Can diabetes medication be reduced in elderly patients? An observational study of diabetes drug withdrawal in nursing home patients with tight glycaemic control.
OBJECTIVE
To explore the feasibility of withdrawal of diabetes medication in elderly patients with HbA1c<or=6.0%.


METHODS
HbA1c was measured in 98 patients with known diabetes in 17 nursing homes in Sweden. Thirty-two subjects with HbA1c <or=6.0% participated in the drug withdrawal study. After measuring plasma glucose on 3 consecutive days, diabetes drugs were reduced, i.e. complete withdrawal of oral anti-diabetic drugs (OADs), complete insulin withdrawal when doses were <or=20units/day and reduced by half in patients on more than 20units/day.


RESULTS
We identified 31 episodes of plasma glucose <or=4.4mmol/l, most of them nocturnal (n=17). Mean HbA1c was 5.2+/-0.4% compared to 7.1+/-1.6% in the non-intervention group. Three months after the diabetes drug discontinuation, 24 patients (75%) remained in the intervention group and mean HbA1c was then 5.8.+/-0.9%. Six months after baseline investigation mean HbA1c in the intervention group was 5.8+/-1.1% compared with 6.6+/-1.4% in the non-intervention group.


CONCLUSIONS
Hypoglycaemic events are common among elderly patients with type 2 diabetes. The withdrawal of diabetes medication in elderly with tight glycaemic control is safe and may decrease the risk for hypoglycaemia.
Sjöblom
Peter
P
Söderköping Primary Health Care Centre, Ostra Rydsvägen, S-614 82 Söderköping, Sweden. Peter.Sjoblom@lio.se
AndersTengblad
Löfgren
Ulla-Britt
UB
Lannering
Christina
C
Anderberg
Niklas
N
Rosenqvist
Ulf
U
Mölstad
Sigvard
S
Ostgren
Carl J
CJ
D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism; D003920:Diabetes Mellitus / Q000097:blood* / Q000188:drug therapy*; D004334:Drug Administration Schedule; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents