liu.seSearch for publications in DiVA
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Can diabetes medication be reduced in elderly patients?: An observational study of diabetes drug withdrawal in nursing home patients with tight glycaemic control
Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in East Östergötland, Primary Health Care in Norrköping.
Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
Östergötlands Läns Landsting, Centre for Medicine, Department of Endocrinology and Gastroenterology UHL. (Landstinget i Östergötland)
The Research and Development Department of Local Health Care, County Council of Jönköping, Jönköping, Sweden.
Show others and affiliations
2008 (English)In: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 82, no 2, 197-202 p.Article in journal (Refereed) Published
Abstract [en]

Aim: To explore the feasibility of withdrawal of diabetes medication in elderly patients with HbA1c £ 6.0%.

Methods: HbA1c was measured in 98 patients with known diabetes in 17 nursing homes in Sweden. 32 subjects with HbA1c £ 6.0% participated in the drug withdrawal study. After measuring plasma glucose on three consecutive days, diabetes drugs were reduced, i.e. complete withdrawal of oral anti-diabetic drugs (OADs), complete insulin withdrawal when doses were £ 20 units/day and reduced by half in patients on more than 20 units/day.

Results: We identified 31 episodes of plasma glucose £ 4.4 mmol/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.

Place, publisher, year, edition, pages
2008. Vol. 82, no 2, 197-202 p.
Keyword [en]
Diabetes, Drug therapy, Hypoglycaemia
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-16312DOI: 10.1016/j.diabres.2008.08.014OAI: oai:DiVA.org:liu-16312DiVA: diva2:133711
Note

Original Publication: Peter Sjöblom, Anders Tengblad, Ulla-Britt Löfgren, Christina Lannering, Niklas Anderberg, Ulf Rosenqvist, Sigvard Mölstad and Carl J Östgren, Can diabetes medication be reduced in elderly patients?: An observational study of diabetes drug withdrawal in nursing home patients with tight glycaemic control, 2008, Diabetes Research and Clinical Practice, (82), 2, 197-202. http://dx.doi.org/10.1016/j.diabres.2008.08.014 Copyright: Elsevier Science B.V., Amsterdam. http://www.elsevier.com/

Available from: 2009-01-14 Created: 2009-01-14 Last updated: 2014-01-21Bibliographically approved
In thesis
1. Monitoring blood glucose and obesity in type 2 diabetes in primary care
Open this publication in new window or tab >>Monitoring blood glucose and obesity in type 2 diabetes in primary care
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Type 2 diabetes is a common chronic disease worldwide. An important part of the treatment is monitoring and treating the elevated levels of blood glucose. But there is also a need for monitoringother risk factors that confer an increased risk for vascular complications. This thesis is based on four studies that explore different aspectsof monitoring blood glucose and obesity in patients with type 2 diabetes in primary care.

Methods: To examine the cost and effect on glycaemic control of patients performing self-monitoring of blood glucose (SMBG) an observationalstudy was performed in the county of Östergötland and Jönköping 2003-2004. The study included all known patients with type 2 diabetes at 18 primary health care centres (PHCC), excluding patients in nursery homes.

A structured observational intervention study of 98 patients with type 2 diabetes living at 17 nursery homes were done with monitoringof hypoglycaemic episodes followed by a controlled withdrawal of diabetes medication in patients with HbA1c ≤ 6.0 %.

Baseline data from the cohort study; Cardiovascularrisk in type 2 diabetes – a prospectivestudy in primary care (CARDIPP), was analysed for correlation analyses between anthropometric status and early cardiovascular organ damage, measured by pulse wave velocity (PWV) and left ventricular mass index (LVMI).

Results: When comparing users of SMBG to non-users, there was no association between improvedglycaemic control and use of SMBG. A plasma glucose profile for three consecutive days of the patients at nursery homes, indentified 31 episodes of plasma glucose levels≤ 4.4 mmol/l. A withdrawal of insulin and oral antiglycaemic medicine was performed, which after 3 months follow up was successful in 24 (75 %) of the patients.

The mean annual cost per PHCC for visits to general practitioner and nurse, insulin, SMBG and oral antiglycaemic agents was586 € (SD 435) per patient. There was no correlationbetween costs and glycaemic control at PHCC level.

In the CARDIPP study, both increased sagittalabdominal diameter and increased waist circumference were, independently of sex, age, blood pressure and HbA1c, associated to increasedPWV and LVMI.

Conclusions: Use of SMBG in primary care confers a substantialpart of the treatment costs, but is not associated with improved glycaemic control. Systematic use of SMBG for patients not treated with insulin should not be recommended. At nursery homes, patients with type 2 diabetes are at risk for harmful hypoglycaemia and may benefit from a more frequent control of plasma glucose and a less strict glycaemic control.

Increased abdominal obesity measured with either sagittal abdominal diameter or waist circumference is associated with early cardiovascularorgan damage. In addition to analyses of blood glucose, blood pressure and lipids, the monitoring of abdominal obesity is a feasible risk factor assessment tool, that provides further information about cardiovascular risk that goes beyond that of traditional risk factors.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2009. 55 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1140
Keyword
Diabetes, primary care
National Category
Family Medicine
Identifiers
urn:nbn:se:liu:diva-20049 (URN)978-91-7393-573-9 (ISBN)
Public defence
2009-09-18, Originalet, Qulturumhuset, Länssjukhuset Ryhov, Jönköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2009-09-15 Created: 2009-08-26 Last updated: 2010-03-02Bibliographically approved

Open Access in DiVA

fulltext(116 kB)1066 downloads
File information
File name FULLTEXT01.pdfFile size 116 kBChecksum SHA-512
8e2aff33a7b93bd25769189fb1f279e384586c4ef4d22c1d4a7eb1668c949c5b4bcb200a3570dbe46d240a770e21298f6f3c7601e6ffbdb740f297e6047d06b5
Type fulltextMimetype application/pdf

Other links

Publisher's full textLink to Ph.D. Thesis

Authority records BETA

Sjöblom, PeterTengblad, AndersÖstgren, Carl Johan

Search in DiVA

By author/editor
Sjöblom, PeterTengblad, AndersÖstgren, Carl Johan
By organisation
Department of Medical and Health SciencesFaculty of Health SciencesPrimary Health Care in NorrköpingGeneral PracticeDepartment of Endocrinology and Gastroenterology UHLPrimary Health Care in Motala
In the same journal
Diabetes Research and Clinical Practice
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
Total: 1066 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

doi
urn-nbn

Altmetric score

doi
urn-nbn
Total: 236 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf