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Reducing Hypoglycemia From Overtreatment of Type 2 Diabetes in Older Adults

In the HypoPrevent study, the use of a clinical decision support (CDS) tool and shared decision-making (SDM) reduced the population of older adults at risk of hypoglycemia and decreased their use of insulin and sulfonylureas. “Using a patient-reported outcome tool, we demonstrated significant reductions in the impact of hypoglycemia on daily life,” the authors report.

In the pre-post, single-arm study, at-risk older adults at a 5-site primary care practice were identified based on age, type 2 diabetes, treatment with insulin or sulfonylureas, and HbA1c < 7.0%. The effects of use of the CDS tool and SDM at 3 clinic visits over 6 months were assessed through setting of individualized HbA1c goals or modified medication use, changes in the population at risk for hypoglycemia, and changes in impact of nonsevere hypoglycemic events using a validated patient-reported outcome tool (TRIM-HYPO).

“We enrolled 94 patients (mean age—74; mean HbA1c (± SD)—6.36% ± 0.43), of whom 94% set an individualized HbA1c goal at either the baseline or first follow-up visit,” the investigators report. “Ninety patients completed the study. Insulin or sulfonylurea use was decreased or eliminated in 20%. An HbA1c level before and after goal setting was obtained in 53% (N = 50). Among these patients, the mean HbA1c increased 0.53% (P < 0.0001) and the number of patients at-risk decreased by 46% (P < 0.0001). Statistically significant reductions in the impact of hypoglycemia during daily activities occurred in both the total score and each functional domain of TRIM-HYPO.”

Source: Journal of the American Geriatrics Society