprescribed, and deprescribing step (i.e. lowering or discontinuing, per protocol depending on the amount of medication used).
Results Out of 197 patients, n = 33 restarted medication, primarily due to increasing glucose-levels (n = 23). After deprescribing, HbA1c-levels increased from 49.0 ± 3.4 mmol/mol to 59.7 ± 12.6 mmol/mol (n = 168, p < 0.05), and HbA1c-levels of 16.8% (n = 33) patients exceeded recommended target range (based on diabetes duration and frailty). The increase in HbA1c-levels was higher when discontinuing medication (12.9 ± 13.5 mmol/mol) compared to reducing the dosage of medication (6.7 ± 8.0 mmol/mol, p = 0.01). Other variables did not influence the effects of deprescribing on the increase in HbA1c-levels.
Discussion Deprescribing sulphonylureas and/or insulin increases HbA1c-levels. The increase was more pronounced for discontinuing medication compared to reducing the dosage of medication.