| アブストラクト | BACKGROUND: Hypoglycaemic drugs (sulfonylureas, glinides or insulins) are commonly prescribed for older adults with type 2 diabetes (T2D) but may carry risks of adverse events. Whether de-intensifying hypoglycaemic drugs is associated with clinical benefit in older adults remains unknown. OBJECTIVE: To evaluate the association between de-intensification of hypoglycaemic drugs and clinical outcomes in older adults with T2D. METHODS: Cohort study conducted with the target trial emulation approach, using data collected from 2000 French general practises between January 2010 and February 2019 (The Health Improvement Network-THIN database). Eligible participants were >/=75 years old, on stable hypoglycaemic drugs (no change in drug or dose) for at least 6 months, and had an HbA1c value <9%. Hypoglycaemic drug de-intensification (exposure) was defined as cessation or reduction of >/=50% of total dose. The primary outcome was a composite measure of all-cause death or hospital admissions within 3 months, and its association with exposure was assessed using multivariable logistic regression adjusted for potential baseline confounders. RESULTS: The study included 14 383 unique individuals corresponding to 177 314 trial emulation participants (mean age 80 years; 44.7% female). Of these, 6480 participants were allocated to de-intensification group, and 170 834 to the control group. At 3 months, the primary outcome occurred in 3.96% of the de-intensification group and 2.99% of controls [adjusted relative risk, 1.33 (95% CI, 1.22-1.43)]. Subgroup analyses showed consistent associations across most participants' profiles. CONCLUSIONS: In older adults with T2D, de-intensification of hypoglycaemic drugs was associated with a higher short-term risk of all-cause death or hospitalisation. |
|---|
| 投稿者 | Christiaens, Antoine; Cochard, Alexis; Tubach, Florence; Thompson, Wade; Sinclair, Alan J; Henrard, Severine; Boland, Benoit; Slaouti-Jegou, Yannis; Lekens, Beranger; Bonnet-Zamponi, Dominique; Simon-Tillaux, Noemie; Zerah, Lorene |
|---|
| 組織名 | Louvain Drug Research Institute, Universite catholique de Louvain, Brussels,;Belgium.;Fonds National de la Recherche Scientifique, Brussels, Belgium.;Pierre Louis Institute of Epidemiology and Public Health, INSERM, Sorbonne;Universite, Paris, Ile-de-France, France.;Unite de Recherche Clinique PSL-CFX, CIC-1901, Centre de Pharmacoepidemiologie;(Cephepi), Departement de Sante Publique, Pitie-Salpetriere University Hospital,;Assistance Publique-Hopitaux de Paris, Paris, Ile-de-France, France.;Department of Anesthesiology Pharmacology, and Therapeutics, Faculty of Medicine,;The University of British Columbia, Vancouver, British Columbia, Canada.;King's College London, London, United Kingdom of Great Britain and Northern;Ireland.;Foundation for Diabetes Research in Older People, Taplow, United Kingdom of Great;Britain and Northern Ireland.;Institute of Health and Society, Universite catholique de Louvain, Brussels,;Geriatric Medicine Unit, Cliniques universitaires Saint-Luc, Brussels, Belgium.;RESIP, Claude Bernard, Boulogne-sur-mer, France.;Observatoire des medicaments, dispositifs medicaux, innovations therapeutiques;d'Ile-de-France Paris, Ile de france, France.;Oncostat U1018, INSERM, Universite Paris-Saclay, Villejuif, Ile-de-France,;France.;Bureau de Biostatistique et d'Epidemiologie Gustave Roussy, Universite;Paris-Saclay, Villejuif, Ile-de-France, France.;Departement de geriatrie, Pitie-Salpetriere University Hospital, Assistance;Publique-Hopitaux de Paris, Paris, France. |
|---|
