Academic Journal
Diabetes overtreatment and flags for deprescribing glucose-lowering treatment in geriatric inpatients with type 2 diabetes: Prognostic insights from a longitudinal cohort.
| Title: | Diabetes overtreatment and flags for deprescribing glucose-lowering treatment in geriatric inpatients with type 2 diabetes: Prognostic insights from a longitudinal cohort. |
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| Authors: | de Terwangne C; Institut de Recherche Experimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.; Division of Geriatric Medicine, Cliniques Universitaires Saint Luc, Brussels, Belgium., Henrard S; Institute of Health and Society (IRSS), Université Catholique de Louvain, Brussels, Belgium.; Clinical Pharmacy and Pharmacoepidemiology Research Group (CLIP), Louvain Drug Research Institute (LDRI), Université Catholique de Louvain, Brussels, Belgium., Marien S; Division of Geriatric Medicine, Cliniques Universitaires Saint Luc, Brussels, Belgium.; Institute of Health and Society (IRSS), Université Catholique de Louvain, Brussels, Belgium., Steinman MA; Division of Geriatrics, University of California San Francisco, San Francisco, USA., Boland BB; Division of Geriatric Medicine, Cliniques Universitaires Saint Luc, Brussels, Belgium.; Institute of Health and Society (IRSS), Université Catholique de Louvain, Brussels, Belgium., Christiaens A; Clinical Pharmacy and Pharmacoepidemiology Research Group (CLIP), Louvain Drug Research Institute (LDRI), Université Catholique de Louvain, Brussels, Belgium.; Fund for Scientific Research - FNRS, Brussels, Belgium. |
| Source: | Diabetic medicine : a journal of the British Diabetic Association [Diabet Med] 2026 Oct; Vol. 43 (10), pp. e70435. Date of Electronic Publication: 2026 Jul 22. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Blackwell Science Country of Publication: England NLM ID: 8500858 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1464-5491 (Electronic) Linking ISSN: 07423071 NLM ISO Abbreviation: Diabet Med Subsets: MEDLINE |
| Imprint Name(s): | Publication: Oxford : Blackwell Science Original Publication: Chichester [Sussex, England] ; New York : Wiley, [c1984- |
| MeSH Terms: | Diabetes Mellitus, Type 2*/drug therapy , Diabetes Mellitus, Type 2*/blood , Diabetes Mellitus, Type 2*/mortality , Hypoglycemic Agents*/therapeutic use , Overtreatment*/statistics & numerical data , Deprescriptions*, Glycated Hemoglobin/metabolism ; Blood Glucose/metabolism ; Humans ; Female ; Aged, 80 and over ; Aged ; Male ; Retrospective Studies ; Prognosis ; Longitudinal Studies ; Hospitalization ; Inpatients |
| Abstract: | Aims: The study investigated diabetes overtreatment (excessively intensive therapy) and flags for considering deprescribing glucose-lowering treatment (GLT) (clinical features identifying patients most likely to benefit from reducing treatment) in older adults with type 2 diabetes (T2D) and their association with five-year survival in geriatric inpatients. Methods: Single-centre retrospective cohort study including geriatric inpatients hospitalised between 2008 and 2015, aged ≥75 years with T2D on GLT. Diabetes overtreatment, according to the 2019-Endocrine Society guidelines, was retrospectively defined based on the patient's health status, level of HbA1c and presence of inducing hypoglycaemia GLT. Flags for deprescribing were selected from a systematic review of recommendations for GLT deprescribing in older diabetic adults. Results: Of the 447 inpatients (women: 52.8%; median age: 83 years), 89% had a poor health status, 55.2% were overtreated, and 99.5% had at least one deprescribing flag, and 44% of patients with ≥1 deprescribing flag were not overtreated. Over the five-year follow-up, median survival time after hospitalisation was 1.83 years [IQR, 1.56-2.09], with an 18% five-year survival [95%CI, 15%-22%]. Both overtreatment (HR [95%CI] 1.29 [1.04;1.58]) and accumulation of flags for deprescribing (HR [95%CI] 1.20 [1.11;1.29] per additional flag) were associated with increased mortality. Patients meeting both ≥4 flags for deprescribing and overtreated had the worst survival outcomes (10% five-year survival rate). Conclusion: The cumulative burden of deprescribing flags provided complementary information beyond the current overtreatment definition. Patients classified as overtreated and combining several deprescribing criteria highlight a particularly vulnerable subgroup of patients with poor survival in which GLT use should be systematically reassessed. (© 2026 Diabetes UK.) |
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| Grant Information: | United States NH NIH HHS; Fonds De La Recherche Scientifique - FNRS |
| Contributed Indexing: | Keywords: deprescribing; glucose‐lowering treatment; health status; older adults; overtreatment; type 2 diabetes |
| Substance Nomenclature: | 0 (Hypoglycemic Agents) 0 (Glycated Hemoglobin) 0 (Blood Glucose) |
| Entry Date(s): | Date Created: 20260723 Date Completed: 20261007 Latest Revision: 20261007 |
| Update Code: | 20261008 |
| DOI: | 10.1111/dme.70435 |
| PMID: | 42487235 |
| Database: | MEDLINE |
| ISSN: | 1464-5491 |
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| DOI: | 10.1111/dme.70435 |