Scopus
🔓 Açık Erişim
A Cross-Sectional Study of Overtreatment and Deintensification of Antidiabetic and Antihypertensive Medications in Diabetes Mellitus: The TEMD Overtreatment Study
Diabetes Therapy · Mayıs 2020
Makale Bilgileri
DergiDiabetes Therapy
Yayın TarihiMayıs 2020
Cilt / Sayfa11 · 1045-1059
Scopus ID2-s2.0-85079739377
Erişim🔓 Açık Erişim
Özet
Introduction: Targeting better glycated hemoglobin (HbA1c) and blood pressure (BP) goals may endanger older adults with type 2 diabetes mellitus (T2DM). Overtreatment of T2DM and hypertension is a trending issue, although undertreatment is still common. We investigated the rates and predictors of overtreatment and undertreatment of glycemia and BP in older adults with T2DM and physicians’ attitudes to deintensify or intensify treatment. Methods: Data from older adults (≥ 65 years) enrolled in a large nationwide T2DM survey in 2017 across Turkey were analyzed. Overtreatment of glycemia was defined as HbA1c < 6.5% plus the use of ≥ 2 oral antihyperglycemics or insulin, and BP overtreatment was defined as systolic BP (SBP) < 120 mmHg or diastolic BP (DBP) < 65 mmHg plus the use of ≥ 2 drugs. Undertreatment of glycemia was defined as HbA1c > 9%, and BP undertreatment was defined as SBP > 150 mmHg or DBP > 90 mmHg. Deintensification or intensification rates were calculated according to treatment modification initiated by the treating physician(s). Results: The rate of overtreatment in the glycemia group (n = 1264) was 9.8% (n = 124) and that in the BP group (n = 1052) was 7.3% (n = 77), whereas the rate of undertreatment was 14.2% (n = 180) and 15.2% (n = 160), respectively. In the adjusted model, use of oral secretagogues (sulfonylureas or glinides) (odds ratio [OR] 1.94, 95% confidence interval [CI] 1.2–3.1) and follow-up at a private clinic (OR 1.81, 95% CI 1.0–3.3) were predictors of glycemia overtreatment. BP overtreatment was independently associated with the use insulin-based diabetes therapies (OR 1.86, 95% CI 1.14–3.04). There was no independent association of BP undertreatment to the study confounders. The deintensification and intensification rates were 25 and 75.6%, respectively, for glycemia and 10.9 and 9.2%, respectively, for BP. Conclusions: The results show that one in ten older adults with T2DM are overtreated while one in four require modification of their current antihyperglycemic and antihypertensive treatments. Physicians are eager to intensify medications while they largely ignore deintensification in diabetes management. These results warrant enforced measures to improve the care of older adults with T2DM. Trial Registration: ClinicalTrials.gov identifier, NCT 03455101.
Yazarlar (93)
1
Alper Sonmez
2
İlker Taşçı
3
Ibrahim Demirci
ORCID: 0000-0002-6808-8550
4
Cem Haymana
5
Cem Barcin
6
Hasan Aydin
7
S. Cetinkalp
8
Feyza Yener Öztürk
9
Kamile Gul
10
Tevfik Sabuncu
ORCID: 0000-0001-6504-5355
11
Ilhan Satman
12
Fahri Bayram
13
Sibel Güldiken
14
Semra Aytürk
15
Murat Yilmaz
16
M. Asik
17
Nevin Dinççağ
18
Ramazan Çakmak
19
Fulya Türker
20
Cemile İdiz
21
Hülya Hacişahinoğullari
ORCID: 0000-0001-9989-6473
22
Elif Bağdemir
23
Büşra Yildiz
24
Volkan Demirhan Yumuk
25
Özlem Haliloğlu
26
Serpil Salman
27
Seda Sancak
28
Levent Özsari
29
Eylem Çağiltay
30
Oğuzhan Deyneli
ORCID: 0000-0001-6582-7031
31
Eren İmre
ORCID: 0000-0003-4044-7133
32
Sait Gonen
33
Şerife Nur Boysan
34
Yüksel Altuntaş
35
Meral Mert
36
Hamide Pişkinpaşa
37
Hasan Aydin
38
Şazi İmamoğlu
39
Canan Ersoy
40
Özen Öz Gül
41
Sinem Küçüksaraç Kiyici
42
B. Cetinarslan
43
Alev Selek
ORCID: 0000-0002-0646-8697
44
Teoman Doğru
45
Ali Kirik
46
Nur Kebapçi
47
Belgin Efe
48
Ahmet Kaya
49
İlker Çordan
50
Süleyman Baldane
51
Cem Onur Kirac
52
Zehra Çapa
53
M. Cesur
54
İlhan Yetkin
55
Demet Çorapçioğlu
ORCID: 0000-0003-0940-9147
56
Şule Canlar
57
Okan Bülent Yildiz
58
Süleyman Nahit Şendur
59
Bekir Cakir
60
Didem Ozdemir
61
Ahmet Çorakçi
62
Mustafa Kutlu
63
Neslihan Başçil Tütüncü
64
Yusuf Bozkus
ORCID: 0000-0002-6976-6659
65
Erman Çakal
ORCID: 0000-0003-4455-7276
66
Berrin Demirbaş
67
Sibel Ertek
68
Mustafa Altay
69
Murat Dağdeviren
70
Oğuzhan Sıtkı Dizdar
71
Fahri Bayram
72
Amir Hassein Abedi
73
Hatice Özişik
74
Gonca Örük
75
Serkan Yener
76
B. Ozgen Saydam
77
Engin Güney
78
Mustafa Unubol
ORCID: 0000-0002-6444-3500
79
Güzin Fidan Yaylali
80
Şenay Topsakal
81
Zeliha Hekimsoy
82
Gülhan Akbaba
83
I. Aslan
84
Mustafa Kemal Balci
85
Şefika Dalkiran
86
Esen Akbay
87
Eren Gürkan
ORCID: 0000-0002-3118-4549
88
Kemal Ağbaht
ORCID: 0000-0003-3122-5491
89
Müge Özsan Yilmaz
90
Emre Bozkirli
91
B. Tamer Tetiker
92
Seher Çetinkaya Altuntaş
93
Aysegul Atmaca
Anahtar Kelimeler
Arterial blood pressure
Glycemia
Older adults
Overtreatment
Type 2 diabetes
Undertreatment
Kurumlar
Ege University Medical School
Izmir Turkey
Erciyes University, Faculty of Medicine
Kayseri Turkey
Harran University, Faculty of Medicine
Sanliurfa Turkey
İstanbul Tıp Fakültesi
Istanbul Turkey
KSU Medical School
Kahramanmaras Turkey
University of Health Sciences
Istanbul Turkey
Yeditepe University
Istanbul Turkey
Metrikler
16
Atıf
93
Yazar
6
Anahtar Kelime